CARE HOMES FOR OLDER PEOPLE
RAFA Respite Home Rothbury House West End Rothbury Morpeth Northumberland NE65 7TU Lead Inspector
Mary Blake Key Unannounced Inspection 10th October 2006 09:30 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 RAFA Respite Home DS0000033419.V295953.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. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service RAFA Respite Home Address Rothbury House West End Rothbury Morpeth Northumberland NE65 7TU 01669 620 235 01669 621600 marilyn.armstrong@rafa.org.uk 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) The Royal Air Forces Association Marilyn Armstrong Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Residents may also have a physical disability (PD) Residents may also suffer from dementia (DE(E)) Residents may also be under the age of 65 Date of last inspection 24th February 2006 Brief Description of the Service: The Royal Air Forces Association and the Royal Air Force Benevolent Fund operate Rothbury House. The service provides respite breaks primarily for ex air force and forces personnel and their families. Guests come from throughout Great Britain and have a wide range of needs. Rothbury House is situated in the centre of Rothbury with easy access to the village and its services. It is registered to provide care for 9 older people, of whom some may have physical disabilities. Couples are able to share facilities within double rooms. All bedrooms are en-suite, with a range of communal lounges, dining room, bar and other areas. There is a shaft lift and a range of aids and adaptations to allow guests to move freely around the building. The extensive gardens and grounds are easily accessible and the home has its own transport. Additional apartments and sheltered accommodation are available but are not part of the registered service and are not included within the inspection process. There is a car park at the front of the building and disabled access to the front door. The home does not provide nursing care, although, if needed, access and support is available from the local medical practice. The fees for the home are currently £370 to £407 per week. The service user guide and latest inspection reports are available within each bedroom. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over one day and involved one inspector. All of the key standards have been assessed during this visit and from other information provided to the Commission. A tour of the premises was carried out. Guests care records, staff records and additional statutory records were examined. The Registered Manager and three staff were spoken to and the inspector met sixteen guests and their families on her visit and spoke privately with four. Six guest questionnaires were received prior to the site visit. These were very positive What the service does well:
Staff were kind and considerate when helping guests. Guests and relatives explained the admission process; this usually includes a visit from a welfare office and a detailed self-assessment process. This helps new guests identify their own needs and enables staff to meet their needs during their short stay. The service gives excellent support to enable individuals to make decisions and participate in the running of the home even though they stay for only short periods of time. Guests said, and it was seen, that staff were kind, considerate and supportive. Guests and their families are fully involved with their care plans. Staff were friendly and relaxed with the inspector and were keen to discuss their work and the guests care needs. The home and staff create a positive atmosphere, which guests commented upon and which is welcoming to families and visitors. “Rothbury House is perfect” The home has strong links with supporting health professionals, who give good health support to guests during their stay. An extensive range of social activities takes place both within and outside of the home and this gives guests the opportunity meet, mix and socialise with others during their stay. The food provided is of a very high standard, with good choice and variety. The dining room is well laid out with good staff attendance enabling guests to have a pleasant and social mealtime. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 6 There is a complaints procedure and in addition guest views are actively sought. Guests felt their views were listened to and acted upon. The home is furnished and decorated to a very high standard and provides comfortable and pleasant surroundings for guests. Individual bedrooms are very well furnished and all are ensuite. The extensive aids and adaptations assist the guests to move freely and independently around and outside of the home. Bathrooms are of a high standard with a number of assisted facilities to enable guests to feel more comfortable and supported to enjoy this time. The communal areas are well decorated and used for a range of social events. The extensive gardens provide opportunity for guests to enjoy the outdoors and are landscaped to provide access for all guests. The home is well staffed with a skilled, consistent and trained staff team giving security to guests. Staff recruitment and training records were clear and concise and contained all relevant information. The vetting process helps protect guests. The staff have a good understanding of guests individual needs. The guests were very complimentary about the staff. For example “they are all very caring and good listeners” “all of the staff were wonderful I had just come out of hospital and they could not do enough for me” More than fifty percent of staff have undertaken National Vocational Training in Care at level Two or above and exceed the minimum standard, ensuring guests receive care from a skilled and knowledgeable staff team. Staff have continued to undertake training and spoke of using this knowledge in their practice. Guests live in a home, which is very well run and managed. What has improved since the last inspection? What they could do better:
To continue to develop their quality assurance and individual risk assessment systems. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 7 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. RAFA Respite Home DS0000033419.V295953.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 RAFA Respite Home DS0000033419.V295953.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): 1,2,3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Rothbury House does not provide intermediate care. Guests have the information they need to make an informed choice before their stay and receive a written agreement. They have their needs assessed and are reassured how these needs will be met. Pre-visits are not always practical due to the national catchment areas for guests, but many guests have regular respite care. EVIDENCE: The welfare officer undertakes pre-admission assessments and where necessary helps guests complete a self-assessment form. This information reflects the needs of the guests. Care plans had good information to ensure that the home can meet the needs of the prospective guest. The Manager is involved in the decisions, prior to their admission.
RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 10 Guests and relatives spoke of their admission “I was asked questions relating to care needs received before coming to the home” “I was aware of format of working practices in the home before applying so knew what to expect” “ I have come here two or three times a year and I wouldn’t go anywhere else since it opened 10 years ago” “ I got information about Rothbury House before I came”. This information helped reduce their anxiety and made the settling in process easier. RAFA Respite Home DS0000033419.V295953.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): 7,8,9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The guests are having their needs met by the staff in the home and the staff are skilled in providing the care in a sensitive and dignified manner. This is shown in the documentation and care plans in place. The guests receive their prescribed medication in line with safe working practices. These systems ensure that guests receive their medication in a safe and appropriate way. EVIDENCE: Three care plans were examined; they were of a good standard, with relevant risk assessments for the prevention of falls, nutrition, moving and assisting, continence promotion. The plans are reviewed and updated on each admission to the home.
RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 12 The care plans showed that the guests have access to all NHS services and facilities if required during their stay. A number of assessment tools are in use. They were reviewed on each admission and were dated and signed by care staff. Daily reporting of guests care was satisfactory with any changing health care of guests being reviewed and up dated. The medicines in the home are well managed and safely disposed. The medicines were stored safely. The controlled drugs procedures were satisfactory. Staff were treating guests with respect and dignity. Personal care was given in privacy. Staff used guests preferred name at all times. Relatives and guests, were very complimentary about the staff in the home and felt that they were able to have privacy in their own rooms “Staff have been caring and thoughtful, helping out whenever needed as well as anticipating needs” “they always gave me my dignity”. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 13 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): 12,13,14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests are satisfied with the flexibility of their routines for daily living and activities. Arrangements for guests to maintain contact with their family and friends and the local community are suited to each individual’s needs and vary accordingly. An extensive range of social activities is in place, which is thoroughly enjoyed by guests and their families. The food served is excellent and the guests are happy with the quality and the quantity. EVIDENCE: Guests were generally happy and enjoyed being able to move freely around the home. Relatives and guests felt that there was an extensive social activities programme both within and outside of the home and this was thoroughly enjoyed by all. There are very strong links with Boulmer Air force Base and the guests spoke about their enjoyment participating in “Battle of Britain” events around the region. The other daily activities that had been provided were varied and thoroughly enjoyed by guests. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 14 The guests are encouraged to go to places in the local area and families are encouraged and supported to take guests out and about. They commented “The support and care we receive here keeps me, a carer at 83 years old, a float!” “It is difficult to express our gratitude and thanks” “Social activities are varied and enjoyable”. Guests take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. All guests said that they are able to make choices about how they spend their day “stay has been enjoyable and restful. Good interaction from most guests” The guests’ bedrooms were personalised during their stay and guests said they were very happy with the decoration and furnishings. Guests have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. The meals served were excellent and all of the guests enjoyed the food, which was well cooked. Staff support was on hand. The tables were nicely set and breakfast and lunch was seen as social occasions. The chef(s) are very much part of the staff team and make themselves available to guests for comments and requests. Guests were extremely positive “There is always an alternative on the menu” “food easily ample, hot and nutritious” “the meals are very good and if you wanted anything else you got it without any problems” RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 15 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): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home ensures guests and relatives aware of the complaints policy by making it available in a variety of places. Complaints are managed satisfactorily and the necessary action taken. Staff had completed training in the Protection of Vulnerable adults and this is necessary to ensure that guests are protected. EVIDENCE: The complaints procedure is displayed in the home and available within each guest bedroom. The records of the complaints made to the home was examined and was satisfactory. Ten of the guests said that they knew problems were dealt with and how this would be done “everyone is approachable” “It has never been necessary here in our experience” “Never had a problem” “I never have any complaints” The Registered Manager stated that staff were aware of the whistle blowing policy and informing the Manager of any incidents or issues of which there are concern. Staff confirmed this. The Registered Manager had completed Protection of Vulnerable Adults training and had dealt appropriately with issues raised. Further staff training is planned.
RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 16 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): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The guests stay in a safe environment. There are good communal areas, bedrooms are ensuite and there are assisted baths and showers. There are a wide range and number of adaptations and aids to assist guests to move freely around the home. The entire home is decorated and furnished to a very high standard. The home is very clean, pleasant and hygienic. EVIDENCE: The location and layout is suitable for the guests who come to stay here. There are lounges and a dining room. These are pleasantly decorated and furnished. Guests were able to use the entire home and there was a range of television and audio equipment available for their use.
RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 17 There are assisted bathrooms and toilets near to all communal areas as well as ensuite facilities in each bedroom. Guests were very positive about the home “A very pleasant atmosphere, rooms, social areas, dining room, outdoor, very smart, clean and nicely laid out for the enjoyment of guests” “my room was always very clean”. The home was extremely clean and has good hygiene practices. The extensive grounds and garden are well maintained, offer beautiful views and are enjoyed by the guests, especially in the warmer months. Several commented upon the colourful displays. The grounds had recently been relandscaped to provide easier access for guests. The building was very well maintained, system testing had been undertaken and maintenance certificates were available. The Manager spoke of future refurbishment of bathrooms to provide overhead transferring equipment and level access shower rooms for easier access. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 18 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): 27,28,29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager ensures there are adequate numbers of staff on duty that have appropriate skills and experience to care for the guests. The recruitment processes in place protect guests. External and internal training takes place and more that fifty percent of staff has completed National Vocational Qualifications in Care Level 2 or above exceeding the standard and providing guests with a skilled, consistent staff team. EVIDENCE: Staffing rotas showed that there are enough staff are on duty to meet the necessary staffing levels. When sickness and staff holidays occur home staff provide cover. There is minimal staff turnover which provides consist care for guests. The home operates with three carers during the day and two waking night staff. Management support is also on hand. Guests made the following comments “The staff cannot do enough to help us” “staff are easily contactable day or night”
RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 19 “We cannot speak highly enough about the quality of the staff here – always so cheerful, efficient and kind”. “The staff are wonderful they could not do enough for me or anyone else” “nothing was too much for the staff” The home closes for one week per year to allow staff to undertake mandatory and other training. During the rest of the year staff undertake, National Vocational Qualifications in Care and other training. This was clarified from the sample of records inspected and discussions with staff. Staff said that they are undertaking or had completed National Vocational Qualification in Care level 2 or over and the home has an induction and training programme for all staff working in the home. Staff spoke knowledgably about the individual needs of guests. There had been minimal staff turnover. Staff recruitment files were examined and were satisfactory. RAFA Respite Home DS0000033419.V295953.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): 31,32,33,35,36,37 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests live in a home, which is well run and managed by an experienced person. The Manager has good systems in place to organise the home taking into account the needs and wishes of the guests. Good quality systems have been established and are being developed. Guest’s financial interests are safeguarded. Progress is being made in staff supervisions. The health, safety and welfare of guests and staff are promoted and protected. RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Registered Manager has completed her Registered Managers Award and the deputy, who oversees care practices, has completed her National Vocational Qualification in Care Level 4. The guests and staff made positive comment about the Registered Manager and staff team; they gave examples of improved practices and of the staff team taking time to listen and respond to any concerns they may have. Regular meetings for guests and relatives are not held due to the nature of their stay. But during their stay each guest is given a questionnaire and actions are taken to address anything from this feedback. Monthly proprietor visits are undertaken with good written reports and any issues addressed. The home has an annual development plan. Other Quality assurance systems have been set up and a policy has been developed. The Registered Manager has delegated some of this quality testing to external consultants, staff and guests. Staff meetings are held for management, carers and ancillary staff and these were documented. Accidents are recorded effectively with accident analyses being completed and risk preventions being undertaken to safeguard guests. Risk assessments in relation to the use of motorised scooters were insufficient and the use of these vehicles was discussed and reviewed in accordance with the homes procedures. The system for checking guest’s monies was satisfactory. Staff supervision records showed a comprehensive process and that the timescales of six per year would be met. System testing had been undertaken and maintenance certificates are available. RAFA Respite Home DS0000033419.V295953.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 4 3 3 3 N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/A 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 4 3 RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard Good Practice Recommendations RAFA Respite Home DS0000033419.V295953.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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
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