CARE HOMES FOR OLDER PEOPLE
Robin Hood House Nettledon Road Little Gaddesden Hertfordshire HP4 1PL Lead Inspector
Julia Bradshaw Unannounced Inspection 4/05/2007 10:30 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 Robin Hood House DS0000019512.V336298.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. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 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 Field Care Home 31 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (31) of places Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users with dementia will only be admitted to the ground floor unit. 10th May 2006 Date of last inspection Brief Description of the Service: Part of Robin Hood House is a 16th Century house situated in the village of Little Gaddesden. Ashridge National Trust Estate surrounds it. It is a threestorey house with a single storey extension, which was added in 1996 to add five single rooms. There has been a further increase of five further beds, which have been registered for people with dementia. The home also has one lounge/dining room and a further separate lounge to the front of the house. In the older part of the building bedrooms are provided on three floors serviced by a lift. There is a pleasant patio are overlooking the garden. Information regarding the service is available in the Statement of Purpose and the Service User Guide. These and a copy of the last inspection report are freely available on request. The range of fees for Robin Hood House is between £400 and £580. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 4th May 2007. The registered manager was on duty at the time of the inspection as well as the deputy manager and four care assistants. There was also a chef and domestic providing housekeeping the support. There were 19 service users in the home on the day of the inspection. The inspection was conducted during the early morning through to the late afternoon. Several service users and family members were spoken to during the course of this inspection. General observations were made of the staff their interaction with service users. Written records and care plan files were examined. A full tour of the premises, including the new bedroom and building adaptations was also carried out. The service users appeared well cared for. Their comments about the care and service provided were all positive. Care staff appeared confident and said they felt supported and happy to work in the home What the service does well: What has improved since the last inspection?
Since the last inspection was carried some re-development and improvements to the existing building have been completed resulting in a completely new roof, an increase in bed space from 23 to 31, which includes 7 registered beds for people with Dementia, increased and adapted communal areas and the creation of a new office. Several carpets have been replaced and new soft
Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 6 furnishings and fittings purchased for both the new and existing bedrooms and communal areas. There are some further developments planned, which will include increasing the current occupancy levels and creating a large two-storey extension to the existing building and a new kitchen and laundry room. However these plans are in the early stages of negotiation with both the building surveyors and planning departments of the Local Council. The proprietors have submitted some initial plans to the Commission for their comments. The requirements made at the last inspection have all been met. The hot water temperatures are now maintained within safe limits to protect service users from accidental scalding. The record and administration of medication is good and safeguards the service users. The issues relating to the environment have been rectified and resolved. 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. The summary of this inspection report can be made available in other formats on request. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 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.V336298.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All new service users have their needs fully assessed before entering the home and are able to visit prior to admittance. In this way both the service user and the care staff can be sure that Robin Hood House is suitable to meet their needs. EVIDENCE: The admission notes and the care plan files of the service users examined confirmed that a full assessment was carried out before a prospective service user was admitted into the home. Records of service users examined contained signed copies of the home’s contract and these listed all relevant information, including the room to be occupied. A copy of the home’s Statement of Purpose and Service User’s Guide is not displayed in the reception area of the home. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 9 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 – 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user care plans are in place detailing individual health, personal and social care needs. Health and well – being is constantly monitored and individual progress is recorded. The medication systems are both comprehensive and detailed protecting service users. Service users feel secure in the home and fell that staff treat them with respect and promote their privacy. EVIDENCE: The members of staff were observed to interact very well with the service users and their relatives. The manager and staff should be congratulated in supporting a couple who have recently moved into Robin Hood House and have assisted them in maintaining an important level of independence and have created an environment in which they can maintain their privacy and dignity. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 10 The service users appeared relaxed and content. The inspector took the opportunity of speaking to several of the service users who were all very positive about the care they receive and spoke very positively about the caring and professional attitude of the care staff. They also stated that the manager and deputy have daily contact with all service users in order to discuss any issues they may have and to hopefully resolve these immediately. The care plans examined have detailed accounts of the healthcare and personal needs of the respective service users. It was evident that care plans are maintained and regularly updated. Records of appropriate health checks were seen and good pressure sore monitoring was documented with details of District Nurse involvement. There appears to be a good rapport with the various healthcare and specialist professionals. The service users and their relatives are involved in the plan of care. Service users spoken to confirmed that staff treat them with respect at all times and knock and wait before entering their bedrooms. There are written policies on death and dying and staff said that all possible care is provided for service users and their families at such times. The deputy manager manages the medication systems both effectively and efficiently. There is a clear commitment to ensuring that good practice is maintained to a high level at all times. Staff are inducted into the administration of medication and are assessed by a senior member of staff before being permitted to administer medication. There is currently one person who self medicates and an appropriate risk assessment is in place. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 11 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 –15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current activities programme needs to be further developed and improved to better meet the service users expectations and needs. There is a welcoming and inclusive atmosphere for all visitors. The meals provided are of a high standard. EVIDENCE: The service users are encouraged to exercise choice and control over their lives. The care workers continue to support the activity programme within the home. However several comments from the service users indicated that there are times when they feel “bored” and would like the provision of more meaningful and interesting activities within the home and that they would also like the opportunity of visiting local places of interest in the summer months. The existing arrangement of using care staff to provide activities means that these activities are not guaranteed to take place uninterrupted, as they often may have to leave an activity to assist service users with personal care. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 12 The standard of food preparation and delivery of meals is maintained at an acceptable standard with the service users satisfied and complimentary about the current menus and choice of foods available. Menus are provided on a four weekly basis and the chef endeavours to provide a seasonal choice of foods available. Service users are weighed monthly as standard practice but if there is a specific concern regarding a service users weight then the regularity of weighing a person is increased and investigated. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. There is a complaints process that all service users can access, both formally and informally. Staff have the appropriate training to ensure that service users are protected from abuse. The service users’ legal rights are protected. EVIDENCE: An appropriate written complaints policy is in place. Four complaints have been received since the last inspection took place. One of these has been substantiated and one has been partly substantiated. There are written procedures in place for Safeguarding Adults (Adult Protection) and a Whistle blowing, staff spoken to were aware of both. There are also policies for handling service users’ money, which were checked at previous inspections and were found to be accurate. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 14 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 –26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained and promotes service user safety and comfort. Individual and communal facilities are adequate to meet all service user needs. Improvments have been made to the communal/bedroom and office areas for the benfit of both the people who use the service and staff. EVIDENCE: Robin Hood House is in the process of re-development and improving the current service provided to people living there. Since the last inspection was carried out in May 2006 there has been a change in registration to include 7 new dementia beds on the ground floor of the home. This has created some adaptations to the existing communal accommodation and generally improved the standard of theses areas for all the service users living at the home. The kitchen has been moved and upgraded. The original dining room has been made into a lounge/dining room and a second dining room has been created.
Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 15 Substantial work has taken place in the garden area, including front fencing has been erected, raised flower beds and a patio has been laid in order to make access to the garden area easier for all service users. The service users have chosen new soft furnishings for their bedrooms, which have generally improved the appearance and standard of the environment. Service users bedrooms are well maintained and reflect people’s interests and hobbies. The manager and staff have created a very welcoming and comfortable environment in which people can live safely. Fire safety records were checked and all records seen on the day of the inspection were accurate and up to date. A specific member of staff is responsible for maintaining the health and safety records, this also includes maintaining a record of hot water temperatures. The last environmental health visit took place on the 31/01/07.The most recent fire drill was carried out on the 10/01/07. All electrical equipment was checked on the 9/02/07. The home has access to a handyperson who carries out the day-to-day maintenance duties. The home was clean and tidy on the day of the inspection and no mal odours were present. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 16 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 –30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective and dedicated team of care workers and other supporting staff, who have a good understanding of the health and assessed needs of the service users. The training programme for staff is structured and consistently maintained. The recruitment process is robust, thorough and complies with legislation so to assist to protect vulnerable people. EVIDENCE: All the staff have demonstrated their dedication to their work in caring for the service users. This was further evident by the complimentary remarks received from the service users spoken to during the inspection. One said, “They are all so kind and caring”. Staffing levels are adequate to meet service users needs with 4 care staff on duty throughout the day plus a deputy manager and home manager. There are two waking night care each night. The members of staff present during the inspection confirmed that they are given opportunities to attend external and in-house training programmes. The standard of staff training is high and records showed that all staff are receiving the mandatory training required including, dementia care, medication training,
Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 17 manual handling, safeguarding adults, food hygiene, medication training and employment law. The manager confirmed that currently six staff have obtained NVQ level 2. The company have a clear commitment to providing a high standard of dementia care training to its entire staff. This training is being provided through North Herts College and is a ten-week distance learning Dementia care training course. The senior staff carries out all supervisions. Staff spoken with confirmed that they received regular supervision and that these were recorded and signed by both parties. Appraisals are held annually and last completed in March 2006. The manager stated that these were due for renewal. Staff meetings are held but records indicated that these are not regularly held with the last recorded meeting held on the 21/02/07. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well managed home where the procedures for maintaining records, promoting safety and supervising staff ensure that the welfare of service users is promoted at all times. EVIDENCE: The administration and management of the home are consistently well maintained. The management approach creates an open, positive and inclusive atmosphere. This is further evidenced from the complimentary feedback from the service users and staff. The manager works as part of a team with the deputy manager and those spoken to said that this group works effectively and well. Staff and service users said that they were clear about procedures in the home and that the manager and deputy were approachable and supportive.
Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 19 The senior staff carry out supervisions to all staff. Records showed that the last staff meeting was held was21/02/07. There was a current insurance certificate displayed and is valid until the July 2007. Health and safety standards are well maintained with all fire records up to date. The last weekly fire checks were carried out on the 2/05/07.There is a current fire risk assessment in place dated 30/05/07. Fire equipment checks were last carried out on the 18/04/07. Staff were aware that service users and families could access their records, subject to individual permission and the Data Protection Act. The accident records were well kept, with an overview maintained so that trends could be monitored, and the system complies with the Data Protection Act. The management provides the Commission with details of all significant accidents and incidents and with regular reports from Head Office staff visits. There were no areas of concern regarding service user finances and service users are encouraged to manage their own money or ask relatives to provide this support. There are currently seven service users who have Power of Attorney status and three service users who handle their own money. All invoices are sent out from Benslow Management services head office. There are various systems to audit the quality of the service, including weekly, monthly and annual audits carried out by a representative of the company. The Regulation 26 visits have been carried out regularly since the last inspection and a file in the main office contains each monthly report. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 21 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. 1. Standard OP12 OP14 Regulation 16(2)(n) Timescale for action The current activities programme 31/07/07 needs to be further developed for all its service users and should include specialist activities for people with dementia so that the needs and expectations of service users are met. Requirement 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 OP30 Good Practice Recommendations Staff meetings should be held regularly and the outcomes of the meetings documented. Robin Hood House DS0000019512.V336298.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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