Care Home: Roby House Care Centre

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What the care home does well Roby House provided a very high standard of accommodation to the people using the service as it is a modern, purpose built care centre. The building and external grounds are accessible for people with a disability and residents had access to the necessary aids and adaptations they required. Feedback received from residents and their representatives was generally complimentary regarding the standard of care provided. Comments included: "Staff are very good and seem to genuinely care"; "On the whole the staff are very kind and respectful" and "I have always found the standard of care to be good." Assessment and care planning systems had been developed to ensure the health, personal and social care needs of residents were identified and planned for. Medical records and discussion with the people using the service also confirmed residents had access to health care services subject to need. Policies and procedures were in place to ensure an appropriate response to complaints and suspicion or evidence of abuse and the registered provider (Meridian Health care Limited) continued to undertake a quality assurance process to monitor the overall standard of service provided. Recruitment and selection practice was good and offered safeguards to the people using the service. Furthermore, staff had access to a range of training and supervisions with senior staff to ensure they had the necessary knowledge, skills and understanding to complete their duties. Staff were observed to communicate and engage with residents in a respectful manner and residents were able to follow their preferred routines and receive visitors at any reasonable time. What has improved since the last inspection? Since the last visit a large print version of the Statement of Purpose and Service User Guide had been developed to enable people with a visual impairment to read the information more easily. An up-to-date record of all training including induction training had been established and maintained to provide evidence that the people using the service were supported by appropriately trained staff. The Controlled Drugs Cabinet had been secured to the wall using the correct method of fixing, to ensure compliance with the Misuse of Drugs (Safe Custody) Regulations 1974 as amended. Action had been taken to ensure medication is not stored in any area where the temperature exceeded 25 degrees centigrade.Handwritten Medication Records had been checked and witnessed by another suitably trained and competent member of staff to confirm the prescribed instructions were identical to the prescription. New and existing staff had received refresher training in the principles of care and other training and development opportunities relevant to their role and responsibilities. The environment had continued to receive investment to maintain high standards. For example, the chairs, carpets and curtains in the lounge area on the upper floor had been replaced and the lounge, dining area and corridors had been redecorated. All the rooms on the upper floor had also been redecorated and the kitchenette areas had been extended on both floors to provide more space including dishwashers. Internet access facilities had also been installed for residents to use. Seasonal plants had also been planted to garden areas. What the care home could do better: Information on equality and diversity issues and prescribed medication should be recorded as part of the assessment process to enable an holistic assessment of needs. Care Plans should include a column on outcomes and more information on how all the routine health care needs of residents are to be met to ensure best practice. Systems should be established to ensure accident / incident forms are always completed to ensure a clear audit trail for incidents affecting the health and welfare of residents. Written medication competency assessments should be undertaken and maintained for all staff designated with responsibility for handling medication to safeguard the welfare of the people using the service. The range and frequency of in-house and community based social activities should be developed in consultation with the people using the service to ensure the recreational and needs, expectations and preferences of the people using the service are fully met. The laundry service should be fully reviewed and closely monitored to ensure appropriate care is taken to return individual items of clothing to the correct residents. This will ensure the dignity of residents is safeguarded. Suitable arrangements must be made to ensure the people using the service have access to sufficient numbers of staff during staff breaks, to ensure the wellbeing of residents at all times. The acting manager should ensure that her mandatory training is up-to-date to ensure safe working practices. Minutes of meetings should be typed up and circulated to for relevant people to view to ensure best practice. All financial records pertaining to the management of resident`s personal finances should be up-to-date at all times to ensure a clear audit trail. An up-to-date fire risk assessment should be completed and available for inspection to ensure compliance with the fire safety regulations. Key inspection report Care homes for older people Name: Address: Roby House Care Centre Tarbock Road Huyton Liverpool Merseyside L36 5XW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Daniel Hamilton     Date: 2 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Roby House Care Centre Tarbock Road Huyton Liverpool Merseyside L36 5XW 01514824440 01512894402 robyhouse@meridiancare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Meridian Healthcare Ltd care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD. The