Inspection on 01/09/08 for Richmond House - North Yorkshire County Council

The home is preparing to move and become an `extra care` service. The people who live at the home have been kept informed about these plans and they have visited an existing `extra care` service, so that they know what to expect. However, the location for the new building and the proposed date for the new scheme opening are not yet known. The home has purchased new televisions and a computer for people who live at the home and their families to use. The fire alarm system and the call system have been updated. Flexible breakfast times have been introduced and the manager is in the process of reviewing how staff hours are used in the home and day centre, to try and make better use of staff. An ongoing recruitment campaign is taking place to try and recruit more staff.

Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOMES FOR OLDER PEOPLE Richmond House - North Yorkshire County Council Richmond House Reeth Road Richmond North Yorkshire DL10 4EF Lead Inspector Rachel Martin Key Unannounced Inspection 1st September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond House - North Yorkshire County Council Richmond House Reeth Road Richmond North Yorkshire DL10 4EF 01748 823135 01748 821465 richmond.house@northyorks.gov.uk www.northyorks.gov.uk North Yorkshire County Council Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Judith Ann Benson Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2006 Brief Description of the Service: Richmond House is a care home owned and operated by North Yorkshire County Council. It is registered to provide a service for 31 older people. A day centre providing up to 20 places per weekday is situated in a separate area of the ground floor. The home is located within a short walk of Richmond town centre. The home was purpose built approximately 45 years ago. The bedrooms are located on the ground and first floors and all bedrooms are now single occupancy. Access to the first floor is made using either stairs or a passenger lift. The home has a number of communal lounges, including a ‘smokers’ lounge. Toilets and bathrooms are located around the building. There is a dining room on each floor and a conservatory. There are extensive grounds and gardens to the rear of the home, with lovely countryside views. At the time of this visit the homes weekly fees were worked out for each individual using a financial assessment, with people paying up to £369 depending on their financial circumstances. Up to date information about fees and the home’s terms and conditions should be sought from the manager. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The Commission for Social Care (CSCI) inspects Care Homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.csci.org.uk . We have recently reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before we visited Richmond House we asked them to complete a selfassessment and provide us with information about the home. The selfassessment was completed on time and contained the information we had asked for. We sent surveys to people who live at Richmond House, some of the staff who work there and health professionals who work with people living at the home. Nine people who live at Richmond House, two staff and two health care professionals completed and returned surveys to us. Before the site visit we spent time looking at this information and any other information that we had received about the home since the last inspection. This helped us decide what to do during our site visit. We visited the home on Monday 1st September, spending from 10am until 4.30pm at the home. Unfortunately the registered manager was on holiday that day, so we went back to the home on Friday 5th September to speak to the manager and finish off our inspection. During our visits we talked to people who live at the home and some of the different staff who work there. We looked at some of the records that the home keeps. We also looked around the building and observed what happened in the home during the day. What the service does well: People said they were happy at Richmond House. They spoke well of the staff and thought they got the care they needed. Comments made by people living in the home included ‘as a family we cannot fault the care and support our father receives at Richmond House. He is always clean and tidy and well fed. The staff are always chatty and helpful and cannot do enough for my father and us’, ‘very good, they’ll help you where they can, they are very good, don’t think I’ve had any trouble with any of them’, ‘very good, some better than Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 6 others, but I find no fault with them, they’ve been very kind to me’, ‘very nice and caring, they always ask first if they can do something’, ‘they are very patient with me, I’m well satisfied’, ‘I have a good thing going on with the girls’, ‘they can’t do enough for me, I love it here’ and ‘staff are gentle and ask what I want’. We also got positive comments from health professionals who work with the home. Staff were recruited well, with checks being completed on new staff before they started work in the home. Comments made by staff included ‘excellent training – skills for care which covers general caring skills’, ‘good general training in cultural, religious and sexual beliefs and preferences with skills for care and National Vocational Qualification (NVQ)’ and ‘good overall training’. Staff also felt that the manager and team managers were supportive and approachable. People have access to activities and events, which are coordinated by the home’s activities coordinator. People described outings and activities that they get to take part in, such as church services, trips in the bus, visits to concerts and from entertainers, craft and baking sessions. People were also positive about the meals at Richmond House, making comments like ‘yes you do, you get choice of two, everything’s nice, it’s set out on your plate, they know exactly what I like now’, ‘plenty choice and plenty to eat as well, never hungry’, ‘the meals are marvellous, I’m not a great big eater, but you have a choice and it’s good’. People said they knew who to speak to if they weren’t happy about something, regular ‘residents meetings’ take place and people felt that their comments and views