Inspection on 17/05/10 for Richmond Court Nursing Home

This is the latest available inspection report for this service, carried out on 17th May 2010.

CQC found this care home to be providing an Good 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

Richmond Court Nursing Home 14/12/06

Richmond Court Nursing Home 08/02/06

Richmond Court Nursing Home 13/06/05

Richmond Court Nursing Home 01/03/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Richmond Court Nursing Home 33/35 Beeches Road West Bromwich West Midlands B70 6QE     The quality rating for this care home is:   two star good 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: Deborah Shelton     Date: 1 7 0 5 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 32 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 32 Information about the care home Name of care home: Address: Richmond Court Nursing Home 33/35 Beeches Road West Bromwich West Midlands B70 6QE 01215005448 01215537357 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richmond Court Nursing Home Ltd Name of registered manager (if applicable) Craig Hill Type of registration: Number of places registered: care home 42 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: 42 The registered person may provide the following category of service only: Care Home with Nursing (Code ); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 42, Old age, not falling within any other category (OP) 42 Date of last inspection Brief description of the care home Richmond Court is a 42 bedded home catering for people who have dementia. On the ground floor there are two lounges and two dining rooms. There are thirty five rooms in total of which twenty one are en suite, seven doubles and twenty eight singles. Outside the home is a large garden with level patio area. The home also has parking facilities available to the side of the home. Richmond Court is situated ten minutes Care Homes for Older People Page 4 of 32 Over 65 0 42 42 0 Brief description of the care home from the town centre of West Bromwich and is on the local bus route. It is five minutes from the local motorway networks making it very accessible. Care Homes for Older People Page 5 of 32 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: two star good 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: This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. This visit took place on Monday 17 May 2010. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An annual Quality Assurance Assessment (AQAA) was completed by the manager. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During the key inspection we used Care Homes for Older People Page 6 of 32 a range of methods to gather evidence about how well the service meets the needs of those people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Face to face discussions were held with people who use the service, staff and the owners. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Two people living in the Home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care plans have been developed regarding behaviour and guide staff of the action to take if someone becomes agitated or upset and the possible triggers of this behaviour. An activity coordinator has been employed to help provide activities for people during the week. Staff supervision sessions are now used to ensure staff have up to date knowledge regarding various topics such as dementia. Where training needs are identified further training is provided. Gloves and aprons are widely available throughout the Home and were seen in use. Correct use can help prevent the spread of infection. Comprehensive bed rails risk assessment and management plans have been introduced. The risk assessment and management plan guidance provided by the health and safety executive has been used. Bed rails are checked regularly to ensure correct fitting and to demonstrate they are still in good working order. Risk assessments have identified those people who would not be suitable to use bed rails and alternative safety methods have been put in place. Training in the fitting and use of bed rails has also been provided to some staff. The management team have attended training regarding the local safeguarding procedures and some staff have undertaken training regarding safeguarding, the mental capacity act and deprivation of liberty safeguarding. This helps to ensure that Care Homes for Older People Page 8 of 32 people living at the Home have their rights protected and promoted at all times. 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 9 of 32 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 10 of 32 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. People are properly assessed before they are admitted to the Home to ensure that staff are able to meet identified needs. People are given enough information about the Home to help them to make a decision about living there. Evidence: The care file of the last person to move into the Home was seen and a discussion was held with the manager to find out the processes for admission. We were told that people are encouraged to come and visit Richmond Court. People can stay for the day if they wish and are introduced to staff and other people living at the Home. During this visit they are given information about the Home and are shown documents such as the Statement of Purpose, Service Users Guide, a copy of our last inspection report and a copy of the last contract monitoring report. This ensures that people have information to help them make an informed choice as to whether they think Richmond Court is the right Home for them. Care Homes for Older People Page 11 of 32 Evidence: We were told that the manager completes an assessment of peoples needs before they decide that they can move in. The