Inspection on 10/07/08 for Robinson House

This inspection was carried out on 10th July 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Robinson House 14/07/06

Robinson House 19/01/06

Robinson House 21/06/05

Robinson House 18/10/04

Robinson House 20/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Robinson House 304 Sturminster Road Stockwood Bristol BS14 8ET Lead Inspector Vanessa Carter Unannounced Inspection 09:30 10th & 15th July 2008 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 Robinson House DS0000020334.V365133.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. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Robinson House Address 304 Sturminster Road Stockwood Bristol BS14 8ET 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) 01275 544452 01275 544452 Brunelcare Sandra Connie Payne Care Home 64 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (5), Old age, not falling within any other of places category (44) Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. May accommodate up to 44 Persons aged 65 years and over requiring nursing care in Wilberforce or Davey Unit Up to 5 of these 44 places may be used for persons aged between 50 65 years with nursing care needs May accommodate up to 20 persons with dementia on the Canynge Unit Up to 5 of these 20 places may be used for persons aged between 50 65 years with dementia care needs Staffing notice dated 12/1/01 applies The Registered Manager must be a RN on Parts 1 or 12 of the NMC Register 14th July 2006 Date of last inspection Brief Description of the Service: Robinson House is a 64 bedded nursing home owned by Brunelcare, a nonprofit making charity organisation. The home is situated in the residential area of Stockwood, on the south side of Bristol. Brunelcare have other nursing homes in the Bristol area, namely Saffron Homes in Whitehall and Deerhurst in Kingswood. The home is purpose built and provides both single and double bedrooms, all with ensuite facilities of shower, toilet and wash hand basin. The home is divided into three separate units. Wilberforce and Davey are the nursing units and the third Canynge, is the unit for older people with dementia. The home is well supported by a team of volunteers who have a daily presence in the home. Placement is offered to both males and females, over the age of 65 years; however the Home can take up to 10 people between the ages of 50-65 (five on Canynge and five between the two nursing units). The cost of placement is between £498 - 572, the price dependent upon assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. Prospective residents can be provided with information about the home and this will detail the services and facilities available. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This key inspection was unannounced and took place over two days. A total of 11 hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources:• Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Talking with the Home Manager • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the people who live in the home • A tour of the home • Case Tracking the care of a number of people • Talking with a number of the people who live in the home • Talking with a number of visitors to the home • Looking at some of the homes records • Information supplied in CSCI survey forms, completed by people who live in the home and/or their relatives • Information supplied by healthcare professionals • Information that has been received by CSCI since the last inspection, from the home itself and Adult Community Care Services. What the service does well: Information made available about the home and the admission procedures ensure that placement is only offered to those people whose needs can be met. People who live in this home will receive the care and support that they need, and they will be treated with respect and with dignity. Care planning processes take into account individual’s specific needs. People who live in this home are provided with the opportunity to participate in a range of stimulating activities and are encouraged to make choices about how they spend their time. Meals provided are of a good quality. Relatives and people who live in this home can be assured that any concerns they may have will be listened to and acted upon. People will be cared for by staff who are aware of abuse issues and will safeguard them from any harm. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 6 Robinson House is a well maintained, tidy and odour free environment. It is nicely decorated and is furnished appropriately to meet the needs of the people who live there. The people who live in this home will be cared for by staff who are skilled and competent and able to meet their care needs. There is a real commitment to staff training and to providing a quality service. Robinson House is a well run home, that benefits from strong leadership and keeps the best interests of those who live there at the heart of all decision making. What has improved since the last inspection? 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. Robinson House DS0000020334.V365133.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 Robinson House DS0000020334.V365133.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, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and the admission procedures ensure that placement is only offered to those people whose needs can be met. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated to include the new registered managers details and the qualifications of the staff team. It provides a true reflection of the service, facilities and staffing arrangements in the home. Both relatives and people who live in the home who completed CSCI survey forms, stated that they had been provided with enough information about the home to make an informed choice about moving to the home. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 9 A monthly newsletter is produced, and people are given the opportunity to include items of interest if they wish. The last newsletter was displayed in the main reception and included details about recent events, new staff who had joined the team and any trips out that were planned. Each person is issued with a ‘licence to occupy’ and this sets out the terms and conditions of living at Robinson House. Where people are assisted with their fee’s by the local authority or the primary care trust, a schedule in respect of the fee’s payable is set up with the relevant party. Pre-admission assessments will be completed prior to any new person moving into the home, or being offered a place. This assessment will be done by the home manager or someone competent who has been delegated on her behalf – this may be the deputy manager, one of the lead nurses, or a staff member who is appropriately qualified. The assessment tool is comprehensive and covers all aspects of a person’s personal needs, healthcare, social, emotional and mental healthcare needs. These measures will ensure that the home is able to meet their needs. Care plans and health needs assessments are provided where local authority are involved in arranging the placement and part- funding the placement. People who are in the process of looking for a nursing home and their relatives are encouraged to visit the home prior to taking up residency. One person spoken with during the course of the inspection said “I looked at several homes but when I came here it felt right. We decided this was where I wanted to live”. Robinson House provides placement for 20 people with dementia care needs and 44 people with general nursing needs. The staff team have the appropriate skills and qualifications to meet the needs of these people. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in this home will receive the care and support that they need, and they will be treated with respect and with dignity. Care planning processes take into account individual’s specific needs. EVIDENCE: Six care plans were looked at in detail, two from each of the three units. In addition, other care plans were examined just to check on specific information. Care plans had been drawn up following a thorough assessment of needs, were person-centred, and also provided information about what the person was able to do for themselves. Those areas where they needed assistance were clearly identified, with instructions for the staff in how these needs should be met. The plans have been written in a person centred way, placed greater emphasis on the skills of the person and then what tasks they needed support with. The plans recognise the need to maintain as much independence as possible, the ability to expresses choices and the need to maintain a person’s well-being. After plans are written, they are shared with the person and/or their family and agreed as being the way they want to be looked after. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 11 One of the plans was in the process of being updated to reflect significant changes in the person’s needs – this had been fully completed by the start of the second day and then presented a true reflection of the care and support that was required. People who completed CSCI survey forms said they “always” got the care and support that they needed. Those spoken with during the inspection had the following comments – “I am well looked after”, “the staff are really good at helping me” and “I like it here. Everything is alright”. The care plans are reviewed on a monthly basis and updated as necessary. For those people who have lived in the home for a long time, their care needs are reviewed and a “re-assessment of care needs” completed. New care planning documentation is then prepared. This is good practice. The quality of assessment and care planning continues to exceed the standards expected and is commended. Alongside the care planning documentation, risk assessments are completed in respect of likelihood of developing pressure sores, nutritional needs, the probability of falls, and to identify the risks involved in any manual handling procedures. From the manual handling assessments a safe system of working is devised – these generally gave clear instructions to staff on what equipment was necessary and what they needed to do, but one needed to be made clearer. Wound care management plans refer to the frequency of dressing needed and the products used, also the specialist pressure relieving equipment being used. Every time that the wound is attended to, an evaluation of the wound is recorded. The manager has recently introduced an additional auditing tool so that she can monitor overall progress of wounds – this shows where other healthcare professionals have been involved in that persons care. A daily record is kept for each person and evidences how identified needs have been met. The recordings were informative and the language used was appropriate. Observations of the interaction between the staff and the people they are looking after evidence a great deal of respect and genuine compassion. Staff care for people as individuals, take in to account personal likes and dislikes, are friendly and professional, and attentive. Records are maintained of all contacts with other healthcare professionals and this includes psychiatric services, social workers, chiropody, healthcare funding nurses, and physiotherapists. A physiotherapist visits the home twice a week and staff will refer any person who may benefit from treatment or advice. GP’s are requested on an “as and when required” basis. One GP wrote on a CSCI comment card “I think in general the level of care given is excellent” and stated that they were satisfied with the overall care provided to their patients within the home. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 12 The home follows safe practices for the receipt, storage, administration and disposal of medications. Official hazard warning signs are displayed where supplies of oxygen are kept. Each unit is responsible for their own medication but controlled drugs are securely kept in one unit. Discussions about medication procedures were only undertaken on one unit. The home provides placement for people who need palliative care and who are at the end stages of their illnesses. The registered nurses and care staff have the necessary skills and have received relevant training to ensure they are able to meet people’s needs. A discussion was held with the manager regarding recordings of any clinical decisions made regarding a person’s resuscitation status. By the second day, the manager had had a discussion with the medical centre about how this could be achieved and documentation for recording decisions made had been formatted. This evidences the services commitment to getting things right. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in this home are provided with the opportunity to participate in a range of stimulating activities and are encouraged to make choices about how they spend their time. Meals provided are of a good quality. EVIDENCE: As part of the person centred care- planning process, a person’s preferred time of waking and retiring is identified. They are always asked what name they like to be called and in general people were heard being called by their first name. Information is gathered about the person’s life and social history – the manager stated that they are hoping to be able to create life history books. This means that staff will have a better understanding of a persons needs and will be able to treat them as an individual. The home now has an activities organiser who covers three days a week. There has been a period of time when the home was without an organiser, but the home has been well supported by visitors from the Grateful Society who have long supported the home. Relatives who completed CSCI survey forms made the following comments – “there should be more activities arranged” and “staff should be able to spend more time with people and sit and chat”. One person who liked to remain in his own room said “Thank you coming to speak Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 14 to me I did enjoy our chat. Everyone is always popping in to see me. They are so kind”. People who live in the home who completed CSCI survey forms said there were activities they could take part in – “I like to sing and listen to music. I like the day trips and the flower arranging”, whilst another said “I am not interested in any of the activities”. The manager explained that the result of the homes customer services survey was “relatives wanted more and residents wanted less”. People who were spoken with during the inspection made the following comments “I like to sit and read my newspaper”, “I prefer to spend my time in my room watching my own TV” and “I like to do my knitting and help the girls as much as I can”. People in Canynge unit are able to go out into the garden independently – this is a safe and secure area and the plants have now established and provide a pleasant area to spend some time. There are plans to provide a garden room off from the ground floor lounge in Canynge. This will enable people to enjoy the garden area all year round. Throughout Canynge there are a lot of ‘oldfashioned items’ dotted about, for example typewriters, kitchen utensils, magazines, books, dish clothes and dusters. People are not prevented from moving these things about and are enabled to safely move about as they wish. Different activities are arranged throughout the week and examples include painting, arts and crafts, hand massage, music sessions, and fortnightly minibus trips. There is a move away from organising large events towards smaller group activities or 1:1 work. The day before the inspection The Grateful Society held a party at the home to celebrate 250 years of their charity work and the 15year birthday of Robinson House. People said “we had a lovely time and the food was good. The kitchen did a marvellous spread”. People can choose whether to participate or not and can remain in their own rooms if they so wish. One person said “I take part in some things. When the trips are arranged to a garden centre I like to go along”. They are able to use the charities minibus on alternate Tuesdays, and up to six people have a trip out. The previous week a group went along to the Imperial Shopping Centre. The next trip has been arranged to a garden centre. The local church now visit the home on a monthly basis and conduct a short communion service in the chapel room in Davey unit. In one person’s plan it stated “religion is very important to me”, but when asked if they had been along to a service they were unable to respond appropriately. Staff said they had offered to take him along but this had been declined. Visitors are welcome at any reasonable time. A group of volunteers also regularly visit the home, participate in activities and sit and talk to people. It was evident throughout the inspection that people are given every opportunity to make choices for themselves. For example they were asked whether they wanted tea of coffee after their midday meal, or a cold drink, and when they wanted to return to their rooms for an afternoon rest. If people do not want to get up until later during the day, their wishes are respected and Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 15 their plan of care is delivered accordingly. This may include providing meals at times other than breakfast, dinner and tea. Meals are prepared in the central kitchens and are transferred to each unit in heated trolleys. The midday meal on the first day of the inspection was either a minted lamb casserole with potatoes and green beans, or a vegetarian potato and leek bake. This was followed by ice cream or rhubarb crumble and custard. Meal times are considered to be sociable occasions - family or friends are able to join their relatives and one person said “I come for dinner regularly and help feed my relative”. Care staff will also join the people and eat their main meals in the unit dining rooms. Staff were observed to be sensitively encouraging some people to eat their meals, whilst others were providing full assistance with feeding. Observations were made during the midday meal on Wilberforce. Appropriate background music was playing, and everyone was reminded of the choice they had made prior to the meal. One person decided that they preferred the other option and this request was met. The meals were attractively presented, and served by the care staff. Mid afternoon, tea and cakes are served. There is a six-week rolling menu and a varied and well balanced diet is provided. Those who live in Canynge are offered a visual choice each mealtime – they can therefore choose what they want to eat at that moment. Robinson House DS0000020334.V365133.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and people who live in this home can be assured that any concerns they may have will be listened to and acted upon. People will be cared for by staff who are aware of abuse issues and will safeguard them from any harm. EVIDENCE: The complaints procedure is contained within the statement of purpose, the “Welcome to Robinson House” brochure and is also displayed in the main reception area. Relatives and people who live in the home who completed CSCI survey forms said that they “knew how to make a complaint and who to speak to”. One person commented “if issues are raised they are acted upon immediately”. A relative wrote “the manager took some concerns I had very seriously and took the appropriate action. I was more than satisfied”. People spoken with during the inspection said that the staff were always helpful and that they felt able to raise concerns and approach the management team. Since the last inspection two complaints have been referred to both adult community care (social services) and CSCI, by relatives. In both cases the issues raised have been fully investigated and