Care Home: Roxburgh House

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What the care home does well Prospective residents of Roxburgh House are given plenty of information about the service, which helps them make an informed choice as to whether this will make a suitable home. People have had their needs assessed before they move in to ensure that staff know the service can meet each person`s needs before they are admitted. A resident said her family had chosen Roxburgh House on her behalf and she was pleased, as she was more than satisfied with the service. Residents have care plans, which give staff guidance as to how the person is to be supported. There are systems for carrying out risk assessments and reviewing care plans to make sure they are amended according to any change in the person`s condition. All residents who were spoken with said they were well cared for, and a visitor said she was pleased with the care provided to her relative, saying she had "No problems and the staff are very good". Ministers regularly visit Roxburgh House to support people who have religious affiliations through communion and prayer. A range of leisure events and outings is on offer for residents and an activities co-ordinator is employed. In this way, the lifestyle in Roxburgh House will meet residents` needs and expectations. It was evident that residents are consulted about activities and all aspects of life in Roxburgh House through care reviews, residents` meetings, satisfaction surveys, the manager`s surgery a comments book, and by asking them each day. There is a complaints procedure, which is given to people when they move in and a further copy is displayed in the reception area. In this way, people will know that if they have any concerns they will be taken seriously and investigated. Roxburgh House is purpose built and gives level access for residents throughout the building and to the gardens. The home is comfortable and well maintained and residents said they were satisfied with their accommodation. The gardens are well maintained and suitable for residents. There is range of environmental aids throughout the home, to support people who have poor mobility to get around, and in this way people`s independence is promoted. Staff said they are well supported by management and they receive regular supervision for advice and guidance, and appraisals to ensure they have the skills to carry out their duties. Staff, who were spoken with showed awareness of best practice in safeguarding and maintaining people`s privacy in care giving, and said they receive plenty of training. What has improved since the last inspection? A requirement from the last inspection regarding security of the grounds has been met as fencing and gates have been fitted at the sides of the building. The manger said that this has made the grounds a lot more safe and free from intrusion. Recommendations from the last inspection regarding NVQ training and staff supervision have been met. In this way, staff feel supported and have the qualifications suitable to their job role. Since the last inspection, the manager has applied for registration with CSCI in accordance with a recommendation. CARE HOMES FOR OLDER PEOPLE Roxburgh House Roxburgh Street Bootle Liverpool Merseyside L20 9PS Lead Inspector Mrs Trish Thomas Unannounced Inspection 19th May 2008 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roxburgh House Address Roxburgh Street Bootle Liverpool Merseyside L20 9PS 0151 525 7547 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) roxburghbootle@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Manager post vacant Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 38 OP. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. The service to accommodate one named resident under pensionable age. 23rd July 2007 Date of last inspection Brief Description of the Service: Roxburgh House is a care home for 38 older people. The registered provider is Southern Cross Properties Limited. The appointed manager is Ms. Tracey Conlin, who has applied for registration with CSCI. Roxburgh House is purpose-built, situated in a residential street, close to main roads, shops and bus routes and is set in gardens, with a car park at the front of the property. Roxburgh House is staffed throughout the day and night, and provides personal care, full board, laundry and single accommodation. All residents are registered with local doctors and are supported by staff in accessing health and paramedical services. The fees charged in Roxburgh House are from £322.00 TO £565.00 with extra charges for chiropody and hairdressing. Roxburgh House DS0000005417.V363380.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 two stars. This means that people who use the service receive good quality outcomes. The methods we (the commission) used to assess standards in Roxburgh House are as follows. We carried out an un-announced visit and talked with residents, visitors, the manager and staff. Their comments on the service are included in the report. To ensure the home is managed in residents’ best interests, we looked at the records compiled in Roxburgh House, including those for health & safety, training and staffing. We looked care plans in detail for three residents to ensure that staff are given guidance to support people properly. The Annual Quality Assurance Assessment had been filled in by the manager and returned to us. This is a self-assessment document, which tells us how the service has improved since our last visit, barriers to improvement (if any) and proposals for the future. We sent out surveys to residents and staff, however none had been returned to us by the date of the report. We looked at complaints records