Care Home: Roby Lodge

What the care home does well The findings of this inspection were positive. The home is providing good quality care and support to people. People who live at the home and relatives who were met were positive about all aspects of the service. Their comments included `staff are nice and the care Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 is good`, `my mother is always clean and well looked after ` and `I couldn`t wish for any more`. New people are only admitted to the home following an assessment of their needs. This is to ensure the home has sufficient information so as to determine if the person`s needs can be met appropriately. Each of the people living at the home has a care plan. The level of information in these was very good and they clearly described how to meet the needs of the person in all aspects of their care and wellbeing. Risk assessments are carried out in relation to people`s care needs. The standard of information in these was very good. Risk assessments not only described in an appropriate level of detail what the potential risks were and how to prevent or manage these, but they also included issues which may eventually lead to an increased risk. This level of pre planning is very good as it aims to slow down any deterioration in the person`s health and well being. There was a clear link between identifying an assessed need and ensuring that information on how to meet this was reflected in the person`s care plan. Alongside this there was clear and comprehensive risk assessment information. All of this information was written in plain language and residents or their representatives sign their care plan as having been included in it and in agreeing the contents. People are well supported with their health care needs and are supported to see a GP, nurse or other relevant health professional when appropriate. Senior staff are trained in administering medication and medication is well managed. The catering arrangements are well organised and people gave good feedback about the quality and choice of food and meals. People have the choice of a cooked breakfast two days per week and a choice of meals from the menu each day. Meals are all prepared from fresh ingredients. The home is very well presented, clean and comfortable. Aids and adaptations are in place to promote people`s independence and to ensure staff carry out safe practices when assisting people with moving and transferring. People who live at the home are provided with their own bedroom and these are fitted with quality furnishings. People are encouraged to bring some of their own belongings into the home so as to personalise their own rooms. Over 50% of staff have attained a relevant qualification to date. Staff are also trained in topics such as supporting people who have dementia care needs, safeguarding adults, fire safety, first aid, food hygiene, administering medication, infection control and moving and transferring people safely. This level of training shows us that staff should be able to safeguard the health and wellbeing of residents appropriately.Roby LodgeDS0000073255.V377249.R01.S.docVersion 5.2Page 7The home is well managed and is run in the best interests of the residents. Health and safety practices and checks are carried out regularly so as to safeguard residents, staff and visitors. What has improved since the last inspection? This was the first inspection since the home was registered with us in February 2009. In the provider`s self assessment (AQAA) the manager has reported some improvements to the service since it became registered. These include; `We have built on relationships with outside agencies. We have extended the training programme to include specialist training on dementia awareness and challenging behaviour. Staff have undertaken safeguarding of adults training`. What the care home could do better: The manager should ensure that people are provided with a copy of the service user guide for their own reference and for information for their relatives / representatives. Staff should make some record relating to wound care when this has been provided by outside health professionals so as to ensure they can demonstrate that they have taken action and what the outcome of this has been. There is room to improve the system for attaining pre employment references for new staff. This includes; ensuring staff name the referee clearly, identify the capacity in which the referee is known to the candidate, references are verified and employer references are attained over personal references where this is possible. Key inspection report CARE HOMES FOR OLDER PEOPLE Roby Lodge Tarbock Road Huyton Liverpool Merseyside L36 5XW Lead Inspector Debbie Corcoran Key Unannounced Inspection 17th August 2009 11:00 DS0000073255.V377249.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 2 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 Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roby Lodge Address Tarbock Road Huyton Liverpool Merseyside L36 5XW 0845 0121132 0161 368 0058 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) Meridiancare.co.uk Meridian Healthcare Ltd Deborah Wilson Care Home 40 Category(ies) of Dementia (40) registration, with number of places Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Dementia - Code DE. The maximum number of service users who can be accommodated is: 40. Date of last inspection Brief Description of the Service: Roby Lodge is registered to provide a residential service for up to 40 people who have dementia care needs. The service is run by Meridian Healthcare Ltd. Roby Lodge was registered in February 2009. It is a purpose built home which meets the environmental standards for a new service and provides all of the required access, aids and adaptations. The home is divided into two areas. These are the ground floor and first floor. Both floors have their own communal facilities and accommodate 20 people. The home is situated within a 10 minute walk from Huyton village where there are shops and local amenities. There are good public transport links to the home with buses and a train station within a 5 minute walk. The fees for residing at Roby Lodge range between £435.96 and £495.65 per week. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The visit to the home was not announced beforehand. During the visit the majority of the people living at the home were met and a number were spoken with on a one to one basis. We looked at a sample of records relating to the people living at the home. We also looked at other records including medication administration records, staff files, staff training records and health and safety records. These help to show us how peoples health and wellbeing are being promoted and whether staff have the skills and training needed to support people appropriately. We sent surveys to people living at the home, to staff and to relatives / representatives and a good return was received. Some of the information from these has been used to inform the findings of the inspection. A tour of the home was carried out which included all communal areas and a sample of bedrooms. Discussions took place with the manager, a senior member of care staff and a member of care staff. The manager returned a self assessment of the service prior to this visit. The self assessment enables the service provider to inform us of what they do well, where they have improved and where they can improve in the future. It also includes information on how they promote equality and diversity, how they seek the views of residents and includes data on staffing and health and safety. The self assessment is referred to as an Annual Quality Assurance Assessment (AQAA). Some of the information in this has been used to inform the findings of the inspection. What the service does well: The findings of this inspection were positive. The home is providing good quality care and support to people. People who live at the home and relatives who were met were positive about all aspects of the service. Their comments included staff are nice and the care Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 6 is good’, ‘my mother is always clean and well looked after and I couldn’t wish for any more. New people are only admitted to the home following an assessment of their needs. This is to ensure the home has sufficient information so as to determine if the persons needs can be met appropriately. Each of the people living at the home has a care plan. The level of information in these was very good and they clearly described how to meet the needs of the person in all aspects of their care and wellbeing. Risk assessments are carried out in relation to people’s care needs. The standard of information in these was very good. Risk assessments not only described in an appropriate level of detail what the potential risks were and how to prevent or manage these, but they also included issues which may eventually lead to an increased risk. This level of pre planning is very good as it aims to slow down any deterioration in the person’s health and well being. There was a clear link between identifying an assessed need and ensuring that information on how to meet this was reflected in the person’s care plan. Alongside this there was clear and comprehensive risk assessment information. All of this information was written in plain language and residents or their representatives sign their care plan as having been included in it and in agreeing the contents. People are well supported with their health care needs and are supported to see a GP, nurse or other relevant health professional when appropriate. Senior staff are trained in administering medication and medication is well managed. The catering arrangements are well organised and people gave good feedback about the quality and choice of food and meals. People have the choice of a cooked breakfast two days per week and a choice of meals from the menu each day. Meals are all prepared from fresh ingredients. The home is very well presented, clean and comfortable. Aids and adaptations are in place to promote peoples independence and to ensure staff carry out safe practices when assisting people with moving and transferring. People who live at the home are provided with their own bedroom and these are fitted with quality furnishings. People are encouraged to bring some of their own belongings into the home so as to personalise their own rooms. Over 50 of staff have attained a relevant qualification to date. Staff are also trained in topics such as supporting people who have dementia care needs, safeguarding adults, fire safety, first aid, food hygiene, administering medication, infection control and moving and transferring people safely. This level of training shows us that staff should be able to safeguard the health and wellbeing of residents appropriately. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 7 The home is well managed and is run in the best interests of the residents. Health and safety practices and checks are carried out regularly so as to safeguard residents, staff and visitors. What has improved since the last inspection? What they could do better: 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. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New people are only admitted following an assessment of their needs and when it has been established that their needs can be met at the home. EVIDENCE: There was an information pack available in the main reception area. This contained the home’s statement of purpose and ‘service user guide’ as a combined document. The manager stated that a copy of this is provided to anybody who requests a copy. It is recommended that copies of the service user guide are provided to people as part of the referrals process and are made freely available for people to take a copy. The records for a number of people living at the home were looked at and these showed that an initial assessment of needs is carried out with the person Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 10 and their representatives before they move to the home. The assessments cover issues such as the persons strengths and needs with personal care, physical well being, diet, weight, eyesight, hearing ability, communication styles, oral health, foot care, mobility, medication, mental health, social interests, personal safety and risk assessment. The outcome of an assessment will determine