CARE HOMES FOR OLDER PEOPLE
Roxburgh House Roxburgh Street Bootle Liverpool Merseyside L20 9PS Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 23rd July 2007 11:40 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 DS0000005417.V346741.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 DS0000005417.V346741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Roxburgh House Address Roxburgh Street Bootle Liverpool Merseyside L20 9PS 0151 525 7547 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) roxburghbootle@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Mrs. Ruth Baggs Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 38 OP. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. The service to accommodate one named resident under pensionable age. 1st August 2006 Date of last inspection Brief Description of the Service: Roxburgh House is a care home for 38 older people. The registered provider is Southern Cross Properties Limited. A manager has recently been appointed who is not yet registered with CSCI. Roxburgh House is purpose-built, situated in a quiet residential street, close to main roads, shops and bus routes and is set in gardens, with a car park at the front of the property. Roxburgh House is staffed throughout the day and night, and provides personal care, full board, laundry and single accommodation. All residents are registered with local doctors and are supported by staff in accessing health and paramedical services. The range of fees charged per week in Roxburgh House is £315.50-£533.00 and there are extra charges for chiropody and hairdressing. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used during the un-announced inspection to Roxburgh House were, discussion with residents, staff and the appointed manager, Tracey Conlin. Records compiled in Roxburgh House regarding health and safety and staffing were read. Residents’ care files were read and a sample of care plans was tracked to ensure they were effectively supporting the residents’ needs. A walk of the premises and grounds was carried out and residents were asked if they were satisfied with their accommodation. What the service does well:
Roxburgh House is a purpose-built care home the service is accommodated on the ground floor with a general office and utility space on the first floor. There is a car park at the front of the building and gardens surrounding with patio areas, which are accessible from the lounges. All bedrooms are for single occupancy some having en-suite facilities, and residents said they were satisfied with their accommodation. Residents have had their needs assessed before they move in to Roxburgh House and they are provided with the home’s brochure, to ensure they have plenty of information about the service, before making the decision to move in. Each resident has a plan of care, which is regularly reviewed and those care plans, which were tracked, were well maintained and meeting each resident’s health, personal care and social care needs. A resident said, “I have no cause to complain about the care I am getting here. I could ask no more.” A visitor to Roxburgh House said that her mother is very well cared for. Residents’ diversity is respected in care planning through recording their beliefs and social histories, and by arranging for their religious beliefs and preferences to be accommodated. There is support for residents to maximise their independence, through risk management and review as needs change, and residents who have poor mobility, are well supported. There is an activities programme for residents who wish to take part and outings are arranged regularly in consultation with them. Residents said that they were satisfied with their meals and that they are offered alternatives choices and that drinks are served regularly. A resident said about the food served in Roxburgh House, “It is to my liking, nice and hot, the service from the kitchen is good.” Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A manager has been appointed but is not yet registered with CSCI. To ensure that the home is consistently managed in residents’ best interests, an application for registration should be made. As there has been no registered manager for several months in Roxburgh House, supervision sessions with staff have fallen behind, as was confirmed by some of the staff on duty. To ensure that staff are well supported and have the skills to meet residents’ needs, recommendations are made regarding provision of ongoing and regular supervision sessions with staff and training for them in NVQ and equality and diversity. As the laundry is on the first floor, a recommendation is made that a risk assessment be carried out for staff, when carrying laundry up and downstairs. This is to avoid the risk of injury and falls to staff in the process. Work was being carried out on the electrical system at the time of the visit. To ensure that there is evidence that building is well maintained, and equipment is in working order, it is recommended that a copy of the latest electricity certificate to be provided to CSCI. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 7 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 DS0000005417.V346741.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Prospective residents have had their needs assessed and are provided with the information they need before making the decision to move in to Roxburgh House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 1,3. A copy of Roxburgh House statement of purpose and service user guide was seen in residents’ bedrooms. These documents provide a description of the facilities provided in Roxburgh House, the complaints procedure and the service aims and objectives. There was evidence in the care files, that residents have had their needs assessed, before moving in to Roxburgh House to ensure that their needs can be met. There is a standard assessment format to be used by staff carrying
Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 10 out the assessments. The format provides for a range of health, social and personal care needs. For people referred by social services, assessments carried out by social workers are obtained. The outcomes of assessments form the basis of each individual’s care plan. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ care plans were meeting their assessed health, social and personal care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9,10. The care files of four residents were tracked by checking that there were written care plans to meet each person’s assessed needs. The care plans follow a standardised format and make provision for risk management (for example, regarding falls and pressure care) and for the review of care needs. The care plans, which were seen, were to a satisfactory standard and had been amended to meet any change in the person’s needs or dependency. A resident said, “I have no cause to complain about the care I am getting here. I could ask no more.” A relative said, “It is so good here, I can only praise the way (name) is looked after. ”
Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 12 There were records in residents’ care files of their medical support services such as, doctors, district nurses and local health centres. There was evidence also that they receive paramedical services such as chiropody. Five residents, who were asked, were satisfied with the medical support they receive and their needs and referrals to health professionals are well documented. Roxburgh House has policies and procedures in place for the safe management of medication, and named staff who give out medication, have recently received training in this. A resident said, “Staff bring round my medication at the same time every day without fail, I would probably forget to take it if they weren’t here to help.” Three members of staff were spoken with and they were aware of Roxburgh House policies on privacy and confidentiality. Residents said that staff are considerate and helpful. One resident said, “The staff are really kind, I have always been treated with respect.” A member of staff said, “We are trained about respect for residents’ privacy. We knock on doors before going into bedrooms and the bathroom and toilet doors stay closed when residents are inside.” Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. The lifestyle in Roxburgh House meets residents’ expectations and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. Residents’ personal choices and preferences are recorded in their care plans. A resident said, “I prefer my own company and staff do not interfere but they are there if I need them.” Another said, “Everything is fine. Sometimes I get involved in what is going on, like bingo, sometimes I don’t. There is no pressure.” There is an activities diary, which sets out leisure events for each week and outings are also arranged. Residents were enjoying a session of music and exercise during the afternoon of the visit. Residents said their visitors are made welcome and there are no undue restrictions on visiting times. A relative who was visiting said, “They are very good to (name) and she is well looked after.” Residents who have no families have access to local advocacy services to ensure that they have representation
Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 14 if needed. There was evidence in files that residents’ families are involved in the care planning and review process in Roxburgh House. Residents’ diversity is respected in care planning through recording religious beliefs and social histories. One resident said, “When I first came here, I wasn’t sure if I would be able to have communion, like when I was at home, but that has been arranged for me and I am pleased.” All residents who were asked were satisfied with their meals. One resident said, “If I don’t like what is on the menu, I have something else. I can’t ask for more. Drinks are brought round regularly and we get a good breakfast.” Another resident said that the food is hot when served, and the service from the kitchen is good. The food stores were visited and stocks of fresh, frozen, chilled and dry foods were substantial. There were stocks of hot and cold drinks, fresh fruit and vegetables and a variety of breakfast cereals. Menus are reviewed seasonally and choices and alternatives are offered. The dining room is well presented, adjacent to the kitchen. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. Residents’ complaints are acted upon and they are protected by the training and procedures in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16,18. Roxburgh House has procedures for complaints, protection of vulnerable adults, (POVA), and “whistle blowing.” A record of complaints is retained, and a report for the most recent complaint (June 07), was read. The complaint was not upheld. The report was clear, and had been dealt with within given timescales. Staff who were spoken with, have received, POVA training to ensure they are aware of the indicators of abuse and reporting procedures if abuse is suspected. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. To ensure that the environment is suitable for residents, the building is well maintained and hygienic, and action has been taken towards securing the grounds. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19,21,22,24,26. The service in Roxburgh House is provided on the ground floor with office space and the laundry on the first floor. The communal areas are furnished and decorated in domestic style with access to the patios from the lounges. Residents said they feel comfortable in their home and were satisfied with the accommodation. There are plans to create a smoking area for residents, and the manager has sought advice on this from the fire safety officer to ensure the proposals will not cause a fire risk. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 17 The garden looked fairly well tended and in better condition than during the last visit. A requirement to make the premises secure from intruders, remains outstanding. The registered providers are taking action having applied for planning permission to put up fences around the perimeter. The requirement is repeated in this report with extended time limit given. There are bathrooms, toilets and showering facilities situated throughout Roxburgh House, with grab rails, raised toilets and assisted baths for the convenience of residents who may be frail or have poor mobility. A number of residents, subject to individual assessments, have mobility and sensory aids and they appeared to be attaining good levels of independence. One resident said, “It takes me a long time but I walk down to the dining room from my bedroom, the exercise is good for me.” Residents’ bedrooms are for single occupancy and many have en-suite facilities. A number of bedrooms have been refurbished since the last inspection and these looked fresh and comfortable. Bedrooms are highly individualised with personal photographs, ornaments and items of furniture. The procedures manual and training schedules were read, and the housekeeper was spoken with. There are policies and procedures in place for COSHH and infection control and there are good storage facilities for cleaning materials. Staff who carry out domestic duties receive relevant training and instruction and are provided with protective clothing. The building was clean and in good order in the areas which were visited. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. Staffing levels were meeting residents’ needs and some further development of their skills and qualifications has been identified. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28,29,30. The staff rosters were read and these provided an accurate record of staff on duty at the time of the visit. Care staffing hours are well supported by ancillary staffing levels, and the manager is on duty during office hours. The staffing arrangements ensure that care staff are not taken away from their duties for domestic work or cooking. There is an ongoing NVQ programme and the manager said that 35 of staff have gained the qualification at level 2, in addition to a number of staff who are currently undertaking the course. It is recommended that at least 50 of staff gain NVQ qualifications to ensure that they have the skills to meet residents’ needs. A sample of staff files was read and discussion took place with staff on duty. Roxburgh House has a robust recruitment procedure, which includes vetting of
Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 19 staff through taking up references, and obtaining criminal records bureau clearance. Staff on duty said they have been issued with job descriptions and contracts of employment. Reference was made to staff training schedules and training was discussed with the manager and staff on duty. A range of mandatory and care related training has been carried out, or is planned for staff in the coming months. As there is no record of equality and diversity training, and to ensure that staff are aware of the promotion of equality and diversity in Roxburgh House, it is recommended that this training is provided. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. There are systems in place to safeguard residents and support staff, but there is no registered manager for Roxburgh House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35,36,38. The acting manager, Tracey Conlin, has not yet applied for registration with CSCI. Roxburgh House has been without a registered manager for a number of months since the previous registered manager left. To ensure that Roxburgh House is managed consistently in residents’ best interests, a recommendation is made that application is made for a manager to be appointed and registered with CSCI.
Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 21 Roxburgh House has a quality assurance system, which is based on seeking the views on residents and their representatives. Ms. Conlin said that the completed questionnaires are returned to head office and there was no sample available to be read from the most recent consultation. There is a fully documented and audited system in place for the billing of fees, accounting for residents’ personal allowances and ensuring they have access to their money as they need it. The records were read and were satisfactorily maintained at that time. Some staff said they had not received formal supervision recently and this was evident in staff files. Given the recent changes in management and to ensure that staff have the support they need to fulfil their roles and responsibilities, it is recommended that staff receive formal supervision at least two monthly. Health and safety and maintenance certification and accident records were read and were generally in good order. Work was being carried out on the electrical system and a copy of the updated electrical certificate was requested, when complete and this is a recommendation of this report. As the laundry is on the first floor, it is recommended that a risk assessment be carried out on carrying laundry on the stairs, to reduce risk of injury/falls to staff. Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 22 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 3 X 3 X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 23 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 OP19 Regulation 23 (o) Requirement Arrangements must be made for the grounds to be made secure from intruders by fitting fencing and gates by the date stated. Timescale for action 14/09/07 Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations The registered person should contact the fire safety officer regarding any risks to access and means of escape, which may be posed by provision of gates/fencing to the grounds. To ensure that staff have the skills needed to meet residents’ needs, it is recommended that at least 50 of care staff achieve NVQ qualifications. To ensure that staff have the skills to promote equality in Roxburgh House, it is recommended that they receive training in equality and diversity. To ensure that staff have the support they need to fulfil their roles and responsibilities, it is recommended that staff receive formal supervision at least two monthly. To ensure that Roxburgh House in consistently managed in residents’ best interests, it is recommended that application be made for registration with CSCI. It is advised that the manager provides CSCI with a copy of Roxburgh House electrical inspection certificate when work is completed. To avoid risks of falls and injury to staff, it is advised that a risk assessment be carried out for staff who carry items for laundering on the stairs. 2. 3. 4. 5. 5. 6. OP28 OP30 OP36 OP31 OP38 OP38 Roxburgh House DS0000005417.V346741.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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