to ensure that the complaints procedure is being followed in Roxburgh House. What the service does well: Prospective residents of Roxburgh House are given plenty of information about the service, which helps them make an informed choice as to whether this will make a suitable home. People have had their needs assessed before they move in to ensure that staff know the service can meet each person’s needs before they are admitted. A resident said her family had chosen Roxburgh House on her behalf and she was pleased, as she was more than satisfied with the service. Residents have care plans, which give staff guidance as to how the person is to be supported. There are systems for carrying out risk assessments and reviewing care plans to make sure they are amended according to any change in the person’s condition. All residents who were spoken with said they were well cared for, and a visitor said she was pleased with the care provided to her relative, saying she had “No problems and the staff are very good”. Ministers regularly visit Roxburgh House to support people who have religious affiliations through communion and prayer. A range of leisure events and outings is on offer for residents and an activities co-ordinator is employed. In this way, the lifestyle in Roxburgh House will Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 6 meet residents’ needs and expectations. It was evident that residents are consulted about activities and all aspects of life in Roxburgh House through care reviews, residents’ meetings, satisfaction surveys, the manager’s surgery a comments book, and by asking them each day. There is a complaints procedure, which is given to people when they move in and a further copy is displayed in the reception area. In this way, people will know that if they have any concerns they will be taken seriously and investigated. Roxburgh House is purpose built and gives level access for residents throughout the building and to the gardens. The home is comfortable and well maintained and residents said they were satisfied with their accommodation. The gardens are well maintained and suitable for residents. There is range of environmental aids throughout the home, to support people who have poor mobility to get around, and in this way people’s independence is promoted. Staff said they are well supported by management and they receive regular supervision for advice and guidance, and appraisals to ensure they have the skills to carry out their duties. Staff, who were spoken with showed awareness of best practice in safeguarding and maintaining people’s privacy in care giving, and said they receive plenty of training. What has improved since the last inspection? What they could do better: To ensure the safe handling of medication, a recommendation is given regarding recording keeping. It is recommended that staff receive instruction on how to accurately record medication, and on following pharmacy instructions as to recording medication, which has been given to residents. In this way an accurate audit of medication will be maintained and all drugs will be accounted for. For “as required” medication, care plans should be set out as to the specific circumstances under which the drug will be given to the Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 7 person. This will provide staff with clear guidance and accountability and will support the residents’ best interests. A recommendation from the last inspection has been met. A risk assessment was carried out regarding transporting soiled and clean items up and downstairs, as the laundry is on the first floor. During the inspection, staff were seen continuing to carry large loads of laundry down stairs, which could cause a risk of trips and falls. It is recommended that for their personal safety, staff are given written guidance regarding safety on the stairs. A serious complaint regarding a medication error has been investigated by the providers and addressed in a satisfactory manner. However CSCI was not informed of the complaint under Regulation 37, which requires the service to give notification of any event, which affects the wellbeing of residents. A requirement is given that in future, such notification will be made known to CSCI in accordance with the regulation. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Roxburgh House DS0000005417.V363380.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 Roxburgh House DS0000005417.V363380.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Prospective residents have had their needs assessed and have the knowledge they need to make an informed choice as to whether Roxburgh House will make a suitable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 1 and 3. Prospective residents are given a brochure about Roxburgh House before they move in. This gives them information about the service, accommodation, and staffing arrangements. The AQAA informs us that the information contained in the brochure (service user guide) is available on video and audiotape on request. In this way, a person will have plenty of knowledge on which to base a decision as to whether Roxburgh House will make a suitable Home and their right to choose their care home will be promoted, through making provision for people who have a sensory impairment or physical disability. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 10 Before each person moves in to Roxburgh House, staff meet with them and carry out an assessment of their needs. We read completed pre-admission forms for three residents of Roxburgh House. The standard pre-admission assessment form used by staff, covers a range of health and personal care needs. The outcomes (together with those of a social worker’s assessment) are used to set out the person’s care plan. This is a record to guide staff as to how the person is to be supported when living in Roxburgh House. Each person’s race, their religion and personal preferences for leisure, meals and daily routines are on record and in this way their individuality and diversity is supported. In carrying out a pre-admission assessment, staff can establish before a person moves in, whether the service in Roxburgh House, has the skills and facilities to meet each person’s needs. The AQAA informs us that people who are thinking of moving in are invited to visit Roxburgh House for a meal or drink, to meet with residents and staff and look around. Also in the AQAA it is stated that all admissions to Roxburgh House are initially for a mutual trail period of twenty-eight days. Roxburgh House DS0000005417.V363380.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff have the guidance they need to support each person’s health and personal care needs in a way which respects their privacy and diversity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7, 8, 9 and 10. All residents of Roxburgh House have a care pan and three were looked at in detail to find out how each person’s needs are supported. For the three people whose care plans were looked at, there were action plans in place to meet the needs identified in their individual assessments. All care plans, which were tracked, had been reviewed at least monthly to ensure they were relevant to any change in the person’s condition. There were risk assessments in place for each person to support them in areas such as those for mobility, nutrition, pressure care and continence. A resident said, “Everything is great. I get all I need here.” A relative said, “The staff are good and (name) is well looked after.” Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 12 Residents’ diversity is respected in Roxburgh House through consulting with them about their ongoing support and through formal reviews with the person, their family and social workers present. We looked at the social worker’s record of such a review for one resident, in which it is stated “(Name) is pleased to stay in Roxburgh House.” Health care plans in Roxburgh House told us that each person who lives there is registered with one of the local doctors. There was also evidence in the records of medical interventions, which we read, that people receive the support they need through domiciliary visits, for services such as for example, district nurses, chiropodists, opticians and dentists. We looked at the procedures in place for staff guidance in managing people’s medication. There are systems for auditing medication by recording drugs which are given to each resident, for signing in all drugs accepted into the home and for returning unwanted drugs to the pharmacy. A member of staff who described the medication system had a good knowledge of procedures in place and had received relevant training. Residents may self-medicate subject to a risk assessment of their capacity to do this. We visited the medication room, which provides secure storage facilities to ensure medication is safe in Roxburgh House. We tracked the medication for three residents and there were stocks of each prescribed drug in accordance with the pharmacy printout of their medication. In three instances we noted, discrepancies in medication administration records. In two cases, for one resident, the medication had not been signed for by staff and there were none of the codes inserted which are required if a resident, for example refuses the drug or is in hospital. In a second instance a drug prescribed once weekly, had been signed for as administered three times in one week. The stock of drugs was counted and was consistent with the drug having been given only once in that week as prescribed. The error appeared to be one of record keeping. A recommendation is given that staff receive updated instruction in maintaining medication records. In filling records of medication administration with care and accuracy, staff will reduce the risk of error and ensure that an accurate audit of medication is kept. For “as required” medication, care plans should be set out as to the specific circumstances under which the drug will be given to the resident. This will provide staff with clear guidance and accountability and will support the residents’ best interests. We looked at the ways by which residents’ privacy and confidentiality will be respected in Roxburgh House. All residents have single bedrooms, some having en-suite facilities. For staff guidance, there are procedures in place on privacy and confidentiality and staff spoken with showed awareness of each Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 13 resident’s right to privacy and their own responsibility to be aware of this when giving personal care and writing in care files. Roxburgh House DS0000005417.V363380.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The lifestyle in Roxburgh House meets residents’ expectations and preferences and they receive a wholesome and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. We were informed by the activities co-ordinator that a range of leisure events is on offer to residents of Roxburgh House and these are recorded on an activities schedule. There is evidence in the minutes of residents’ 16/4/08, that they are consulted about what they like to do. One resident is on record as saying, “Don’t stop bingo.” Another person said he/she was happy with the home and activities. Another person said, “I don’t want to get involved in activities.” The activities co-ordinator said that outings, such as those to coffee mornings are ongoing and residents’ enjoy watching films, arts and crafts and bingo. She said she is working with residents and their families to compile individual life histories for each person to ascertain their preferences and the outcomes will help in compiling future activities diaries. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 15 We spoke with two visitors who said they are always made welcome when they call in and that their privacy with their relative is respected. A visitor said, “The staff are very kind, they help in any way they can.” A resident said, “My friend calls in often and she comes to my room where we can have a talk. It is good to stay in touch.” Residents’ diversity is respected through recording their beliefs and making arrangements for those with religious affiliations to be visited by ministers for prayer and communion. We saw in the minutes of a recent residents’ meeting that they are asked about what they like to eat. One person asked for more cabbage and cauliflower. Other comments were, “The food is great.” “Meals are good.” During the inspection all residents who were spoken with said the food is very good. The dining room was bright and clean and the tables are nicely laid. The kitchen was visited and was clean and well organised. There were good stocks of dry, chilled, fresh and frozen foods. These were safely stored and catering records were in good order at the time of the visit. The menus show good variety and alternatives on offer and it is usual for staff to consult residents daily about their meals, as witnessed during the visit. People who live in Roxburgh House confirmed that drinks are served regularly to residents and their visitors. We looked in care plans and saw records of nutritional risk assessments and weight monitoring to ensure that everyone is receiving a wholesome and nutritious diet. The AQAA informs us that the NUTMEG system has been introduced which gives guidance to further promote a healthy diet for residents. Roxburgh House DS0000005417.V363380.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are protected through safeguarding procedure in Roxburgh House and they have access to the home’s complaints procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16 and 18. Roxburgh House has complaints and safeguarding procedures and staff receive relevant training. The AQAA tells us that a copy of the complaints procedure is given to residents when they move in and a further copy is displayed in the reception area. There have been no complaints to CSCI about Roxburgh House since the last key inspection. A concern regarding a medication error was investigated internally through the home’s complaints procedure, in communication with the resident’s placing authority. The concerns were upheld and in response, changes have been made to the medication forms, which relate to verbal instructions for drugs. In this way the risk of medication being overlooked and a person not being given their prescribed medication will be avoided. We looked at procedures in place for protection of vulnerable adults and “whistle-blowing”, we discussed them with staff and checked the training records. The procedures were satisfactory and staff were aware of the indicators of abuse and safeguarding procedures. The training matrix for Roxburgh House records twenty staff having received training in Protection of Vulnerable Adults. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Roxburgh House is well maintained and comfortable, and is a suitable home for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19 and 26. Roxburgh House is a purpose-built care home situated in a residential area of Bootle, near to local shops and amenities. Bedrooms, bathrooms, toilets and communal areas for residents, offices and the kitchen are on the ground floor. The administration office, laundry and staff facilities are on the first floor. Residents who were spoken with in their bedrooms said they were comfortable and satisfied with their accommodation. A resident said, “It is like a hotel, I could not want for more.” The home has recently been refurbished and bedrooms are in good decorative order and are well fitted out and individualised with personal items such as family photographs and ornaments. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 18 A range of environmental aids is in place for those people who have limited mobility. Examples include assisted baths, showers, raised toilets and grab rails. The corridors have been enhanced through a series of orientation art, which is of interest to people who live in Roxburgh House. These include historical photographs of Liverpool and film memorabilia from the 1900s. Some residents like to sit in the lounges and others in the main reception area, where comfortable seating has been placed for them. The gardens are pleasant and were very well maintained at the time of this visit. The entrance has been made attractive with tubs and planting. There are patio areas and seating for residents use in fine weather, with level access from the building. At the last residents’ meeting (April 2008), residents said they were satisfied with the home environment. The building was clean and odour free throughout, domestic staff are employed and the training records show they receive training in infection control and COSHH (control of substances hazardous to health). Domestic staff said they are provided with protective clothing and for their guidance and for residents’ protection, have infection control procedures to follow. The AQAA tells us that daily checks are carried out by the manager or deputy, to ensure that hygiene standards are maintained. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are protected through the training, recruitment and vetting procedures followed in Roxburgh House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28,29,30. A staff roster is maintained in Roxburgh House and that for the day of the visit gave a true representation of the staff on duty. The manager said there was one care post of thirty-three hours and one post of deputy manager vacant and currently being recruited and the post of activities co-ordinator has recently been filled. To obtain evidence that staff have received training in accordance with their job descriptions, we looked at the training plan for Roxburgh House and spoke with the manager, who confirmed that over fifty percent of staff have National Vocational Qualifications. Staff who were spoken with had completed, or were undertaking NVQ, and said they receive regular mandatory training and updates. This was confirmed in the training records. A sample of three staff files was read and gave evidence of the recruitment and vetting procedures followed in Roxburgh House. Staff files contained application forms with employment histories, two satisfactory references, Criminal Records Bureau clearance, contracts of employment and job descriptions. There was evidence in one file of the organizational disciplinary procedures having been followed. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Roxburgh House is managed in a way, which protects residents’ best interests, however staff may be putting their own safety at risk by not following safe working practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35,38. The appointed manager, Ms. Tracey Conlin, has twenty years experience as a care worker has NVQ to level 3. She is currently undertaking the Registered Managers Award. Ms. Conlin informed us during the visit, that she has applied for registration with CSCI. Staff said they receive good support from management, and supervision records gave us evidence that formal one-to ones were up to date at that time. Residents and visitors who were spoken with said that the manager is approachable and very kind. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 21 There is an internal quality assurance system in Roxburgh House. This is based on distributing questionnaires to residents, visitors and staff and using the outcomes as a means of developing the service in residents’ best interests. Records showed us that there are regular staff and residents’ meetings to ensure they can discuss any matters of interest and be aware of proposals for the future. It is policy in Roxburgh House, that staff do not become involved in residents’ personal financial affairs. For residents’ protection, records are kept of their personal allowances, charges and fees. Staff confirmed that receipts are retained for any purchases made on behalf of residents, to ensure that all money is accounted for. For residents’ protection Health & Safety procedures and certification of maintenance checks are maintained in Roxburgh House. The records were seen and were in order. We also looked at the fire records, which record that regular checks on the fire alarms and fire fighting equipment are carried out and the last fire drill had been recent. There are systems in place for assessing risk and recording accidents in Roxburgh House and these are monitored to ensure that future incidents will be avoided. There is a system for CSCI to be informed of incidents, which affect the wellbeing of residents. A requirement is given as in one instance it was evident that such an incident, regarding a medication error, had not been notified to CSCI under Regulation 37. There are systems in place for infection control, the laundry was well organised and all equipment was in working order at the time of this visit. The laundry is on the first floor and staff will regularly carry laundered items downstairs to the residents’ bedrooms and the bathrooms. A member of staff was seen carrying a large quantity of laundry downstairs, which could cause a risk to her of falls and injury. The manager confirmed that a recommendation from the last inspection that has been addressed as a risk assessment in relation to this has been carried out. She said staff, at times continue to take risks by carrying too many items at once, for efficiency. To protect the safety of staff, who may not always be following safety procedures in such instances, it is recommended that they receive written guidance on safety on the stairs. Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 22 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 X 3 X 3 X X 2 No Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 37 Requirement Notifications regarding incidents, which affect the wellbeing of residents, are to be made known to CSCI in accordance with the regulation. Ongoing from the date stated. Timescale for action 19/06/08 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 OP9 Good Practice Recommendations To ensure the safe handling of medication, it is recommended that staff receive instruction as to how to accurately record medication and follow pharmacy instructions as to recording the dose administered. In this way an accurate audit of medication will be maintained and all drugs will be accounted for. . For “as required” medication, care plans should be set out as to the specific circumstances under which the drug will be given to the person. This will provide staff with clear guidance and accountability, and will support the residents’ best interests It is recommended that for their personal safety, staff are given written guidance regarding safety on the stairs. 2. OP9 3. OP38 Roxburgh House DS0000005417.V363380.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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