pre-admission assessment is undertaken to find out about an individuals needs and abilities and helps the Home decide whether they would be able to care for the person. This assessment takes place at the persons current address. The care file of the person who most recently moved in to the Home showed that a pre-admission assessment was conducted two days before the person moved into the Home. This assessment covered a range of areas such as diagnosis, evidence of pressure areas, special equipment needed, eating and drinking, personal hygiene, vision, hearing, hobbies, interests amongst other things. Information was recorded under each heading about equipment to be used, personal preferences and the number of staff required to provide assistance. Documentation seen also confirmed that the person has visited Richmond Court to have a look around. When both parties have agreed that Richmond Court would be able to meet their needs and they wish to move in, a letter is sent confirming the placement. This was evident on the file reviewed. Information obtained during the pre-admission process is then used to form initial plans of care upon admission to the Home. The care files seen on this occasion, included copies of agreements that detailed the terms and conditions of residency at this Home. Care Homes for Older People Page 12 of 32 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. Detailed plans of care identify individual needs. People can be confident that these needs will be met in a safe, caring and dignified way. Medication systems and practices ensure people receive their medication as prescribed. Evidence: Two people were chosen to case track during this inspection. This involves looking at their care files and other information such as medication records, information about activities, meals and equipment used. We were told that everyone who lives at the Home has a care file. Only one of the care files seen contained as assessment undertaken before admission to the Home. We were told that the other person was an emergency admission. This means that they were admitted to the Home in an emergency situation, often within a few hours of the initial enquiry. The manager said that in emergency situations they try and get as much information as possible before admission such as details regarding medication, diagnoses and pressure areas. Plans of care are developed for Care Homes for Older People Page 13 of 32 Evidence: everybody when they come to live at Richmond Court. Care plans seen recorded information about various aspects of daily life, for example, maintaining a safe environment, personal cleansing, eating and drinking, communication, sleeping, mental health, mobilising, hypertension, medication, social and recreational. They record details of any equipment needed to provide care, what the person is able to do independently and what support is required from staff in order to meet their needs. Most of the information recorded in care plans was very detailed and gave clear instructions to staff of the action to take to meet care needs. However, some instructions were not specific, for example needs assistance toileting - this does not say what assistance is required or how many staff are needed, encourage and assist to use toilet regularly - this does not give an example of how often regularly is, ensure X wears correct pads provided by continence nurse - to avoid confusion this should record which pads are to be used. Care plans were in place regarding mental health and behaviour. These give staff information about external professionals to contact for help if needed and suggested action that staff should take if someone becomes agitated or aggressive, this helps to ensure that the atmosphere at the Home is relaxed and calm, for example always explain what and why you are doing and reassure, staff to allow time and not rush X which could escalate behaviour, if behaviour continues leave and try again, later on another staff to try an repeat All care plans seen had been reviewed monthly and an audit of some care files had taken place in May 2010. This shows that the manager is reviewing documentation to ensure that sufficient information is recorded to enable staff to be able to provide care for those living at Richmond Court. Personal preferences and any routines are recorded such as likes to get up 8 - 9am, go to bed around 12 - 2am, likes two pillows on bed, preferences regarding showers or baths, whether they prefer male or female staff to provide personal care and types of activities they like to do. Care files seen had been signed by the persons relatives to demonstrate that they had read the care plans and were happy with their content. Records indicate that relatives will be invited to a review of the care plans within a six month period. Risk assessments are also completed. These identify the risk to the person and record the action that staff should take to reduce the risk. Risk assessments were seen regarding falling, developing a pressure area, use of bed rails, constipation and nutrition. Risk assessments had also been reviewed on a monthly basis and had been Care Homes for Older People Page 14 of 32 Evidence: updated as necessary. Moving and handling assessment were completed which recorded whether the person is able to mobilise unaided, any equipment needed to help the person mobilise, and the number of staff to provide any assistance. Daily records are made per shift, including night shifts. Staff record information about the actions they have taken to meet care needs, general health and wellbeing or any other important information such as details of GP visits with action to be taken by staff following this visit. Records show that people are weighed on a regular basis and their weight is monitored as unexplained