an action plan put together to resolve issues, demonstrating that the people who live in the home, their families and other representatives will be listened to if they are unhappy about any aspect of the service they receive. Brunelcare have a clear policy document named Abuse of Older People, supported by a clear flow chart that details out the actions the staff must take Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 17 if an allegation of abuse is made or abuse is suspected. This has been checked at previous inspections and is in line with locally agreed protocols. Staff spoken to demonstrated good awareness of adult abuse matters and of their responsibilities in protecting the people they look after from any form of abuse. Brunelcare have a number of qualified trainers in adult abuse awareness, and a programme of training sessions are included in the organisation’s annual training plan. This subject is also covered in the induction-training period for new recruits. Staff spoken with confirmed these arrangements. Robinson House DS0000020334.V365133.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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robinson House is a well maintained, tidy and odour free environment. It is nicely decorated and is furnished appropriately to meet the needs of the people who live there. EVIDENCE: Robinson House is a purpose built care home and is designed to meet the needs of elderly and disabled residents. It was opened 15 years ago and the property has been well maintained. It is fully accessible and has two shaft lifts up to the first floor. The home has three separate units, two for general nursing (Wilberforce and Davey) and the third for those who have dementia nursing care needs (Canynge). Canynge is split between the two floors and each part is able to accommodate up to ten people. The whole home is well decorated and there is an ongoing programme of redecoration. All areas were light and airy. Particular attention has been made to the wall colourings in the long corridors in Canynge – different shades Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 19 have been used to break up the length, this simple method is very effective in achieving this. Each of the units has at least one lounge and dining room, but smaller “quiet” rooms have been made on the upper floor in Canynge and in Wilberforce. Assisted bathroom and toilets are located throughout the home in sufficient numbers to meet people’s needs. In addition en-suite facilities have level access shower room and toilets. There is an abundance of nursing equipment to assist the care staff in moving and transferring people – these items were seen to be appropriately stored and did not hinder those people who were walking around the home. The home has 48 single bedrooms and eight shared rooms – there are three shared rooms in Wilberforce, three in Davey and two in Canynge. All but one bedroom has en-suite facilities. In the shared rooms privacy screening is fitted. Each bedroom is fully furnished – people are encouraged to bring in small items of furniture to make them “feel at home”. When rooms are being prepared for new people, they are asked to choose what colour they would like their room decorated. The home has a dedicated team of housekeeping staff who were observed meticulously cleaning in both communal areas and people’s bedrooms. Although a significant number of people have problems with continence, there were no residual smells “we pay particular attention to those areas and don’t allow soiling to become ingrained”. The home was fresh smelling and clean throughout, on both inspection days. People who live in the home who completed the CSCI survey forms said that the homes was always fresh and clean and relatives made the following comments “the home is always clean”, “my relatives room is cleaned every day” and “the domestic staff should be proud of the job they do”. In between each of the units, alcohol gel units are fixed on the wall, preventative measures to stop the spread of any infection. Robinson House DS0000020334.V365133.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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who live in this home will be cared for by staff who are skilled and competent and able to meet their care needs. There is a real commitment to staff training and to providing a quality service. EVIDENCE: The home has a staff team of 77, consisting of registered nurses, senior carers and care staff, an administrative worker and ancillary staff who work in the kitchens, laundry, housekeeping and an ‘handyman’. There has been very little staff turnover since the last inspection “I really enjoy working here and have no desire to work elsewhere”. The homes records show that only minimal use of agency is made, with at the most only a couple of shifts per month covered by an agency worker. There is currently only one registered nurse vacancy but this has been filled and pre-employment checks are being undertaken. These measures ensure that people are cared for by staff who are familiar with their care needs and conversant with the policies of the home. Discussions with staff during the course of the inspection evidenced their awareness of each persons specific care needs. Each of the units will be staffed with one registered nurse plus three or four care assistants each morning – the staffing levels are arranged according to the dependency levels of the people on the unit and would be adjusted to take account of any changing needs. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 21 Staff will always receive an in-depth handover report at the start of each shift and are told about any changes that have occurred with the people they are to look after. Each unit has a team of “core staff” who will always work on that unit plus others who move between the three units. The percentage of care staff who are have achieved at least a NVQ level 2 qualification is approximately 80 and this shows a commitment of Brunelcare to provide a quality care service of the people who live in the home. This is commendable. One staff member who had been working at the home for eight months was expecting to start the NVQ 2 in September. Other staff spoken to had completed NVQ level 2 and NVQ level 3. Some senior carers are also working towards level 4. A sample of six staff recruitment records were examined and evidenced that the home follows a robust recruitment procedure. This will ensure that the right people are employed to work at the home, and the people who live in the home will be safeguarded. Pre-employment checks are always carried out. Two