Care Home: Robinson House

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What the care home does well The information that Robinson House provide about their service and the pre-admission assessment process will 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 they need because care planning processes take into account individual`s specific needs. Medications are well managed and so is the care for people who have end of life care 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. 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. 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 managed care home where the best interests of those who live there are kept at the heart of all decision making. What has improved since the last inspection? No requirements were issued following the last inspection. What the care home could do better: Risk assessment processes need to be more robust to protect people from harm. This includes specific risk assessments in respect of individual people and also manual handling risk assessments, for everybody, and risk assessments prior to the use of bed rails. These measures will ensure that risk management strategies are in place and the likelihood of injury is eliminated. The handling of any complaints or concerns people may have regarding the delivery of service has not been consistently well managed. This means that relatives, and people who live in this home may not be listened to, or their concerns acted upon. The staff team must ensure that they safeguard the people they are looking after, at all times. Key inspection report Care homes for older people Name: Address: Robinson House 304 Sturminster Road Stockwood Bristol BS14 8ET     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 2 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Robinson House 304 Sturminster Road Stockwood Bristol BS14 8ET 01275544452 01275544452 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.brunelcare.org.uk Brunelcare Name of registered manager (if applicable) Mrs Sandra Connie Payne Type of registration: Number of places registered: care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 64 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Robinson House is a 64 bedded nursing home owned by Brunelcare, a non-profit 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 Care Homes for Older People Page 4 of 29 Over 65 0 64 64 0 Brief description of the care home 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. The cost of placement in the home is dependent upon assessed need and the home manager will provide details about the weekly charges. 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. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was undertaken in July 2008 and our overall judgement about the quality of the service provided for the people who live in Robinson House Nursing Home was that people received an excellent service. After that inspection we planned to visit again within three years. In the meantime, we have completed an annual service review in 2009 and were assured that the service was still providing good or excellent quality outcomes. We were not due to inspect this service again until 2011 however a number of significant events have led to us visiting the home earlier to check on the quality of the service. These events have highlighted a number of shortfalls and this has affected the overall quality rating of the service. Because this inspection was brought forward we had not asked the home manager to complete an annual quality assurance assessment (AQAA) prior to our visit, neither did we send out survey forms for people who live in the home, relatives, health or social care professionals, or staff members to complete. Care Homes for Older People Page 6 of 29 During this inspection we spoke with the home manager, those staff who were on duty, people who live in the home and relatives. We looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We observed the interactions between the staff and the people who live in the home. We have included evidence in the report regarding a number of issues that have happened since the last inspection. 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. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information that Robinson House provide about their service and the preadmission assessment process will ensure that placement is only offered to those people whose needs can be met. Evidence: The Statement of Purpose and Service User Guide are kept under regular review and updated as and when necessary. They both remain a true reflection of the service, facilities and staffing arrangements in the home. Copies of both documents are kept in the main reception area a long with the last inspection report. We did not send out surveys prior to this inspection, those people spoken with during the inspection said that their relatives had sorted everything out. One set of visitors told us that they had been given plenty of information about the home and chose this one after visiting many others. We are assured that both relatives and people who live in the home are provided with enough information about the home to make an informed choice. Care Homes for Older People Page 10 of 29 Evidence: At the last inspection we were told that 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 fees by the local authority or the primary care trust, a schedule in respect of the fees payable is drawn up between Brunelcare and the relevant party. Prior to any new person being offered a place and moving in to the home, a preadmission assessment will be undertaken. This may take place in the persons own home, another care facility of the hospital ward. This will ensure that that care staff have the