Robin Hood House

Robin Hood House is a residential care home providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 23 people.

The home accommodates people over three floors. People had access to various communal areas, such as lounges and dining rooms, where they could spend their time in private or with others. The home had a generous garden and surrounding countryside views which people could enjoy from their bedroom windows.

People’s experience of using this service and what we found

Risk to people were not always fully mitigated. Risk assessments in place were not always completed fully to indicate the level of risk to people’s health or well-being. Guidance for staff was not always in place to help support people safely to manage the medical conditions they lived with. Medicines were not always managed safely. There were not enough staff to keep people safe. Staff were allocated additional tasks like meal preparation which took the support away from people in the communal areas. We found a high number of falls in the home were unwitnessed and in communal areas.

Care records were not always up to date and not completed in enough detail to ensure staff could fully meet people’s needs. Governance systems in place were not always effective in identifying areas in need of improvement. Lessons learnt process was not embedded in daily practice to ensure continuous learning and improvement of care practices.

People and relatives were positive about the staff team and management in the home. People told us they felt safe. However not all safeguarding incidents were reported to the local authority or CQC.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, a detailed record of the least restrictive methods considered for people who had one to one support in place was not kept.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was not rated (published 22 March 2022.). The last rating for this service was good (published 08 August 2020).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about medicines, pressure care, falls and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

The provider developed a service improvement plan following the inspection to ensure they effectively planned the improvement needed. They also increased staffing for day and night shift to ensure the safety of the people in Robin Hood House.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff received Infection Prevention and Control (IPC) training and how to correctly put on and take off their Personal Protective Equipment (PPE). External health professionals were in close contact with the home and delivered refresher training in these areas for staff.

Cleaning schedules were completed by staff and the registered manager checked if areas in the home were clean.

Visitors were informed of the correct process they had to follow when visiting people in the home. The registered manager changed the visiting process in the home following our inspection to ensure there were no restrictions and this was in line with current government guidelines.

People had to have a Covid-19 test before they could move in the home. Staff carried out a rapid test before they started their shift. Visitors had to show a negative test result on arrival or carry out a rapid test at the home.

Robin Hood House is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 23 people.

The home accommodates people over two floors. People had access to various communal areas like lounges and dining rooms where they could spend their time in private or with others. The home had a generous garden and surrounding countryside views which people could enjoy from their bedroom windows.

People’s experience of using this service and what we found

People told us they felt safe at the home. Staff knew how to recognise possible signs of abuse and how to report their concerns internally and to external safeguarding authorities. Risks to people’s well-being were assessed and plans were in place to mitigate these. There were enough staff recruited through robust procedures to meet people’s needs safely. Trained staff safely administered people’s medicines.

Staff felt supported and had training to understand and meet people’s needs according to best practice guidelines. People’s dietary needs were met and if they were at risk of malnutrition health professionals were involved in their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, relatives and health professionals praised staff for their caring attitude. People where possible were involved in their care and if appropriate their relatives supported them with this. Staff demonstrated good knowledge about people’s likes dislikes and preferences.

Care plans were developed for each identified support need people had and regularly reviewed. Activities were provided to people including opportunities of day trips and involving in daily tasks like laundry folding. People and relatives told us they knew how to complain; however, they were happy and had no concerns.

A range of audits were carried out by the registered manager and provider to check on the quality of the service provided. Where needed actions were in place to continuously improve the care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 04 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 07 April 2015 we rated the service Good. At this inspection we found the service remained Good.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were safe and their needs were met by staff. Staff were knowledgeable of people`s needs likes, dislikes and preferences. Staff were aware of safeguarding processes and how to report any concerns to the registered manager or local safeguarding authorities.

Staff and the registered manager were aware of people’s choices and provided people with support in a person centred way.

The provider had a robust recruitment process in place which ensured that qualified and experience staff were employed at the home. Staff received training and support and were aware of their responsibilities when providing care and support to people at the service.

People and their relatives where appropriate were involved in the development and the review of their care and support plans. Support plans were kept electronically and automatically updated. Staff recorded on their hand held devices what support people received daily. People were supported to take decisions about their care and be independent.

People were supported to have sufficient food and drink. People had access to healthcare professionals such as their GP as and when required. People received appropriate support from staff to take their medicines safely.

The registered manager carried out regular audits and surveys to ensure they maintained effective monitoring of the quality of the services they provided.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

We found that the home was meeting all areas.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We found that the people were cared for in relaxed, comfortable environment by caring staff. We observed care and saw that there were sufficient staff on duty to spend one to one time with the people. We saw affection between the staff and the people. There was a homely atmosphere, with the people at the centre of all activities.

Is the service responsive?

We were told by the people who lived in the home that ‘the staff will do anything for you as soon as you ask’. We saw that staff were vigilant at all times and were ready to respond to the wishes and needs of the people. People who were confined to bed or had chosen to stay in their own rooms had regular visits from the staff to ensure they were comfortable and staff told us that they like to have a chat with the person to ensure they were well and see if they needed anything. We were told that calls for assistance were responded to in a timely manner.

Is the service safe?

We saw that there was sufficient, appropriately recruited staff to meet the needs and wishes of the people. We saw that staff were aware of risk management and the balance between promoting independence and keeping people safe. We saw that equipment used to keep people safe had been serviced appropriately. Staff had been trained to recognise and respond to signs and allegations of abuse.

Is the service effective?

We looked at the care plans of four people and found that people or their representative had been involved in establishing what care the person needed and how they wanted it delivered. We saw that care plans gave detailed directions to staff to ensure the care they gave was effective. We saw that people who had long periods of inaction were protected from the risk of pressure areas. People had access to the local community and local shops and where necessary were accompanied by staff.

Is the service well led?

The home was managed in the best interests of the people who live there. Staff told us that the manager was available to them should they need assistance. The manager and the assistant manager supervised the staff while they are delivering care and if there were issues they were addressed before they became a problem. Staff were well trained in all aspects of care delivery.

Staff were supported to deliver care in a relaxed manner and they told us that the manager and assistant manager were available and were very easy to talk to if they had any kind of a problem. All of the staff we spoke with were happy with the care delivery in the home and were very happy working there. There was a very low turnover of staff within the home. This meant that the staff knew the people’s needs and wishes and were able to create a homely atmosphere in the home suited to the people who lived there.

We observed care and saw that the people were very relaxed and that there was good interaction between the staff and the people who lived at Robin Hood House. We saw that the people enjoyed the company of staff and that there was affection and kindness in their interactions. On our arrival at the home we saw that people were in the garden enjoying the sunshine and we could hear the people laughing and engaging in general ‘banter’ with the staff.

We saw that the people's dignity, independence and health had been promoted at all times. An example of this was, one resident who helped out at the home was rewarded for their efforts in a manner that had been agreed.

Food was freshly prepared and the people said that their lunch was very good. The home had systems in place that ensured all aspects of the people’s care had been risk assessed and reviewed regularly.

We saw from how the staff cared for the people that they understood how the person’s dementia affected them and we saw that the staff were able to understand the person’s needs. All aspects of the running of the home had been audited and where there was a problem an action plan had been put in place and implemented to address the issues.