weight gain or loss could be due to underlying health problems. Those people who are cared for in bed have records in their rooms which staff sign to show that they have completed two hourly turns if necessary. Staff sign pre-printed turn charts stating that they have assisted the person to move position in bed. Currently they do not record the time that they complete the task but sign a preprinted time sheet. However the actual time that the task was undertaken might not be that as recorded on the pre-printed time sheet. We were told that these forms will be changed to ensure information recorded is accurate. Records demonstrate that people have access to external professionals such as dentists, opticians, chiropodists and GPs as necessary to ensure health and wellbeing is monitored. The medication and records of the people being case tracked were reviewed and found to be up to date and accurate. Medication Administration Records (MAR) detail medication taken and any times when medication is not taken with codes recorded. Medication records are audited monthly. This audit checks for the date of opening being recorded as appropriate on medication with a limited shelf life, correct amounts received and remaining and correct completion of records. Satisfactory equipment and procedures are in place for administration and storage of controlled drugs. Medication is stored appropriately in a locked room in lockable trolleys, fridge and cupboards. The temperature of the medication room and fridge are taken and recorded on a daily basis. There is an extractor fan and a cold air fan in the room to keep temperatures within the required limits and records are available to demonstrate appropriate temperatures are maintained. Care Homes for Older People Page 15 of 32 Evidence: Key custody practices were satisfactory and safe. Copies of prescriptions were available and we were told they are used to check against medication received into the Home to ensure that the correct medication is received. Medication is administered by either nurses or senior care staff as appropriate to the needs of the person. Only those senior carers who have completed training can administer medication. The medication room was clean and orderly. Staff appeared to have a good relationship with those under their care, during the morning staff were seen playing dominoes and chatting with people in the dining room. People were dressed accordingly for the time of year and had their hair brushed and were neat and tidy. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to receive visitors when they wish. Meals are wholesome and nutritious and offer people a balanced diet. Activities take place that people can take part in if they wish. Evidence: During the morning of our inspection the activity co-ordinator was seen playing dominoes with five people, all were chatting amongst each other and appeared to be enjoying the experience. We were told by the manager that the activity co-ordinator is employed on a full time basis working at Richmond Court and other Homes owned by the company. The activity co-ordinator apparently works at Richmond Court three or four times per week from 9am until 3pm. Care staff are responsible for conducting activities when the activity co-ordinator is not available. Records seen show that set activities are planned on a daily basis. Activity log sheets were available for each person, these show the activities planned for the week for example arts and crafts, reminiscence, hairdressing, hoop, therapeutic touch, bingo or sing a long. These activities are planned on the same day each week. Staff sign standardised documentation to demonstrate that someone has taken part in an activity and write a comment if they are doing something else instead of the activity, Care Homes for Older People Page 17 of 32 Evidence: for example watching the television. The weekly activity chart shows Saturday as residents choice and Sunday as free time. None of the records seen had been completed to show what people had been doing on a Saturday or Sunday. We were told that the activity co-ordinator asks people which activities they wish to undertake and then makes a note on their records. People are also asked during residents meetings what activities they wish to undertake and this is recorded in the minutes of these meetings. Meetings are held on a monthly basis and people are asked on an individual basis questions about their satisfaction with activities, meals, bedrooms, staff and a general opinion about the Home. One person had said that they would like to go out into the garden, there was no action plan to demonstrate that this happens, however the manager said that people do go out and comments made in meetings would be acted upon. Both of the care files seen contained a map of life neither of these documents had been fully completed. This information may be useful to try and plan activities suited to individual wants and needs. Care plans are in place regarding social and recreational and comments were recorded regarding activities that the person enjoys taking part in such as likes playing cards and bingo unable to concentrate, encourage family and friends to visit. The weekly activity chart is on display in small print on a noticeboard, this would be difficult for those with sight problems to see. It is therefore difficult to ensure that everyone is aware of the activities on offer each day. Arts and craft work completed by people is on display in corridors and some people have designed their names on paper for their bedroom doors. Pictures of people undertaking activities are also on display in corridors. From records seen it was difficult to demonstrate that activities are offered to everyone consistently and work should be undertaken to ensure that records clearly