maximum number of service users that can be accommodated is: 54. Date of last inspection Brief description of the care home Roby House is a purpose built, three-storey residential care centre for older people that has been developed to provide 54 registered places. The care centre is situated in Huyton and is close to all local amenities and transport routes. The reception area and managers office is located on the ground floor, which is accessible via a ramp and an electric front door with intercom system. This level has also been designed to accommodate 24 older persons who may have a physical Care Homes for Older People Page 4 of 33 Over 65 54 0 0 54 Brief description of the care home disability. The upper floor is designed to accommodate up to 30 older people who who may have a physical disability, 22 of these places are also registered for nursing care. Each room is equipped with ensuite facilities that include a toilet and hand basin. The ground floor rooms also have en-suite showers. Communal areas are situated on each floor, which consist of a main lounge, a small quiet lounge and dining rooms (with tea making areas). Toilet and assisted bathing facilities are located throughout. The ground floor has a hairdressing salon and the upper floor is fitted with a snoozelum - (a room fitted out with sensory equipment which provides a soothing environment for residents). The lower ground floor accommodates the care centres kitchen facilities and food storage, laundry, staff room, staff training room, storage rooms, cinema, staff changing rooms and two spare bedrooms for staff or guests. A passenger lift has been installed and loop systems have been fitted in each of the lounges. Handrails have been fitted in all areas of the care centre and grab rails in each en-suite, subject to the needs of the people using the service. A call bell system is fitted throughout the home. A patio area with seating and a water fountain is accessible via the ground floor lounge. Car parking facilities are available at the rear of the premises. Fees range from £373.94 to £550.00 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced inspection took place over two days and lasted approximately 18 hours. A partial tour of the premises took place and observations were made. Five care files and a selection of staff and service records were examined and the operations manager, acting manager, care staff, six relatives, a health care professional and 13 residents were spoken with during the visit. An expert-by-experience assisted in the inspection process. An expert-by-experience is someone who, because of their shared experience of using care services or ways of communicating visits a service with an inspector, to help get a picture of what it is like to live in or use the service. Care Homes for Older People Page 6 of 33 Reference was also made to an annual quality assurance assessment (AQAA) which was completed by the acting manager. This document enables a person to undertake a self-assessment on the service prior to an inspection and contains information on how the people living in Roby House are supported, together with numerical information on the service. Survey forms were distributed to a number of residents or their representatives prior to the inspection in order to obtain additional views and feedback about the service. All the core standards were reviewed and previous requirements and recommendations from the last inspection in July 2008 were reviewed. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Since the last visit a large print version of the Statement of Purpose and Service User Guide had been developed to enable people with a visual impairment to read the information more easily. An up-to-date record of all training including induction training had been established and maintained to provide evidence that the people using the service were supported by appropriately trained staff. The Controlled Drugs Cabinet had been secured to the wall using the correct method of fixing, to ensure compliance with the Misuse of Drugs (Safe Custody) Regulations 1974 as amended. Action had been taken to ensure medication is not stored in any area where the temperature exceeded 25 degrees centigrade. Care Homes for Older People Page 8 of 33 Handwritten Medication Records had been checked and witnessed by another suitably trained and competent member of staff to confirm the prescribed instructions were identical to the prescription. New and existing staff had received refresher training in the principles of care and other training and development opportunities relevant to their role and responsibilities. The environment had continued to receive investment to maintain high standards. For example, the chairs, carpets and curtains in the lounge area on the upper floor had been replaced and the lounge, dining area and corridors had been redecorated. All the rooms on the upper floor had also been redecorated and the kitchenette areas had been extended on both floors to provide more space including dishwashers. Internet access facilities had also been installed for residents to use. Seasonal plants had also been planted to garden areas. What they could do better: Information on equality and diversity issues and prescribed medication should be recorded as part of the assessment process to enable an holistic assessment of needs. Care Plans should include a column on outcomes and more information on how all the routine health care needs of residents are to be met to ensure best practice. Systems should be established to ensure accident / incident forms are always completed to ensure a clear audit trail for incidents affecting the health and welfare of residents. Written medication competency assessments should be undertaken and maintained for all staff designated