Inspection on 22/05/06 for Roxton Nursing Home

This inspection was carried out on 22nd May 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

Roxton Nursing Home 28/10/08

Roxton Nursing Home 30/10/07

Roxton Nursing Home 12/02/07

Roxton Nursing Home 10/02/06

Roxton Nursing Home 31/05/05

Roxton Nursing Home 12/01/05

Roxton Nursing Home 10/12/04

Roxton Nursing Home 29/03/04

Roxton Nursing Home 03/02/04

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 Roxton Nursing Home 154 Birmingham Road Sutton Coldfield Birmingham West Midlands B72 1LY Lead Inspector Karen Thompson Unannounced Inspection 22nd May 2006 08:00 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 Roxton Nursing Home DS0000024884.V295715.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. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roxton Nursing Home Address 154 Birmingham Road Sutton Coldfield Birmingham West Midlands B72 1LY 0121 354 2621 0121 355 2135 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) Neil E Hamilton Kim Louise Milligan Care Home 45 Category(ies) of Dementia - over 65 years of age (45), registration, with number Terminally ill over 65 years of age (45) of places Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 49 patients including 4 day patients To successfully complete a management qualification at level 4 NVQ or its equivalent by 2005. That the home can take both female and male service users over 55 years of age. That the home can provide nursing care and/or palliative care (TI)(E) and care to service users who may be suffering from dementia (DE)(E) 10th February 2006 Date of last inspection Brief Description of the Service: The Roxton Nursing Home is a converted Victorian Building accommodating 45 older residents. The home is situated in a residential area close to Sutton Coldfield town centre. The home is within in walking distance of bus and train links and is situated on the main road into the town centre. There is limited car parking to the front of the building, but a larger additional car park is at the rear of the building The home has been converted and retains some of its original features. The home offers a mixture of single, double and one double bedroom which provides access to a single room, an arrangement which fails to afford privacy over three floors. There are two passenger lifts. The Roxton aims to cater for the older service users some of whom may have palliative care needs. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The findings of the report are following a statutory unannounced inspection visit. The inspection was conducted by two inspector’s over one day. Information for the report was gathered from a number of sources: tour of the building, examination of records and documents, talking to residents and staff members, direct and indirect observation. The Commission has meet with the Care Manager following the inspection and agreed an immediate plan of action to met the requirements. During this discussion the Commission were informed that some of the requirements have been met. What the service does well: What has improved since the last inspection? What they could do better: Staff training and supervision needs to be developed to ensure that those who deliver the care to residents are competent and safe. Care plans must be based on a thorough assessment and tailored to meet individual service users needs. Medication practices and procedures need to be reviewed to ensure that residents’ welfare and well-being is maintained. Activities provision for resident need to be reviewed to ensure that residents have a varied and interesting lifestyle based on their preferences and choices. Policies and procedures need to be reviewed to ensure they reflect current good practice and legislation. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 6 Systems for monitoring and recording complaints need to be review to ensure that these processed in a sensitive and professional manner There are a number of maintenance and refurbishment issues that need to be addressed to promote the well-being and dignity or residents. COSHH management needs to be reviewed as at present they have potentially poor outcomes for residents. There needs to be a more proactive approach to ensuring cross infection practice is adhered to ensuring both residents and staff are not exposed to any unnecessary risks. A number of areas in respect of the maintenance and servicing of equipment and facilities need to be addressed with some urgency. 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. Roxton Nursing Home DS0000024884.V295715.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 Roxton Nursing Home DS0000024884.V295715.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): 1.2.3.4 The quality in this service outcome area is poor. The judgement has been made using available evidence including a visit to this service. The information available ensures that prospective residents can make an informed choice about the home but this needs to be distributed in a format that is accessible to the present group of residents. Contracts could be seen as misleading in parts and minor amendments are needed to ensure that resident are aware of their rights. The pre-admission documentation is not comprehensive and consequently it cannot be guaranteed that residents needs will be identified and met. Staff knowledge in meeting residents’ needs is not comprehensive and thus has potentially poor outcomes for residents. EVIDENCE: The amended Service Users guide had not been distributed to residents. The Care Manager stated that relatives would be given a copy of the guide but she was concern that the present format was not suitable for residents. The present format therefore needs to be reviewed. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 9 The Statement of Purpose whilst recently amended but needs minor amendments to bring it up to date to reflect the Managers recent NVQ qualification and changes to meal provision. The residents contract has recently been amended. The contract mentions assistance will be given with claiming attendance allowance. This might be misleading, as attendance allowance is not available to those in receipt of nursing care. The pre-admission procedure has been reviewed and now includes the booking process and a pre-admission assessment. A small sample of the new preadmission assessment tools was reviewed. These were not detailed and the assessment was not able to demonstrate that potential residents needs were fully assessed. Some staff have undertaken training in respect of caring for people with dementia, but this needs to be put in place for all staff to ensure they have appropriate skills and knowledge. The manager has been reviewing staff training needs since the previous inspection. Some of the rooms are small and in one case staff said that furniture had to be removed from the bedroom to allow hoisting of the resident to take place. The home has a variety of hoists; slide sheets and handling belts to assist with manual handling. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 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): 7.8.9.10.11 The quality in this service outcome area is poor. The judgement has been made using available evidence including a visit to this service. Care planning systems do not adequately provide staff with all the information they need to meet residents’ needs satisfactorily. The health needs of residents are well met with good evidence of multidisciplinary working taking place on a regular basis. Medication management needs to be more robust and could potentially put residents at risk. Staff ensure that they are aware of good practice guidance and community links in relation to palliative care. EVIDENCE: Care plans sampled were not comprehensive, detailed or holistic and were not reviewed with either the residents or their representatives. Residents care plan arrangements are to be found in a number of places and are not comprehensively detailed in any one document. The communications book also contained care plan information. This care plan information should not be recorded in the communication book, as information could be lost. Residents with dementia did not have any plan of care to meet their needs in relation to cognitive impairment. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 11 Care planning should identify strengths and abilities as well as problems and difficulties. One resident with cognitive impairment and recorded outbursts of aggression did not have a plan of care in place with strategies to identify, monitor or reduce such aggressive behaviour. One resident had been identified as sometimes ‘given to wandering’ but there was no description or characteristics of this behaviour, no indication of when or why it occurred and there was no photograph in the care plan. Falls assessments are taking place but these are not being linked into the care planning process. The Manager has implemented falls diaries for residents. Residents are referred to a falls clinic for assessment. Following the previous inspection the manager was asked to review staff deployment at night as a number of falls were occurring during this time period, which was deemed to be unusual. The manager continues both to look at cause for residents’ falls and works sensitively with external health professionals in this field. Risk assessments were generic with the exception of skin integrity, nutrition and falls. There was no specific risk assessment in place for continence, manual handling, mental health or bedrails. The inspector cannot emphasis strongly enough the need for a specific risk assessment in relation to bedrails being placed on residents beds and especially so following a recent incident where a resident becoming entrapped between bedrails and mattress. The manager was advised after this incident to contact the medical device agency for guidance. In this particular case the overlay pressure-relieving mattress was not stabilised to the bed divan mattress and the home needed to contact the pressure relieving manufacturers for advice on strapping the two mattresses together. The manual handling assessment requires further development. For example, some manual handling assessments did not state what hoist or sling size to use. One resident was observed to have bruising to both hands. This had been recorded in their care plan but again no cause had been identified. The inspectors would query whether these bruises were linked to manual handling techniques applied. In residents records there was evidence of multidisciplinary health care involvement. The home had recently completed a Chronic Disease assessment form sent to them by the GP service. The inspectors were informed that an annual health check is in place for residents with diabetes. There was no evidence to indicate monitoring of any other chronic disease. The manager should liaise with the G.P service regarding monitoring of other Chronic diseases such as hypertension, asthma etc. One relative commented that “staff will inform of change of condition” and that if they had any concerns they could speak to the manager. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 12 Medication was safety stored, although not all medication was auditable by the inspectors. Nursing staff had reduced one resident’s night sedation medication but records indicated it was six days later that nurses contacted the GP about this. This is a serious omission. Creams were observed in residents’ rooms but these had not been dated on opening. The Manager has carried out staff drug audits once and no problems were found. Following this inspection it is apparent problems do exist and staff drug audits should be recommenced. The inspectors did see examples of good interactions between staff and residents, which seemed to be based on a respect relationship. However, overall the regularity and quality of staff interaction was mixed with some residents left without stimulation for long periods of time. The inspectors also observed a resident being hoisted from a chair in a passive hoist. The staff chatted and kept the resident fully informed but they did not have the residents’ wheelchair at hand and one of the carers left the room leaving the resident hoisted up in the air. The home is registered for terminal illness and trained staff have links with the local hospice and have recently registered with the PCT to attend a study day looking at end of life care plans. The manager was able to demonstrate an awareness of a number of these plans that were available and their strengths and weakness. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 The quality in this service outcome area is poor. The judgement has been made using available evidence including a visit to this service. The home was unable to actively demonstrate that service users views and preferences are sought or acted upon in respect of leisure and recreational activities. The meals provided were not always delivered to residents at the appropriate time. Service users are able to maintain contact with family and the community in keeping with their wishes EVIDENCE: Care plans sampled did not demonstrate how residents’ preferences and dislikes were to be accommodated with regards to daily routines. The admission assessment listed residents’ social interests, hobbies, and cultural and religious needs. This is a positive step in person centred planning but needs to be developed further. Care plans contain a socializing and communicating care plan but this did not look at preferred social activities and how these would be meet. Records detailing when and what activities had taken place were not being kept. Although the manager informed the inspectors they could produce invoices to demonstrate that progressive mobility takes place in the home on a regular basis. Staff also informed the inspectors that as well as progressive mobility an entertainer visited the home once a month. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 14 One resident remained in their room throughout the inspection, with no television or radio. This resident received little stimulation or interaction from staff except at meal, drink or change times. Visitors were observed around the home during the inspection. Residents’ rooms were personalised with their own possessions. The home employs separate catering staff. One relative commented that the “food was good”. The menus have recently been reviewed and the manager hopes to implement changes in June. These will consist of offering two active choices at meal times. Other changes that have occurred include food for residents that need assistance being cut up prior to serving to eliminate staff leaning over residents in the dining room, pureed meals being improved by pureeing each item of the meal separately and full fat milk has replaced semiskimmed. Fresh vegetables are prepared the day before use the home needs to review this practice, as nutritional value will be lost. Jugs of squash and a variety of drinking cups/glasses were available. Breakfast is served to residents from 7am onwards. A trained nurse was supervising the breakfast on arrival to the home in the dining room. Meals are also taken to the residents’ rooms on a tray. There is no heated trolley. The inspectors observed three breakfasts left on the middle floor near to the nurse station for over 50 minutes uncovered and close by 2 open dishes of cat food were on the floor. The inspectors saw staff reheat a breakfast in a microwave until it was visibly steaming hot. Food should not be left near the cat food, as there is potential for cross contamination. One resident’s lunch time meal was observed to be placed in their room, at the bottom of the bed, but at least 25 minutes elapsed before they were assisted to eat the meal. The home needs to review systems for delivery of food and take into consideration the number of assisted feeds they have. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 The quality in this service outcome area is poor. The judgement has been made using available evidence including a visit to this service. Systems are in place to deal with concerns but these are not robust. Staff training is required in adult protection to ensure that residents’ are protected from all forms of abuse. EVIDENCE: The manager informed the inspectors there had been no complaints since the previous inspection. Records and discussions with relatives demonstrate that two incidents that should have been investigated via the complaints process had not taken place. One relative commented that they could approach the manager if they had concerns. The restraints procedure requires further work to ensure that this procedure is in line with current recommended good practice. Staff knowledge was mixed in relation to adult protection. The home has a copy of the Multi-agency guidelines for adult protection and reference is made to this in the home’s own adult protection procedure. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.21.22.23.24.25.26 The quality in this service outcome area is poor. The judgement has been made using available evidence including a visit to this service. The home is furnished to basic standards and a considerable amount of refurbishment and redecoration is required. The environment does not always provide a homely and comfortable environment for residents’ in all areas. Staff practice and systems for management of cross infection and controls need to be reviewed. EVIDENCE: The home does not have a planned refurbishment or redecoration schedule and this is an outstanding requirement from the last two inspections. Corridors on two of the west wing floors have been repainted. New blinds have been installed in the conservatory. A number of communal rooms and bedrooms are in need of redecorating and/refurbishment. The home has a pleasant enclosed garden at rear. The fencing is broken in place and needs to be replaced or repaired as this has security implications. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 17 Zimmer frames were observed in the garden area, by the bins. Lighting in bedrooms and communal rooms was domestic in appearance. Staff responded quickly to residents’ summoning help via the buzzer being rung. The call buzzer system does not have an emergency call facility. This will need to be upgraded in the near future. As a result of the meeting post inspection the home will re introducing a buzzer system. Residents were observed on some occasions to be in the lounges without any staff present. The home has three assisted bathrooms and one level access floor shower room. Space is limited in the bathrooms. These three assisted bathrooms are set along the west wing corridors of the home with the seven residents’ bedrooms within close proximity on each floor. Not all residents on these wings are able to use the bathrooms due to spatial limitations and instead use the shower room on the ground floor. The bathrooms on the west wing were observed to have enamel missing from the baths and bath panels were out of alignment with the baths. The home must review its bathing facilities to promote greater independence and privacy Only one bedroom contained a lockable facility. Bedrooms did not contain all the furniture and fittings required by the standard The manager stated that as part of the decoration programme doors were due to be repainted and on painting locks would be fitted. The situation at present fails to afford privacy for service users, impacting on their ability to lock bedroom doors. The home has 11 double bedrooms and one bedroom that can only accessed via a double room. Signage and decoration of communal areas of the home needs to be reviewed with regards to the needs of some service users who have dementia. The premises have been extended from the original Victorian origins and as a consequence have numerous corridors, which reduce opportunities for staff to observe and support service users when they wish to walk around the home. Clear signage and creative use of decorative styles could assist service users’ orientation within the home. Grab rails were observed in parts of the home. Feedback from one relative in the quality assurance questionnaires also pointed to the fact that signage could be improved in the home Bins in toilet areas were found to be without lids. Foot operated bins did not work and the lids had to be lifted by hand. There was a good supply of vinyl gloves and white aprons. A member of staff carrying a soiled sheet but not wearing any protective gloves or clothing greeted the inspectors. A white apron was observed hung over a banister. One staff member of staff was observed wearing gloves but carrying a soiled sheet from the top west wing corridor down to the laundry. Staff informed the inspectors that the home does not have red alginate bags but soiled linen is put in yellow or black bags. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 18 The home needs to review how laundry is collected and the systems in place for disposal of soiled linen. No liquid soap was available for hand washing in the ground floor bathroom. Not all commode pots in residents’ rooms were found to be clean. The commode chairs were found to be rusty and in some instances foam was also observed to be protruding from the vinyl covering of the commode chairs. Staff were observed cleaning commode pots in the bathrooms and not in the designated sluice areas. This is apparently normal practice as toilet brushes and disinfectant are stored in the bathrooms and was confirmed as such by staff. All these have implications for infection control measures, as surfaces cannot be cleaned properly. Two of the homes sluice facilities are located in a bathroom and the laundry, which poses health and safety risks. They need to be relocated and upgraded to provide a higher standard of cleansing. The home has two passenger lifts, the space is limited in one of these and a procedure for accessing with a wheelchair has had to implement. Residents did not always have footplates on their wheelchairs and residents were seen being transferred with their feet just above floor level. The home needs to review its uniform policy as staff were observed wearing jewellery and nail varnish. This again has potential cross infection consequences. The home recently liaised with health protection about an outbreak of diarrhoea and vomiting and barrier nursing measure were implemented. Staff felt they had dealt with this viral outbreak swiftly and professionally. The above observations however are cause for concern as staff practices and facilities need to be reviewed. Following the previous inspection deployment of cleaning staff has been reviewed with some cleaning activity taking place during the evenings. Some areas of the home will be very difficult to keep clean, as surfaces are not intact or are heavily stained, for example the dining room chairs remain heavily stained from food debris. Some areas of the home were found to be emitting an odour. One armchair was found to be wet first thing in the morning. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 19 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 in this service outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Staffing numbers are sufficient to meet the needs of residents but training has elapsed in some areas therefore the home cannot meet all residents care needs. Recruitment practices are robust with the exception for the need of a photograph to confirm identification. EVIDENCE: Four-week rotas were supplied to the Commission. The Care Manager informed the inspectors that they have three supernumerary shifts per week. There are sufficient numbers of staff available. The Pre inspection questionnaire stated that 81 of staff had NVQ 2 or above. The inspectors at the time of inspection did not verify Staff have an individual training plan and the training needs of staff were reviewed in February. The home has commenced training for staff but training is still outstanding in a number of areas for all staff such as manual handling, fire safety, adult protection, challenging behaviour and dementia. Recruitment was robust with the exception that photographs of staff were not always found in staff files. Schedule 2 requires a recent photograph on staff files. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 20 Staff confirmed that they did receive induction training but the home needs to ensure that it meets Skills Council standards. Information about the Skills Council Standards was given to the Manager during the inspection. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 21 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): 31.33.35.36.37.38 The quality in this service outcome area is poor. The judgement has been made using available evidence including a visit to this service. The arrangements for health, safety and welfare of residents and staff are incomplete and do not fully promote and protect well being of residents and staff. EVIDENCE: The Manager has many years experience of working in the capacity of care manager and has recently completed an NVQ 4 in management. Evidence to confirm this qualification was sent after the inspection. The home has a quality assurance system in place. The home is aware of what action is required from this audit but the manager stated that this was not always leading to action. Action needs to have agreed timescales to ensure that the home is successful in meeting objectives. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 22 The home does not hold any money for residents. There is one exception where a set of relatives might leave money if they going on holiday, records for these were not seen at this inspection. Supervision is based on an appraisal system and recording was only brief so it was difficult to assess the quality of the supervision. At present supervision records are kept in the individual staff files it is recommended that a separate file be created for each staff members supervision records. A number of health and safety requirements are still outstanding from the February inspection. These include an obstruction of the fire exit leading down from the west wing of the home and a Television and Zimmer frame obstructing the fire exit in the main downstairs lounge. COSHH items were observed in bathrooms along with toiletries and were accessible to residents. The COSHH file had data sheets but no risk assessments had been carried out. A bottle of Hibiscrub was found in one of the bedrooms. This needs to be secured to the wall, as there has been a recent death of a patient from ingesting the substance. The homes has not obtained an up to date gas safety certificate. The last gas certificate that meet regulations was issued Jan 03. The premises risk assessment is brief and not comprehensive and needs to be reviewed. There was no evidence of nurse call bell servicing. The Emergency lighting had not records of testing for Feb, Mar and April. Staff knowledge of fire procedures was mixed and in some instances unsafe. Fire drills were taking place and staff and records supported this. Staff practice and knowledge in relation to manual handling was variable. Policies and procedures are in place but the home does not have any clinical policies for nursing staff, the manager was asked to review this. Food items were observed not to be dated on opening and those that required refrigeration was not stored as instructed. Hot food probing was taking place along with daily monitoring and recording of fridge and freezer temperatures. Staff did not wear blue aprons whilst servicing or helping with food. Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 23 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 2 2 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 1 1 2 1 2 2 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 1 Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 5 Requirement The Registered Person must ensure that a copy of the service users guide is disturbed to each resident in a format that is accessible to him or her. The Statement of Purpose must be amended to reflect changes that have occurred within the home The Registered Person must ensure that the pre admissions assessment is comprehensive and identifies the needs of residents. The Registered Person must ensure that staff are not put at risk from unnecessary manual handling tasks. Manual handling risk assessment must be carried out in relation to any identified problem and appropriate action taken. The Registered Person must ensure that care planning is based on a comprehensive assessment and that individual needs are identified, monitored, reviewed regularly and external health professional’s advice DS0000024884.V295715.R01.S.doc Timescale for action 30/09/06 2 OP1 4 30/09/06 4 OP3 14(1) 30/09/06 5 OP4 18(1)(c) 30/08/06 6. OP10 OP4 OP7 OP8 OP12 15(1)(2) 30/09/06 Roxton Nursing Home Version 5.2 Page 25 7 OP9 13(2) incorporated into these care plans. Service users and or their representative must be given the choice to take part in drawing up of the care plan and sign to say they have been involved.