necessary skills and qualifications, and the home has any required nursing equipment, in order to meet the specific needs of the person. This assessment may be completed by the home manager or one of the qualified staff who have been delegated. The assessment document is comprehensive and covers all aspects of a persons personal care, healthcare, social, emotional and mental healthcare needs. These measures will ensure that the home is able to meet the persons specific needs. Care plans and health needs assessments are collected from the social worker where the local authority are involved in arranging the placement and part- funding towards the fees. Robinson House currently provides placement for 20 people with dementia care needs and 44 people with general nursing needs. There are plans in the pipeline to increase the number of beds by six, subject to registration with the Care Quality Commission and to have two units, each with 35 beds. This will also involve building works and planning permission is just about to be applied for. These changes have been proposed for a number of years and when in place will provide a much more suitable environment for those people with dementia. Information about these changes are displayed in the reception area and consultation meetings are taking place. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home will receive the care and support they need because care planning processes take into account individuals specific needs. Risk assessment processes need to be more robust to protect people from harm. Medications are well managed and so is the care for people who have end of life care needs. Evidence: Six care plans were examined, two from each of the three units. The plans had been put together based upon the information gained during the assessment of needs process. The plans were person centred, and each provided a clear picture about what the person was able to do for themselves, and those areas where they needed support. The personal hygiene and dressing plan for one person stated is very particular about how he likes things done. Another example of a good plan was one written in respect of a behavioural management plan for a person who resides in the dementia care unit - the plan detailed a consistent approach in dealing with the persons behaviour and we heard on several occasions, the staff adopting this approach. Plans are written in a person centred way, and place emphasis on the skills of the person as well as the assistance they need. After plans are written, they are Care Homes for Older People Page 12 of 29 Evidence: shared with the person and/or their family and agreed as being the way they want to be looked after. Care plans are reviewed on a monthly basis and updated as and when necessary. For those people who have lived in the home for a long time, their care needs are reviewed and a reassessment of care needs completed. New care planning documentation is then prepared. This is good practice. The quality of assessment and care planning continues to be good, but supporting documents need to be improved. Alongside the care planning documentation, risk assessments are completed in respect of likelihood of developing pressure sores, nutrition, falls, and manual handling. These are completed for everyone. We also saw risk assessments that had been completed where specific risks had been identified, for example smoking, or the likelihood of a particular medical event. Since the last inspection, there has been an event where a person sustained injuries because staff, although aware of a particular hazard, had not undertaken a risk assessment. This means that there was no risk reduction management plan. As a result of the investigation that resulted from this incident the home have taken steps to improve their risk management strategies however there is still further work to be done to ensure peoples safety. Under the heath and safety part in the last section of this report we have referred to manual handling risk assessments and safe systems of work, and also risk assessments for the safe use of bed rails. Wound care management plans record how often dressings need to be attended to and what products are used. An account is recorded each time the wound is attended to. We saw that photographs had been taken of the wounds and this is done so that staff can monitor progress. Since the last inspection one family has raised concerns that the management of wounds is lead by the qualified nurses and not the GP. This has been agreed by the GP and staff have received up to date information about wound management. However, in this instance the home did fail to seek medical advice about the wound that had occured. A daily record is kept for each person and evidences how identified needs have been met. The recordings we looked at were detailed and written in an appropriately respectful style. Records are also kept of all contacts with other healthcare professionals such as the GP, psychiatrists, social workers, chiropody, CHC nurses, and physiotherapists for example. We did not look at the medication systems in place during this inspection but did have a cursory look at the medication administration records (MAR charts) on one unit. We saw that hand written entries were double signed, where medications had been discontinued these were clearly crossed through, and an up to date photograph of Care Homes for Older People Page 13 of 29 Evidence: each person was kept along side their charts. We did note however that where people are prescribed to have creams or ointments applied these are not being signed as given. We have been notified of a number of incidents concerning medications but the home has always told us what they have done to prevent a reoccurence. The