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Inspection on 23/11/09 for Radbrook Nursing Home

Also see our care home review for Radbrook Nursing Home for more information

This is the latest available inspection report for this service, carried out on 23rd November 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People moving into Radbrook can be confident that staff will be able to meet their needs. This is because they are involved in a detailed assessment, before they are offered a place. The home has an experienced manager and staff are trained in meeting the needs of older people. A resident told us that Radbrook `provides excellent management and nursing services`. Another person told us their relative is `looked after very well and receives a high standard of care`. People can be confident that they will be involved in planning their care so staff know how they wish to be supported and they are offered choices. A relative told us that staff were `always pleasant and caring`. Residents, relatives and staff feel Radbrook provides a homely environment for people to live in. People can be confident they will be offered a choice of meals that they will enjoy and meets their dietary needs. People can be confident that robust recruitment procedures are in place to ensure suitable staff are employed. The manager demonstrates a positive approach to seeking the views of residents and their relatives. She makes sure people are kept informed of developments and changes within the home and seeks their views as to whether they are suitable or not. The information in the manager`s self assessment (AQAA) provided us with reliable information about the service and matched our assessment that the home is well managed and seeks to continually review and develop the service it provides.

What has improved since the last inspection?

The provider has continued to update the fixtures, fittings, furnishings and fabric of the home to improve the quality of the environment for people who live there. The staff team has been developed with new appointments, bringing with them new ideas to further improve care. This means people are supported by people they know and staff are able to work more efficiently. A relative told us that the regular carers were `excellent`. Another person said `the staff are wonderful I cannot praise them enough`. People could tell us who their key worker is by name.

What the care home could do better:

The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. The recording in care plans could be written by staff in a way that shows the resident`s involvement more. The views and wishes of a person in how care is agreed to be delivered could have more emphasis.