whether or not a person will be admitted to the home and this is based on the homes capacity to meet the assessed needs of the person. The manager reported that the referring agency, for example Social Services, are asked for assessment information when a new person is referred to the home. This was confirmed in the records for one of the people living at the home where a copy of the persons community care assessment was available. Following the initial assessment there is then a monthly review of the persons assessed needs and this then links closely with the persons care plan. For example if a person was assessed as being nutritionally compromised then their care plan would contain information on how to meet their dietary needs. Prospective residents and their relatives or representatives are invited to visit the home and spend time there before deciding whether or not to move in. The manager has detailed in the self assessment of the service (AQAA) ‘We carry out pre-admission assessments involving service users, families and social workers in the process. The assessment is then discussed with myself and the senior team, prior to admission to ensure all needs can be met for the individual. The assessment is usually carried out by myself or the Deputy Manager. Assessments made by Social Services social workers are given to myself or deputy manager prior to our assessment. This gives a full overview of the service users needs. We give all prospective clients the opportunity to visit Roby Lodge prior to admission and can spend the day with other service users’. People living at the home are provided with a contract as to the terms and conditions of their residency. Relatives or representatives are requested to sign these on behalf of the person living at the home where this is appropriate. The home does not currently provide intermediate care and therefore standard 6 was not assessed on this occasion. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the 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 well supported with their health, medication and personal care needs and the privacy and dignity of the person is protected. EVIDENCE: Each of the people living at the home has a care plan. We looked at the care plans for four people in some detail. The level of information in care plans was very good. Care plans included information on how to meet the needs of the person in areas such as their personal care, dietary needs and weight, health needs, communication needs, mobility, medication needs, mental state, social interests, personal safety. Care plans were found to have been reviewed and updated on a monthly basis. The manager has informed us in the providers self assessment (AQAA) that ‘We ensure that every service user has in individual person centred care plan that details all the individual’s personal needs. This will include race, gender, Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 12 sexual orientation, age and religion. All individuals have a person centred care plan which has full involvement of the service user/relative/representative. The care plans are reviewed on a monthly basis, or sooner if required. The care plans are the working tools for all staff and are written in a concise, clear and user friendly format for all staff to understand. Each service users care plan includes a comprehensive individual risk assessment, all risks identified with documented instructions on how these risks are managed, whilst taking into consideration the promotion of choice and independence’. The above statement was confirmed as actual practice and the system for assessment, care planning and risk assessment was thorough, auditable and there were clear links between identifying an assessed need, ensuring that information on how to meet this was reflected in the person’s care plan and alongside this there was clear and comprehensive risk assessment information. There were many visitors to the home during the day and a small number were asked to comment on the home. Their comments included it’s very good, we have had no cause for complaint at all, our mother seems to be very well looked after and the staff are very good and (persons name) seems to have settled in here well. We also asked relatives to complete surveys about the service and many of these were returned. Comments in surveys included; ‘Personal care and appearance of residents are always very good’ and ‘They look after my mother really well, meet all her needs’. Risk assessments are carried out where a person living at the home is thought to be at risk of harm. These include risks such as falling or not eating a nutritional diet. Where a risk had been identified then there was information in the persons care plan as to how to manage or reduce the risk. For example, one person had been assessed as being at risk of developing a pressure area. The persons care plan then explained in a good amount of detail what steps staff were taking to prevent a pressure area. The risk assessments looked at were comprehensive and detailed how to keep people safe in the practical sense of ensuring the safe moving and transferring of the person. They also included risk associated with issues such as potential isolation as a result of the person speaking quietly or potential nutritional problems as a result of a person no longer being able to use cutlery and the actions which need to be taken to prevent a problem from developing in the first place or an escalation of the problem. Risk assessments also instruct staff to observe for particular issues for example relating to a health concern or condition and the signs and symptoms to look out for are clearly documented. Records showed that people are well supported with their health care needs. People are regularly supported to see their GP, nurse, optician etc. It was noted that there had been a delay in seeing a chiropodist for a couple of people. The manager explained that this was as a result of the frequency of visits of the chiropody service and that she had already taken steps to secure an alternative resource for this. The manager was able to give clear examples Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 13 whereby the advice or