Inspection on 29/08/07 for Roxburgh House

This inspection was carried out on 29th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 27/01/09

Roxburgh House 11/02/08

Roxburgh House 03/01/07

Roxburgh House 12/01/06

Roxburgh House 18/08/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Roxburgh House 29 Roxburgh Road Westgate-On-Sea Kent CT8 8RX Lead Inspector Christine Grafton Key Unannounced Inspection 29th August 2007 09:50 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 DS0000062994.V348450.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 DS0000062994.V348450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roxburgh House Address 29 Roxburgh Road Westgate-On-Sea Kent CT8 8RX 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) 01843 832022 Discovery Care Ltd t/a Roxburgh House Post Vacant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (6) of places Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The residents with physical disabilities shall be aged 35 years and over. 3rd January 2007 Date of last inspection Brief Description of the Service: Roxburgh House provides care and support for 22 older people including some people with physical disabilities. The home is a large detached property with accommodation on four floors, including a basement level, ground and first floor that are all accessible via a shaft lift. There are two bedrooms on the second floor and the occupants of those rooms need to be able to walk up one flight of stairs. There are a total of seventeen bedrooms, twelve of which are singles and five doubles. The home is situated in a small, slightly privately sectioned area, close to the railway, local shops and within walking distance of the sea front. The frontage of the home is on level ground and gives access for wheelchair users. This paved frontage area has seating arranged for service users to enjoy during good weather. There is on street parking available. The home is staffed by an acting manager and team of carers who work a rota that includes two staff on waking duty at night. There are also catering staff and a part-time domestic. The fees for support from the home are set during the assessment period and are very individual to the needs of the service user, depending on the level of support required and the staffing numbers provided. On 29th August 2007, the proprietor stated that the average fee levels at this time are roughly between £312.81 and £560.00 per week. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report takes account of information received since the last inspection, including two visits to the home. An unannounced visit took place on 29th August 2007 between 09.50 hours and 17.55 hours. A second visit was made on 4th September 2007 between 14.30pm and 17.45 hours. The visits included talking to residents, staff members and Mr Isiakpere (one of the registered providers); looking at records and undertaking a tour of the home. Observations of the home routines, activities and staff practices have also informed judgements made in this report. At the time of the visits there were sixteen residents living at the home. What the service does well: What has improved since the last inspection? Five staff have attended training on adult protection since the last inspection. Staff on duty at the visits indicated good awareness of issues that might indicate abuse and were clearly committed to ensuring that residents’ best interests are protected. A number of staff had attended recent training on infection control that should help to develop their skills in this area and provide extra protection for residents and themselves. However, management need to take further action in this area to ensure safety – see next section. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 6 A new wide screen television has been provided in the main lounge and residents expressed that the picture quality is good and they enjoy watching it. One bedroom has been redecorated since the last inspection and provides a pleasant environment. A new ‘wet room’ shower facility is being created, which when completed will provide more choice for residents. Radiator guards have been delivered and there are plans to fit them by the winter to address the risk of burns from radiator surfaces. However, this was identified at the last inspection as necessary to ensure the safety and well being of residents in all areas. The guards should be fitted in priority according to assessed risk. What they could do better: The current management structure is not sufficiently effective. Although this home has some strengths, weaknesses have been identified at this inspection that could adversely affect residents’ welfare. The home sets out the level of care and service provided in its statement of purpose and service users’ guide. However, it was not meeting some of its stated aims, for example, to deliver quality care via personalised “holisitic” care plans, which evidence in this report suggests is not always happeneing. Both documents could therefore mislead prospective residents. The documents also contain some factual inaccuracies that need reviewing and updating. Assessments carried out prior to admission are not sufficiently thorough and do not demonstrate if the home can meet the person’s needs. This places them at risk of their care needs not being fully met. Although each resident has a plan of care to provide the basis for the care to be delivered, some care plans were not at the home. Therefore the quality of care provided to residents is dependent upon staff carrying information in their heads, or passing it on verbally. Discussion with staff indicated that they do understand residents’ care needs, but some of the information in the care plans seen did not fully support this, posing the risk of inconsistent care being delivered to residents. Practices for managing medications in the home were mainly appropriate. A couple of improvements were identified for the safe administration of medications and to protect residents’ welfare at all times. These were to ensure that all staff that administer medications have received appropriate medication training and that a dedicated drugs refrigerator is provided. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 7 There were a number of maintenance and safety issues that were discussed with Mr Isiakpere. There needs to be a system in place to ensure that such issues are dealt with promptly to safeguard residents and staff. There has been a change to the home’s smoking policy to comply with the new smoke free regulations. Smokers now have to smoke outside. However, this has not been made clear in the statement of purpose and service users’ guide so that residents who smoke know what is expected. The home has some specialist disability equipment to maximise independence for people with physical disabilities. However, some adaptations are necessary to ensure that people in wheelchairs can access all communal areas without the need for staff assistance, for example the step into the sun lounge. Any specialist equipment, such as mobile hoists, must be maintained in good working order. Suitable arrangements must be in place to prevent the spread of infection within the home. This must include procedures for dealing with soiled articles and bodily waste in a safe way that protects residents and staff. Appropriate hand drying facilities also need to be provided. A review of staffing levels must be carried out and there must be sufficient staff on duty to meet residents’ needs, taking account of the layout of the home. Structured induction and ongoing staff training must be provided to give them the necessary skills and knowledge to deliver the appropriate care to residents and ensure residents are safe. Staff should receive appropriate supervision. Robust quality assurance systems need to be in place, to ensure that the home is run in the best interests of the residents. This must include monthly monitoring visits by a responsible person of the organisation, to review the quality of care provided and ensure acceptable standards are maintained in all areas of the home. All working practices must ensure the safety and welfare of residents and staff. Action needed includes: to carry out regular staff fire safety training and drills; to ensure sufficient staff are trained in moving and handling and food hygiene. 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 DS0000062994.V348450.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 DS0000062994.V348450.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): 1, 2, 3, 4 & 6 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents are given the information they need to decide if the home is right for them. Residents’ needs are assessed before they move into the home, but the process is not thorough enough to ensure that the home can meet their needs when they move in. The home offers a respite and rehabilitation service, but there are not always enough staff on duty to ensure they have sufficient time to promote rehabilitation. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home’s statement of purpose and service users’ guide clearly set out the facilities, services, level of care provided and those services not provided. The documents provide an insight of what prospective residents should expect upon moving into the home. It was discussed with the provider that the documents need to be kept under review to address the out of date information about staff numbers and qualifications and changes to the building, including the home’s smoking policy. Pre-admission assessments are carried out to decide if the home can meet the needs of the prospective resident. However of the six residents’ files selected for case tracking at the first visit, only two had copies of the pre-admission assessment and these provided only very brief details and did not demonstrate whether or not the home could meet the person’s needs. A resident with complex needs was re-admitted back to the home from hospital without a thorough assessment having been completed. Staff spoke of their concerns that the home could not properly meet the resident’s care needs. Discussion with the resident and a review of the care plan indicated needs that the home does not have the capacity to meet. Arrangements had already been made for the person to move to a nursing home, but this had been instigated by the resident and not by the home. At the second visit Mr Isiakpere confirmed that the resident was leaving the home the following day. Since the last inspection the residents’ statement of their terms and conditions of residency has been amended to include details of the fees and room number. The home’s statement of purpose and service users’ guide state that respite and rehabilitative care is provided. However, with only two carers on duty throughout the day to provide care for all of the residents, staff said they do not always have the time to provide the level of support to promote independence. Roxburgh House DS0000062994.V348450.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): 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Inconsistencies in the care planning system and the absence of some care plans at the home places residents at risk of their health care needs not being met. The home’s medication procedures and practices provide residents with adequate protection. The principles of respect, dignity and privacy are generally put into practice, but could be improved to promote equality and diversity. EVIDENCE: At the first visit, the acting manager was on leave. Mrs Isiakpere (registered provider and responsible individual) was not at the home, but contacted by telephone and stated that she had most of the care plans with her to review. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 12 Therefore, of the six care plan files selected for case tracking, only three contained the actual care plan documentation. The care plans seen were well organised and consisted of individual plans for each need identified, covering a wide range of personal and health care needs. Each plan describes the actions required by care staff and separate risk assessments are recorded. However, risks are set out on a pre-recorded form with set risks specified and plans of action that would have universal application that are not individual to the person. Some of the care plan instructions are too general and not specific enough. For example a care plan for a person unable to weight bear stated that two carers are needed to assist with transfers and then states “all carers trained in manual handling” with no instructions on how to do this, what type of hoist to be used, or the procedure to be followed. Discussion with the resident and staff indicated that there was a problem with the hoist that should have been used and staff were sometimes manually transferring, or using another resident’s hoist. This places both the resident and staff at risk of injury. The acting manager records monthly reviews for each care plan and there was evidence of contacts with doctors, district nurses and other health care services. It was clear that the home is working hard to address the issues raised at the last inspection and is trying to improve the care planning system to ensure residents’ well being. However as a number of care plans were not at the home at either of the two visits, residents well being cannot be assured at all times. Mr Isiakpere stated that his wife was changing the care plan layout to encourage staff to record the appropriate information. Medications are supplied in a monitored dosage system and stored in a purpose made trolley that is kept in the staff room. Medication records contain photographs and other useful information to support the correct administration of medication. Medication administration (MAR) sheets had been appropriately signed. It was discussed with the acting manager to ensure the correct use of codes for non-administration on the MAR sheets. One resident self-administers their own insulin injection and has asked for a staff member to be present when they do this. The care plan for this resident was not available, but the acting manager said there is a care plan that covers this medication need and associated risks. Medications that require cold storage are kept in a refrigerator in the kitchen used to keep food items. A recent Food Safety report had identified this as unsafe and Mr Isiakpere indicated that he would provide a separate dedicated drugs refrigerator. The senior carer confirmed they had attended a medication-training course in the past, but indicated the training was done in a day and had not been updated. The staff-training matrix indicates that only four staff (including the Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 13 acting manager) had completed certified medication training. Mr Isiakpere stated that his wife is qualified and does medication training with staff. However, this could not be validated. This is important to ensure that staff have the necessary skills to protect residents. Residents spoken to felt that staff in the home treat them with respect. Observations of the interactions between residents and staff supported this. Staff had a friendly approach and encouraged residents to participate in the inspection, although there was poor staff morale at the first visit, but this did not affect the way they interacted with residents. With only two care staff on duty care tasks such as baths are spread throughout the week to less busy times, which does not provide much choice for residents. During the morning of the first visit, a resident’s bath had to be delayed, which meant that they were still in their nightclothes when they were taken to the dining room at lunchtime, in their wheelchair. There was a lack of information in the care plan on how to support a resident’s communication needs although on the second visit, the acting manager described how this need is being met. The home’s statement of purpose sets out its commitment to meet residents’ individual needs through personalised, holistic care plans that recognise racial, cultural and religious needs and that emotional and physical needs are considered. Evidence indicates that the equality and diversity needs of residents are not always being met and staff are working in a task-orientated way, rather than a person centred approach. Therefore, more could be done to promote dignity and equality for people with disabilities. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 14 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to keep in contact with families and friends. Residents are encouraged to exercise choice and control over their lives, but some choices that would promote independence are limited for people with disability needs. Residents enjoy their food and choices are readily available. EVIDENCE: Care plans contain brief details about residents’ past occupations and interests, but there are no personal profiles recorded and they lack information on how the social care needs of the residents are being followed through. However, residents did say that they exercise choice in their daily routines and some pursue their own interests. One resident goes out into the local community regularly and clearly enjoys this. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 15 There is an activities timetable on display in the home. Planned sessions include: bingo, memory lane, sit and keep fit, ‘sing a longs’ and nail painting. However at both visits, there were no activities taking place, although at the first visit, staff did spend approximately half an hour in the afternoon sitting with residents in the lounge and chatting to them. Therefore the activities timetable is applied flexibly and not a true indication of what happens each week. Residents indicated that their friends and families are welcomed. An example was discussed whereby the home supported a resident to re-establish contact with relatives. Religious needs are identified in the care plans. Two clergymen of different denominations regularly visit the home and once a month a communion service is held. The home is registered to care for up to six people with physical disabilities. Care staff endeavour to support those residents who use wheelchairs and one wheelchair user was seen moving themselves about independently. However wheelchair users wishing to access the sun lounge have to negotiate a step, so are reliant on staff assistance. This does not promote their independence. All residents spoken to expressed that the food is good and that they have a choice at every mealtime. The lunchtime meal was observed and consisted of soup, a choice of two different main courses and dessert. The meal was attractively presented and the cook went round and asked everyone if they were satisfied with their meal. One resident who did not finish the meal was asked if they would like something else, but declined. Staff were ready to offer assistance in eating where necessary and the mealtime was an unhurried affair, with residents being given plenty of time to eat and chat with each other. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be listened to and acted on. There is a process for resolving complaints but the home needs to better evidence its application and to ensure that outcomes are fully recorded. The home has appropriate procedures in place to safeguard residents from abuse. EVIDENCE: Residents spoken to expressed that they can speak to any of the staff if they have a concern and are confident that if there are any issues troubling them, they will be dealt with. The complaints policy is displayed and clearly set out in the service users’ guide. Since the last inspection a compliments and suggestions book has been introduced and is kept by the visitors book. Comments included, “Happy with the overall care, so far so good. Thank you All.” “Always a warm reception.” The commission has received one complaint since the last inspection that was investigated by the home. The home responded promptly and the investigation report demonstrated that the complaint had been taken seriously and was not substantiated. However some of the issues raised in the Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 17 complaint are linked to the national minimum standards and evidence obtained at the visits to the home indicates that some elements were founded. For example, poor infection control procedures, fire safety risks and some out of date training. These matters were discussed with Mr Isiakpere and requirements have been made. The home has a policy and procedure to protect residents from abuse. Five staff have attended adult protection training since the last inspection. Staff confirmed their commitment to challenge and report any instances of adult abuse. The staff-training matrix indicates that six staff have attended training on managing challenging behaviours. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 18 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, 25 & 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is comfortable, but more attention is needed to ensure adequate maintenance and safety. The physical design and layout of the home could be improved to ensure that adaptations and equipment to encourage choice and independence are provided to meet the assessed needs of all residents. Practices to maintain hygiene and prevent the spread of infection within the home are poor and need improving to ensure residents and staff are protected from risk of harm. EVIDENCE: All areas of the home used by residents were found to be comfortable and reasonably clean, with a number of homely touches throughout. Bedrooms are individual and personalised. Several residents said how much they like Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 19 their rooms, indicating that they suit their needs. One bedroom has been redecorated since the last inspection and provides a pleasant environment. There were a number of maintenance and safety matters identified that were relayed back to Mr Isiakpere: fire doors propped open; lack of paper towels or warm air driers where soiled articles, or clinical waste is handled; torn wallpaper in one bedroom; unfixed headboard in another bedroom; an armchair placed in front of a fire extinguisher in a corridor and fire exit route corridors still being used to store some items, although not as cluttered as at the last inspection. A new wide screen television has been provided in the main lounge since the last inspection which residents were clearly enjoying watching. The sun lounge, off the main lounge, opens onto the front patio and was the designated room for smoking. Carers stated that residents are no longer allowed to smoke inside the home, so the two residents who smoke do so outside on the front patio area. However, this change has not been reflected in the statement of purpose or service users’ guide. Mr Isiakpere indicated that the home’s smoking policy is currently being revised and he was unsure whether to keep the room as non-smoking. There is one bath with a bath hoist and two baths that are not adapted. Mr Isiakpere is currently working on the creation of a new ‘wet room’ shower facility for residents which when completed will provide more choice. There is a limited range of equipment and adaptations available, including a stand aid turntable and mobile hoists. Residents have access to their own wheelchairs, walking frames and other mobility equipment. However, not all communal areas are independently accessible to people in wheelchairs, for example the step to the sun lounge inhibits their independence. The national minimum standard 22 for care homes for older people specifies that an assessment of the premises be made by a suitably qualified occupational therapist and that any recommended disability equipment and environmental adaptations are provided to meet the needs of residents. This is particularly important as the home offers care for some people with physical disabilities. At the last inspection a requirement was made for pipe work and radiators to be guarded to ensure safety from the risk of burns. Mr Isiakpere stated that the radiator guards have been delivered and he made an undertaking to have them fitted by the winter. The laundry was untidy, dusty and in need of a good clean. It was cluttered with a vacuum cleaner and carpet shampooer in the middle of the room posing a hazard. There were also two plastic containers full of coat hangers, two cardboard boxes and the door was propped open with a large packet of Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 20 washing powder (creating a fire risk). There are two domestic washing machines and one tumble drier. The carer stated that there is no sluicing facility and soiled articles are hand sluiced in plastic washbowls (that were seen on the windowsill). She also stated that the home does not provide any “yellow bags” or pedal bins for the disposal of clinical waste, such as soiled incontinence pads. Staff confirmed they are provided with protective gloves and aprons. Liquid soap is provided, but there was an absence of any appropriate hand drying facilities. Mr Isiakpere stated that about eight staff had recently attended infection control training in June 2007. However, if they are not provided with adequate protective equipment, it is doubtful that they would be able to put all of the principles learnt into practice. The risks that these practices pose were discussed with Mr Isiakpere, who said that the home has a contract with a registered waste contractor. However, the waste transfer note does not indicate that it includes category E waste, which covers soiled incontinence pads. The above practices do not ensure the safe handling and segregation of clinical waste within the home and pose a risk of spread of infection to residents and staff. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 21 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 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty is not sufficient to properly fulfil the stated aims of the home and meet the changing needs of residents. EVIDENCE: At the first visit there were two carers on duty all day, plus a cook and domestic on duty in the morning. The acting manager and two carers were on leave and the remaining care staff were working extra hours to cover the gaps in the rota. Staff morale was low, with carers stating they were working long shifts; one carer was due to work from 18.00 hours that evening through the night until 08.00 hours the next day. A carer spoke of having to act up in the senior carer role and of the anxiety that this was causing them, plus having no recognition for this, or the extra hours worked. At that visit the staff spoke of not having enough time to spend with residents when attending to care tasks and were driven by tasks needing to be done. On the second visit the acting manager had returned from leave, but she was one of the two care staff on duty that day and her shift finished at 15.00 hours. Rotas indicate that it is normal for there to be only two carers on duty and care staff said that the acting manager only does one supernumerary day each week. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 22 Staffing numbers and deployment do not allow for staff to have opportunities to offer much individual stimulation to residents, or support them with the maintenance, or development, of living skills. There was little evidence of the principles of holistic care planning being properly translated into practice. This does not comply with the home’s statement of purpose that indicates its commitment to this. The staff training matrix indicates that nine staff have completed their National Vocational Qualification (NVQ) in care level 2 or above and new staff are enrolled on NVQ 2. However, one carer spoke of having had no proper induction and another carer said they had not completed their induction and had not received any fire training since they started work at the home (over six months ago). Three staff files were checked and seen to contain documentation indicating appropriate recruitment checks. However, induction records had been mainly completed in one day, which does not comply with the Skills for Care certified training. A new carer was on duty as the second person, without completion of the full criminal records bureau (CRB) check, although there was evidence of the protection of vulnerable adults (POVA) register first check. The application form did not provide enough information to confirm if a full employment history had been obtained. These things combined lead to inconsistent care practices that could compromise the safety and well being of the residents. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37 & 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management practices in this home do not ensure that residents’ best interests are properly safeguarded and promoted. The health, safety and welfare of residents could be compromised because of deficiencies of (or lack of) some safety equipment and insufficient numbers of staff trained in safe working practices. EVIDENCE: The home has not had a registered manager for over a year. The acting manager has an NVQ level 3 in care and has started working towards the registered managers award. However, Mrs Isiakpere (the responsible Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 24 individual) has been writing the care plans and training the acting manager in care management practices when she visits the home (at least once a month) usually at weekends. Mr Isiakpere is at the home most days and deals with the financial management and maintenance. He supports the acting manager in other management respects. Care staff spoken to did not feel supported by this management structure and indicated they had received no formal supervision. At the last inspection it was identified that the monthly visits by the responsible individual were not being formally recorded. Mr Isiakpere stated that his wife does do the monthly visit reports, but he could not provide any evidence of this. Records of the last staff meeting and residents’ meetings were seen and indicated that residents’ views and their suggestions are taken seriously and that supervision and appraisals had been discussed with staff. Satisfaction surveys are not currently being used as a method of monitoring the home’s quality. The current practice of revising the care plans away from the home indicates that residents are not involved in this process. Mr Isiakpere stated that the home deals with small amounts of personal spending monies for some residents and confirmed that records are kept of all transactions. Most of the records required for the protection of residents were available, but the absence of care plans at the home and the lack of any recorded fire practices, or drills does not comply with regulations. The staff-training matrix indicates that only seven out of fifteen staff have done any fire training and three of these date back to 2005 or before. The latest fire training recorded dates back to March 2006. This does not comply with fire safety guidance. Use of a daybook to record personal information about residents was also discussed as inappropriate. A number of health and safety breaches have been identified already in this report, namely: moving and handling risks; fire safety risks and poor infection control practices. There were also significant gaps in the numbers of staff trained in health and safety and food hygiene that need addressing. Evidence was seen indicating that the home’s equipment is regularly serviced, including the mobile hoist that staff had indicated was faulty. At the second visit, the acting manager said they had checked the hoist and found it to be working properly. This hoist is due for another service in September 2007 and it is important that the service engineer is informed about the problem that care staff had identified when using the hoist so that it can be properly investigated to ensure safety. Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 25 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 3 3 1 1 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 3 1 X 3 2 1 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 x 3 1 1 1 Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 OP4 Regulation 14(1) Requirement A full assessment of needs must be undertaken, prior to admission, for all prospective residents and any residents readmitted to the home from hospital. The registered persons must ensure that the home can meet the assessed needs of people admitted and that there are enough staff on duty with the skills to deliver the services and care that they need. 2 OP19 23(2) (a) & (b) The home must be kept safe and in a good state of repair. A programme of routine maintenance to be produced and implemented to ensure residents’ safety. 3 OP22 23(2)(n) The registered persons must ensure that the home is suitably adapted and any specialist disability equipment provided to meet the assessed needs of residents to maximise their independence and to ensure that DS0000062994.V348450.R01.S.doc Timescale for action 31/10/07 31/10/07 30/11/07 Roxburgh House Version 5.2 Page 27 the services specified in the statement of purpose are met. To consult with a qualified occupational therapist and produce evidence that the recommended disability equipment has been provided and environmental adaptations made to meet the needs of residents. 4 OP25 13(4) Any unnecessary risks to the health & safety of residents are identified and so far as possible eliminated. To consult with the Environmental Health Officer regarding the guarding of radiators and pipe work to reduce the risk of burns and confirm if your plan and timescale for addressing this meets with health and safety legislation requirements. (Previous requirement made under this standard 03/01/07). 5 OP26 13(3) 16(2)(j) 23(2)(k) Suitable arrangements must be in place to prevent infection, toxic conditions and the spread of infection within the home, in accordance with relevant legislation and published professional guidance. Consult with the Environmental Health Officer and the Infection Control & Health Protection Unit regarding procedures for dealing with clinical waste in the home. (With reference to the correct segregation and removal of clinical waste, sluicing facilities and appropriate hand drying Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 28 31/10/07 31/10/07 facilities in areas where clinical waste are handled). (Previous requirement made under this standard 03/01/07 and only partially met). 6 OP27 OP30 18 (1) A review of staffing levels must be carried out and action taken to ensure that there are enough suitably qualified, competent staff on duty at all times, taking account of the numbers and assessed needs of residents and the layout of the building. (2) Persons employed to work at the care home must receive structured induction training in line with the Skills for Care specification to equip them for the work they are to perform. (3) Where a new worker starts work at the home prior to receipt of the full CRB check they must be properly supervised and there must be enough staff on duty for this. Improvements to be implemented and evidence submitted. 7 OP31 8(1) As the registered provider is an organisation, there must be an individual appointed to manage the home and be in day-to-day charge who is qualified, competent and experienced to run the home to meet its stated aims and objectives. The person appointed must make an application to be registered to be in compliance with Section 11 of the Care Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 29 09/10/07 30/11/07 Standards Act 2000. 8 OP33 24 & 26 To ensure that the home is run 31/10/07 in the best interests of the residents, a system for reviewing at appropriate intervals and improving, the quality of care provided at the home must be maintained. To include monthly visits and reports as specified in regulation 26. (To ensure acceptable standards are maintained in all areas of the home). Copies of monthly regulation 26 visit reports to be sent to CSCI. (Previous requirement made under this standard 03/01/07). 9 OP37 17 To protect residents best interests, the registered persons must make sure that all the records required by regulation are kept, are up to date and are available at all times for inspection in the care home by any person authorised by the commission. (Including service user plans). The registered person must take any necessary action to promote and protect the health, safety and welfare of residents and staff. To ensure safe working practices, staff must receive the training they need in: (1) moving and handling techniques (2) fire safety – including attendance at fire practices and drills as specified in fire safety guidance Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 30 31/10/07 10 OP38 13((4)(5) 23(4)(e) 30/11/07 (3) food hygiene for all staff that handle food (4) health and safety (5) fire doors to be kept shut unless fitted with special closures that allow them to shut in the event of a fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Roxburgh House DS0000062994.V348450.R01.S.doc Version 5.2 Page 32 - 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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