(Outstanding requirement Dec 2005) The Registered Person must 30/08/06 ensure that all prescribed creams are dated on opening and stored appropriately. (Outstanding requirement Feb 2006) The Registered Person must ensure that all medication is dispensed as per prescribers instructions. The Registered Person must ensure that residents’ dignity is promoted at all times and that staff are aware of the needs for the correct manual handling procedures. The Registered Person must ensure that residents have the opportunity to part take in leisure activities of their choice and records are kept to demonstrate that these needs are being meet. The Registered Person must review the current arrangements for the delivery of food. Ensuring that the meals are not left standing to go cold. The Registered Person must review the siting of the cat food, so that it is not near any clinical or human food areas. The Registered Person must ensure complaints are logged and investigated appropriately. The Registered Person must ensure that staff are aware of the adult protection procedure. The Registered Person must DS0000024884.V295715.R01.S.doc 8 OP10 12(4) 30/08/06 9 OP12 OP14 12(1) 30/09/06 10 OP15 13(4) 30/07/06 11 OP15 16 J 30/07/06 12 13 14 OP16 OP16 OP18 22 13(4) 13(7) 30/07/06 30/09/06 30/09/06 Page 26 Roxton Nursing Home Version 5.2 15. 19 23(2)(b) 16 OP19 23(2)(o) 17 OP22 23 (2) 18 OP24 12(4)(a) 13(4)(a,c) 23 19 OP26 13(3) 20 OP26 13(3) 21 OP26 13(3) review its restraint procedure in keeping good practice.(Outstanding requirement Feb 2006) The Registered Person must ensure that the home has a programme of planned maintenance and refurbishment to the premises and consideration for the resiting of the sluicing facilities at a determined date in the future. (Outstanding requirement Nov 2005) The Registered Person must ensure that the damage to the garden fence is made good and discarded furniture is removed from the garden. The Registered Person must ensure that the call bell system is serviced - that as part of the refurbishment there are plans for replacement to include an emergency call bell system. Contingency plans should be drawn on how to summons and response to emergency based on a risk assessment. The Registered Person must ensure that residents’ private accommodation are fitted with locks suited to residents capabilities and accessible to staff in an emergency. Outstanding requirement Feb 2006 The Registered Person must ensure that vinyl gloves and aprons are worn for the task they are appropriate for such use to minimize the spread of infection. The Registered Person must review staff practice in relation to cross infection and implement training in this area The Registered Person must DS0000024884.V295715.R01.S.doc 30/05/06 30/09/06 30/10/06 30/08/06 30/07/06 30/07/06 30/07/06 Page 27 Roxton Nursing Home Version 5.2 22 23 24 25 OP26 OP26 OP26 OP28 13(3) 23(2)(d) 23(2)(d) 18 (10(c) 26 27 OP29 OP30 Sch 2 18(1)(c) 28 36 18(1) (c)(i) 29. 38 23(2) 13(4)(c) 30 38 23(2)(c) 31 OP38 13 (4) review the provision of bins in areas where hand washing takes place, ideally these bins should be foot operated. The Registered Person must review staff practice in relation to dealing with soiled linen. The Registered Person must ensure that all parts of the home are kept clean The Registered Person must ensure that all part of the home are clean and free from odours The Registered Person must retain evidence to demonstrate that staff have obtained NVQ 2 or above. The Registered Person must ensure they have a photograph of each member of staff on file. The Registered Person must review the induction programme for new staff and ensure that this is in line with the Skills Council standards. The Registered Person must ensure that all staff have supervision and this is recorded and takes place a minimum of six times each year. (Outstanding requirement Jan 2003) The Registered Person must ensure that the premises risk assessment is reviewed and that this includes the grounds and gardens. (Outstanding requirement May 2005.) The Registered Person must forward copies of the most recent gas safety certificate. (Outstanding requirement Oct 2005) The Registered Person must ensure that fire exits are kept clear of obstructions at all times. (Outstanding requirement Feb 2006) DS0000024884.V295715.R01.S.doc 30/07/06 30/07/06 30/07/06 30/10/06 30/11/06 30/10/10 30/05/06 30/09/06 30/08/06 30/07/06 Roxton Nursing Home Version 5.2 Page 28 32 OP38 13(4) 33 OP38 13(4)(c) 34 OP38 OP30 OP18 13(6) 4 (c) 23(4)(d) The Registered Person must ensure that all COSHH items are safety stored and are not accessible to residents. (Outstanding requirement Feb 2006) The Registered Person must ensure that the COSHH file contains risk assessments. The Registered Person must ensure that Hibscrub is secured to the wall when in use or locked away. The Registered Person must carry out a training audit in relation to mandatory training and address any deficities (Outstanding requirement Nov 2005) 30/08/06 30/07/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. Refer to Standard OP9 OP4 OP38 Good Practice Recommendations Regular staff drug audits must be undertaken before and after medication rounds to confirm staff competence in medicine management The Registered Person should review the environment to see whether signage and decoration can be improved for service users with dementia. The Registered Person should review records pertaining to hot water temperature recording as to the specific area that the hot water outlet was tested and that all hot water outlets service users can access are tested systematically throughout the home. The Registered Person should review its Statement of Purpose to include those bedrooms that due to limitation of space cannot hold all the furniture listed in standard 24 are identified The Registered Person must review the staff dress code and ensure all staff are familiar with it. DS0000024884.V295715.R01.S.doc Version 5.2 Page 29 4. OP24 5 OP26 Roxton Nursing Home Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Roxton Nursing Home DS0000024884.V295715.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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