Inspection on 06/06/06 for Roxburgh House

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Roxburgh House 02/07/08

Roxburgh House 02/07/07

Roxburgh House 23/02/06

Roxburgh House 27/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Roxburgh House Warwick Road Kineton Warwickshire CV35 0HW Lead Inspector Martin Brown Key Unannounced Inspection 6th June 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roxburgh House Address Warwick Road Kineton Warwickshire CV35 0HW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01926 640296 01926 640306 Pinnacle Care Ltd Ms Stephanie Robson Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. An upgrade of the homes décor is planned and implemented within 18 months, (31st October 2006) Stephanie Robson must complete the Registered Managers Award by 31st December 2006 23rd February 2006 Date of last inspection Brief Description of the Service: Roxburgh House is in Kineton, which is a village on the ‘bus route to Stratfordupon-Avon and Leamington Spa. The original building dates back over 150 years. Accommodation is provided on two floors and there are two lifts, one recently fitted. Both communal areas and bedrooms are to be found at each level. The home has gardens to the front and rear and car parking to the side. It is within easy walking distance of local amenities such as churches, doctors’ surgeries, the post office, pubs, banks and shops. The home is registered to provide specialist care to elderly people who have dementia. It does not provide nursing care, but residents have access to the community nursing service, as they would if they were living in their own homes. Fees are currently £498 per week per person. Outings, hairdressing and chiropody services are extra. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Tuesday between 8.30am and 4pm. The manager, deputy manager, a number of staff, as well as residents and a number of relatives were spoken to during the inspection. All were helpful and co-operative. The pre-inspection questionnaire completed by the home and returned two months previously also informed the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that all required redecoration and environmental improvements are progressed as rapidly as is consistent with the residents’ well-being and with health and safety in the home. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 6 Recruitment of more cleaning and cooking staff will free existing staff to concentrate more fully on direct care of the residents, and in the case of cleaning staff, ensure standards of cleanliness and maintenance match the current and planned improvements to the fabric of the home. Fire safety issues must be addressed, especially the effective use of fire doors. Care plans must show that they have been regularly reviewed. The commitment by the staff, the manager, and the organisation to improving the environment and all other aspects in the running of the home is noted, and it is hoped that this commitment will continue and will be able to be reflected in future reports. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 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 The quality for this outcome group is adequate. Initial assessments help the home in ensuring it only admits people whose needs it can meet. Fuller life histories would assist in the home being able to meet individual needs more comprehensively. EVIDENCE: A sample of care plans looked at showed that assessments are completed of service users prior to their admission. Life histories are in place, but in many instances these are brief. The manager advised that the home was reliant in most instances on information supplied by families. Individual photographs were seen on care records. There was only one example witnessed of a resident being agitated or distressed, and this person was soon seen to be content once given some time and positive attention, and was later a picture of happiness. Amongst the many positive comments by relatives was the observation that their loved ones had in some cases put on weight and looked healthier after their admission to the home, and had become more alert. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality for this outcome group is adequate. The health, personal, and social needs of residents are met in a manner that upholds their privacy and dignity. A lack of evidence of regular, recorded reviews of individual care needs means there is a risk of significant changes not being noted and fully taken account of when trying to meet current needs. A lack of a written procedure for the administration of medicines may compromise the residents’ well-being in this area. The poor practice in moving people in wheelchairs puts their well-being at risk. EVIDENCE: Care plans are in place and contain information regarding residents’ health and care needs. It was not evident in all the care plans that reviews were taking place on a monthly basis, or that relatives were aware of significant changes. Relatives were very complimentary as to how staff cared for residents. Observations showed staff displaying a good awareness of individual needs and were providing discrete and sympathetic support. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 10 Medication records were examined; blister packs are not used, so accurate recording of their administration, combined with accurate stock control monitoring, is essential to evidence that medicines have been administered as required. All medication was recorded as being given. The manager explained the procedure for administering medication, which is done directly from the medication room to individuals. There are no written guidelines to help ensure staff do not deviate from this routine. Examination of records, and discussion with staff and relatives, showed that health issues, including falls, are dealt with appropriately, with outside professionals being called in as and when needed. One unfortunate example of poor practice that of a resident being moved in a wheelchair without footrests was observed. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14,15 The quality for this outcome group is adequate. Residents benefit from wholesome meals, are given relevant choices and are supported to eat in a relaxed and appropriate manner. Contact with family and friends is supported, chiefly through providing a welcoming environment. Activities are provided and encouraged; a lack of detailed life histories hampers the provision of activities tailored to individual preferences and experiences. EVIDENCE: All relatives spoken to during the inspection were keen to emphasise how welcoming and accommodating the home was. Many were frequent visitors, and familiar and at ease with staff, other residents, and the environment. A dozen or so residents went out for a pub lunch in a mini-bus supplied by the organisation, later in the day, a music activity organiser visited, with a helper, and a dog. Residents were able to join in, according to abilities, with movement, singing along, throwing and catching a large, balloon/ball, and enjoying the presence of a friendly dog, so that the inspection finished to the sound of music, singing and occasional barking. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 12 Residents receive a freshly cooked breakfast if they wish; these were served over a prolonged period in the morning, and were eaten in a variety of settings; some in residents’ bedrooms, others in the lounge, and some in the dining rooms. Some were full cooked breakfasts, eaten with a knife and fork; some were in sandwich form, where residents were more comfortable with this. The main meal of the day was served for the majority in the dining room; two residents were helped by their partners, who said they often helped out at this time. Staff helped residents where necessary, and ensured; although they were busy themselves, that the residents were able to enjoy the meal at their own pace. Staff individually offer choices at the table, so that residents make decisions not reliant on memory, but on immediate wishes. The meal was tasty, well-presented, freshly cooked and nutritious. One lady, who had earlier been anxious about her stay at the home (and was the only example witnessed of anyone being at all agitated), came to the kitchen asking when dinner would be ready, was told it would be a little while yet and was offered some biscuits to stave off hunger pangs, with which she was very happy. Staff were able to give some examples of specific interests of some residents, and photographs and memorabilia in some rooms gave impressions of past interests. Care files contained some information as to what might spark individuals’ responses and interests, but in many cases these were brief. The manager advised that the home was reliant in most instances on information supplied by families. Staff were able to demonstrate a good awareness of and response to individual preferences of residents. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality for this outcome group is adequate. Relatives and residents can have confidence in the home’s response to any concerns they may have. Clearer evidence of relatives’ involvement in care reviews would help ensure perspectives other than the homes contributed to these reviews. EVIDENCE: There is a complaints procedure and a complaints book; the manager advised that there have been no formal complaints. Relatives were full of praise and confirmed that they were able to raise any concerns directly with the home. A recent Vulnerable Adult meeting had been held; the relatives of the person involved had no concerns about the role played by the home. Relatives also praised the open and transparent way in which the home and organisation was run, and said that the manager and staff were always available to hear if they had any concerns. One person felt that they were not always aware of problems, and agreed that relatives being more fully involved in care plan reviews would help ensure that they were aware of care issues involving their loved ones. The manager later advised that relatives are informed of care reviews, but in the absence of any evidence of their involvement, this was hard to ascertain. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality for this outcome group is adequate. The organisation is working hard to ensure much-needed environmental take place. There is much still to do. The work, when completed, should enhance the lives of those living in the home. There is a danger that areas for improvement may be missed if a full environmental audit update by the management is not carried out. The replacement of carpets, lighting and wall coverings with anything other than ones specifically suited for people with dementia would be potentially detrimental to people living in the home. EVIDENCE: The home is currently undergoing major refurbishment. Re-wiring has been completed, a new lift has been installed; this was broken on the morning of the inspection, but was fixed by the contractor by mid-morning. A new call alarm system has been fitted. Some bedrooms have been redecorated, improving their appearance immensely. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 15 Other areas of the home now await redecoration, especially where rewiring and building work has left bare plaster on the walls. Toilets and bathrooms also await renewal. Carpets are to be replaced; the manager is keen to ensure that the carpets and wall coverings are fit for purpose. Residents’ doors now mostly have their names and/or other personalising features on. The kitchen is spacious, but in need of refurbishment and redecoration. The cook advised that stainless units are to be installed, with new cupboard and storage space to replace existing ones. Fly screens had been removed during decorating work, and are to be refitted/replaced. The laundry has suitable machines to manage the needs of the residents in the home. Paint is flaking from the ceiling in this room. Some window frames are in need of attention on the outside; one downstairs one has rotted; the manager advised that some do not close properly. Relatives and staff commented on the difficulties of entering and exiting the building with wheelchairs. Odours noticed on previous inspections are still present, although not so intensely on this occasion. The manager advised that the flooring was to be intensively cleaned when the old carpets were removed and replaced. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality for this outcome group is good. A consistent staff team provides good, patient, care for residents. This is currently compromised by insufficient staff to clean the home and launder clothes and bedding. EVIDENCE: There were five staff on duty during this unannounced inspection, in addition to the manager, with four staff to be on duty later in the day. There is a cook, and one cleaner; the manager advised that they are seeking to recruit another cleaner, and that an additional cook is used from other homes within the organisation whilst the second cook is currently on sick leave. Staff were busy throughout, but observations showed that residents were not rushed and were accorded individual respect and dignity. Examination of staff records showed that suitable recruitment procedures are in place. Satisfactory Criminal Records Bureau checks were in evidence, as were application forms and written references. Thorough induction processes are in place for the more recent recruits. Samples of recorded supervision records showed that these were thorough and positive in tone. The majority of staff are now on or have completed National Vocational Qualifications Level 3; mandatory training programmes are in place, and staff attend dementia and other specialist training. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 17 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 quality for this outcome group is adequate. The home works hard to ensure it is running with the best interests of residents foremost. The home works to safeguard the health, safety, and welfare of residents. At present, this is compromised by the fact that some fire doors are held open by other than alarm activated fire closures. EVIDENCE: The manager advised that she has recently completed her Registered Manager’s Award and will be able to produce evidence of this as soon as the certificate arrives. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 18 Radiators are covered, the manager advised that mixer valves are now in place to ensure water does not scald. A thorough policy and set of procedures is in place to ensure water systems are safe. Relatives spoken to were very complimentary about the way the organisation has been consulting them, in addition to or on behalf of residents, concerning the running of the home, and one person gave as an example how he had been fully consulted as to what colours and furnishings his wife might prefer in her room. Regulation 26 visits now take place at more varied times, in order to give a wider view of the home and activities. The manager advised that the home does not manage any of the residents’ finances. One resident spoken to likes to go to the bank to draw out money; staff support him to do this, whilst he maintains control of the money. Systems are in place for the testing of fire equipment and appliances. All the electrical wiring has just been replaced. The new call system is operation; its principal role on the day of the inspection was to alert staff to the fact that the main door had been opened. This was invariably because of staff, relatives, or other visitors entering or leaving. Fire procedures and checks of equipment are in place. Fire doors used as frequent thoroughfares were kept open by other than alarm activated closures. The risk to residents of these remaining open in the event of a fire was discussed with the manager. A ‘heated’ trolley, awaiting removal, was partially obstructing a fire exit. A large ‘hamper’ basket in a corridor was a potential tripping hazard. The home, at present, has no sign outside. The manager advised that the previous sign was removed as it was stigmatising. Now there is nothing, and several people have commented that they have had initial difficulty in finding the home. The manager, and others, agreed that a small tasteful sign, identifying just the name of the home, would be of help in visitors finding it. Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 20 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. 2 3 Standard OP7 OP8 OP9 Regulation 14,15 13(4) 13(2) Requirement Care plan reviews must be signed and dated to evidence that this is done monthly. Footrests must always be in place when residents are mobilised in wheelchairs. To ensure that medication is always administered according to the agreed procedure, this process must be documented in the medication folder and evidenced as agreed by all staff responsible for administration. Rotting window frames must be replaced As part of the improvements, better/easier wheelchair access and exit must be considered Plans for redecoration and refurbishment must proceed as swiftly as is compatible with health and safety and residents’ well-being, and include carpets throughout, the kitchen, laundry, and toilets/bathroom, and all other areas identified as in need of refurbishment and redecoration. Timescale for action 01/08/06 01/07/06 01/08/06 4 5 6. OP19 OP19 OP19 23 13,16,23 13,16,23 01/10/06 01/08/06 01/08/06 Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 21 7. OP19 12,16,23 8. OP26 13,16,23 9. OP27 18,13 10 OP38 23 11. OP38 13,23 The registered provider must ensure that any new carpets and wall coverings are such that will not cause any additional difficulties to the residents. The home must investigate and eliminate the unpleasant odour on the ground floor and implement regular deep cleaning of the home including the shampooing of carpets. (Not met from previous inspection) The registered person must recruit sufficient ancillary staff to ensure that the laundry is done and the home is kept clean. The ‘hamper’ in the corridor by the lounge, and the heated trolley by the front fire exit, must be removed, or moved to a more suitable location. The home must only have fire doors kept open by alarmactivated door closures, unless it can produce written confirmation by the local fire officer that the current practice of having them held open by other means is acceptable. 01/08/06 01/08/06 01/08/06 01/07/06 01/08/06 Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 22 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 OP7 OP19 OP19 Good Practice Recommendations It is recommended that life histories are signed and dated, and further efforts are made to add to information obtained. It is recommended that the name of the home is displayed, to help visitors locate it. It is recommended that the manager work with the owner and all those with an interest in the home to produce a full audit of all the improvements that the current round of building and redecoration work should include. It is recommended that staff attend moving and handling update training. 4. OP30 Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Roxburgh House DS0000064118.V297711.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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