demonstrate the activities that take place and who is involved. The Home has an open visiting policy and people can visit at any reasonable time, but are asked not to visit at lunchtime if possible as this may distract the person or others from eating their meal. People would be able to eat in their room if they preferred to receive visitors at this time. We were told that the Home tries to maintain community links by taking people who are able go out to visit the GP surgery, the opticians or a local Church as required. Care Homes for Older People Page 18 of 32 Evidence: Peoples religious needs are met by visiting clergy from the Catholic and Church of England faiths. We were told that there are no other religious needs that need to be attended to in the Home at the moment. Information regarding food likes and dislikes were recorded in care files seen. A menu preference form is completed within the first few days of admission and this information is used to ensure that people have the meals that they would enjoy. The manager said that people are asked the what they would like to eat for both lunch and evening meals and their choices are recorded. There is a choice of two things for all meals including puddings. A meal preference sheet seen confirmed this, showing that each person was asked whether they wanted roast beef or chicken breast with vegetables and a desert of peaches and cream or mousse. There was also a choice of cooked breakfast or cereal and a choice of two different sandwiches for the evening meal. A discussion was held regarding any special diets that need to be catered for and we were told that one person has pureed food, some people have soft diets and sugar alternatives are used in the preparation of diabetic meals. One person spoken to commented the food is good, I sit here and they bring me my food and its nice, what more do you want. Care Homes for Older People Page 19 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their complaints will be listened to and acted upon. Staff have a good knowledge and understanding of what abuse is and know what to do if they suspect abuse. This helps reduce the risk of harm to people living at Richmond Court. Evidence: A discussion was held with the manager regarding complaints received and the action taken to address issues. We were told, and records show that various people are contacted when a complaint is received. The persons GP, social worker and the police are involved as necessary and issues are reported to safeguarding and appropriate documentation such as notification of incident and vulnerable adult protection forms are completed. Any complaints received are recorded in a register which is audited on a monthly basis. The complaints procedure is available in the Home in larger than normal print so that people with poor eyesight can access this document. Currently this is only available in English but we were told that it could be translated into other languages if needed. Records show that staff have done training in the protection of vulnerable adults. The manager is responsible for completing adult protection training with staff and he has undertaken training regarding local safeguarding procedures. Care Homes for Older People Page 20 of 32 Evidence: All of the recent complaints received at the Home have been reported following correct procedures for the protection of vulnerable adults and appropriate documentation completed. We were told that all staff have up to date criminal records bureau checks which helps to ensure that they are safe to work with vulnerable adults. Staff appeared to have a good relationship with those under their care. Moving and handling practices seen protect people from the risk of harm, appropriate equipment was available to assist people with mobility. People spoke positively about staff saying everyone is kind and friendly, they help you out when you need it. Care Homes for Older People Page 21 of 32 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. People live in suitably adapted, clean, comfortable, pleasant surroundings. There are good systems in place to prevent the spread of infection. Evidence: Richmond Court is located in a residential area of West Bromwich close to public transport and shops. The Home has three floors, the ground floor having two lounges, two dining rooms, laundry, kitchen and two bathrooms. The first floor has bedrooms a bathroom, assisted bathroom and a shower room. The second floor has bedrooms, a bathroom and shower room. All floors of the Home can be accessed by a passenger lift. There are also stairs to each floor which are secured by a stair gate. This is linked to fire alarm so that if the gate is opened the alarm goes off to alert staff that someone is trying to walk up the stairs. The Home has 35 bedrooms, 28 single and 7 double, all of which are currently for single use. Double rooms have curtain screening in place should the need arise for them to be occupied by two people. Twenty one of these bedrooms have en-suite facilities. Bedroom doors can be locked and exited from the inside without the use of a key. Staff have a master key if they need to get into the room in an emergency. We were told that all bedrooms have call alarms next to their beds and those rooms with enCare Homes for Older People Page 22 of 32 Evidence: suite facilities have an alarm in the en-suite. This was evident in the rooms seen. All en-suite and bathroom doors throughout the Home are painted red. This is a different colour to other doors. There was also written and picture signs on bathroom and toilet doors to help people orientate themselves in their surroundings. Corridors have motion sensitive lighting which stays on as long as there is movement, this helps to ensure that if people leave their rooms during the