Robinson House is a care home with nursing for up to 70 people, many of whom are living with dementia. The home is split in to four houses, Blaise, Dundry, Clifton and Ashton.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in place. 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.

At our last inspection in March 2015, although the service was good overall, a breach of regulations relating to medicines was found. At this inspection we found that improvements had been made and the service was meeting the regulation. A new electronic system for administering medicines had been introduced and was in the process of being spread to all areas within the home. Since our last inspection, staff reported they had received medicines training to refresh their skills. Processes for administering covert medicines had been improved.

People reported feeling safe living in the home. Staff were trained in safeguarding vulnerable adults and confident about reporting any concerns they had. There were sufficient numbers of staff available to ensure people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where people lacked capacity to make decisions, the principles of the Mental Capacity Act were followed in making decisions in their best interests.

Staff received good support and training to carry out their roles effectively. New staff to the home completed the Care Certificate. This is a nationally recognised set of standards that staff in the care sector are expected to meet. Staff were supervised regularly so that their performance and development needs were monitored.

People were supported by kind and caring staff. Staff were respectful in their interaction and told us about the ways in which they supported people’s independence. The views of people and their relatives were taken in to consideration when making decisions about their care. Relatives were made welcome in to the home and able to visit as they wished.

Care was responsive and met people’s individual needs. Staff were knowledgeable about the people they supported. There were person centred care plans in place to guide staff in how people wanted to be supported. People could be assured their complaints and concerns would be listened to and action taken to resolve them.

The home was well led. Staff were positive about working in the home and felt that communication was good. There were systems in place to monitor the quality and safety of the service provided.

Further information is in the detailed findings below

We undertook this inspection visit in response to concerns raised about the care and welfare of people who lived at Robinson House Care Home. These concerns related to the care and welfare of the people who used the service, staff understanding of the needs of people living with dementia, suitability of staffing levels and training and supervision.

We spent time observing people and staff in the lounges to help us understand better the experiences of care. Some people were unable to talk to us due to their complex needs.

We also spoke with 10 people about what they thought of the care that was provided by the staff. People responded positively when asked about their care. Most people we spoke with told us that they thought the care was good. One person told us "I am happy here" another said “the staff are good to me no complaints".

Care records seen were up-to-date to support staff to manage risks and to deliver care to people. We saw that people had their preferences and choices respected and their health and wellbeing needs met. This meant the service could be confident that care had been delivered in a consistent manner.

We saw that staffing levels on the day of our visit met the care needs of people who lived there.

We saw that staff were trained and supported to provide care to people who used the service.

During the inspection we found that the service had taken steps to make improvements and address matters that had been raised with CQC.

This was a follow up inspection to check on one compliance action following a previous inspection.

People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

We spoke with one person who told us they were happy with their medication. The person told us “they give me my medicine I am quite happy. I feel safe with them”.

Robinson House offered a welcoming atmosphere that both people who used the service and their representatives told us made them feel at home. For example, relatives and visitors were offered drinks on arrival to the home.

Not all the people we met were able to speak with us about the care they received and their experience of living in the home. We observed how staff interacted and supported people. This helped us to make a judgement on how their needs were being met.

People told us that staff asked for their consent before offering them support. One person told us “they won’t do anything without asking me first which is quite nice”.

People who used the service and their representatives told us they were able to contribute to their care plans, these reflected their personal preferences.

We found that people who used the service were protected from the risk of abuse. This was because the provider had taken reasonable steps to identify potential abuse and acted appropriately.

We saw that the provider did not have arrangements in place to protect people against the risk associated with medicine. This put people at risk of mistakes being made.

Staff were trained and supported to care for people safely. People we spoke with were happy with the way staff cared for and supported them.

We found that there were quality assurance systems in place and opportunities for people to tell the provider what they thought about the service and how it could be improved.