manager stated that no changes have been made to the management of medications and we have no other evidence to suggest otherwise. We are assured that the home continues to follow safe practices for the receipt, storage, administration and disposal of medications. We saw that official hazard warning signs were displayed where supplies of oxygen are kept. Each unit is responsible for their own medications but controlled drugs are stored in 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 peoples needs. We looked at the paperwork that is used to records clinical decisions made when a person is not for resuscitation. We saw that for one person, relatives wishes had been recorded and the form was not signed by the persons GP, neither was it signed by a representative of the home or dated. For another the form was signed by the GP after consultation with the nursing staff and the family. When appropriate an End of Life Tender Loving Care plan is completed and this records the different actions taken for example medication reviews, wishes regarding family involvement, and contact details. We discussed with the manager how often these TLC plans are reviewed. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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 persons 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 persons life and social history. This ensures that staff will have a better understanding of a persons needs and will be able to treat them as an individual. The home has a designated activities organiser and different activities are arranged throughout the week. Examples include painting, arts and crafts, flower arranging, aromatherapy and hand massage, and music sessions. The home has access to a minibus on a fortnightly basis and up to six people are able to have a trip out from the home. Visitors are welcome at any reasonable time. A group of volunteers also regularly visit Care Homes for Older People Page 15 of 29 Evidence: the home, participate in activities and sit and talk to people. We visit as often as we can and the welcome is always warm, from the staff. Mum is very well looked after. During the course of the inspection, in the main we observed positive and respectful interactions between staff and the people they were looking after. However there were also some negative interactions noted - for example we saw people having their aprons removed after their midday meal and having a flannel wiped around their faces without being told what was going to happen. The conduct of this staff member was discussed with the manager at the end of the inspection who must ensure that at all times, people are treated with respect and dignity. Whilst people are given every opportunity to make choices for themselves, those who are unable to speak out (for example those who are frail, ill or have a dementia) are often left hanging around until staff are ready to assist them. After the main midday meal, a number of people were left sitting in front of empty dining tables, with nothing to do. Meals are prepared in the central kitchens and transferred to each of the units in heated trolleys - they are served out by the care staff from the kitchenettes. There is active encouragement for people to receive their meals in the dining rooms but people can choose to have their meals served in their own bedrooms. Family or friends are able to join their relatives and we saw one relative who was helping their relative to eat their meal. We saw staff providing sensitive and discreet support to eat their meals. Appropriate background music was playing, and everyone was reminded of the choice they had made prior to the meal. 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 for the actual meal. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The handling of any complaints or concerns people may have regarding the delivery of service has not been consistently well managed. This means that relatives, and people who live in this home may not be listened to, or their concerns acted upon. The staff team must ensure that they safeguard the people they are looking after, at all times. 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. 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. One relative said the staff are always really kind and go out of their way to sort out any concerns, we as a family may have. In the last year we have been contacted on three occasions by family members who were concerned about aspects of the care their relatives were receiving. In two of the cases the home advised us of the outcome of their investigations and we were satisfied with the actions taken. The home told us about concerns they had for one person and these were referred to the safeguarding adults team with Bristol Council. In addition, there have been two safeguarding adults investigations undertaken by Bristol Council, in the first instance, the actions taken by the home were appropriate. In the second event, the home failed to act appropriately after the event, did not communicate effectively with family or the GP, and did not take immediate action to Care Homes for Older People Page 17 of 29 Evidence: gather the evidence necessary for an investigation following the event. Brunelcare have a clear policy document named Safeguarding Adults, supported by a clear flow chart that details out the actions the staff must take if an allegation of abuse is made or abuse is suspected. Some staff are overdue their refresher training and this is being arranged. The manager is also due to complete additional safeguarding awareness training. The manager and those staff spoken with during the inspection demonstrated good awareness of safeguarding adult issues and of their responsibilities in protecting people from being harmed, however they must ensure that their actions do not pose any additional risks and where risks are identified then a risk management strategy be deveolped. We have previously referred to this in the health and personal section. Brunelcare have a number of qualified safeguarding trainers who provide a programme of training sessions to the staff team - this has been verified at previous inspections. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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, designed to meet the needs of elderly and disabled people. It was opened approximately 17 years ago and the property has been well maintained since. It is fully accessible and has two shaft lifts up to the first floor. The home is currently arranged has three units, two for general nursing care (Wilberforce and Davey) and the third for those who have dementia nursing care needs (Canynge). Canynge is split between the two floors with ten people on each floor. These are not ideal arrangements but the planned changes will provide an extra 15 beds for people with dementia, and all 35 beds will be on the ground floor. The whole home is well decorated throughout and there is an ongoing programme of redecoration and refurbishment. All areas were light, airy and fresh smelling. Each of the units has at least one lounge/dining room, but there are a number of smaller quiet rooms in the home. Assisted bathrooms and toilets are located throughout the home in sufficient numbers to meet peoples needs. These are in addition to the ensuite facilities of a level shower Care Homes for Older People Page 19 of 29 Evidence: area and toilet. The home has an abundance of nursing equipment to assist the care staff in moving and transferring people from one place to another. This includes hoists, stand aids and sliding sheets. The home has 48 single bedrooms and eight shared rooms - there are shared rooms in each of the three units. All but one of the bedrooms has en-suite facilities. In the shared rooms privacy screening is fitted. Each bedroom is fully furnished but people are encouraged to bring in small items of furniture to make them feel at home. Rooms will be redecorated When they become vacant and then are prepared for new people. The home was clean, tidy and fresh smelling throughout and housekeeping staff were observed working in both communal areas and peoples bedrooms. Those people who we spoke with during the inspection said that the homes was always fresh and clean and one relative said when we visited the home looking for a place for our mother, Robinson House didnt smell and that was a big factor in us choosing the place. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 large staff team of consisting of registered nurses, senior NVQ Level 3 carers and care staff, plus an administrator and ancillary staff who work in the kitchens, laundry and housekeeping. There is minimal use of agency staff and records are kept of the number of care shifts covered by an agency worker each month. This means that people will be cared for by staff who are familiar with their care needs and conversant with the policies of the home. Those staff we spoke with during the inspection were fully aware of the specific care needs of the people they were looking after. Staff told us that they will generally work on one of the three units but can cover shifts in any of the units. Staffing levels are currently arranged as follows - one registered nurse plus four care assistants for each of the general nursing units and one registered nurse plus five carers in the dementia care unit. 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. The number of care staff who have achieved at least an NVQ level 2 qualification in care is currently about 88 - all staff are expected to complete NVQ training. Since Care Homes for Older People Page 21 of 29 Evidence: the last inspection Brunelcare have introduced an extended care role for senior care staff who have attained an NVQ at level 3. One such staff member we spoke with during the inspection has also completed NVQ level 4. We did not look at staff recruitment files on this inspection. We do not have any evidence to suggest that the robust recruitment procedures that the home have previously demonstrated have been changed. The home manager confirmed that the processes are the same - pre-employment checks are always carried out and these include two written references and a full enhanced CRB disclosure. These measures ensure that only suitable staff are employed to work in the home. All new staff will complete an induction - training programme at the start of their employment, to ensure they are aware of the policies and procedures of the home and are competent in all areas of work. This programme includes the mandatory training such as food hygiene, person centred care, manual handling, fire awareness and safeguarding of vulnerable adults. The staff team are able to access a wide range of training courses however we have been told that there has been some slippage in staff training. Some staff members are overdue for mandatory training. There are already processes in place to address this issue. The training matrix shows that infection control and first aid training has already been booked for dates in July 2010. We saw that others are overdue for person centred care training, manual handling and safeguarding of vulnerable adults. At the same time as the inspection visit was taking place a dementia care specialist was in the home undertaking an audit of staff working practices. The information gleened from this exercise will be used to update the person centred care planning training. A number of the senior staff team are also the trainers, for example in manual handling, person centred care, safeguarding awareness and equality and diversity. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robinson House is a well managed care home where the best interests of those who live there are kept at the heart of all decision making. Evidence: The home manager Mrs Sandra Payne is registered with the Care Quality Commission. She is a registered nurse, qualified over 20 years ago and has experience both in NHS work and district nursing care. She has achieved the registered managers award (RMA) and is an A1 assessor for NVQ. She provides good leadership for the staff team, and is supported by a deputy manager and senior qualified nurses. Regular meetings are held with relatives and people who live in the home, most recently this has been in respect of the proposed changes to the environment and building works. Meetings are recorded and copies of the notes are distributed and displayed on various notice boards throughout the home. People spoken with during the course of the inspection, said that they were encouraged to express their views and opinions and that what they have to say is taken account of. Staff are listened to, Care Homes for Older People Page 23 of 29 Evidence: and encouraged to put forward ideas. Audits of various home activities are undertaken by either the manager or a delegated member of staff. Examples of audits completed include any accidents or incidents, pressure sores, wound care, falls and dependency levels of each person These are done on a monthly basis in order to identify any trends occuring, and enables corrective actions to be put in place. Brunelcare undertake an annual Customer Satisfaction Survey and results are analysed and an action plan formulated we did not look at the latest survey as part of this inspection. Brunelcare senior managers visit for monitoring visits on a regular basis, speak to people and staff. We continue to be assured that the home is run with the best interests of those who live there, at the heart of any decision-making. The home holds money for a number of the residents and has the same accounting systems in place to account for all transactions in and out of the accounts. We did not check a sample of the accounts on this inspection. People are able to access any money held on their behalf at any time including the weekends. The home has always had a planned programme of staff supervision for the staff team members. The manager supervises the trained staff and cascades responsibility for the supervision of junior staff members to these staff. We did not look at the records of staff supervision on this inspection but the manager confirmed that this programme is in place. Those staff spoken with during the inspection confirmed that they are regularly supervised. In addition each staff member will have annual appraisal in which their training and development needs are discussed. Information is fed into the homes development and training plan. We continue to be assured that staff 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 were readily produced. This made the inspection a smooth process and further evidences that the home is well run. We did not ask to look at evidence to show that maintenance contracts are up together for all utility services and electrical equipment, and that regular health and safety audits and training are undertaken, but we have no evidence to indicate that the home is not meeting its health and safety responsibilities. We asked the manager to relook at working practices in respect of manual handling practice after we observed two staff members assisting an individual. Whilst the staff were clear that they were not lifting the person with an underarm lift, if the person lost their footing, Care Homes for Older People Page 24 of 29 Evidence: they would need to do so. The home should consider the use of a handling belt in this instance. Manual handling risk assessments are completed for all people and a moving and handling management plan is devised. The sample that we looked at did not always conatin sufficient enough information to provide staff with exact details about how to move the person. A full and robust risk assessment is not undertaken prior to the use of bed rails, neither is consent for their use consistently obtained. These two measures need to be addressed to ensure the continued safety of people and staff members. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that specific risk assessments are completed when hazards or risks have been identified. This is so that a risk management strategy can be devised to reduce or eliminate the risk. 21/07/2010 2 16 22 The registered person must ensure that any complaints or events are handled appropriately. This is so that people can be assured that they are listened to. 21/07/2010 3 18 13 The registered person must ensure that all staff are up to date on safeguarding protocols. This is so that people are safeguarded. 21/09/2010 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 38 13 The registered person must 21/07/2010 ensure that risk assessments are undertaken prior to the use of bed rails. Bed rail use must be consented to. This is so that there use does not pose additional risks. 5 38 13 The registered person must 21/07/2010 ensure that manual handling risk assessments are completed robustly This is so that staff are provided with clear information about how to move and transfer people, Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 11 Recordings should be made when prescribed creams and ointments are administered. End of Life/Do not resiscitate forms must be signed by the Gp making the clinical decision. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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