with responsibility for handling medication to safeguard the welfare of the people using the service. The range and frequency of in-house and community based social activities should be developed in consultation with the people using the service to ensure the recreational and needs, expectations and preferences of the people using the service are fully met. The laundry service should be fully reviewed and closely monitored to ensure appropriate care is taken to return individual items of clothing to the correct residents. This will ensure the dignity of residents is safeguarded. Suitable arrangements must be made to ensure the people using the service have access to sufficient numbers of staff during staff breaks, to ensure the wellbeing of residents at all times. The acting manager should ensure that her mandatory training is up-to-date to ensure safe working practices. Minutes of meetings should be typed up and circulated to for relevant people to view to ensure best practice. All financial records pertaining to the management of residents personal finances should be up-to-date at all times to ensure a clear audit trail. Care Homes for Older People Page 9 of 33 An up-to-date fire risk assessment should be completed and available for inspection to ensure compliance with the fire safety regulations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding whether to move into Roby House. This enables the service to identify needs and to determine whether care needs can be met. Evidence: A combined Statement of Purpose and Service User guide document had been developed in a standard and large print format to provide information on Roby House Care Centre for prospective and current residents and their representatives. The acting manager made arrangements to display a copy of the complaints procedure in the reception area of Roby House during the visit as information on the full complaints procedure was missing from the document in the reception area. Feedback received from the majority of residents and their representatives via surveys and through discussion confirmed that people had generally received information on the service and a contract / statement of terms and conditions before deciding Care Homes for Older People Page 12 of 33 Evidence: whether to move into Roby House. Information received from the acting manager prior to the inspection in the form of an Annual Quality Assurance Assessment confirmed policies and procedures were in place for referral and admission as previously noted. Five of the residents personal files were viewed during the visit. Three of the files viewed were for residents who had recently moved into Roby House and two were for residents who had lived in the care centre for more than two years. Each file viewed was found to contain a pre-admission assessment of needs. Overall, assessments viewed contained basic information on the needs of residents. One assessment did not include information on the name of the assessor or the date of the assessment and information on equality and diversity issues such as religion, gender and ethnicity had not consistently been recorded on assessments viewed. The acting manager was requested to address theses issues and advised to obtain more detailed information on prescribed medication as part of the assessment process. Following the pre-admission assessment a more detailed assessment had been completed and copies of social work assessments or care plans had been obtained for people referred via Care Management arrangements. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Roby House are involved in the development of their individual care plans so they receive the care and support they need in the way they prefer. Evidence: The Annual Quality Assurance Assessment for the service confirmed that the Registered Provider had corporate policies and procedures in place covering Individual Planning and Review and the Control, Storage, Disposal, Recording and Administration of Medication as previously noted. Five of the residents personal files were viewed during the visit. Three of the files viewed were for residents who had recently moved into Roby House and two were for residents who had lived in the care centre for more than two years. Each file viewed contained a care plan that outlined Identified need, Action required to meet need and By whom. Care plans had been signed by residents or their relatives (where practicable) and had been kept under monthly review. The acting manager was recommended to include a column on outcomes and to include information on how all the routine health care needs of residents was to be met. Care Homes for Older People Page 14 of 33 Evidence: Supporting documentation including; declaration of wishes in relation to the administration of medication, monthly weight charts, risk assessments, daily living reports, personal property / inventories and personal and health care reports were also in place. It was noted that accident records had not been completed for some incidents that had occurred in the care centre and the acting manager was reminded of the need to ensure these records were always completed to account for accidents and injuries. Feedback received from residents and their representatives via Care Home Survey forms and through discussion confirmed the people living in the home received the medical support they required. Medical intervention records viewed detailed that residents had received visits from: general practitioners, district nurses, health visitors, chiropodists, opticians and tissue viability nurses etc subject to individual need. Medication was dispensed by a local pharmacist on a monthly basis in a blister pack system. Medication was stored in medication trolleys, which were secured to walls in storage cupboards when not in use. Since the