support of health professionals had been sought in meeting the needs of the people living at the home. There was one area for improvement noted with regards to documenting wound care. The manager reported that district nurses are called in to support a person at the first signs of a pressure area and the nurses are then treating the pressure area. The district nurses were reported to keep their own records for this. It is recommended that staff make a record of the nurse’s visits and include in this a summary of the outcome of these and general overview of advice as provided by the nurses. The manager stated that she has recognised this gap in records and has liaised with the district nurses as to how this can best be resolved. People living at the home were observed to be well supported with their personal care and comfort. For example people looked well presented and were wearing appropriate foot wear, spectacles etc.. Pressure relieving equipment was being used, hoists were being used to support people with moving and transferring and staff presented as competent when using this. During discussions with a member of staff they were able to give examples of how they maintain peoples privacy and dignity when supporting them with personal care tasks. A sample of medication administration records and medication in stock was checked. This showed that medication is recorded and administered appropriately. There was one example whereby staff had signed as having given a particular medication to a person when the amount of medication in stock meant that the records must have been incorrect. This did appear to be an exception to the rule and all other medication which was looked at was accurate and well managed. Medication is administered by senior members of staff who have been provided with training in administering medication. The manager reported in the providers self assessment (AQAA) that Roby Lodge operates the company medication policy which ensures staff are competent in the administration of medication and receiving training in the safe handling of medication. There are systems in place for the safe storage of medication. All administered medication is recorded on MAR sheets’. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the 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 have opportunities to get involved in activities and to exercise choice. People are provided with a choice of good quality food and catering arrangements are well organised. EVIDENCE: The manager reported that the home has employed an activities co-ordinator. However, this post is now vacant. Records and photographs indicated that people are supported to be involved in regular activities such as board games, darts, sing along, manicures, cards, karaoke, art and crafts, reminiscence, watching films, listening to music, bowling, hand and foot massage, gardening, pampering, bingo. A ‘pen picture’ / client history profile has been introduced to enhance care planning and activities planning. The manager described how some of the people living at the home are encouraged to get involved in some tasks because they find this enjoyable and other people are distracted from things which worry them at key times of the day. A religious service takes place on a regular basis for those people who wish to attend. Activities are still being developed especially as there is a vacant post for this position. A number Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 15 people will choose not be included in group activities and their choice to do this is respected. The home has a small number of quiet lounges were people can go and spend time on their own or with a small group or with their visitors. One of the people living at the home gave good feedback on the quality of meals and food provided. People have a choice of a cooked breakfast twice per week and a choice of meals from the menu. Staff ask people each day what they want from the choice of menu for the following day. People are weighed on a regular basis and any indication of weight loss is followed up with a risk assessment and care plan. There was evidence of weight gain for a number of people since their admission to the home and this indicates that people are being well supported to maintain a nutritious diet. The kitchen was found to be clean, well organised and well stocked. Meals are cooked from fresh ingredients which are delivered to the home throughout the week. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the 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 safeguarded through procedures and practices being in place for dealing with complaints and for protecting people from abuse or neglect. EVIDENCE: The home has a complaints policy and procedure which is time scaled appropriately and includes contact details for the Commission. We asked people living at the home and their relatives in surveys if there was someone they can speak to informally if you are not happy or if they knew how to make a complaint and the general response was that they did. Information on how to make a complaint is provided to people in the service user guide or information pack. A log of complaints is maintained. This showed that there have been two complaints made directly to the home since it was registered. The details of these were looked at and there were no concerns as to the practices of the home. An adult protection policy and procedure is in place. This needs to be reviewed and amended as it fails to identify both some of the responsibilities and limitations of responsibility for different staff roles. For example it reads ‘Witness statements must be written on the corporate witness form’ this may mislead people into starting an investigation and this may be inappropriate depending on the nature of the allegation. Another example is that the Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 17 procedure states ‘Any incident must be reported to head office personnel before informing outside agencies’. Again this may not be appropriate particularly if a criminal offence may have been committed. This may delay the reporting of a safeguarding concern unnecessarily. A copy of the Local Authority (in which the home is