Inspection on 10/05/06 for Robin Hood House

This inspection was carried out on 10th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Robin Hood House 04/04/07

Robin Hood House 07/11/05

Robin Hood House 07/06/05

Robin Hood House 03/11/04

Robin Hood House 01/09/04

Robin Hood House 21/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Robin Hood House Nettledon Road Little Gaddesden Hertfordshire HP4 1PL Lead Inspector Julia Bradshaw Key Unannounced Inspection 10th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 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. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Robin Hood House Address Nettledon Road Little Gaddesden Hertfordshire HP4 1PL 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) 01442 842759 01442 842759 deborah@benslow.co.uk Benslow Management Company Limited Deborah Ann Porter Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Part of Robin Hood House is a 16th Century house situated in village of Little Gaddesden. It is surrounded by Ashridge National Trust Estate. It is a threestorey house with a single storey extension, which was added in 1996 to add five single rooms. In the older part of the building bedrooms are provided on three floors serviced by a lift. The communal areas consist of two lounges and a dining room. There is a pleasant patio are overlooking the garden. Fees for the service range from £400-£520 per week. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection and was carried out by one inspector over one day. The manager and deputy were unavailable as they were already committed to training day. However the inspection was carried out effectively and efficiently with one of the senior carers on duty. Time was spent talking to service users, staff and visitors to the home. Overall this was a positive inspection with the majority of key standards being met. Some of the paperwork relating to staff employment was unavailable on the day of the inspection as confidential information is locked away and only accessible by the manager. What the service does well: What has improved since the last inspection? The propreiotors, manager and staff strive to improve the environment of this very old building and certain areas of the home have been improved since the last inspection. There is an extensive re-development programme being planned to extend the capacity of the home and to diversify the service currently offered at the home. The first phase of this is currently being implemented with the redevelopment of the kitchen/staff area of the home. Care plans continue to be developed and improved since the last inspection took place. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 7 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 Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Quality in this outcome area is good. This judgement has made using available evidence including a visit to this service. There is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. Staff are provided with the necessary training and support to give them the knowledge and skills that they need to be able to meet the varied care needs of residents. EVIDENCE: Care records of service users were inspected and there was evidence of pre admission assessment of needs being carried out in each case. The home receives a copy of the pre admission assessment of needs of prospective service users for those who are funded by the Social Services and discharge letters from hospital, where applicable. The manager or a senior member of staff would carry out the home’s own pre admission assessment of needs of any referred service user. A comprehensive and holistic pre admission Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 9 assessment of needs which is used to formulate an initial care plan on admission is in place. Staff members were observed to be interacting well with service users; demonstrating good skills and knowledge to meet the specific care needs of the respective residents. Prospective service users are invited to look around the home. Relatives are encouraged to visit the home prior to admission of their next of kin to the home, where possible Care plans were examined and a robust and thorough assessment process was seen to be in place to ensure that only those people whose care needs could be appropriately met were admitted. Staff spoken to were very positive about the standard of training they receive, which includes Adult protection, moving and handling, fire safety, first aid, continence care, health and safety and introduction into Parkinson training. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There is a robust system for the administration of medicine in place and staff are provided with the necessary training to enable them to administer medication safely. However there was one instance where storage of Lactulose was above the recommended temperature for this particular liquid medicine and the controlled medication book needs replacing. All medication that is no longer being used must be dispensed with safely. The standard of care planning is good and residents have access to appropriate community healthcare services. EVIDENCE: Lactulose was being stored at above the recommended temperature of 20°C, which may affect its effectiveness. The manager must ensure that all controlled medication that is not currently being used, is dispensed with safely. On the day of the inspection there was some diazepam that was prescribed for a service user as a “one off” dental treatment that was still being maintained Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 11 in the controlled medication cupboard. This medication must be disposed. The controlled medication book is in poor condition and should be replaced in order to avoid loss of pages. All service users spoken with appeared well cared for and clean. Self-care is promoted where ever possible. Appropriate risk assessments and monitoring charts are in place to ensure an appropriate level of support is offered, including risk assessments for two service users where there is a risk of choking. Specialist medical support and advice is offered within the home to any service users who may require it. All necessary equipment is provided to meet service users needs. Following discussions with service users is was generally felt that the staff are very caring and supportive, encouraging them to make decisions about their lives with appropriate assistance provided. Service users commented that they felt respected at all times. Privacy and dignity was observed being upheld within the home. Service users looked well cared for, and were treated sensitively. One service user commented ‘All the staff are lovely –like Angels”. Information contained in the care plans was comprehensive and reviewed regularly. All service users retain their own G.P.All service users have their personal care needs met within the privacy of their own rooms. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The staff support all service users to maintain family, representative and community links as they wish empowering and encouraging service users to maintain, respect, dignity and personal autonomy over choices in their lives, where possible. Wholesome, adequate, varied meals are provided presenting a well-balanced nutritious diet for all service users supporting them to maintain a healthy life. EVIDENCE: Daily activities are offered and are currently provided by care staff. Residents meetings (last held 29/3/06) do occur and minutes are typed and maintained in the office. If further support and/or advice is required in order to ensure freedom of choice for the service users the home should seek specialist advocacy services in the best interests of the service user. Some relatives and friends visiting residents were spoken to during this inspection visit and all confirmed that their visits are encouraged and facilitated and they all spoke very positively about the home. The home has a Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 13 very welcoming and inclusive atmosphere, which was reflected by both the service users and visitors. Service users spoke very positively about the meals that they receive. Although there is only one choice at the main mealtimes, service users commented on how the cook is very flexible in offering alternative choices to people. The inspector took the opportunity of sampling the mid-day lunch, which proved to be both nourishing and flavoursome. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The complaints policy and procedure together with staff training in the recognition of adult abuse and the correct response if it is suspected should provide confidence in this service for residents, their relatives and those who care for them. EVIDENCE: Staff training in Adult Abuse was last carried out in April 2006.There have been no complaints since the last inspection was carried. The last complaint that was received by the home was in 2005. Staff had a good understanding of adult abuse issues and the appropriate action to take if it were suspected. A robust complaints procedure is in place and those residents and relatives spoken to during this inspection visit confirmed that they felt confident that any complaint or concern raised would be dealt with. “ I can always speak to the manager if I need to.” was the comment of one relative. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 23, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users health and safety is currently compromised. Residents’ rooms are well furnished and can be personalised with familiar items of furniture, pictures and ornaments to reflect the personality and taste of individual residents. Specialist equipment is provided within the home and maintained in satisfactory condition, ensuring that service users needs can be met. EVIDENCE: Generally the environment was in a satisfactory condition with the exception of the temperature of the hot water, which was measured at 48 degrees on the day of the inspection. Also the flooring between the main building and the ‘annex’ was uneven and unsafe and requires urgent attention. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 16 Housekeeping staff were active throughout this inspection visit and the home was very clean with no evidence of unpleasant odour. Visitors and residents were very complimentary about the standard of cleanliness they experienced. Residents’ rooms had a variety of items in them which they had either brought with them or had obtained after admission and this means that each room is slightly different and has a sense of being personal to the particular resident. The home is currently undergoing some re-development, which includes a new kitchen being fitted and alternative staff rooms being created. There are also plans for the home to extend its current capacity and provide a more diverse service including service users who require nursing care. Documentation received as part of the inspection process confirms that the manager is carrying the correct fire safety checks. The fire equipment was last checked on the 4/5/06.The annual fire safety check was carried out on the 21/4/06.The last fire drill was carried out on the 23/8/05. Fire training was last carried out on the 18/4/06. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service EVIDENCE: Residents and relatives spoken with during this inspection visit were very positive and supportive of the quality of the staff team and the care that is provided. “They are very good” was a typical comment. Training records, including a new induction programme in line with the requirements of “Skills for Care”. Recent training includes fire safety training, first aid, an introduction into Parkinson’s and manual handling. There are currently three out of nine care staff trained to NVQ level 2. There are also five care staff who have applied to commence NVQ level 2 training and are awaiting interviews. Staff supervision is carried out and this was confirmed when speaking to three members of staff during the inspection. The supervisor records supervision sessions. However staff do not always take a copy of the notes taken during supervision. It is recommended that this procedure is improved and that both parties take a copy of the supervision notes and sign to say they agree with what has been agreed and written down. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 33 & 36 - 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager and her team provide a clear sense of leadership and purpose and have put in place, together with the proprietor, a robust and effective system of quality assurance to monitor how the home operates. The health and safety of users is currently compromised due to two health and safety issues within the home. EVIDENCE: Staff and residents were very positive about the manager and her team, how open and accessible they were and the atmosphere within the home supported this throughout the inspection visit. The manager and deputy were both away from the home on the day of the inspection attending a training course on the introduction to Parkinsons. However one of the senior carers represented the Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 19 managers in their absence and the inspector would like to thank her for all her help and assistance. Certain records relating to staff recruitment were unable to be inspected due to these documents being secured in the office for confidentiality reasons. However documentation that was required in order to complete the inspection process was sent by the manager to the CSCI office on 15th May 2006 and used to complete this report. The manager and staff carry out a weekly audit sheet regarding health and safety within the home. The manager and cook must ensure that all food that is kept in the fridges has a date of opening displayed. So that good food hygiene practices are followed and safety ensured. The hot water temperatures were checked and found to be unsafe at a reading of 48 degrees. The handyperson agreed to adjust the temperature on the day of the inspection. All health and safety records were up to date. The flooring within the single storey building requires urgent attention. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 20 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 X X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 3 X 2 X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 2 Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4)(a) Requirement The Registered Provide must ensure hot water is delivered at no more than 43 degrees Centigrade. THIS STANDARD HAS NOT BEEN MET AN IMMEDIATE REQUIREMENT HAS BEEN LEFT TO MONITOR AND CORRECT THE WATER TEMPERATURE. 2. OP9 13(2) The manager must ensure that all medication procedures are adhered to. Lactulose syrup must be stored at 20 degrees and the controlled medication book must be replaced. Dates of opening on all non blister pack medication must be recorded. The manager must arrange for the flooring in the corridor to be repaired and made safe for both service users and staff. 11/05/06 Timescale for action 10/05/06 3. OP19 13(4)(a) 12/05/06 Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP36 Good Practice Recommendations It is recommended that supervision notes are given to the supervisee as well as being maintained by the supervisor. Robin Hood House DS0000019512.V293036.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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