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Inspection on 21/10/08 for Robertson Nursing Home

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

This inspection was carried out on 21st October 2008.

CSCI found this care home to be providing an Good 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

The home provides a good standard of care for the people living there. All the residnets looked well groomed and the residnets who were being nursed in bed appeared comfortable. The home provides sufficient information to prospective residnets in order to enable them to make a choice about moving into the home. Needs assessmnets are in place prior to admission to establish in care needs can be met. These needs form the basis of well written care plans. Activities are provided in the afternoons and an activity coordinator oversees this. The staff recruitment procedures are good and all the necessary checks are in place to protect residnets living in the home. The home is well manager by an experienced manager who has a good understanding of the needs of older people. The health, safety and welfare of the residnets and the staff are observed and promoted.

What has improved since the last inspection?

Since the last inspection the home has changed ownership. The new providers acquired the business in March 2008, and continued to run the home as an ongoing business. The manager was registered in May 2008. She had previously been in post as the deputy manager for eleven years. There is an ongoing programme of maintenance and refurbishment in pace. Rooms are redecorated and the carpet changed if necessary prior to a new residnet moving in. There is a new chef in post and menus are arranged according to need and choice. Staff training and development is ongoing and one of the senior sisters in an NVQ assessor. Activities have increased and more events have been provided for example a visiting farm. A suggestion box has been introduced to get more ideas regarding the type of activity people would like. The requirements made at the last inspection have been met.

What the care home could do better:

The service continues to develop and the new owners are gradually introducing further policies and procedures as required. Contracts of occupancy are in place but not all are retained in the home for information. A recommendation has been made that these documents are kept in the home and a copy provided to the residnet.There is a copy of Surrey`s Safeguarding Vulnerable Adult procedures in the home. It was recommended that the manager attends trainig provided by the local authority regarding these procedures and cascades this to the staff. The home provides adapted bathrooms and facilities to meet the mobility needs of the residnets. Currently there is a Parkre bath on the ground floor out of order. A recommendation was made to follow up the repair status of this in order to provide residnets with sufficient bathing facilities to meet their assessed needs.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Robertson Nursing Home Priorsfield Road Godalming Surrey GU7 2RF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Williamson     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Robertson Nursing Home Priorsfield Road Godalming Surrey GU7 2RF 01483421033 01483428358 slaterj1@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julie Marie Slater Type of registration: Number of places registered: The Robertson Nursing Home Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 41. The registered person may provide the following category/ies: of service only: Care Home with Nursing (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 in any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Robertson Nursing Home has provided nursing care for approximately fifty years. The current providers have owned the home since April 2008. The property is over a hundred years old and has retained a lot of its original character. In the past few decades, extensions have been added, which have provided additional bedrooms and communal space. The property is set in its own grounds and is surrounded by a large mature garden. A range of communal facilities are located through the home which Care Homes for Older People Page 4 of 26 Over 65 0 41 41 0 Brief description of the care home include a sitting room; dining room; library and conservatory. The library provides a quiet room with a range of books. The bedroom accommodation is arranged over two floors, with the provision being mainly single rooms with en-suite toilet facilities. The registered manager oversees the clinical and care practices and takes responsibility for the administration and practical running of the home. The providers visit the home several times a week. The home is able to provide nursing care for up to forty-one older people, 10 of whom may have a diagnosis of dementia. Fees range from £536 to £937 per week. This fee does not include chiropody, hairdressing or newspapers. Additional physiotherapy is available on request at an extra charge. This information was provided on 21/01/2008 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is a two star rating. This means that people living in this home experience good quality outcomes. This was the first site visit of a key inspection and was unannounced. The inspection was undertaken over a period of five hours, by Mary Williamson who is a Regulation Inspector. The Registered Manager Mrs Julie Slater represented the service for the duration of the inspection. A tour of the premises was undertaken and records relating to the care of the residnets and the management of the home were examined. Care Homes for Older People Page 6 of 26 Some of the records seen incluced individual care plans and assessmnets, medication records, menus, activity arrangements, staff training and employment files and health and safety documentation. It was possible to meet most of the residnets throughout the day and to talk to them regarding their experiences about livingin the home. It was also possible to talk with some visiting relatives. The kitchen was visited and the catering arrangements explored. Residnets gave very positive comments regarding the food. It was possible to talk with the staff on duty either in groups or individually. They were all aware of the needs of the residnets in their care and were able to confirm some of the training they had attended. The new providers visited the home during the inspection and it was possible to discuss future pans for the home, and to answer some of their questions regarding CSCI issues. The manager completed an Annual Quality Assurance Assessmnet (AQAA) prior to the inspection which provided us with detailed information about the home. Diverse needs of residnets are supported. The complaints procedure was seen and there have been no complaints since the last inspection. The CSCI would like to thank the residnets, relatives, and staff team for their assistance and hospitality during this ispection process. What the care home does well: What has improved since the last inspection? What they could do better: The service continues to develop and the new owners are gradually introducing further policies and procedures as required. Contracts of occupancy are in place but not all are retained in the home for information. A recommendation has been made that these documents are kept in the home and a copy provided to the residnet. Care Homes for Older People Page 8 of 26 There is a copy of Surreys Safeguarding Vulnerable Adult procedures in the home. It was recommended that the manager attends trainig provided by the local authority regarding these procedures and cascades this to the staff. The home provides adapted bathrooms and facilities to meet the mobility needs of the residnets. Currently there is a Parkre bath on the ground floor out of order. A recommendation was made to follow up the repair status of this in order to provide residnets with sufficient bathing facilities to meet their assessed needs. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 10 of 26 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. Prospective residnets and their relatives have access to sufficient information in order that they can make an informed decision about the home. Contracts of occupancy and needs assessmnets are in place. Evidence: The home has a statement of purpose and service user guide in place. All prospective residets and their relatives have access to a copy of this prior to being admitted to the home. This provides prospective residnets with sufficient information regarding the home to help them to make a choice. A visitor stated that she chose the home as they could meet her relatives diverse needs. A copy of of the service users guide is available in individual bedrooms, and in communal areas. All prospective residnets have a needs assessment undertaken prior to being admitted to the home. These are undertaken by the manager or the qualified nurses in order to Care Homes for Older People Page 11 of 26 Evidence: establish if specific needs can be met. Four needs assessmnets were sampled and are detailed and informative. Contracts of occupancy are in place some of which were seen during the visit. These outline the accommodation offered, the care provided, the fees payable and the method and frequency of these. Some contracts are retained in head offic and the providers agreed that these would be kept in the home for future reference. The home does not provide intermediate care. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are outlined in individual care plans. Appropriate arrangements are in place to meet the health care needs of the residents. Privacy and dignity is observed. Evidence: Individual care plans are in place , four of which were examined in detail during the inspection. These are well written based on the information gathered from the pre admission needs assessment, input from residnets whenever possible, information given by relatives and any other relevant health care professional reports. These are reviewed and audited every month or when needs change. Care plans also include risk assessmnets for example, Waterlow score skin care assessment, manual handling, nutritional assessment and a general health assessmnet. Arrangements are in place to meet the health care needs of residnets. All residnets are registered with a local GP who visits the home every Wednesday or more frequently if necessary. Residnets stated that they liked their GP. There is also access to chiropody, and dental care. The manager stated that she was making alternative arrangements Care Homes for Older People Page 13 of 26 Evidence: for eye tests to combine this with hearing tests. The home provided a wide range of pressure relieving equipment and profile beds to promote best practice. Currently there are no residnets in the home with a pressure sore. It was possible to speek with the physiotherapist who has been working in the home for five years. She gave a positive account of the care provided and the support she recieives form the staff. The home has a medication policy in place. Qualified staff administer medication according to this policy, and The Nursing and