CARE HOMES FOR OLDER PEOPLE
Roxburgh House Roxburgh Street Bootle Liverpool Merseyside L20 9PS Lead Inspector
Mrs Trish Thomas Unannounced Inspection 28th February 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roxburgh House DS0000005417.V285292.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 DS0000005417.V285292.R01.S.doc Version 5.1 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) Southern Cross Home Properties Limited Mrs Ruth Jane Baggs Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 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. 08/08/2005 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, and the registered manager is Mrs. Ruth Baggs. The home is purpose-built, situated in a quiet residential street, close to main roads, shops and bus routes. Roxburgh House is set in gardens, with a car park at the front of the property. The home is staffed throughout the day and night, and provides personal care, full board, laundry and single accommodation. All residents are registered with a G.P. and supported by staff in accessing health and paramedical services. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used during the inspection were, discussion with nine residents four members of staff and a visitor, touring the premises and reading records compiled in the home. The manager, Mrs. Baggs, was on duty and provided information as requested. What the service does well: What has improved since the last inspection?
Residents receive regular chiropody services and the frequency of visits, is recorded on their care plans. Residents said they were satisfied with the activities on offer in the home and they take part as and when they choose. The menu is written on the notice board every day for residents, prior to the mealtimes, and alternatives are offered for those who want them. A training day in nutrition, has been provided for staff and Basic Food Hygiene Training, has been arranged. The hall carpet has been replaced since the last inspection. The manager has distributed quality assurance questionnaires to residents and their representatives but has received no responses to date.
Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 6 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 DS0000005417.V285292.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 DS0000005417.V285292.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): 3,4 All residents who are admitted to the home have their needs assessed by health/social work professionals and by staff from the home. EVIDENCE: Three care files were read and each resident’s needs had been assessed prior to admission to Roxburgh House. Staff follow a standard assessment document for each prospective resident referred to the home. In one instance, this document had not been signed or dated by staff, who carried out the assessment. One social work assessment did not provide a full account of a new resident’s condition on discharge from hospital to Roxburgh House. There are records in her care plan of referrals to the district nurse and G.P. for pain relief, and for paramedical services. This resident was spoken with, and she said that she was comfortable and has all she needs. The manager said this lady’s condition has improved and the home was meeting her needs at that time. It is written in her records that the G.P. considers her needs to be within the category of residential care. It is advised that all care staff, including night staff, receive instruction in stoma care.
Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 9 The home is not registered to provide a dementia service, or to admit residents who are assessed with dementia. Some of those living in the home have become confused and frail with age. Their presenting behaviour is monitored to ensure that the home is meeting their mental health needs. In order to have the skills to support residents, whose needs are within the early stages of dementia, it is recommended that staff receive training in dementia care. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 10 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 All residents have their health, personal and social care needs set out in a care plan. Residents’ health care needs are addressed in care plans. The home has policies and procedures for managing medicines and suitable storage and recording systems. EVIDENCE: Reference was made to three care plans. The format of care plans has changed and staff are becoming accustomed to these new records. Care plans have not been signed by residents/ their representative, as evidence that they have been involved in the planning process. Plans were in place to address personal care and risk assessments and review systems were in place. All residents are registered with a G.P. Medical and paramedical referrals are recorded on professional visits records and there was evidence regular health care input. A recently admitted resident said he likes living in Roxburgh House and he wants to stay. His care plan was one for minimal support, prompting and supervision to ensure personal safety. The care plans of two residents of higher dependency, reflected the higher levels of support in place regarding health care, pressure care, nutrition, continence and mobility and risk. Social profiles are completed for all residents and details of their interests, religion, next of kin health professionals and social workers are included.
Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 11 There are arrangements in place for residents to self-medicate or for the management of their prescribed medication. The drugs trolley is secured in a locked room and records are maintained of medication brought into the home and administered. Staff who administer prescribed medication receive training and updates. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 12 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): 12,13,15 Residents were satisfied with activities on offer and the lifestyle of the home. Residents maintain contact with family/friends and the local community. Residents receive a wholesome and balanced diet in pleasing surroundings and at convenient times. EVIDENCE: Residents were spoken with about the activities on offer in the home and some were taking part in a (safe) pancake tossing competition. They had no complaints and said that social events are arranged regularly. A number go out to tea dances and take part in a table football contest at a local club. Two residents said that they don’t get involved and that is their choice. One lady said, “I feel very happy here, it is great.” Her mobility has improved since she was admitted to Roxburgh House last year and she has made friends with another resident. There are weekly aromatherapy sessions and a calendar of popular seasonal activities, bingo and film shows. Transport for shopping trips and visits to local places of interest are by disabled taxi, for those who have poor mobility. The activities co-ordinator’s hours are supernumerary to care hours. There were visitors to the home during the inspection. One lady said “I come every day and everything is fine.” She prefers to sit and chat with the residents. Another resident went to his room to chat with a relative in private.
Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 13 Six residents and one visitor said the food is very good, “We go short of nothing here.” “I get plenty to eat and I feel so much better for it.” A new cook has been appointed since the last inspection. The manager explained the system in place until laminated menus are available. The menu of the day is written on a board and alternatives are offered to residents as necessary. Menus are on a four weekly rota and are reviewed seasonally. The manager said Food Hygiene and nutritional training has been arranged for staff. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 14 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, 18 The home has a complaints procedure, which is made available to residents and their representatives. The home has adult protection and “whistle blowing” policies. EVIDENCE: The home’s complaints procedure is clearly stated and provides steps to be taken, contacts and time limits. There has been one complaint investigated by the registered provider, since the last inspection. The home has an adult protection procedure and “whistle blowing” policies and staff receive related training. There have been no adult protection investigations in the home since the last inspection. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 15 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 interior of the building is well-maintained, the grounds are not in good condition and give a poor first impression of the home. The home is clean internally and in good order. There was litter in the grounds, which appears to have blown in from the street. The bins were overflowing and pose a risk of attracting vermin. EVIDENCE: Much investment is evident in the condition of the interior of the home. Bedrooms have been very pleasantly decorated in neutral shades and there is an ongoing programme for providing new bedding, curtains and carpets. The hall carpet has been replaced since the last inspection. The gardens are not in good condition and require regular maintenance, particularly as summer approaches. The grounds remain unsecured, which poses a problem at night, when (the manager said), local youths often enter, leaving bottles and cans behind them, which are later removed by the handyperson. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 16 This nuisance and the risks it poses, could be avoided if the grounds did not given open access from the street and fencing and gates will be required to secure the residents’ home. Domestics are employed and the interior of the home is clean and hygienic. There are procedures in place for infection control and control of substances hazardous to health. Externally, the bins were overflowing and they looked unsightly. Rubbish was in plastic sacks, but not contained and covered, as there did not appear to be enough bins in relation to the capacity of waste. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 17 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): 28 There is an ongoing training programme in the home and over 50 of staff have NVQ qualifications. EVIDENCE: The manager said that NVQ 2 and 3 are arranged for care staff and she is due commence the Registered Managers Award. Mandatory training updates are ongoing and recent training arranged or undertaken by staff includes medication administration, Food Hygiene, Nutrition, Moving & Handling, Oral Health, TOPPS Induction, Fire Safety. Roxburgh House DS0000005417.V285292.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 The manager is qualified, experienced and fit to be in charge of the home. The home is run in the best interests of residents and their financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The manager had recently returned to duty following extended leave. Mrs. Baggs is registered with CSCI and has four year’s management experience in social care. Mrs. Baggs holds a management qualification and is due to undertake the Registered Managers Award. Staff said they felt well supported by the manager and she is approachable. She appears to have a good rapport and empathy with residents. Mrs. Baggs said that when she last distributed quality assurance questionnaires to residents and relatives there was a nil response. Two relatives attended the last residents’ meeting. She said she will continue to distribute questionnaires and invite relatives to meetings.
Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 19 The administrator, Mrs. Tootle, explained the system in place for management of personal allowances held on behalf of residents. Individual resident’s personal allowance accounts are maintained, recording deposits and withdrawals. The records are regularly audited. The home does not become involved in residents’ financial affairs and residents with savings have personal bank accounts. Health & Safety certification was up to date. Fire safety training and drills have been provided for staff. Roxburgh House DS0000005417.V285292.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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 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 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Roxburgh House DS0000005417.V285292.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 OP19 Regulation 23 (o) Requirement The manager must make arrangements for the grounds be made secure from intruders by fitting fencing and gates by the date stated. This requirement is outstanding from the last inspection and an extended time limit is given. The manager must make arrangements for the grounds to be maintained to a good standard by increasing staff hours, or employing the services of a gardener. This requirement is outstanding from the last inspection and an extended time limit is given. The manager must arrange for all care staff (including night staff) to receive instruction in stoma care. The manager must arrange for all care plans to be formulated in consultation with residents, (their representatives) and signed. The manager must arrange for provision of enough bins to contain and secure rubbish and
DS0000005417.V285292.R01.S.doc Timescale for action 14/06/06 2. OP19 23 (o) 14/05/06 3. OP4 14 (1) (d) 14/05/06 4. OP7 15 (1) 14/06/06 5. OP26 13 (3) 14/04/06 Roxburgh House Version 5.1 Page 22 clinical waste. 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. Refer to Standard OP4 OP4 OP19 Good Practice Recommendations The manager should arrange for care staff to receive training in dementia care. The manager should instruct staff that pre-admission assessments are signed and dated by the assessor. The manager 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. Roxburgh House DS0000005417.V285292.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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