located) safeguarding procedures was in place and the manager reported that she would follow these. One safeguarding referral has been made and investigated and it was deemed to have been handled professionally by the service. Staff recruitment procedures include a check against the ‘Protection of Vulnerable Adults’ register and attaining a criminal records bureau check for new members off staff. It was reported that all staff have been provided with adult protection training. During discussions with one member of staff they were able to explain what they would do in the event of an allegation of abuse being made. Accidents and incidents are appropriately recorded and audited. The record of accidents was looked at and this showed that some residents have had frequent falls. The manager reported that she feels this is as a result of the nature of the needs of the people living at the home. The manager has ensured that the number of falls has been analysed so as to identify any particular triggers, patterns, risks which may result in increased falls at any given time of day. The manager demonstrated that she has responded to falls by ensuring appropriate safety equipment is being used and professional advice has been sought in the care of people most at risk of falling. The manager will continue to monitor falls. The manager has reported in the self assessment of the service (AQAA) in relation to these standards, ‘Roby Lodge has a clear policy and procedure for making complaints. The complaints procedure is displayed in each room for clients/representatives. We have a positive attitude to complaints and document this, responding within 28 days of the complaint. The company has a designated ‘Safeguarding Adults’ Manager who will co-ordinate any investigations. Details are displayed in the home and are readily available for all service users/representatives. The company provides a free ‘safeguarding adults’ helpline. All staff are trained in ‘safeguarding adults’ and through training and supervisions are instructed on ‘whistle-blowing’ policy, understanding the importance of reporting any concerns/issues and how to do this. All potential new employees receive an enhanced CRB check and a POVA first check before they can begin employment. All staff receive mandatory training and regular supervisions and team meetings’. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the 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 provided with a clean, safe, well maintained and comfortable home environment which is presented to a high standard. EVIDENCE: The home was recently purpose built and it therefore meets required standards in relation to size, facilities, and accessibility. It is a two storey building situated in well maintained accessible grounds. The home has an enclosed rear garden for the safe use of people living at the home. The home is furnished and presented to a high standard. The home is divided into two separate areas, one on each floor of the building. Each area has an open plan lounge, dinning room and satellite kitchen. This area tends to feel a bit cramped especially when staff are using hoisting Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 19 equipment. The manager should review the current arrangements to see if any more floor space can be made available. Each floor has a smaller ‘quiet lounge’ and there is also a lounge where people living at the home can smoke. A sample of bedrooms were looked at. These were noted to be furnished and presented to a high standard. Every bedroom has en suite toilet and wash basin facilities. People are encouraged to personalise their room with some of the own belongings and pictures and ornaments. Each room is supplied with a free view television and phone line if people wish to have their own personal phone. A ‘nurse call’ system is in place in each room so that people can summon help or support from staff. The home has adapted bathing facilities, walk in shower rooms and aids and adaptations are located around the building. The home is fully accessible to people who use wheelchairs and a passenger lift provides access to the first floor as an alternative to the staircase. The décor and lighting of the home lend to a relaxed and calming feel. There are pictures of past events, of local interest, on display around the home. There is a fully equipped hairdressing salon for people’s use. A sensory room is also available to assist people in relaxing. The home is clean, well maintained and well presented. The presentation, safety and maintenance of the home is checked on a regular basis as part of the quality assurance process. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the 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 the home are supported by staff who are appropriately recruited, trained and well supported. EVIDENCE: There is a manager or deputy and senior staff on duty throughout the day. Staff roles and lines of accountability are clear. This means that staff know their responsibilities and know when to refer to a senior person for advice or support. Staff were observed to interact with residents with warmth and familiarity. People living at the home gave good feedback on the staff team. One person commented the staff are nice people and a relative commented they all seem to be very good. We also received positive comments from relatives who we surveyed, two examples of this being ‘Everybody does a wonderful job. The staff all give their best under a very stressful work load. I am very happy to leave my mother in their care. That means a lot to me’ and ‘I notice a great deal of patience is used not only to my mother but with all residents whatever their personal problems are’. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 21 At the time of the visit there were 20 residents on each floor of the home. The staffing levels at the time of the visit were; three care staff to each floor, 1 senior member of staff covering both floors and the manager of the service. The home has domestic and maintenance staff in addition to care staff. An activities co-ordinator post is in addition to the care staff. However, this post is currently vacant. The manager reported that this post will be filled in the near future. We looked at a sample of staff files to assess recruitment and selection practices and ensure these were in line with protecting people. This showed that all relevant pre employment checks, for example, attaining references and carrying out a criminal records check, had been made prior to starting new members of staff. These practices aim to safeguard people living at the home. The manager was advised to ensure the provision of references was in line with best practice. This includes ensuring applicants provide explicit information as to who the referee is, in what capacity they are known to the applicant, that references are verified and where possible are attained from previous employers. New staff are reported to undergo an induction programme and this includes some core health and safety related training. The manager has detailed in the self assessment of the service (AQAA) ‘All new employees undergo induction training with a competently trained mentor and are supernumery to the rota. This gives them the opportunity to get to know the clients, the systems that are in place and the layout of the building. All new recruits have a 13 week probationary period, in which all mandatory training is given and an induction workbook is completed. This gives me the opportunity to monitor their competency for their role and identify any training needs’. We looked at a sample of training records. These showed us that care staff have been provided with training in topics such as fire safety, moving and handling, food hygiene, infection control, pressure relief, care planning adult protection. The manager reported that all staff have either completed or are undertaking training in dementia awareness and equal opportunities. This level of training tells us that the staff team should be able to promote and safeguard the wellbeing of people living at the home. The manager reported that just over 50 out of care staff have attained a relevant National Vocational Qualification (N.V.Q) in Health and Social Care. We sent surveys to staff and a number of these were returned. The surveys asked question such as; did your employer carry out checks such as your CRB and references before you started work, did your induction cover everything you needed to know to do the job when you started, are you being given training which is relevant to your role, does your manager meet with you to give you support and discuss how you are working, do you feel you have the right support experience and knowledge to meet the different needs of people Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 22 who use services. All responses were positive and there were no areas of concern raised. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 People using the 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 live in a home which is well managed and run in their best interests. Peoples health and welfare is safeguarded by appropriate procedures and practices. EVIDENCE: The home is well managed and staff roles and lines of accountability are clear. The manager has attained relevant qualifications and presents as committed to providing a good quality service. A system for checking on the quality of the service is in place. The home is visited by a representative of the organisation on monthly basis and a report of Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 24 the findings of these visits is made. Further checks and audits are in place to ensure that the service is meeting the required standards. The manager reported that plans are in place to survey people living at the home and their relatives as to the quality of the service and their feedback will be used to contribute to the development of the service. Staff do not deal with the personal finances of the people living at the home. The manager reported that she only deals with relatively small amounts of personal allowance personal allowance which is provided by relatives / representatives acting on behalf of the residents. Records confirmed this. The manager reported a monthly audit takes place on this and that an annual audit will also be carried out. Staff records showed us that staff are provided with regular supervision meetings. Staff team meetings are also taking place. Both of these forums give staff the opportunity to review their practice, share good practice, develop their skills and knowledge, develop as workers, contribute to decision making and shaping the service and to share important information on the needs of the people they support and on the service in general. Health and safety policies, procedures and practice are in place to safeguard the well being of people living at the home, staff and visitors. A safe working practice risk assessment has been carried out. This identifies potential areas of risk and includes information on how these are being managed. The manager has informed us in the providers self assessment (AQAA) that all health and safety checks are carried out on a regular basis and are up to date. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP1 Good Practice Recommendations The service user guide should be distributed to people using the service and copies should be made freely available to any person who requires a copy. So as to ensure all relevant parties have ready access to information on the service provided. A record of all district nurse visits and outcomes should be documented in the personal records of the people living at the home. So as to demonstrate the actions taken in response to a health concern and the outcome of this. The system for attaining pre employment references should be developed. So as to further safeguard the people living at the home. The adult protection procedure should be reviewed and amended to ensure staff roles and responsibilities are clear DS0000073255.V377249.R01.S.doc Version 5.2 Page 27 2 OP8 3 OP29 4 OP18 Roby Lodge and are as appropriate to the situation. So as to ensure staff are clear as to their responsibilities in dealing with a safeguarding concern. Roby Lodge DS0000073255.V377249.R01.S.doc Version 5.2 Page 28 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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