written references and a full enhanced CRB disclosure will be obtained before employment starts. All new staff will complete a ‘corporate’ induction- training programme at the start of their employment, this will be before they start work at the home. This ensures they are aware of the policies and procedures of the home and are competent in all areas of work. This programme will include the mandatory training such as food hygiene, person centred care, manual handling, fire and abuse awareness. The staff team are able to access a wide range of training courses, and the courses available for 2008 are posted on the staff notice-board. These include specific clinical updates, equality and diversity, person centred planning, health and safety, mandatory updates and various management courses. Staff spoken with during the inspection were very positive about the training opportunities they are able to access. The training matrix evidenced that staff uptake for the training is good. The manager is able to maintain an overview of who has done what and ensures that all mandatory training is at least completed. All this training is in addition to the NVQ training programme. A number of the senior staff team are also the trainers, for example in manual handling, person centred care, abuse awareness and equality and diversity. Because there is such a commitment to training, the quality of the care service is high. Robinson House DS0000020334.V365133.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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Robinson House is a well run home, that benefits from strong leadership and keeps the best interests of those who live there at the heart of all decision making. EVIDENCE: Since the last inspection there has been a change in home manager and Mrs Sandra Payne is now the manager who is registered with the Commission for Social Care Inspection. She is a registered nurse, qualified 20 years ago and has experience both in NHS work and district nursing care. She has already achieved the registered managers award and is an A1 assessor for NVQ. She provides strong leadership for the staff team, and is supported by a deputy manager and three senior qualified nurses. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 23 ‘Resident and relative’ meetings are held on a monthly basis. The meetings are recorded and copies of the notes are distributed and displayed on various notice boards throughout the home. The catering manager will attend these and this means that people can feedback directly, their views about the menus. They are actively encouraged to make suggestions about what meals they would like. “I told the cook that we want more salads and now I can have one every day if I want”. People spoken to during the course of the inspection, said that they were encouraged to express their opinions and would be listened to. Staff spoken to spoke enthusiastically about working at Robinson House, and stated that they were listened to, and encouraged to put forward ideas. The manager or a delegated staff member completes audits of various home activities. These are done on a monthly basis in order to identify ‘trends’, and any possible corrective actions. Falls and wound care are examples of monthly audits. Any other incidents/accidents and numbers of deaths are also monitored. Brunelcare undertake an annual Customer Satisfaction Survey and the results are analysed and an action plan formulated. A brief summary of the results will be reported in the monthly newsletter. In addition an “external” survey is carried out and this is already planned for the end of the year. The manager talked about the results of the last survey and what they had done about the suggestions made. This all evidences that the home is run with the best interests of those who live there, at the heart of decision-making. Brunelcare senior managers visit for monitoring visits on a regular basis, speak to people and staff. After a person has been admitted to the home they are offered the chance of completing a short questionnaire about their experience of moving in to the home and whether their expectations have been met. The home holds money for a number of the residents and has good accounting systems in place to account for all transactions in and out of the accounts. People are able to access any money held on their behalf at any time including the weekends. The home has a planned programme of staff supervision for all staff members. The manager supervises the trained staff and cascades responsibility for the supervision of junior staff members to these staff. The records of staff supervision evidenced that the staff are generally supervised on at least a six times per year basis, but there has been some slippage recently. This is already being rectified and staff spoken with confirmed that they are regularly supervised. Staff have all had an annual appraisal in which their training and development needs are identified – these have been completed for the whole staff team. This information is fed into the homes development and training plan. Discussions with staff evidenced that they are well supported by Brunelcare to develop their skills and reach their full potential. The homes records were all in order. There are good administrative systems in place, which means that all records that were asked for during the inspection Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 24 were readily produced. This made the inspection a smooth process and further evidences that the home is well run. Maintenance contracts are in place for all utility services and electrical equipment – all were up to date. Any repairs or maintenance tasks are undertaken by the Brunelcare maintenance team – they visit the home on a regular basis and as required. Health and safety audits are undertaken on a regular basis and staff training is available on health and safety issues. Safe working practices in respects of manual handling were observed during the course of the inspection. Manual handling risk assessments are completed for all people. A moving and handling management plan is devised – some needed minor adjustment and this was discussed with the manager. The fire log evidenced that staff have had fire training in February or March of this year. Regular fire drills are undertaken for both night and day staff, at the recommended intervals. Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 3 3 Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Robinson House DS0000020334.V365133.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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