night, corridors are sufficiently illuminated, therefore reducing the risk of accident. All bedrooms seen had a piece of lockable furniture to store personal items if they wish. Bedrooms were clean, hygienic and no unpleasant odours were noted. People had personalised their rooms with pictures and ornaments. Some bedroom doors have names written on labels on doors, other people have made name plates (paper) for their doors during art sessions. Two shower rooms seen were clean and hygienic both had liquid soap and disposable hand towels for use to help prevent spread of infection The laundry was clean and all equipment was in good working order. The washing machine has a sluice cycle and hot wash programme to help reduce the spread of infection from soiled laundry. The handling of soiled laundry is reduced by the use of washable red laundry bags which are used to transport and wash soiled laundry. Although the Home provides care for people with nursing and non nursing needs, people are able to choose where they spend their time and they are not restricted to stay in a particular lounge dependent upon their needs. The garden was pleasantly laid out with a decked area to enable people to sit out in the sun if they wish. People spoken to said they like to go out in the garden. Care Homes for Older People Page 23 of 32 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 are cared for by staff that are suitably trained, safely recruited and competent to do their job. This helps to keep them as safe as possible. Evidence: There were 35 people living at Richmond Court of the day of inspection. A copy of the duty rota for the weeks of 10 and 17 May 2010 were taken for review. The number of staff on duty on the day of inspection was in line with the information recorded on the duty rota. Records show that in addition to the manager, there is a registered nurse on duty in the daytime along with five care staff. At night there is a registered nurse and three or four care staff. Ancillary staff such as cooks, kitchen assistants, domestic and laundry assistants each work at least six days per week. The personnel files of all staff employed since the last inspection were reviewed. Records seen demonstrate that the Home operate robust recruitment procedures. Information such as employment history including explanation of any gaps in employment, application forms, job description, medical questionnaires two written references, criminal records bureau check were all seen on personnel files. Staff have also signed a document to say that they have not had any disclosable criminal convictions within last twelve months. Care Homes for Older People Page 24 of 32 Evidence: Various policies and procedures are also kept on file. Staff have signed a document to say that they have read and will work to the procedures that are kept in their personnel file. A separate file is kept to record details of supervision and appraisal Supervision takes place approximately six times per year, a topic is picked to discuss with staff to ensure their knowledge is up to date. One supervision file seen showed that the staff member received supervision regarding dementia, health and safety, abuse, infection control and nutritional risk all records seen were dated and signed. The manager records in supervision records if any training is required. A separate training file is kept which shows details of training undertaken and dates. Training certificates were kept on file. We were told that out of the twenty one care staff employed, eleven have completed a National Vocational Qualification in Care at level two, four have done this qualification at level three and one at level four. This helps to ensure that staff have the required skills and knowledge to be able to care for people at Richmond Court. We took a copy of the Homes training matrix to review. This showed that a majority of staff have undertaken training regarding moving and handling, first aid, health and safety, abuse, food hygiene and fire safety. Training for some people dates back to 2006/2007 and consideration should be given to providing refresher training for these people. The training matrix shows that training has been provided for some staff regarding mental capacity, dementia, challenging behaviour, bed rails and incontinence amongst other things. Training is also provided to the nurses employed and they have undertaken both mandatory and specialist training in areas such as peg feeding, oral health, deprivation of liberty safeguarding and assessment and treatment of incontinence. The induction of new staff was discussed with the manager and we were told that the Home has recently purchased Skills for Care Induction training records and any new staff employed will be completing this induction in the future. In house induction is also undertaken by all staff and records were seen to confirm this. Staff appeared to have a good relationship with those under their care, they sat chatting to residents, all appeared to be at ease. Care Homes for Older People Page 25 of 32 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. The Home is safe and well managed. Systems are in place to continuously monitor the service on offer with a view to continuous improvement and ensure that people who live at the home are listened to. The home is run in the best interests of people who live there and their health and welfare is promoted through safe working practices. Evidence: The manager has been in post since December 2005 and he has the necessary qualifications and experience to be left in charge of Richmond Court. Management qualifications include a National Vocational Qualification in care at level 2, 3 and 4, the Registered Managers Award and mandatory training updates undertaken as needed. Registered nurses and senior