Key inspection report Care homes for older people Name: Address: Radbrook Nursing Home Stanhill Road, (Off Bank Farm Road) Radbrook Shrewsbury Shropshire SY3 6AL     The quality rating for this care home is:   three star excellent 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: Pat Scott     Date: 2 3 1 1 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 23 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 23 Information about the care home Name of care home: Address: Radbrook Nursing Home Stanhill Road, (Off Bank Farm Road) Radbrook Shrewsbury Shropshire SY3 6AL 01743237800 01743237813 radbrook@morris-care.co.uk www.morriscare.co.uk Morris & Co Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Susan Austin Type of registration: Number of places registered: care home 43 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 maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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 (OP) 43, Physical disability (PD) 43 Date of last inspection Brief description of the care home Radbrook is one of a group of nursing homes run by Morris Company Care Division. The home is situated on the outskirts of Shrewsbury with local bus services close by. There is access to a garden and car parking is available. Care Homes for Older People Page 4 of 23 Over 65 43 0 0 43 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: three star excellent 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: This was a routine key inspection for Radbrook. This inspection site visit provided an opportunity for us to review the performance of the service and to get a picture of what it is like to live in, or use the service. The service last had a key inspection on 23/11/2006 and two subsequent Annual Service Reviews. Annual service reviews do not include a visit to the service but are an assessment of risk. Our assessment at these times was that Radbrook continued to provide people with an excellent service.. This report also draws on information received from the home in their Annual Quality Assurance Assessment (AQAA), which is a self-assessment process that requires care services to record how well care outcomes for the people living in their service are being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints. What the service has told us about things that have happened in the Care Homes for Older People Page 5 of 23 service which would affect the well being of a person. These are incidents such as, accidents, medication errors, outbreaks of infectious disease and any deaths, these are called notifications and are a legal requirement. We also considered the previous key inspection outcomes and the results of any other visits that we have made to the service in the last 12 months. We reviewed relevant information from other organisations and what other people have told us about the service. In addition to reviewing all this information, we spent four hours at the home talking to people who live there and the staff who work there, as well as looking at records and some areas of the living accommodation. We examined the care provided for four people in detail, and were able to speak to two of them. The manager was available throughout the time to answer any questions. Care Homes for Older People Page 6 of 23 What the care home does well: 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. Care Homes for Older People Page 7 of 23 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 8 of 23 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 fully involved in the decision to move into Radbrook and invited to provide information, that enables staff to support each person, according to their individual preferences and care needs. Evidence: A relative of a resident told us they were happy and well looked after. Pre-admission assessments seen confirmed the manager always went out to assess people before accepting them to see if staff could meet their needs. Two residents whom we spoke with said they had received enough information about the home to help them in their decision to move in. One person said their relative had visited the home and been given a full guided tour. A new resident confirmed that they were receiving the help and support they needed. We were able to see that their needs had been assessed by the manager before offering a place. A further assessment was carried out on admission and a care plan put in place so staff know what they need to do. The assessments are detailed and Care Homes for Older People Page 9 of 23 Evidence: thorough. People are involved in developing their care plans and invited to sign them. Further reviews are carried out after 6 weeks, with the resident, relatives and funding authority, if involved, so people can give their views and make suggestions for changing the care plan if need be. On arrival people are given a welcome pack which provides useful information about what they can expect during their stay including the names of staff, times of meals and visits from hairdressers and chiropodists. Care Homes for Older People Page 10 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the care they receive will be based on their individual needs and support their dignity. People will be supported to have their medicines and there are safe systems in place for people who need help with this area of their lives. Evidence: We observed a very high level of personal care and attention to clothing, nail and hair care that enabled people to maintain their dignity and individual identity. Some one told us their relative was spotlessly clean and fresh when they visited. People spending time in bed because of their frailty, all looked comfortable and well supported with drinks and call bells to hand. Aids to independence and prevention of pressure sores are available and in use. Assessments for the safe and appropriate use of items such as bed rails are in place. People told us that Radbrook felt like home. A resident said we are very spoilt and the staff are all lovely. Two out of four residents who we spoke to told us they always received the care and support they needed. One person said this was usually the case. They all said they Care Homes for Older People Page 11 of 23 Evidence: always received the medical support they needed. A relative told us the nurses are very efficient and always call the doctor when needed. People commented that care was usually delivered at a time convenient to them. Our interviews with staff confirmed their understanding of the key worker, named nurse role in supporting the needs and interests of individual residents. The care plans we looked at were detailed and individual to the person concerned. Sight of reviews provided confirmation that people are involved in planning and reviewing their care. The manager is working with staff to make the recording of information more person centred. The nursing outcomes described in the care plans are linked to current nursing research and staff are provided with clinical training so they keep up to date and practice evidence based nursing. There are good systems in place for ensuring people receive their prescribed medication safely and regular audits are carried out to confirm staff are working to the homes polices and procedures. Staff have a positive approach to promoting the health of the people living at Radbrook. Regular assessments of their nutritional status and weight are carried out. Where needed people are given dietary supplements to boost their intake and immune system. Care Homes for Older People Page 12 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to lead dignified, comfortable and fulfilling lives based on their individual preferences, abilities and choices. People are provided with a choice of meals that they enjoy and maintain their health. Evidence: Details of the activities and events taking place on a daily basis are displayed for people to see. In addition to the one to one and group activities, arranged by the coordinators, trips out and visiting entertainers also provide for leisure opportunities. Coordinators are also trained exercise therapists. A relative told us that staff make an effort to stimulate and entertain residents. People told us the home was very welcoming. We saw that visitors are served with tea and coffee. Some one told us they were encouraged to stay for meals with their spouse. The activity program includes opportunities for relatives to join in with events. The staff have introduced a restaurant evening, where