CARE HOMES FOR OLDER PEOPLE
Robin Hood House Nettledon Road Little Gaddesden Hertfordshire HP4 1PL Lead Inspector
Marian Byrne Unannounced 7th June 2005 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 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 I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Robin Hood House Address Nettledon Road, Little Gaddesden, Hertfordshire, HP4 1PL Telephone number Fax number Email 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 Benslow Management Company Limited Deborah Ann Porter Care Home, PC Care Home only 23 Category(ies) of OP Old Age - 23 registration, with number of places Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration. Date of last inspection 03/11/04 Brief Description of the Service: Part of Robin Hood House is a 16th Century house situtated in village of Little Gaddesden. It is surrounded by Ashridge National Trust Estate. It is a three storey 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. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a positive inspection. The inspection was carried out on the 7th June 2005. It was conducted in the morning and afternoon by two inspectors. The home continues to make good progress. The service users declared themselves satisfied with the service and were happy with the care they got and very complementary about the staff who delivered the service. There was a steady stream of visitors to the home during the inspection. The day of the inspection was a sunny day and the service users were enjoying being outside on the patio. Pathways have been laid in the garden to facilitate the service users who may want to take a walk. The new lay out of the home – changing the site of the dining room - is working well. The Statement of Purpose was reviewed in December 2004. All service users and their families/representatives are given a copy. What the service does well: What has improved since the last inspection?
The home had a problem employing weekend housekeeping staff which resulted in a less than acceptable standard of cleanliness. This has been resolved. On the day of the inspection the home was clean and fresh. New paths have been laid in the garden to facilitate the service users’ enjoyment of the very beautiful countryside surrounding the home. New policy on death and
Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 6 dying has been introduced. The manager and senior staff had recently completed training on adult protection. The home has introduced new keypads on outer doors eliminating the need for the very loud alarm previously used. The manager has introduced a very good system to ensure accountability for all monies spent on behalf of service users. The system is transparent and easy to understand. 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 I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5 Service users have the appropriate information to make an informed choice about the home. They are offered a trial period in which to decide if they have chosen the most suitable home for themselves or their relative. Good assessments had been carried out on the suitability of the home for the service user. EVIDENCE: The home reviewed its Statement of Purpose and Service Users Guide in December 2004. All service users and their families/representatives are given copies. This ensures the service users know what to expect from the service. Three service users files were inspected and they contained assessments of service users needs. Service users and their families are welcome to visit the home to assess it. Service users may visit at any time prior to admission and spend a day in the home. Many service users had used the home for respite care prior to admission. All service users have a review at six weeks to assess the suitability of the home t meet their needs. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11, In the main all these standards were met. Care plans contained good information on service users. Service users were treated with respect and their dignity was preserved. The home wishes where possible to offer a home for life to all service users. The home needs to take more care with the recording of administration of medication. EVIDENCE: Three care plans were inspected and they reflected the needs of the service users. They contained good information and are reviewed regularly to ensure optimum care. Service users have their health care needs met through the use of community health care services. All service users where possible retain their own GP. If that’s not possible the home acquaints them with the local GP practices where they can make a choice about the GP they want to attend them. All service users have their health and social care needs met in the privacy of their own rooms. The home must take more care when recording the administration of medicines. There were gaps in the recording charts and where medicines were possibly refused. If medicines are refused the reason if known, must be recorded as there may be a need for a GP referral to review the service users’ medication. All controlled drugs were well recorded and an audit showed that the records were reconciled with the drugs in the home. The
Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 10 home has written a new policy on death and dying. This shows the home’s wish to make the passing of life as compassionate as possible and support the wishes of service users and their families. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The day to day life at Robin Hood House is very relaxed. Visitors are encouraged to visit at reasonable times but may visit at any time. Service users chose their own routine as to rising and going to bed. Breakfast and supper may be taken at any time to suit. Good quality fresh food is taken in pleasing surroundings. EVIDENCE: Service users reported that they were happy with the routines at Robin Hood House. One service user does her own ironing and has tea making facilities in her room. The home is in the countryside and could be isolated, however, the service users take regular trips out to the local town. Children from the local school visit on festive occasions. There is a steady stream of visitors to the home. The food on the day of the inspection was of good quality and where tasted was found to have a good flavour. The service users declared themselves happy with the quality of the food. The menu is on display in the home. Service users were surveyed and asked for their favourite food. Efforts will be made to include these on future menus. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 12 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 standard(s) These standards were not inspected. EVIDENCE: While these standards were not inspected staff showed an awareness of the Whistle Blowing Policy. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19,23,25,26. The environment of Robin Hood House is homely, safe and welcoming. Service users have personalised their rooms. In the main the home is well maintained with extensive gardens. The home was clean and odour free and nicely decorated. Service users safety must be assured by putting protective covers on radiators. EVIDENCE: Robin Hood House is welcoming and homely. In the main it is well maintained. Paths have been laid in the garden to facilitate those service users whose mobility does not allow them to roam freely thus opening up the gardens to all service users. All service users rooms had been personalised to reflect the personality of the service users. Radiators must be covered to protect the service users from injuring themselves on the hot surfaces. The home was clean and hygienic on the day of the inspection. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29. The home now has a core of dedicated staff. The home has good recruitment practices. Staff are undergoing appropriate training. Care must be taken with moving and handling. EVIDENCE: The home has a core of well trained staff. All staff are willing to undertake an National Vocational Qualification in care (NVQ). Three members of staff have completed NVQ2 and five more are currently undertaking NVQ. Four are working towards NVQ2 and one member of staff is working towards an NVQ3. All service users have a key worker. This is being reviewed as some key workers are night staff. This may prohibit a good working relationship building up. Three recruitment files were inspected. They all contained the appropriate identity and security checks including two written references and a Criminal Records Bureau check. Recent training included the protection of vulnerable adults (POVA) . The need to review moving and handling training was evident in the attitude some staff showed to service users. One staff member was observed to lead a service user out to the patio by leading her by the hand. This was judged not to be age appropriate and could impact on the dignity of the service user. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,38. The home is run in the best interests of the service users in an open and transparent way. Excellent records are kept of all service users’ financial transactions. Risk assessments must be done on the safekeeping of ‘Steredent’ dental cleaner. Fire doors where automatic closures are fitted close effectively. EVIDENCE: Since the last inspection was carried out the Manager of the Home has been registered by this Commission. The appointment and registration of a manager has brought stability to the home. The service users informed the inspector that she is approachable and easy to talk to. One service user described her as a ‘sweetie’. She is planning to start her NVQ4 management course in September 2005.The home has worked hard to meet the requirements of the last inspection and in the main has succeeded. Care must be taken with the administration of medication. The manager has introduced a transparent
Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 16 procedure for the recording of service users’ monies. Service users are consulted on all aspects of running the home via service users meetings and a quality monitoring system. The safety of service users must be preserved by ensuring that the automatic closures fixed to fire doors will close in the event of fire. The uneven floors in the older part of the home prevents this at the moment. Hot water should be delivered at a temperature of no more than 43 degrees Centigrade. Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 N/A N/A N/A 3 N/A 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A 3 3 3 N/A 3 N/A N/A 2 Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 18 Are there any outstanding requirements from the last inspection? 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 19 Regulation 23(4)(a) Requirement The Registered Provider must ensure that automatic door closures perform the function they were installed to do The Registered manager must safeguard the service user by ensuring that all substances covered by COSHH are stored appopriately. The Registered Provide rmust ensure hot water is delivered at no more than 43 degrees Centigrade. The Registered Manager must ensure that all staff are appropriately trained in the administration of medication and the moving and handling of service users. Timescale for action Immediate 2. 38 13(4)(a) Immediate 3. 38 13(4)(a) Immediate 4. 30 18(c )(i) Immediate 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.
Robin Hood House I52 S19512 Robin Hood House V225426 070605 Stage 4.doc Version 1.30 Page 19 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection 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
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