carers are in place to support the manager and lines of accountability in the Home are clear and understood by all. We were told that the manager is on call when not on the premises. This helps to ensure that staff on duty have access to help and advice 24 hours per day, seven days per week. Managers from other homes owned by the company would be on call if the manager of Care Homes for Older People Page 26 of 32 Evidence: Richmond Court was on holiday. During discussions the manager demonstrated an awareness of areas that needed to be addressed and was keen to ensure that peoples needs are met in a way in which they prefer. Quality assurance systems in place are well developed and include satisfaction surveys sent out to relatives, outside agencies, staff and people living in the Home. These are completed on a six monthly basis. The survey for February 2010 was seen, it was noted that all results are provided in graphical format to enable people to quickly and easily see the results of the survey. From review of the results of the February survey it was noted that some relatives responded that there was an odour in the Home, and commented that they are only sometimes happy with the activities provided. The survey sent to outside agencies did not report any odours. Whilst two people who responded to the residents questionnaire said that they were not satisfied with the meals. We were shown a blank action plan form which is to be introduced which records details of the issue identified and the action taken to address any shortfalls identified. This form had not been used at the time of inspection. Quality assurance systems include audits of all of the national minimum standards. A list of the standards is signed to confirm that an audit has taken place and a statement is recorded to detail changes made or whether the standard is met and no action is needed. We were told that the Home currently audits medication, care plans, accident records, bed rails, air mattresses, equal opportunities, pressure areas and complaints. Regular one to one meetings are also held with people living in the Home to find out their views of the service they receive. Group staff meetings are also held. Minutes of these meetings are kept showing details of discussions held and peoples comments. We were told that the manager has an open door policy and people can speak to him when they wish to make any suggestions or complaints. The Home holds small amounts of personal allowance money for people. We looked at the records and monies for two people to see how this was managed. Funds available balanced with records held. Receipt and expenditure of money is recorded and two staff sign records to demonstrate income and expenditure. Care Homes for Older People Page 27 of 32 Evidence: Invoices are sent out to families who prefer to keep personal allowance monies for their relatives. This ensures that people are still able to spend money on items of their choice even though the Home does not hold any money on their behalf. A selection of health and safety and maintenance records were checked. These records are kept to ensure that equipment is safe and in good working order. The Home has up to date insurance as required and a Gas safety certificate seen was also in date. Electrical installations were checked in 2009 and are required to be checked every five years. An external company checks fire alarm systems, water storage and lifts. All checks were up to date and equipment and systems were in good working order. A food premises inspection was understood by Sandwell Metropolitan Borough Council in October 2009. Richmond Court were awarded the Gold EAT hygiene award in recognition of high standards of food safety found during their inspection. On checking fire system check records undertaken by the Home it was noted that the there were no emergency lighting records since 12 March 2010. These should be checked on at least a monthly basis. Other internal records show that the fire alarm actuation points are checked approximately every week. Hot water temperatures are checked and recorded on a monthly basis. Temperatures recorded ranged from 37 degrees Celsius to 46 degrees Celsius. When temperatures were too high (above 41 degrees Celsius), a note was made to adjust to the required maximum. There were no records available after the 12 March 2010. Care Homes for Older People Page 28 of 32 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 29 of 32 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 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 7 Care plans should include detailed instructions for staff of the action to take, including details of timings and equipment to be used, to enable them to meet peoples care needs. Records should clearly demonstrate what social and leisure activities people have been offered and participated in on a daily basis. Details of activities on offer on a daily basis should be in a format that is accessible to all who live at the Home. This is to ensure that everyone is aware of the activities that take place. Staff should be provided with regular mandatory training updates. Emergency lights should be tested on at least a monthly basis to ensure that they are in good working order. Details of the test and any action undertaken to rectify shortfalls should be recorded. Hot water temperatures should be tested on at least a monthly basis to ensure that people are not at risk of scalding from excessively hot water. Temperatures should Page 30 of 32 2 12 3 12 4 5 30 38 6 38 Care Homes for Older 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 be recorded and details of any action taken to reduce temperatures should be recorded. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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