residents invited their families to an evening with a special menu prepared by the Head Chef. The residents dressed for the occasion, were wined and dined in style and enjoyed the company of their relatives. There are regular opportunities for residents and relatives to give their views on how the home is run. Each person living in the home has a plan of care that takes account Care Homes for Older People Page 13 of 23 Evidence: of their individual interests, preferences and life history so activities can be matched to their individual needs. A relative said Radbrook is their home. Friends and relatives are encouraged to visit any time of the day and are made to feel very welcome. Another person said There is a lovely family atmosphere. They keep us very well informed of all aspects. People are offered a choice of meals each day. We could see from our discussions with people that individual arrangements are made for people who need special diets or have particular preferences. One person told us their relatives meal was always beautifully presented on their plate. Care Homes for Older People Page 14 of 23 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. People can be confident that they will be protected and their individual rights supported because there is an open and inclusive atmosphere in the home and staff work in their best interests. Evidence: In several sections of this report we have identified that the manager has a very open approach to listening to residents, relatives and staff and involving them in the running of the home. This means that the home has not received many complaints and we have not been notified of many concerns between our inspections. Information on how to make a complaint is available in the home and copies are available in each persons room to remind them of their rights. One person told us they have peace of mind after each visit knowing their relative is safe and well cared for. The manager has taken on board the implications of the Mental Capacity Act in making sure people act in the best interests of residents and involve them in decisions about their lives. This has included updating the documents available in each persons care plan and providing staff with training. Staff receive training in protecting people from abuse and understand their responsibilities to report any concerns they have. The nurses work under the Nursing & Midwifery Council Code of Conduct. People tell us that they are listened to by the manager. One person told us that the managers door is always open and she is really helpful. A relative told us that Care Homes for Older People Page 15 of 23 Evidence: residents are given plenty of opportunities to express their needs and concerns. Care Homes for Older People Page 16 of 23 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 excellent 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 safe, clean home, which is kept under review by the manager and provider, so they can make improvements where they can, to benefit the people who live there. People can be confident that there are suitable systems in place to provide them with fresh clean laundry and prevent infections spreading. Evidence: All areas of the home we visited were fresh and clean. A relative told us the home was very clean and fresh. People are provided with freshly laundered clothing and bed linen that promotes their dignity. There are good systems in place to reduce the risk of infection. This includes staff, resident and visitor access to liquid soap and paper hand towels. Staff have access to protective clothing and disposable gloves. Care Homes for Older People Page 17 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team that have been selected for their suitability to work with vulnerable people and receive the training and supervision they need to respond to peoples diverse and changing needs. Evidence: People commented positively on the approach of staff. One person said the staff are always pleasant and caring. Two other people said The staff are wonderful. I cannot praise then enough. They work very hard to a very high standard and we feel the staff are very hard working and welcoming. The recruitment records we reviewed showed us that the manager is receiving the required criminal records bureau check and references before staff are employed. There are good records of the recruitment and interview process to show that the correct procedures have been followed. There is a training plan in place to make sure staff receive the regular training they need to stay up to date. Staff are trained in specific areas, according to their role in the home, to enable them to support the needs of older people. Clinical training for the registered nurses to maintain their practice is supported. A recent employee told us about the induction process she had received and subsequent mandatory training. Staff confirmed they are well supported and are able to approach senior staff and the manager. Staff are able to contribute agenda items to influence the regular staff meetings. Care Homes for Older People Page 18 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the services provided at Radbrook because the home is well managed and takes account of their views. There is a genuine commitment to reviewing the quality of the service provided and making sure that the health & safety systems in place to protect people living, working and visiting the home are up to date. Evidence: The manager provides effective leadership and management of the home based on providing good outcomes for the people who live there and involving their relatives. A relative told us there is a genuine commitment from the manager to listen to what people say about the home, ideas are acted upon by taking them to senior management and directors and people are provided with feedback. A member of staff told us the manager of our home is very interested in what the staff have to say. There is a detailed quality assurance program in place that provides the manager and provider with a system of continued review and reflection on the standard of service provided. There are well established systems described in other areas of this report for Care Homes for Older People Page 19 of 23 Evidence: obtaining the views and experiences of people who live, work and visit the home. Residents and their relatives receive feed back from the surveys carried out via meetings or newsletters. The home has a good history of meeting the required standards and providing excellent outcomes for people. The manager who is a registered nurse and experienced manager keeps up to date with current nursing practice to ensure appropriate procedures are followed and any nursing intervention is based on evidence based practice. The self assessment (AQAA) the manager submitted was sent to us on time. The information provides a true reflection of the service and confirms what we found during our visit. It also shows us that the manager works to achieve excellent outcomes for the people living in the home and is open to new opportunities. There are clear systems in place to account for any money deposited and paid out on behalf of residents for example to the hairdresser or chiropodist. There is an annual appraisal system in place to review the work of each member of staff. Staff confirm that they receive regular supervision. The manager has a supervision schedule and says that she links discussions to each persons training and development plan. The training records we saw confirmed that staff receive the health & safety training they need to support safe working practices. These include food hygiene, fire safety, moving and handling and first aid training. Health and safety risk assessments covering the work of the home are in place and kept under review. Records of all accidents are maintained and reviewed by the manager to identify any emerging patterns or risks for individual people. The manager keeps us informed of events in the home, such as accidents and incidents. The range and frequency of notifications have not raised any concerns with us. The manager has provided dates of regular servicing of equipment and systems within the home. Care Homes for Older People Page 20 of 23 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 21 of 23 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 Care Homes for Older People Page 22 of 23 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. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!