Midwifery Councils (NMC) Code of Professional Conduct. Medication is supplied by Boots the Chemist who also undertake audits of medication. The medication recording charts (MAR charts) were seen and are well maintained. All medication entering and leaving the home is recorded in the MAR charts. Currently there are no residnets in the home able to self medicate. Privacy and dignity is observed. Personal care is undertaken in private. Staff address residents respectfully and knock on bedroom doors prior to entering. Locks can be provided on bedroom doors if required. Care Homes for Older People Page 14 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity programme in place meets the individual and collective needs of the residnets. Family links are maintained, and residnets are encouraged to exercise choice whenever possible. The nutritional needs of the residnets are being met. Evidence: The home has an activities programme in place, which is coordinated by an activities coordinator who works in the home three afternoons a week. Some activities include creative art, quiz, interactive word games, bingo, occupational craft, and reminiscence. External entertainers are also incorporated into the programme for example pantomime, bell ringing, music, and a visiting farm. Pupils from the local college choire and local school children also visit the home. Residnets stated that there is plenty to do. Family and frirndship links are maintained. Visitors are encouraged to visit the home at any reasonable time. Relatives are encouraged to attend reviews of care, contribute to the care planning process and attend home functions. Spiritual needs are supported and local clergy visit the home regularly. Holy Communion can be arranged and a monthly church service takes place in the home. Care Homes for Older People Page 15 of 26 Evidence: The nutritional needs of the residnets are met. There is a new chef in post and he is operating a four week menu plan. The food provided is fresh, wholesome and varied. Residents are supported to make a choice regarding the food they choose. Daily menus are provided on each table to remind residnets the food on offer. Lunch was observed being served in a pleasent dining room in a relaxed atmosphere. Staff were seen to offer sensitive support the residnets who required help with feeding. Several residnets made positive comments about the food offered and the lovely home baking. The kitchen is clean and orderly with all the required records in place relating to food safety. All staff have a current certificate in food hygiene. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure and the safeguarding awareness procedure in place protect the residnets living there. Evidence: The home has a complaints procedure in place. This is available to all residnets and their relatives which is included in the service user guide. There is also a copy displayed on the homes notice board. Residnets stated that if they had to make a complaint they would know how to use the procedure. The home maintaines a complaints and compliment log. There have been no complaints noted since the last inspection, however several compliments and thank you cards were sighted. The home has a safeguarding vulnerable adults procedure in place. All staff undertake training in this policy during induction training. During a group discussion with staff they were aware of this procedure. There is also a copy of Surreys Multi Agency Policies and Procedures on Safeguarding Vulnerable Adults in place. During discussion with the manager she agreed to access this training at the earliest convenience. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for its stated purpose. Residents live in a homely, comfortable and safe environment. There is an ongoing maintenance and decoration programme in place. The standard of cleanliness and hygiene is good. Evidence: A tour of the premises was undertaken. The home is high maintenance due to the age and layout of the building. It provides a homely, comfortable and safe environment for residnets to live. Communal space is ample and includes two lounge areas one of which does not have a television. There is a large dining room which is well appointed and overlooks a sun room leading into well established attractive gardens. Individual bedrooms are single with en-suite toilet facilities. Bedrooms have been personalised to reflect individual personalities. Residnets can bring their own furniture and personal belongings with them on admission to the home. Several residnets stated that they are satisfied with their rooms. The home has been adapted to meet the mobility neds of residnets. Assisted bathrooms are available on both floors, although the Parker bath on the ground floor is out of order, and awaiting repair. Toilets have raised seats, and grab rails fitted to meet assessed needs. Hoists are available throughout the home. A call bell system is in place in all rooms, and there is a shaft lift to access the first floor. The laundry is well equipped and suitable fot the required need of the home. Care Homes for Older People Page 18 of 26 Evidence: The standard of cleanliness is good and the home manages odour well. There is a control of infection policy in place and all staff undertake training in this policy. Care Homes for Older People Page 19 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residnets needs are met by the number and skill mix of staff employed in the home. The recruitment procedure in place protects the residnets living there. Evidence: The staff duty rota was seen. The number and skill mix of care staff employed in the home is sufficient to meet the current assessed needs of the residnets. The home also employs ancellary staff including two cleaners, two chefs, a laundry assistsnt, a kitchen assiatant, a physiotherapist and an activities coordinator. Residnets stated that staff are very kind, and relatives stated that the staff team are very caring. The core staff team heve been employed in the home for many years and have considerable experience between them. Indiivdual training and development profiles are in place. All staff undertake induction training coordinated by the home manager. Mandatory training is accessed from outside resources and records retained on file. Distance learning courses have been undertaken through Guildford College. NVQ training is ongoing at level 2 and level 3. One of the qualified nurses employed is an NVQ assessor. The recruitment practice in the home is safe. All staff have a face to face interview. Three staff employment files were seen. These are well maintained and include an Care Homes for Older People Page 20 of 26 Evidence: application form, two written references, an employment history, and a Criminal Records Bureau (CRB) disclosure. Formal staff supervision is also in place. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well managed home that is run in their best interests. The health, safety and welfare of the residnets and the staff are promoted and protected. Evidence: The home is well managed by the registered manager. She is a qualifide nurse with eleven years experience as the deputy manager of the home. She operates an open and inclusive style of management and the staff on duty stated that they felt well supported by the management structure within the home. There are two senior sisters in post, who both undertake management resopnsabilities to support the manager. Systems are in place to monitor quality assurance. The providers undertake regulation 26 visits monthly and reports retained in the home for information. Monthly audits of care plans, medication, health and safety, maintenance, and hygiene are also undertaken and recorded. Questionnaires are distributed to residnets, relatives and other stakeholders for comments and feedback acted upon. Residnets financial interests are safeguarded. No member of staff act as apointee for residnets and Care Homes for Older People Page 22 of 26 Evidence: receipts are kept for all financial transactions. Formal staff supervision is undertaken and recorded on staff files. Health and safety policies and procedures are in place, and staff are made aware of these during induction training. Risk assessmnets are in place for all identified risks to promote the health safety and welfare of residnets and staff and for safe working practice. Fire safety is observed and contracts are in place for the maintenance of fire fighting equipment and emergency lighting. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 It is recommended that a contract of occupancy outlining accommodation, care anf fees are retained in the home for inspection and information. It is recommended that the registered manager attends the local authority training provided regarding safeguarding. It is recommended that the Parker bath on the ground floor is repaired as soon as possible in order to meet the mobility requiremnets of the residnets. 2 3 18 22 Care Homes for Older People Page 25 of 26 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. 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