CARE HOMES FOR OLDER PEOPLE
Robins Close Nursing Home Middle Green Road Wellington Somerset TA21 9NS Lead Inspector
Shelagh Laver Unannounced Inspection 5th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Robins Close Nursing Home DS0000003284.V341928.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. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Robins Close Nursing Home Address Middle Green Road Wellington Somerset TA21 9NS 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) 01823 662032 01823 665010 robinsclose@majesticare.co.uk Majestic Number One Limited Miss Mathilda Ngomane Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61), Physical disability over 65 years of age of places (61) Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Up to 35 places for elderly persons of either sex, not less than 60 years, who require general nursing care. Up to four persons of either sex, between the age range of 50-59 years, who require general nursing care. To include up to 31 beds for personal care. Registered for a total of 61 places in Categories PD(E) and OP. The manager must commence Registered Managers training within 6 months and achieve a relevant Manager`s qualification by 2005. 29th June 2006 Date of last inspection Brief Description of the Service: Robins Close has been part of Majestic Number One since September 2001. The home offers nursing and residential care. Matilda Ngomane is the manager after being promoted from her post as deputy. The Home is situated in the countryside on the outskirts of Wellington, surrounded by lawn and gardens, which now includes a new level access sensory garden. The home is well presented and has ample parking. The home accommodates up to 61 service users in total. Thirty nursing places are provided. Where nursing is provided the corridors are spacious and wheelchair users can be accommodated. There is a large passenger lift between floors. The facilities for functions and some activities are in the older part of the house previously known as the residential unit. The home has been suitably adapted to provide general nursing care and personal care for an elderly client group. The home is adequately equipped and adjustable beds are provided in the nursing wing. There is a registered nurse on duty at all times. The communal areas have been refurbished and a new kitchen had been installed. The ongoing refurbishment programme has included new carpets having been fitted to some rooms and redecoration of the dining room. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Key inspection was carried out by two inspectors for CSCI over one day. The inspection was supported by the Manager who had returned from maternity leave the day before and staff on duty. Further information to support the inspection was received on 18/07/07. A second short visit was made to the home on the 1/07/08. This was to review the investigation of an issue of concern that had been raised by the South Western Ambulance Service. An Annual Quality Assurance Assessment had been received prior to the inspection completed by the acting manager. The inspectors had an opportunity to discuss this completed document and previous reports with the Manager. A tour of the premises was undertaken. The tour included all communal accommodation and the majority of service users individual rooms. The inspectors met and spoke with service users and staff throughout both days in both communal rooms and in private in their bedrooms. Very positive comments about the care, the staff and home surroundings were heard at this inspection. Lunch was observed in both of the dining rooms. 7 “Have your say” comment forms were received. All confirmed that staff listened to them and acted on what they said. People said that they were “always” (5) or “usually” (2) staff available when they needed them. One comment card stated “I came here for respite care and was going to move to Taunton but the care I received here changed my mind to stay on the residential unit.” Another card said, “I am very satisfied.” There have been three random inspections since the last Key Inspection. As a result of a concern expressed with regard to palliative and care of people with dementia a comprehensive training programme was commenced. The staffing levels of the home has been monitored as at recent inspections people in the home felt that there were insufficient staff. Review of duty rotas indicated that there are sufficient staff on duty. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 6 What the service does well:
Robins Close is able to provide a home for people requiring nursing care and also those requiring personal care only. The home is surrounded by large well-maintained grounds with attractive views. Most rooms have attractive views and service users spoke of their enjoyment of the environment. The home provides a comfortable, clean, well-maintained, well-adapted and safe environment for service users. The majority of service users spoke positively about the catering service although there were some less positive comments. Food seen during the inspection looked and smelled appetising and the choice was evident. The dining rooms are attractively presented. The manager is supported by company senior management to ensure service improvement continues. Five care plans were reviewed and were seen to be detailed and gave clear instructions of the care needs of service users. There was evidence of careful consideration of individual requirements. There was evidence of regular reviews and service users signed when possible to indicate their involvement. One plan contained a detailed life history prepared by the family. There was evidence that some peoples health improved while they were at Robins Close. One person said, “I was very poorly…. I am better now. Staff have been very kind. They get the doctor to you quickly.” All comment cards returned by service users stated that staff listened to them and received the care and support they needed. Service users spoken to during the inspection confirmed that staff were kind and polite to service users. The home has implemented comprehensive and interesting training. There were positive comments from staff about the training provided. Dementia care and palliative care training was praised. “I learnt a lot …” The management of the home are proactive in addressing issues within the home. Concerns raised about the home are addressed by the manager or regional manager. At this inspection a detailed investigation had been taken into the concerns raised by the ambulance service. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Some frail service users observed in their rooms and communal areas in the afternoon were alone for long periods. The home should continue to look at ways in which all staff can be involved in improving social interaction with people. While the manager has been away from the home the formal supervision of staff has lapsed. This needs to be recommenced. During this inspection a concern was expressed regarding the transfer to hospital of very frail people at the end of their lives. Whilst the particular incident was fully investigated by the manager the lack of protocols and procedures in the home were identified.
Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 8 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. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 9 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 Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 10 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): 3 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has information available for service users to make an informed choice. Service users are assessed prior to admission to ensure that care needs can be met and a trial period is offered. Visits to view the home can be made by service users and their families. EVIDENCE: The home has a Statement of Purpose and the updated Service User Guide was seen at inspection. The Service User Guide is given to all service users and copies were seen in bedrooms during the tour of the premises. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 11 Service users who returned comment forms felt that they had been given enough information although sometimes had been assisted by relatives or social workers due to physical frailty. Care plans seen evidenced the pre admission assessment process by the home Manager. One service spoke of a visit from the manager while she had been in hospital. Contractual arrangements for a sample of service users were seen. These included reference to the room to be occupied, terms and conditions. Social service contracts and third party contributions were documented. The current fees for range from £361 to £700 depending on whether the rooms are residential or nursing fees. The home has been adapted for purpose to meet general nursing and residential service user care needs; it has pressure relieving equipment, hoists and assisted bathing facilities. The home also offers respite care. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans seen contained relevant information and demonstrated care assessment. Care being given was in line with the care planned to meet the service users needs. Service users confirmed and were observed to be treated well by staff. There is a safe medication system. The home must ensure that on all occasions people’s wishes are respected with regard to admission to hospital. EVIDENCE: People appeared comfortable and well cared for. There was evidence of daily monitoring, regular fluids and position changes.
Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 13 5 Care plans seen at this inspection were comprehensive and met minimum standards. Care plans reflected changes to people’s condition and had been up-dated and reviewed. Examples of good practice included weekly reviews for one very person. One care plan seen had clear instructions to staff to assist with mental health needs. There are links with the Community Psychiatric Nurses for those who need it. Community nurses visit people in the residential wing. There was evidence that people have regular doctors visits and access specialist clinics. One care plan indicated an allergy to a medication but this was not transferred to the medication chart. The home should review the way in which peoples’ wishes with regard to hospital admission are managed. A concern has been received from the Ambulance Trust following the admission of a frail person to hospital that had expressed a wish not to be sent to hospital. The manager has agreed to implement policies and procedures to ensure peoples wishes are respected. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers a range of activities arranged by a dedicated activities organiser. Some service users would benefit from more social interaction. People can make choices from the menu. Food served looked appetising and was served in comfortable dining rooms or the service users own room. EVIDENCE: People were observed to be able to vary their routines according to choice. One person was having a late breakfast. Others chose to spend time in their rooms or in communal rooms. The home has two activities organisers. There is an activities program that indicated either 1:1 or group activities offered most days. In the written feedback to CSCI comments included “There are some good activities although I do not take part.” And “I am given an activities list each month.” The inspectors were concerned that some people appeared to spend a great deal of time alone in their room and were unable to express any choice about this. Some activities listed included a few able people for example afternoon
Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 15 tea on the Tiverton canal. Other days services for people were listed for example “shopping for residents” or “organising the garden party”. It is recommended that the home reviews the way in which all people spend their time and considers ways in which care staff might ensures some social interaction for people each day. On the day of the inspection a small group of people were painting. A musical afternoon due to start at 2pm started at 3pm because the organiser was doing fire training. Care plans identified previous interests and social contact is recorded for some people. Some people appear to have very little social stimulation. The home is not registered to provide dementia care but continues to care for people whose primary need is nursing care or who have been at the home for some time. One person had activities recorded infrequently in 2006 and nothing at all in 2007. This person was unable to express an opinion and on the day of the inspection was sat alone in the bedroom. Visitors are welcomed, confirming this at the inspection and in writing on the feedback forms to CSCI. Service users also felt that their visitors are made welcome at the home and are offered refreshments. Social care is included in the care planning. The two dining rooms are well decorated and the tables are attractively laid for meal times. Meals were served from hot trolleys and were attractively presented. Staff assisted service users requiring help, discreetly. Overall service users liked the meals in the home. Yoghurt and fresh fruit is available as an alternative dessert at lunchtime. Lunch was seen and consisted of home made main course and dessert. Special diets and individual choices were observed. Cold drinks were available in service users rooms and in the communal rooms. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 16 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 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an up-dated complaints policy in the Service User Guide. Service users are protected from abuse by the homes policies and current recruitment practice. Staff have received training in the protection of vulnerable adults. EVIDENCE: Each service user has a Service User Guide in their room. This contains the complaints policy and information for those wishing to make a complaint. Service users and relatives stated they would know how to complain and would know who to speak to if they were unhappy or worried. The home has a whistle blowing policy to protect staff to enable staff to raise concerns about practice without fear of losing their position. The homes recruitment practice was satisfactory and included CRB, POVA First checks on all employees. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 17 Staff have received training in Protection of Vulnerable Adults most recently on 4/07/07. The manager has demonstrated her knowledge and ability to protect vulnerable adults. There have been two complaints during the past 12 months. Records of appropriate action was noted in the records. CSCI has investigated one of the complaints. All service users responding to the CSCI questionnaire responded to say that they knew how to make a complaint or talk to someone if they were unhappy. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 18 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, tidy and well maintained and appropriately adapted. There is level access around the home and level access around the grounds and garden. Communal and individual accommodation is comfortable and can be personalised. There is on-going investment in the fabric of the home. Action must be taken to address the one room with an odour problem. EVIDENCE: Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 19 The home sits in large grounds and there is a sensory garden with level access. A tour of the premises was made and the home was found to be clean and tidy. Communal rooms are comfortably furnished and arranged to feel homely. There are large screen televisions to make viewing easier. There is an attractive conservatory. Service users bedrooms were personalised and many had their own items of furniture, pictures, photographs and other personal item. There are 35 bedrooms with en suite facilities. Of the 26 residential bedrooms and 2 are below 10sq.m in size. The bedrooms on the residential wing are smaller than the nursing bedrooms. Commodes are available for the bedrooms (if required) where there is no en suite provision. It was identified at the random inspection on 09/05/07 that one room had a serious malodour problem. This was again evident at this inspection and action must be taken. The home has separate sluice facilities for hygiene purposes. Staff hand washing facilities were available through out the home. Aids and adaptations are sufficient to meet the general personal and nursing care needs of the service users at Robins Close. There is a nurse call system throughout the home that is serviced. There are assisted baths. Hot water bath temperature checks are made and the bath water outlet tested at this inspection was within the safe range at 41 degrees Celsius. Pressure relieving and manual handling equipment identified in care plans was seen in use. The home has a fire alarm and detection and fire fighting equipment. The fire risk assessment has been completed. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that there are sufficient staff on duty. The recruitment practice was of a good standard. There is a comprehensive and organised approach to staff training. EVIDENCE: Staff recruitment files were sampled and four were examined in detail. All had been completed in line with NMS 19 and schedule two and included CRB checks and were satisfactory. The home invests in staff training. The inspectors reviewed detailed training records for all staff including domestic staff. New staff received a six- week induction. There is evidence that staff had received Manual Handling up-dates in July 07. Other training sessions listed are raising concerns; Person centred care and Effective Communication. A training plan for 2007 gave details of the Palliative Care/End of Life care training programme undertaken by 11 people. This includes an introduction to the “Liverpool Pathway.”
Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 21 Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 22 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 33 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified and experienced to run the home. The home is well maintained. Records are stored safely. All financial accounts checked were satisfactory. EVIDENCE: The manager had returned from maternity leave the day before the inspection. During her absence two acting managers and the area manager had provided cover for the home. Quality assurance questionnaires are sent to service users annually. The response to the reviews is audited by the manager. Service reviews are held
Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 23 with Somerset Community Directorate twice yearly. The most recent review notes were seen. Service user files were examined and their contractual arrangements were examined. These appeared to be clear and the fees are clearly broken down. Small amounts of personal money can be held for safe keeping, the records of this money were examined and two signatures were seen for all transactions. Receipts are kept for expenditure, the balances are stored safely and access is restricted. Maintenance records were sampled. Fire prevention records were comprehensive and up to date. There is a methodical and efficient system of managing the required servicing contracts and clear records are maintained. The hoists are maintained according to LOLER requirements. Other equipment monitoring seen was satisfactory. The home has arranged an appropriate waste collection contract that includes the movement of pharmaceutical waste. Accident records were observed, there had been no accidents reported under RIDDOR since the last inspection. Employers Liability Insurance was displayed. All records were stored securely and appropriately. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 24 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 25 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 Regulation 12(a) Requirement Timescale for action 01/09/07 2. 2. OP26 16(2) k 15 12(2) OP11 The home must review the amount of time that people unable to make a choice spend alone in their rooms. Appropriate activities must be offered to these people for some of each day. Action must be taken to address 01/09/07 the odour in the one room discussed at inspection. Action must be taken to ensure 01/01/08 that when people have expressed a wish regarding care it is respected. Specifically if a person does not wish to be admitted to hospital these wishes are respected. Appropriate policies and procedures must be developed to protect people making such choices. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 26 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 Supervision meetings of staff should be restarted in line with NMS. Robins Close Nursing Home DS0000003284.V341928.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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