last visit arrangements had been made to correctly secure cabinets containing controlled drugs to the wall using the correct method of fixing and air conditioning had been fitted in both rooms used to store medication to ensure the temperature in the room was correctly regulated. Staff responsible for the administration of medication had completed appropriate training and systems were in place to help staff correctly identify residents prior to administering medication. The Care Quality Commission had received notification since the last visit of a medication dispensing error however appropriate action had been taken by the acting manager in response to the incident. The acting manager was recommended to also ensure that medication competency assessments are routinely undertaken and recorded for staff designated with responsibility for administering medication to ensure best practice. Medication was checked with the deputy manager during the inspection. Overall, Medication Administration Records viewed had been correctly completed to account for medication administered. Some minor recording omissions were noted and these were brought to the attention of the acting manager to ensure a clear audit trail. Advice was also given regarding the timescales needed for re-ordering of medication. Care Homes for Older People Page 15 of 33 Evidence: Staff spoken with during the visit demonstrated an awareness of the value base of social care. Feedback received from the majority of residents regarding the standard of care was generally positive and people spoken with confirmed their privacy was respected. Comments included Staff are very good and seem to genuinely care; On the whole the staff are very kind and respectful and I have always found the standard of care to be good. Likewise, comments from relatives included I cant praise them [staff] enough and The level of care is excellent. Concern was raised by one relative regarding the standard of personal care received by a resident. This is currently being investigated by the Registered Provider (Meridian Healthcare Limited). Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of stuctured in-house and community based social activities does not satisfy the recreational and needs, expectations and preferences of the people using the service. Evidence: A monthly programme of activities had been developed which was displayed on notice boards to provide residents with information on the range of activities provided at Roby House. Examination of activity records revealed that very few activities had been provided for several months and feedback received from residents and relatives highlighted concerns regarding this issue as previously noted. The acting manager reported that the previous activities coordinator had stopped facilitating activities on a regular basis since September 2008 due to difficulties in undertaking a dual role. Arrangements had been made to appoint a new activities coordinator who was due to commence employment shortly and was contracted to work five hours per day (Monday to Friday). Comments received from residents included: There are no structured activities; Care Homes for Older People Page 17 of 33 Evidence: Theres nothing to do only sit, eat and sleep; There are not enough activities and We dont have many activities. There is room for more. Representatives from the local Roman Catholic Church visited Roby House regularly to offer communion, subject to the individual wishes of the people using the service. The knowsley library service and outside entertainers also continued to visit the care centre periodically. Residents were observed to follow their preferred routines and receive visits from their family and friends throughout the day. This created a very positive feel to the care centre which had a busy atmosphere. Residents spoken with reported that the environment was relaxed and friendly and rooms viewed had been personalised by residents and contained personal possessions including pictures and ornaments. The acting manager reported that the service continued to provide a three-week rolling menu. This was in the process of being reviewed at the time of the visit in consultation with residents and relatives. Daily menu plans had been developed in large print and copies of the menus were available in a file in each dining room. Alternative choices were listed for each sitting and records of the meals served to each resident were maintained. Meals were served in the dining rooms on each unit. Dining rooms were pleasantly decorated and furnished. Tables were set with napkins, condiments, coasters and dried flowers. Staff were observed to be present during meals to offer support for residents as required. Additional drinks were also served throughout the day and residents were able to eat their meals in the rooms if they wished. Separate facilities were available for residents to prepare drinks and snacks and special diets were catered for, subject to individual needs. Feedback received from residents and their representatives highlighted different views on the standard of catering however many residents reported that the quality of meals had recently improved since the two new chefs had commenced employment. Comments included Until recently the meat was always tough and difficult to chew; Personally I have no concerns about the food. It is always hot and there is plenty to eat and The food is OK but in my opinion it needs more flavour. Care Homes for Older People Page 18 of 33 Evidence: The acting manager was able to provide evidence that the catering service was being kept under review in consultation with residents and staff in order to further improve standards. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Roby House and their relatives understand how to complain and systems are in place to safeguard people from abuse. Evidence: The Annual Quality Assurance Assessment (AQAA) for Roby House confirmed a concerns and complaints policy was in place as noted at the last visit. The procedure was displayed on a notice board near the reception area and copies had also been laminated in a standard format and displayed in each residents room for reference. Feedback received via care home surveys and discussion confirmed the people using the service and their representatives were aware of how to complain. The AQAA for Roby House detailed that 14 complaints had been received from the people using the service or their representatives in the last 12 months. Examination of the complaints log record revealed the nature of the complaints concerned: the level of noise from a TV in a residents bedroom (1); missing articles (2); the quality of food (1); standard of catering service (1); standard of cleaning (2); lost or missing laundry (4); soiled bedding (1) and care practices (1). Records showed that each complaint had been logged and appropriate action taken by the acting manager in response to the complaints. The Care Quality Commission had also received one complaint from a relative prior to Care Homes for Older People Page 20 of 33 Evidence: the inspection. This concerned a number of issues including limited activities, staffing levels and staff duties, the skill mix of staff and standards of personal care. This complaint was referred to the Registered Provider to investigate. Previous inspection records confirmed the Organisation (Meridian Healthcare Limited had developed an Abuse and Whistle blowing policy. A copy of Knowsley Councils adult protection procedures was also in place for the staff to reference. The AQAA for Roby House detailed that there had been five adult protection referrals and two investigations since the last visit. Records confirmed that the service had taken appropriate action in partnership with the local authority to safeguard the welfare of the people using the service and to improve standards of care. The acting manager and staff spoken with demonstrated a sound awareness of their duty of care to protect the welfare of the people using the service and how to recognise and respond to suspicion or evidence of abuse. Records showed that all staff had completed safeguarding adults training. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Roby House Care Centre provides a safe and comfortable environment for residents that is well maintained and decorated and furnished to a good standard. Evidence: Roby House Care Centre was opened in July 2006 and was purpose built to accommodate 54 people. A 35 hour per week handyperson was employed by Meridian Healthcare Limited (The Provider) to undertake minor maintenance tasks at Roby House and another care centre within the organisation and contractors were hired as and when necessary to attend to specialised maintenance work and the servicing of equipment. A maintenance book was in place to record jobs in need of attention. The home was fully accessible to residents. The front entrance had ramp access and an electric front door with intercom system. A passenger lift had been installed which was compliant with Disability Discrimination Act guidelines and a call bell system was fitted throughout the home.Handrails had been fitted along the corridors of the home and grab rails were sited in each room / en-suite, subject to the needs of the residents. Each lounge was equipped with a loop system. Although close circuit television cameras had been fitted to the perimeter of the home, the cameras did not intrude on the daily life of the residents. Residents had access to personal mobility Care Homes for Older People Page 22 of 33 Evidence: aids, subject to individual needs. (Please refer to the Brief Description of the Service section for more information on the premises). Examination of the Annual Quality Assurance Assessment (AQAA) for the service and a partial tour of the premises confirmed the service had continued to receive ongoing investment and maintenance since the last inspection. For example, the chairs, carpets and curtains in the lounge area on the upper floor had been replaced and the lounge, dining area and corridors had been redecorated. All the rooms on the upper floor had also been redecorated and the kitchenette areas had been extended on both floors to provide more space including dishwashers. Internet access facilities had also been installed for residents to use and seasonal plants had been planted to garden areas. The home employed four part-time domestics and two part-time laundry staff. The laundry was appropriately equipped and sited away from food preparation areas and the AQAA for Roby House confirmed that policies and procedures were in place for Communicable Diseases and Infection Control and the Control of Substances Hazardous to Health. Records showed that 24 staff had completed training in infection control training and areas viewed were generally clean, tidy and hygienic. Overall, feedback received from the majority of residents and / or their relatives confirmed the care centre was kept clean and fresh and areas viewed during the visit were clean, tidy and hygienic. One relative spoken with during the inspection expressed concern regarding the condition of a residents bathroom and two other relatives highlighted concerns regarding the laundry service i.e. items of clothing going missing or being incorrectly returned to other residents. This issue was also highlighted in some care home surveys and the record of complaint log for Roby House detailed that four complaints had been received from relatives regarding lost laundry in the last 12 months. For example, one relative reported: Laundry - a big problem. Socks which I understand can be a problem disappear even with name tapes sewn on never to reappear. Pyjamas worn once never seen again ever although tapes are sewn on. I do not think this is all the laundrys fault - I think the people who sort the garments when they arrive in the correct department dont take enough care. I have re-distributed garments to other patients found in X [residents] drawer. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for staff deployment are in need of review, to ensure the people living in the home have access to suitable numbers of trained and competent staff at all times. Evidence: Since the last inspection, the registration categories of Roby House had been changed in order to remove dementia and include nursing care. Examination of the staffing rota and discussion with the manager and staff confirmed one senior and three carers were on duty each day to provide care to the thirty two people receiving residential care. Likewise, one registered general nurse and two carers were on duty in the morning for the eight people requiring nursing care. In the afternoon the staffing for nursing care reduced to one Registered General Nurse and one carer. At night the care centre was staffed with one Registered General Nurse and three night care assistants. The acting manager worked supernumerary hours or as required by the service and confirmed that the staffing levels would be continually reviewed subject to the changing needs of the people using the service and occupancy levels. Ancillary staff were employed for catering, domestic and laundry duties. The acting manager was able to provide evidence that a number of experienced staff had remained in employment at Roby House following the opening of Roby Lodge (a new service for people with Dementia within the grounds of Roby House). Care Homes for Older People Page 24 of 33 Evidence: Feedback received from the majority of residents or their representatives via Care Home Survey forms and discussion highlighted different levels of satisfaction regarding the standard of care provided as previously noted. Three staff were observed to arrange a break together during the inspection and three residents spoken with expressed difficulties in obtaining staff support during staff breaks. For example, one person reported; Staff often go out for cigarettes together and have left people needing the toilet. Sometimes its a task to find people and another resident stated Sometimes the staff dont come quickly and we have accidents. That upsets us. They go out for smokes together. This issue was raised with the acting manager during the visit. Concerns were also expressed by a relative regarding staffing levels and the skill mix of staff however no evidence could be obtained to substantiate this issue. Feedback received from staff via surveys and discussion confirmed staffing levels were generally adequate for the duties they undertook however some staff were of the opinion that additional staff would always be helpful. A number of positive comments were also received regarding the staff team including The carers are brilliant, The care is superb, everyone is kind and The staff are very good. The Annual Quality Assurance Assessment (AQAA) for Roby House confirmed the Registered Provider had developed a corporate policy for recruitment and employment. Furthermore, the document confirmed that all the people who had worked in Roby House in the past twelve months had completed satisfactory preemployment checks. The Acting manager reported that ten staff had commenced employment at Roby House since the last visit. This number consisted of six care staff, two chefs and an administrator. The personnel files of three care staff were viewed. Each file contained a copy of an application form, recruitment records, two satisfactory references and evidence that a Protection of Vulnerable Adult (POVA) and /or Criminal Record Bureau (CRB) had been undertaken. Two files did not contain a medical questionnaire and this was brought to the attention of the manager. CRB and POVA checks were also checked and found to be in place for the other new employees. The acting manager reported that the home employed 23 care staff (not including nursing staff). Examination of the Annual Quality Assurance Assessment (AQAA) and the staff training matrix revealed that 18 staff (78.26 ) had completed a National Care Homes for Older People Page 25 of 33 Evidence: Vocational Qualification (NVQ) at level 2 or above in Care. Files viewed contained evidence of corporate induction workbooks and records of training / observation in the principles of care practice were also on file. A training matrix had been completed to provide an overview of the training completed by staff and files viewed contained documentary evidence of training completed. Feedback from staff confirmed they had access to a range of training and development opportunities including Induction, National Vocational Qualifications, Safe Working Practice, Safeguarding Adults, Medication etc. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems are subject to ongoing development and review to ensure Roby House is run in the best interest of the people using the service. Evidence: Since the last inspection the Registered Provider (Meridian Health Care Ltd) had appointed Ann Cowgill as the new Acting Manager of Roby House Care Centre. The Acting Manager reported that she had recently submitted an application to the Care Quality Commission to Register as the manager. The Statement of Purpose for the service detailed that Anne has over 21 years experience in the social care sector including 5 years previous experience as a care centre manager. Anne has also achieved her Registered Manager Award and a City and Guilds in Leadership and Management. She has completed a wide range of training programmes to complement her role including the NVQ A1 Assessor and Train the Trainer in moving and handling. Care Homes for Older People Page 27 of 33 Evidence: Examination of training records confirmed the acting manager had completed a range of training relevant to her role and responsibilities and Mrs Cowgil reported that she was in the process of completing the NVQ (National Vocational Qualification) level 4 award in Health and Social Care. It was noted that the acting manager needed to complete food hygiene and infection control training also to ensure her mandatory training was up-to-date. Feedback received from residents and staff confirmed the new acting manager was approachable and helpful and relatives spoken with complimented the managers overall commitment to developing the service. The Operations Manager continued to undertake monthly visits on behalf of the Registered Provider in accordance with Regulation 26 of the Care Home Regulations 2001 and records of monthly visits were available for inspection in the home. Copies had also been forwarded to the Commission for reference. An annual residents / representative survey was undertaken and a summary of results for July 2008 was displayed in the reception area of the home. The findings were well presented and provided useful information for current and prospective residents, their representatives and other interested parties to view. Quality audits were also completed on a bi-annual basis. Records showed that the acting manager had coordinated meetings with residents, staff and relatives periodically. The acting manager was advised to ensure that all minutes were typed up and circulated for the relevant people to view. Evidence of staff supervisions and appraisals were also on file to view. The Annual Quality Assurance Assessment (AQAA) for the service detailed that policies and procedures on the Management of Services Users Money, Valuables and Financial Affairs had been developed for staff to reference as previously noted. The acting manager reported that residents were encouraged to manage their personal finances independently or with support from family members or personal representatives. At the time of the visit the acting manager and local authority did not act as an appointee for any residents. Systems had been established by the Registered Provider for issuing invoices to residents or their representatives for fees and to enable payments to be made via standing order. Care Homes for Older People Page 28 of 33 Evidence: At the time of the visit the Acting Manager was responsible for the safe storage and management of personal spending money for 29 residents. Systems had been established to ensure money was not pooled and written records of all financial transactions, receipts and cash balances were maintained. Four records were viewed two of which did not correspond with the cash balances which were greater. Pre-inspection records detailed that Health and Safety policies and procedures were in place and examination of the AQAA confirmed that test, maintenance and / or associated records were in place and up-to-date for all key areas. Fire log and service records were checked during the visit. Fire log records viewed confirmed that the fire alarm system, panel, means of escape, emergency lighting and fire extinguishers and hose reels had been regularly tested or visually inspected. Documentation was also in place to confirm the fire alarm system and extinguishers had been routinely serviced. At the time of the visit an up-to-date fire risk assessment could not be located however risk assessments for general cleaning; manual handling; slips, trips and falls and medicine practice were available for reference. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Information on equality and diversity issues and prescribed medication should be recorded as part of the assessment process to enable an holistic assessment of needs. Care Plans should include a column on outcomes and more information on how all the routine health care needs of residents are to be met to ensure best practice. Systems should be established to ensure accident / incident forms are always completed to ensure a clear audit trail for incidents affecting the health and welfare of residents. Systems should be established to ensure accident / incident forms are always completed to ensure a clear audit trail for incidents affecting the health and welfare of residents. The range and frequency of in-house and community based social activities should be developed in consultation with the people using the service to ensure the recreational and needs, expectations and preferences of the people using the service are fully met. The laundry service should be fully reviewed and closely monitored to ensure appropriate care is taken to return individual items of clothing to the correct residents. This Page 31 of 33 2 7 3 7 4 9 5 12 6 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations will ensure the dignity of residents is safeguarded. 7 27 Suitable arrangements must be made to ensure the people using the service have access to sufficient numbers of staff during staff breaks, to ensure the wellbeing of residents at all times. The acting manager should ensure that her mandatory training is up-to-date to ensure safe working practices. Minutes of meetings should be typed up and circulated to for relevant people to view to ensure best practice. All financial records pertaining to the management of residents personal finances should be up-to-date at all times to ensure a clear audit trail. An up-to-date fire risk assessment should be completed and available for inspection to ensure compliance with the fire safety regulations. 8 9 10 31 33 35 11 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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