We spoke with nine people receiving a service, six members of staff and the deputy manager during our visit. Some people were unable to talk to us about their experiences of the service due to their medical condition.

We also used the Short Observational Framework for Inspection (SOFI) as part of our review of this service. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. This helped us make a judgement about the quality of care in the home.

We observed the interaction between staff and people who used services over a period of two hours on both floors of the home. During this period we saw staff assisting individuals. On one occasion a staff member sat with an individual who was distressed. They spent time reassuring the person and helping them with a drink. On another occasion two staff members used a hoist to move an individual. They did so in a supportive way talking to the person telling them what they were doing and giving clear instructions to the person. They also returned to the person when they saw the person was not comfortable and that using the hoist made them comfortable.

During a period of our observations an individual was calling out and was quite agitated. We saw that a staff member sat with the person for varying periods of time trying to calm them and find out what was causing their distress and having a conversation with them.

During the period of our observations individuals were prompted to go for lunch. We noted that people were given a choice of where to sit. People were offered a choice of drink and when meals were offered people were shown and told the options available. We noted that people were asked if they wished to wear a plastic apron rather then have the use of serviettes. We saw that the meals were of a good portion and well presented. People we asked told us they had enjoyed the meal. One person told us, “I always enjoy the food here”.

We saw that staff on occasions would walk through the lounge area without acknowledging the people sitting in this area. On one occasion a staff member walked through and said to an individual, “are you alright” but did not wait for a response from the person. On another occasion a staff member helped an individual with a biscuit but did not talk to or acknowledge in any way the person sitting next to them.

We noted that when talking to or supporting individuals staff did so in a respectful and sensitive manner. One person wanted to go to the toilet and was directed by a member of a staff. Again they did this in a quiet and sensitive manner.

People told us they liked living in Robinson House. They told us that the staff were supportive and friendly.

People told us they felt safe and well supported by the staff working in the home.

This inspection took place on 16 and 17 March 2015 and was unannounced. Robinson House provides accommodation for up to 70 people who require nursing or personal care. There were 67 people living in the home on the day of our inspection. The home specialises in providing a service to older people who are living with dementia. At our last inspection on 18 December 2013 there were no breaches of the legal requirements identified.

A registered manager was in post at the time of our visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirement of the law; as does the provider.

Medicines support plans were available to enable staff to have a good understanding of the medicines they were administrating. However, hand-written administration charts had not been signed by two staff to minimise the risk for medicines errors.

Staff responsible for administering medicines had not maintained their skills and had not received regular updates of their knowledge and skills. We observed a specific medicine was not administered correctly. Some people did not receive their morning medicines at the correct time although they were recorded as having been given at 8 am. This could mean that some medicines could be ineffective and could be a risk to the wellbeing of the person.

The people we spoke to told us that they were well supported in their home and felt safe and happy. Staff completed risk assessments to help minimise risks for people. The equipment used was serviced and checked regularly by staff. There were policies and procedures to guide staff in how to keep people safe and staff had completed safeguarding training.

There were various quality assurance systems in place. These included audits, house checks and through regular discussions during the annual support plan review. The home was found clean, hygienic and well maintained.

People and their representatives and others were asked for their views about their care and support and they were acted on. When people were unable to make their own decisions, staff consulted with appropriate people and planned care in the person’s best interest. People were registered with a doctor, dentist and an optician to ensure their health was monitored.

Staff demonstrated an awareness of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This legislation is intended to ensure people receive the support they need to make their own decisions wherever possible. When restrictions were placed on people’s liberty, the registered manager ensured this was authorised legally by the local authority.

People were supported to make choices around the care they received. People’s nutritional needs were met and they told us they liked the meals provided; there were lots of choices and alternatives to the main menu.

Each person had their own weekly activity planner in their support plan. The staffing levels were safe and met the needs of the people who used the service. Health and social care professionals told us they had no concerns about Robinson House.

You can see what action we told the provider to take at the back of the full version of this report