Inspection on 31/05/05 for Roxton Nursing Home

This inspection was carried out on 31st May 2005.

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 22/05/06

Roxton Nursing Home 10/02/06

Roxton Nursing Home 12/01/05

Roxton Nursing Home 10/12/04

Roxton Nursing Home 29/03/04

Roxton Nursing Home 03/02/04

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Heathlands

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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 B72 1LY Lead Inspector Karen Thompson Announced 31 May 2005 st 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 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 E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Roxton Nursing Home Address 154 Birmingham Road Sutton Coldfield B72 1LY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 354 2621 Mr N. E. Hamilton Mrs Kim Milligan Care Home 45 Category(ies) of Dementia over 65yrs of age (45) Terminal registration, with number illness over 65yrs of age. of places Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 49 service users 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 male and female service users over the age of 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). Date of last inspection 12th January 2005 Brief Description of the Service: The Roxton Nursing Home is a converted Victorian Building accomodating 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 E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The findings of this report are based on the outcome from an announced inspection. The inspection was carried out over one day and took ten hours. Information for the report was gathered from a number of sources: tour of the building, examination of records and documents, lunch with service users, talking to five staff members, talking to five service users, talking to one relative, completed questionnaires from multi disciplinary health professionals, direct and indirect observation. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 7 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 standard(s) 1.2.3.4.5. Service Users Guide and contracts need to be developed to ensure service users are fully informed of the facilities available and limitations where the standard can not be met as well as the terms and conditions of their stay. EVIDENCE: The home has made amendments to its Service User Guide and Statement of Purpose. Further work is needed on the Service Users guide. The staff are at the present reviewing the contract and will need to ensure that the room to be occupied is identified, the complaints procedure is amended, fees state who pays and how the nursing element contribution is involved in the fee calculations. The staff do not record a pre admission assessment as identified in standard 3 but information is collected from a variety of sources. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 8 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 standard(s) 7.8.9.10. Care plans for service users heath and social care plan lacked detail and could lead to service users needs not being met. The home had robust comprehensive arrangements in place for medication management to ensure service users safety and wellbeing. The staff have developed good links with multi health care professionals giving support and advice to enhance the care give to service users. EVIDENCE: Care plans were not always comprehensive, detailed or holistic and were not reviewed with either the service user or their representative. Risk assessments were generic with the exception of skin integrity and there was no specific risk assessments in place for falls, continence nutrition or bed rails. Pressure relieving mattresses and equipment was noted to be in place. There was evidence of multi-disciplinary health care involvement and feedback from these was positive. The home’s system for medicine management is unique but robust. The majority of audits undertaken were correct indicating that the medicines have been administered as prescribed. Regular medication reviews are sought. Bathing facilities will be reviewed in further detail at the next inspection. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 9 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 standard(s) 12.13.15 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 are good and plentiful. Service users are able to maintain contact with family and community in keeping with their wishes EVIDENCE: Service users were observed to have visitors throughout the inspection, some go out with support. A relative spoken to at the inspection was happy with the care provided and felt progress had been make by the home staff in relation to the service users general well being. No records of leisure interests of service users are maintained. The meals were nutritious, wholesome and well presented. Staff offered assistance but due to the limitations of space in the dining room this was not discreet. Staff practice needs to be reviewed in regards to assisting service users. The dining room can accommodate 25 service users at one sitting. Some service users have their meal in the lounge in armchairs and an extra table was bought into the lounge at mealtime to allow service users to be accommodated around a table. Conversation with service users was mixed and revealed that they were not clear if they were offered a choice or not at mealtimes. A main meal is provided and an alternative is only offered if service users do not want this main meal. Jugs of squash and glasses were observed all around the home for service users to have on demand. The Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 10 management team advised that the menus are changed quarterly to reflect the seasons. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 11 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 standard(s) 16.18 The complaint procedure needs some amendment to ensure that service users and relatives would be confident that any complaint made would be acted on. Training provided for staff indicates that service users are protected from abuse, which needs to be underpinned by revision of the adult protection procedure. EVIDENCE: The Complaints procedure needs to include details of CSCI and ensure that the revised procedure is given to all service users and their representatives. The home has an adult protection procedure but this does not conform to the Department of Health guidance “No Secrets” and the manager was advised to obtain the Birmingham Multi agency guidelines for adult protection that staff should follow in the event of an adult protection concern. Staff have received adult protection training via their NVQ training. The restraint procedure, is detailed and provides guidance for staff. This procedure needs to reviewed in line with recent legislative changes and current good practice. The pre inspection questionnaire states that the home have never used restraint. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 12 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 standard(s) 19.20.21.22.24.25.26. The provision of additional facilities and equipment needs to be reviewed to ensure service users health, safety and welfare needs are met. EVIDENCE: Relatives and service users commented on the environment as being ‘homely’. The Manager advised that bedrooms are redecorated at a change of service user and at present the home does not have a planned refurbishment or redecoration schedule. The home has a pleasant enclosed garden at rear. Lighting in bedrooms and communal rooms was domestic in appearance. Two of the homes sluice facilities were noted to be 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 implemented. Assisted bathing facilities are provided and this will be reviewed at the next inspection. A bath was noted to have chipped enamel which must be attended to. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 13 The home is advised to review signage and decoration of communal areas of the home in regards to the needs of some service users who have dementia. The premises have been extended from is original Victorian origins and as a consequence has 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. The home has 11 double bedrooms and one bedroom that can only be accessed via a double room. This fails to afford privacy for service users, imparting on their ability to lock bedroom doors. Bedrooms did not contain all the furniture and fittings listed in standard 24. Bedroom doors are not lockable and no lockable facilities were available for service users to keep personal possessions safe and secure. Radiators were either low surface temperature or guarded. Service users could not access thermostatic controls. Infection control measures and practices need to be reviewed. Bins in toilet areas were noted to be without lids and there was no hand washing facilities for staff in the laundry. Legionella prevention control measures had been carried out but the provider was unable to produce a certificate as to water quality. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29.30 Systems are in place for a robust recruitment and selection procedure. Staff training was in place but is not fully comprehensive to ensure staff are competent to do their jobs. EVIDENCE: There are a number of vacancies of care staff and recruited staff are awaiting CRB clearance. The Manager has worked hard to ensure that over 50 of its staff are NVQ trained but has not completed other aspects of staff training which could lead to potentially poor outcomes for service users. The manager and one other staff member have undertaken training in dementia mapping which they intend to utilise to develop care practice. There are links with a local hospice which are utilised to ensure that care given is based on current good practice. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.35.36.38 The home does not undertake staff supervision and fails to provide mandatory training for staff and thus they are not fully supported to meet service users needs. Systems in place ensure that service users financial matter are safeguarded. EVIDENCE: The Manager has many years experience of working in the capacity of care manager but still needs to obtain a formally recognized management qualification. Staff were not receiving formal supervision. The Manager is doing yearly appraisals. Manual handling and fire training has elapsed. The Care Manager has implemented a monthly falls audit but this requires further development. The home needs to update the premises risk assessment. Hot water testing of out lets that service users have access to are taking place did not detail the exact location that these are tested at. The home was unable to locate an up to date gas service and lift maintenance certificate, these need to be forwarded to the Commission. The Care Manager is aware that staff need Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 16 training with regards to COSHH items and has arranged for this to take place. In addition the Manager needs to ensure that COSHH data is available and accessible to staff. The home has its own accident forms, and needs to ensure they conform to the Data Protection Act. The home has a ‘pool’ of wheelchairs for service users Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 x 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 x x 2 2 2 2 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x x x 3 1 x 2 Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 18 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 1 &16 Regulation 4 Sch 1 & 22 Requirement The Registered Person must ensure that the Service Users Guide is up to date and contains all the information listed in the Schedule. The complaints procedure within the guide needs to be simple and clear to ensure there are dealt with prompty and effectively and that service users are aware that they can contact the Commission at any point in the process The Registered Person must ensure each Service user is provided with a Contract and a Statement of Terms and conditions at the point of moving into the home (as detailed in Standard 2) and states whether the nursing element is deducted from the fee or included. 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 professionals advice incorporated into these care plans. Service users and or their representative must be given the Timescale for action 1st Nov 2005 2. 2 5 1st Nov 2005 3. 4. 7.8&12 15(1)(2) 1st Dec 2005 Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 19 4. 15 23(2)(h) 5. 18 13(6) 6. 7. 18 19 13(7) 23(2)(b) 8. 26 13(1) 16(2) 9. 36 18(1) ( c)(i) 10. 38 23(2)13(4 )( c) 11. 38 23(2)(c ) choice to take part in drawing up of the care plan and sign to say they have been involved.. The Registered Person must review with service users the present dining arrangements with a view to improving the dining experience and comfort for service users at mealtimes. The Registered Person must review the adult protection procedure to ensure that it complies with local guidlelines. (Outstanding requirement Jan 03) The Registered Person must review its restraint procedure in keeping good practice. 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. Hand washing facilities must be prominently sited in areas where infected material and/or clinical waste are being handled. (Outstanding requirement Jan 2003) 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. The Registered Person must forward copies of the most recent gas safety certificate and details of passenger lift 1st Oct 2005 1st Oct 2005 1st Nov 2005 1st Nov 2005 1st Nov 2005 1st Oct 2005 1st Nov 2005 1st )ct 2005 Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 20 12. 38 15(1) 13. 38 & 18 13(6)4 (c )23 (4) (d 13(6) 12(4) 14. 15. 38 23 insurance. Outstanding requirement from 12th Jan 2005. The Registered Person must ensure that the accident form they are at present using complies with legislation and the Data Proctect Act.. The Registered Person must carry out a training audit in relation to mandatory training and address any deficities The Registered Person must ensrue that the home has a current Legionella Certificate An Action plan must be submitted indicating how the home intends to provide privacy for service users who use both the double and single bedrooms where the single room is accessed from the double 1st Oct 2005 1st Nov 2005 1st Aug 2005 1st Nov 2005 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 21 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. 4. 5. Refer to Standard 9 26 3 4 38 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 contact the Health Protection Unit at Bartholew House, Hagley Road, Birmingham to carry out an environmental audit. Tel 0121 224 4670 The Registered Person should carry out a formalized pre admission assessment as standard 3. 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 tersted 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 should consult with service users with regards to meals and menu choice to ensure they are able to exercise a choice at all meal times 6. 24 &! 7. 15 Roxton Nursing Home E54_S24884_RoxtonNH_V221262_300505 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Birmingham Local 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. 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