Inspection on 23/02/06 for Roxburgh House

This inspection was carried out on 23rd February 2006.

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

Other inspections for this house

Roxburgh House 02/07/08

Roxburgh House 02/07/07

Roxburgh House 06/06/06

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 Jo Johnson Unannounced Inspection 10:30 23 and 27 February 2006 rd th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 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.V284544.R01.S.doc Version 5.1 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 01926 640306 Pinnacle Care Ltd Ms Stephanie Robson 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.V284544.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. An upgrade of the home’s décor is planned and implemented within 18 months, (31st October 2006) All outstanding requirements made at the October 2004 inspection are actioned within the recorded timescales. Stephanie Robson must complete the Registered Managers Award by 31st December 2006 27th September 2005 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 shaft lift. Both communal areas and bedrooms are to be found at each level. 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. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There have been two additional unannounced inspection visits to the home since the last published inspection. These additional inspection visit reports are available on request. The first day of inspection took place between 10.30am and 2pm and was unannounced. There were 29 residents at the home during the inspection. The first day was conducted with deputy manager and care staff, residents, health professionals visiting the home and relatives were spoken with during the inspection. Residents’ assessments and care plans and staff rotas were seen. The manager was on annual leave. It was arranged to conduct the rest of the inspection with the manager on her return from holiday. The second day of inspection took place between 9.30am and 11.30 and was conducted with the manager. Records and maintenance records were seen. Three comment cards were received from relatives between November and December 2005. Two were very positive about the staff and the overall care provided. One was positive about the programme of refurbishment and one relative was unhappy with the overall care and did not feel welcome in the home. What the service does well: What has improved since the last inspection? There has been progress on meeting requirements following each inspection. Important information about residents is now kept up to date and made readily available to staff in assessments, areas of risk, in some life history books and care plans. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 6 Records about the care of residents are now kept accurately and stored safely. Staff now make sure that they sign the records for medication to show that is administered. Fire doors are now kept clear of furniture and are not be propped open. Staff recruitment and personnel records are now kept in the home. More staff have been recruited and the reliance on agency staff has reduced. There is an improved understanding of the reporting of vulnerable adults issues. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Assessment format and procedures that are in place now have sufficient information to ensure that the staff can meet the residents’ needs. EVIDENCE: The assessments of the last two residents who moved into the home were seen. These assessments gave staff enough information to be able to understand the residents’ needs. Life stories were seen for two of the residents at the home. Families should be encouraged to complete life histories were possible. Life stories and histories must continue to be produced to ensure that staff have enough knowledge about the residents that are working with. A photograph of each resident was seen on his or her care records. There was evidence of good practice in a situation where a resident was unsettled and awake during the night. She believed that it was daytime and was hungry. The night staff prepared a meal for her in the early hours of the morning. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Important elements of resident’s personal and social care needs are now set out in care plans. Staff now have all the information required to fully meet residents’ needs. Service users health needs are met. Medication practices and recording systems are now safe. EVIDENCE: Requirements were followed up on care planning, medication and privacy and dignity. Three residents’ care plans were seen. Overall the care planning has improved, there was evidence of regular review and nutritional and falls risk assessments and plans were in place. Medication records and practices observed were safe and there were not any gaps in the records. District nurses were visiting during the inspection; they saw residents in their own bedrooms. Staff ensured that residents’ bedroom doors were closed if they were in a state of undress or they were receiving personal care. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 10 Screens were available in all of the shared bedrooms and were being used. From discussion with the deputy manager and in care plans residents have access to appropriate health care. Specialist community psychiatric support is available and residents are referred to specialists appropriately. One of the GP’s had held a drug review the day before. One of the purposes of this review was to reduce the amount of psychotropic medication in use. The district nurse who visited during the inspection commented on how well the staff had managed one resident’s pressure area. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Apart from the days when the activity worker is supernumerary, the limitations of staff time mean that residents are not provided with adequate support to maintain their social, psychological and recreational interests and needs. Residents families and friends are made welcome. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet. Mealtimes are more relaxed and residents are offered both verbal and visual choices. EVIDENCE: There was an activity worker on duty who was doing some baking with residents. Music was being played in the main lounge during the inspection. Residents who were engaged in these activities seemed to enjoy their time with the worker. Staff observed interacted very positively and sensitively with residents. Again, due to the time spent providing personal care, the staff had little time to problem solve, be creative, keep people occupied and be person centred in the ways in which they work with residents. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 12 There are still no obvious things or items of interest around for the residents to pick up and do, this means that there is very little stimulation for residents and that they are not able to do things independently. A majority of the residents (who were not involved in the bakery session) were either walking or just sitting down. Relatives that were spoken with said that they were supported to remain involved in their relative’s care. They said they were ‘made to feel welcome’ and they could visit whenever they chose. One relative brings the family pet. At lunchtime there were at least five people who needed support to eat and drink. Staff observed talked with the residents and supported them to eat, the mealtime was a much more relaxed occasion than the previous inspection. The dining tables have been distributed in two areas and it was much less cramped. The cook now serves up the meals and this releases the care staff to assist with residents. Two relatives come and assist their relative with their main meal. Again if these two relatives had not come in there would have been insufficient staff to assist residents with eating and drinking. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, Complaints policies and procedures are in place. The manager and staff have an understanding of how to recognise and report any allegations of abuse. EVIDENCE: There is a written complaints procedure in place that meets the national minimum standards. The manager said that there have not been any formal complaints. She described that a majority of concerns are addressed before they reach the formal stage. A relative had raised concerns with the inspector prior to the previous additional inspection visit. The inspector looked at the issues raised and advised the manager to meet with the relative. The concerns have now been resolved. It is recommended that the manager keep a record of any concerns that have been addressed to show that action is taken at an early stage. All of the staff apart from one have attended protection of vulnerable adults training. The manager has also attended training. The inspector is now satisfied that any vulnerable adult matters will be reported. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home is still in need of refurbishment in areas and the owner has a plan of refurbishment. Good progress has been made on the refurbishment and replacement programme. However, the general cleanliness of the home is still not satisfactory and there are still unpleasant smells on the ground floor. The risk of accidents to the residents is increased with the presence of builders, electricians etc. The lack of any risk assessments and action plans may place the residents at risk EVIDENCE: Since the last inspection the home has been rewired, had new furniture and had new fuel tanks fitted below ground. A new call bell system is to be fitted and the home redecorated and re-carpeted. The provider has written to relatives to keep them updated on each stage of the refurbishment programme. The inspector is very concerned that from discussion with staff that the provider may be planning to use highly patterned carpets and wallpaper to replace the current décor. The registered provider must ensure that any Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 15 carpets and wall coverings are none patterned to ensure that the environment does not cause any additional difficulties to the residents as they have dementia. This use of non-patterned carpets and wall coverings is a well recognised consideration when designing environments for people with dementia. There remains a very strong unpleasant smell on the ground floor. On the first day of inspection there were only four staff plus the cook on duty this included the deputy manager. There were not any cleaning staff on duty and the home smelt very unpleasant and was not clean. There was no toilet rolls in two of the bathrooms. The laundry staff has not been replaced and the care staff are still having to undertake the laundry. This is of great concern particularly as there are continued concerns about the staffing levels in the home. The more time staff have to spend doing laundry and cleaning the less time they have to spend with the residents. Comments from relatives and from the comment cards reflected that they are also concerned about the cleanliness of the home. There must be more ancillary staff appointed to keep the home clean and undertake the laundry and due to the needs of the residents this needs to be every day of the week. One of the residents had fallen in a room and injured his face where the builders had half lifted the carpet. The manager must ensure that risk assessments are completed for all areas of the building whilst the builders are completing the refurbishment. Specific advice should be given to the builders to minimise the risks to residents. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 There are still insufficient staff on duty at the home to safely support the needs of the residents. Staff shortages puts the safety and well-being of residents at risk. The use of care staff to undertake laundry and at times to be responsible for the home compromises the care, safety and well being of residents. EVIDENCE: Staff recruitment procedures were the subject of one of the additional visits to the home and the requirements are now met. From observation on the first day of inspection and from staff rotas the staffing levels have not been maintained. The deputy manager confirmed that whilst there has only been 28 residents at the home they have worked with four care staff and one senior or manager supernumerary, this has been the case a majority of the time. However, one weekend there had only been three staff on duty in the afternoons and evenings and this number had included the manager. A requirement was made at two of the last three inspection visits that staffing levels must be maintained. Further action will be taken if this requirement is not met. Again the staff did a commendable job providing basic care to the residents. They remained sensitive to residents needs and all interactions that were seen were positive. They also had to do the laundry, clean and make resident’s beds. The staffing levels must be reviewed against the needs of the residents Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 17 and increased so as to meet the current needs of the residents. This requirement is outstanding from previous inspections and now must be met. There is a comprehensive mandatory training programme in place. Staff have attended this training. However, the staff have not been provided with dementia care training in the last year. Specific dementia care training must be provided to all staff. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33,35, 38 Quality assurances systems are in place to ensure that residents’ best interests are taken into account. Residents’ financial interests are safeguarded. In the main the health, safety and welfare of the residents and staff are promoted. However, the refurbishment programme may be placing some residents at risk. EVIDENCE: The manager has recently completed the fit person process and has been registered with the Commission. The manager described the quality assurance systems in place these include consultation with residents and relatives through meetings and regulation 26 Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 19 visits by the area manager. It was noted that a majority of regulation 26 visits took place on the same day as the activity worker was at the home. It is recommended that these unannounced visits take place on other days of the week to reflect an accurate picture of the activities taking place when the activity worker is not on duty. The manager does not manage any of the residents’ finances. All of the systems for fire testing and routine maintenance of appliances are in place. However, there are no certificates for the boiler services just a small ticket left by the boiler. There are cracked and missing tiles above the new cooker in the kitchen and a risk assessment must be completed for residents who take an active role in the kitchen. These matters must be addressed Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14,15 Requirement Residents ‘Life stories and histories’ must be produced to ensure that staff have enough knowledge of the individuals to be able to meet their needs. (part met from previous inspection) Provide items of interest, things to do, daily living tasks and additional staff time to ensure that residents are occupied and stimulated. (not met from previous inspection) Timescale for action 01/05/06 2 OP12 12, 16 01/04/06 3 OP19 13,16 4 OP19 12,16,23 5 OP19 13,23 The registered person must 01/04/06 ensure that the cracked and missing tiles in the kitchen are replaced. The registered provider must 01/06/06 ensure that any carpets and wall coverings are non- patterned to ensure that the environment does not cause any additional difficulties to the residents. The manager must ensure that 10/03/06 risk assessments are completed for all areas of the building whilst the builders are completing the DS0000064118.V284544.R01.S.doc Version 5.1 Page 22 Roxburgh House 6 OP26 13,16,23 refurbishment. Investigate and eliminate the unpleasant odour on the ground floor. (Not met from previous inspection) Implement regular deep cleaning of the home including the shampooing of carpets. (Not met from previous inspection) 01/04/06 7 OP26 13,16, 23 01/04/06 8 OP26 13 Ensure that toilets and 01/11/05 bathrooms are supplied with toilet roll and have the means for people to wash and dry their hands. (Not met from previous inspection) Staffing levels must be increased to meet the communication, psychological, personal and social care needs of the residents. The registered person must undertake a review of current staffing levels and determine how many staff are required to meet the needs of the residents. As part of the review the additional tasks that care staff undertake such as laundry, cleaning bed making must also be considered. (Not met from previous inspection) 01/12/05 9 OP27 18 10 OP27 18,13 11 OP27 18 The registered person must recruit sufficient ancillary staff to ensure that the laundry is done and the home is kept clean. Staffing levels must be maintained with a minimum of four staff on duty in the afternoon and evenings. (Not met from previous inspection) DS0000064118.V284544.R01.S.doc 01/04/06 01/03/06 Roxburgh House Version 5.1 Page 23 12 13 OP3030 OP38 18 13,23 The registered provider must provide the staff with dementia care training. The registered manager must obtain a boiler servicing and safety certificate. 01/08/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP15 OP19 OP1919 OP19 OP3030 OP3333 Good Practice Recommendations The menu should be displayed each day. Residents’ bedroom doors should be personalised and have their name on the door. Specific advice should be given to the builders to minimise the risks to residents. It is recommended that when the carpet is replaced that it be replaced with a non-patterned carpet that is suitable for people with dementia. It is recommended that staff attend dementia care training or update training at least every two years. It is recommended that Regulation 26 visits take place on different days of the week (when the activity worker is not there) to reflect an accurate picture of the activities taking place. Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Roxburgh House DS0000064118.V284544.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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