were listened too. What has improved since the last inspection? What they could do better: Some people living at the home and staff felt that staffing levels weren’t always what they should be. People made comments like ‘sometimes it’s difficult to get staff. The other evening I rang my bell because it was getting Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 7 dark and I was sitting on my own in the dark and wanted the light on, but it took a long time to get their attention, they were busy with other people. When she eventually came she said to me ‘what are you doing sitting in the dark?’ and ‘they haven’t got time (to come in and spend time with her), but if I ring the bell they’ll come in and see what I want’. Staff said things like ‘we have a number of residents with high dependency levels which really would benefit if we had the staff at critical times to be able to cope better’ and ‘evening shift is the worst, when we are full it’s horrendous’. Some of the homes record keeping needs to improve. Care records werent always being updated properly, even when reviews had taken place. The training records provided were also not up to date. Staff and managers need up to date, reliable information about peoples care needs and the training staff have completed. This is important so that staff can make sure that people are getting the care they need and that staff receive the training they need to do their jobs well. Care records could also be developed so that they provide more information about peoples nutritional and dietary needs and the care they need to maintain their skin integrity. Assessments and information about these things could help identify what preventative action is needed to prevent people loosing weight or developing pressure damage to their skin. The home is now approximately 45 years old and some of the bedrooms are very small and difficult to manoeuvre around when fully furnished. The manager and staff do their best to make sure that people with mobility difficulties and equipment are given larger rooms. Some of the toilets and bathrooms were not very pleasant and homely. The buildings’ limitations are recognised by the council and this will no longer be an issue when the service moves to the new extra care scheme. However, a date for this move is not yet known. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 People who use the service experience good quality outcomes in this area. People are usually given information about the service and have their needs assessed before they move into Richmond House. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: In their self-assessment the home told us ‘we issue new service users with a service user guide containing our statement of purpose when we go out to assess their needs. We discuss and record how they want to be cared for. We invite new users and families to visit prior to admission and suggest that they talk with existing service users, rather than staff, to find out about the service we offer’. We discussed the way people are admitted to Richmond House with the manager and other staff. They confirmed that before people move into the home, information about their needs is obtained from the local authority. They also confirmed that they usually visit people to assess their care needs and to make sure that Richmond House can meet their needs. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 10 We looked at the records for two people who had come to live at Richmond House in the last nine months. These records contained information about people’s needs that had been collected from the local authority, the home’s own assessment and in one case information from the hospital that the person had come from. Nine people who live at Richmond House returned surveys to us. When we asked people if they had received enough information about Richmond House before they moved in, eight people said ‘yes’ and one person said ‘no’. When we asked if they had received a contract, four people said ‘yes’, four people said ‘no’ and one person said that it was ‘too long to remember’. We asked the manager if people received a contract, setting out their fees and the terms and conditions for living in the home. People receive a copy of ‘terms and conditions’ in the service users guide and a letter from the finance department setting out what their fees are. However, people do not sign to say they agree with the terms and conditions and the manager was unsure what information people are provided with about their fees. We asked the manager to look into this, using the Office for Fair Trading’s (OFT) report ‘Fair Terms for Care’, to make sure that people are being provided with clear and transparent information about their fees and terms and conditions. Richmond House does not provide a specialist intermediate care service. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. People are treated with respect and have their care needs met by the home’s staff. However, recording and risk assessment practices could be improved, so that more accurate and up to date information is available about people’s needs. Medication is stored and administered safely. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Nine people who live at Richmond House returned surveys about the home. We asked them if they got the care and support they needed and if they got the medical support they needed. Six people answered ‘always’ and three answered ‘usually’ to these questions. We asked if staff listened and acted on what people said. Eight people said ‘yes’ and one person didn’t answer. A relative who helped someone complete a survey said ‘as a family we cannot fault the care and support our father receives at Richmond House. He is always clean and tidy and well fed. If under the weather the care is very good, making time pass quickly and recovery speedy. The staff are always chatty and helpful and cannot do enough for my father and us’. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 12 We spent time talking to people who live at the home. Their comments to us included ‘very good, they’ll help you where they can, they are very good, don’t think I’ve had any trouble with any of them’, ‘I have a catheter and they take me to the toilet to empty it (the manager) insists, on going to the toilet and closing the door etc, so you are private’, ‘very good, they treat you well’, ‘very good, some better than others, but I find no fault with them, they’ve been very kind to me’, ‘very nice and caring, they always ask first if they can do something’, ‘they do everything in their power to help’, ‘they are very patient with me, I’m well satisfied’, ‘I have a good thing going on with the girls’, ‘they can’t do enough for me, I love it here’ and ‘staff are gentle and ask what I want’. In the surveys we asked two health professionals if they thought the home sought advice, and acted on it appropriately, to manage and improve people’s health. Both answered ‘yes’. We also asked if individual’s health care needs were met by the care service. One answered ‘always’ and one answered ‘usually’. Each person living at Richmond House has a record of the care they need. We spent time looking at four people’s care records. These records included assessments, personal details, information about the persons care needs and the support they needed in fifteen key areas, records of contact with health professionals and of the care people received. Risk assessments were in place for manual handling, ‘falls, slips and trips’, and some individual areas. For example, not using footplates on wheelchairs, problems using a particular hoist due to a deep pile carpet and falling out of bed. The records provided a reasonable amount of information about people’s care needs. However, some of the homes record keeping needs to be improved. Some records contained more detail about people’s preferences than others. For example, information such as people’s preferred times for getting up and going to bed, how often they wanted a bath or shower and what time of day they preferred to have it. People’s records weren’t always up to date. For example, the bath charts didn’t reflect how often people were actually getting bathed or showered, with the recording suggesting that one person had gone 25 days in between baths. Another person’s continence chart suggested that they hadn’t had their bowels opened since 18th July. Although staff were completing regular reviews of people’s needs, the actual records of their care needs weren’t always being up dated. For example, one person’s records said that they still looked after their own painkillers when they no longer did. Another person’s manual handling risk assessment still referred to the hoist not being used because of a deep pile carpet, when the carpet had actually been replaced some time ago. The home does not currently routinely assess people’s nutritional needs or weigh people regularly. The manager said that they currently observe people and only carry out a nutritional assessments and weighing if someone looks Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 13 like they have lost a substantial amount of weight. People should have their nutritional needs assessed and reviewed regularly (including regular weighing if the assessment suggests this is necessary), because it would help to identify people who are at risk of malnutrition or weight loss and allow appropriate preventative action can be taken. One person had moved into the home with a pressure sore. They described how the home had provided a special mattress and cushion for them and how the district nurses and staff had helped the sore to get better over the last year. She said ‘it’s getting lovely now’. However, the home does not currently complete risk assessments to see if people are at risk of developing pressure damage. Appropriate risk assessments which are reviewed regularly (for example, the Braden or Waterlow systems), could help to identify who is at risk and what preventative action should be taken by staff. We looked at how medication is stored and administered at Richmond House. The home uses the Boots monitored dosage system (MDS), where medication is dispensed every 28 days in handy blister packs. The team managers (who usually administer the medication) and some care staff have completed medication training. We watched a staff member give out medication at lunchtime and they did this in a safe and appropriate way. We checked one person’s medication records and found that these were accurate. The home currently has five people who take controlled drugs. We checked the records and stock of these for two people. We found that the drugs were stored correctly and that accurate records were available in a ‘controlled drugs register’. A medications fridge is available to store medication that needs to be kept cool. However, staff didn’t always use this. Sometimes they were using one of the home’s ‘food’ fridges instead, because it was more conveniently situated in the dining room. By the second day of our inspection staff had been reminded by the manager to always use the medication’s fridge. Medication that didn’t fit into the MDS (for example, Tramadol and Movicol) were sometimes being carried over from one month to the next. When this happened staff weren’t always writing the amount of medication that had been carried over onto the new Medication Administration Record (MAR) chart. This made it difficult to check if the records and stock balances added up and were correct. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. People receive a choice of nutritious meals, are given the opportunity to take part in activities and social events and there are no unreasonable restrictions on visiting. People are given some choices about their daily lives, although some routines in the home could be tailored more towards people’s individual preferences and wishes. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: In their self-assessment, the home told us that they ‘have one member of staff who is responsible for organizing the activities within the home, who is very enthusiastic, the activities are tailored around individual needs and preferences. We have a computer in one lounge for resident’s use which includes web cam to enable family contact, at present this is mainly being used by relatives and staff to show relevant digital photos’. We talked to the person who organizes activities and they showed us photographs of some of the things they had been doing with people. These activities included bus trips, organ and piano playing, baking cakes and pizza (including diabetic and ordinary cakes), picking lavender in the garden, attending rotary club concerts, spending time in the garden, making dolls, visiting entertainers, lunches out and card making. People we talked to said ‘my favourite is Millstones, you have your lunch there and quite often you have a drink, look round the shop and there is Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 15 a chap singing and in the afternoon you play bingo’, ‘oh yes there is plenty going on’, ‘I’m a bit of a loner, I read a lot, watch telly in the evening and night, odd times go to bingo’. We saw that quite a few people had their own newspapers and that people spent time in different lounges or their bedrooms, depending on what they wanted. Visitors came and went throughout our visit. People we talked to said that they had family who visited regularly and that they could go out with their family when they wanted. A lot of people had mobile phones or their own phone in their bedroom. This means that they can contact their friends and family when they want to, independently and in private. We asked people about routines in the home. For example, if people can get up, go to bed and have a bath or shower when they wanted. People made the following comments ‘generally have one on your bath day, once a week, I have a shower now’, ‘shower on a rota each week, if I asked for one (extra) I dare say they’d give me one’, ‘they go with what I want (bedtime, getting up etc)’, ‘sometimes I have a ride out in the bus on Friday morning, but can’t go today because the staff member who usually goes was on nights last night and needs to sleep’. Staff confirmed that there is a bath/shower rota in place and that people get a bath or shower once a week. Staff also said that they would do their best to do what people wanted, but that sometimes staffing levels made this difficult. In the home’s self assessment they told us that they have a flexible breakfast time, to fit in with when people want to get up and they intend to ‘offer flexible lunch and tea times’ in the future. However, information in people’s care plans did not always include their personal preferences for routines. For example, preferred times for getting up, going to bed, the preferred frequency and timing of bath and showers, peoples preferred meal times. This information is important so that staff are aware of peoples preferences and so that staffing levels and routines can be tailored more to meet peoples wishes. We talked to people about the meals at Richmond House and they made the following comments; ‘sometimes tea time isn’t to my liking and I’ll ask if I can have toast and yes I can have toast. Last night I had ham salad’, ‘yes you do, you get choice of two, everything’s nice, it’s set out on your plate, they know exactly what I like now’, ‘they’ll make me things that I want and if I don’t want it I don’t have to have it’, ‘foods alright, but I’ll tell you what we haven’t had for a long time, broad beans, I like broad beans and we only get brussel sprouts at Christmas’, ‘plenty choice and plenty to eat as well, never hungry’, ‘the meals are marvellous, I’m not a great big eater, but you have a choice and it’s good’. The lunch and teatime meals are served at set times, although the home told us, in their self-assessment, that they plan to offer more flexibility around mealtimes in the future. We observed the lunchtime meal. The tables were set nicely with tablemats, cutlery, salt and pepper pots and sugar bowls. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 16 People were offered a choice of sausage with onion gravy or liver and onions, served with potatoes and vegetables. Pudding was apple pie and cream, but one person had a yoghurt instead. Staff served the meals and appeared to have a good knowledge of who liked onions, who didn’t like carrots and who liked bigger or smaller portions. People were asked if they wanted any more and the food looked pleasant and appetising. Staff asked people if they wanted help cutting up their food and provided help in a pleasant manner. The atmosphere was pleasant and relaxed, with two staff and a volunteer assisting thirteen people with their meals. However, the volunteer only works two days a week and we wondered what meal times were like when she wasn’t available. We discussed this with the manager who agreed that, although staff managed when there were only two of them in the dining room, sometimes this meant that there were not enough staff available to give some people the one-to-one attention they should ideally receive. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. People know how to raise concerns and feel that staff will listen to what they say. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: In our surveys we asked people who live at Richmond House if they knew who to speak to if they were unhappy. Six people said ‘always’, two people said ‘usually’ and one person said ‘never’. We also asked if people knew how to make a complaint. Seven people said ‘yes’ and two said ‘no’. People we spoke to made the following comments, ‘it’s not very often I complain, but we had a lady in our corridor shouting during the night. I went to the office to talk to the manager and you know, that lady was moved upstairs’, ‘we have a residents meeting every two months. It’s up on the (notice) board. You can talk to them, very good, and if you want to talk privately you can do’. The staff who returned surveys said that they knew what to do if someone was unhappy or had concerns about the service. One staff member commented ‘all information is in the pack that all residents receive on entering the home. Minor concerns such as being able to have a cup of tea when wanted can be dealt with by staff, but if there is a concern that is more or we can’t sort out then the concerned person will be able to go to the office to speak to management and they can fill out a complaints sheet if necessary’. A team Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 18 manager told us that the majority of staff had received training on the protection of vulnerable adults, although training updates and training for new staff is needed. We asked two health care professionals if the service had responded appropriately if they or someone living at the home had raised concerns. They both said ‘always’. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate quality outcomes in this area. People live in a safe and homely environment. However, some parts of the home should be refurbished and some of the bedrooms are very small. This makes it difficult for some people to move easily around their rooms, particularly if they need to use walking frames or wheelchairs. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: We spent time looking around the building with a member of staff. They showed us around the home’s communal areas, bathrooms, the gardens and a selection of bedrooms. People’s bedrooms contained personal possessions, such as pictures, ornaments and small pieces of furniture. They were homely and comfortable. The communal lounges, dining rooms and the conservatory were also homely and comfortable. The gardens were very pleasant and could be easily accessed by a ramp from the conservatory. The garden provided seating areas and had lovely views over the surrounding countryside. The new shower room provided a practical and pleasant space for people to use. Some parts of the home are in need of refurbishment. For example, some of the Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 20 toilets and bathrooms look old and feel institutional. They are not very homely facilities for people to use and the home’s self assessment told us that they plan to improve these facilities in the next twelve months. Some areas of the home needed to be redecorated. For example, some doorframes and paintwork were badly scraped. During our visit there was work being done to improve and replace some of the fire doors and the fire alarm had recently been upgraded. Richmond House was build approximately 45 years ago. As a result of its age and changes to the standards that are expected of care homes, some aspects of the building are no longer ideal. Some of the bedrooms are very small, making it difficult for people with mobility difficulties to manoeuvre around the furniture and more difficult for staff to assist people. One person commented on how they found it difficult to manoeuvre themselves around in their wheelchair, because the doorways were too narrow. We discussed the small bedrooms with the manager. Where possible they try to give people the option of moving to a larger room when one becomes available. They also try not to put people who need to use equipment, such as wheelchairs and hoists, into the small rooms. On the day of the inspection we heard one of the team managers taking an enquiry about a possible new resident. They told the enquirer that they didn’t have a suitable room available if the person needed to use a hoist. In the next few years the council intends to transfer the service to a new, purpose built, extra care scheme, which will address these problems. However, at the time of this inspection the staff we spoke to did not know when this move would actually happen. We saw that people were provided with equipment to help them maintain their independence and make life easier for them. Equipment we saw being used during our visit included hoists, stand aids, wheelchairs and walking frames, pendant call bells that people could wear around their necks and use to call for staff assistance, special beds, mattresses and cushions. The home has also provided large, flat screen, wall mounted televisions and a computer. In the surveys we asked people if the home was kept clean and fresh. Four people answered ‘always’ and five answered ‘usually’. One person we talked to said ‘the cleaner does a good job, but she’s on her own and retiring in a little while’. The manager confirmed that they currently have a vacancy for a cleaner. As we looked around Richmond House we found that the majority of the home was clean and free from unpleasant smells. However, we did notice that a bedroom and some of the toilets smelled a little unpleasantly. We also spoke to the person who works in the laundry. The home only employs one member of laundry staff, who works five days a week. On her days off, care staff do what they can and any backlog of laundry is dealt with when she returns to work. This is not ideal, however, people’s comments about the laundry service included ‘its really good’. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. Staff are recruited in a thorough way, provided with regular training and people felt that the staff did a good job. However, staffing levels dont always adequately reflect the needs of the people living at Richmond House. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: At the last inspection we made a requirement that North Yorkshire County Council needed to review the levels and deployment of staff at Richmond House, so that staffing was appropriate to the needs of the people living there. In the surveys we asked if staff were available when people needed them. Five said ‘always’, three said ‘usually’ and one said ‘sometimes’. Comments made by people living in the home about staffing levels included ‘sometimes it’s difficult to get staff. The other evening I rang my bell because it was getting dark and I was sitting on my own in the dark and wanted the light on, but it took a long time to get their attention, they were busy with other people. When she eventually came she said to me ‘what are you doing sitting in the dark?’’, ‘they haven’t got time (to come in and spend time with her), but if I ring the bell they’ll come in and see what I want’, ‘sometimes they’re busy with others and they can’t just leave that other person to come to you, but I very rarely have to wait a long time’, ‘sometimes there doesn’t seem to be enough of them. For example, last night (evening) there were two agency staff on and I don’t think there should be, there should be one agency and one of the staff from here. We didn’t get our night drink until 10:30 because they were slower than the normal staff’. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 22 Staff who returned surveys and were spoken to during the inspection made the following comments, ‘there are staff shortages which can sometimes mean that although the physical needs are met, sometimes we find we have not the time to spend on a one-to-one basis which some of our clients would like more of’, ‘more staff at critical times to avoid over stretching existing staff and therefore enabling more time to be spent with the residents. When there is time the residents love to talk and appreciate it, they are much happier’, ‘we have a number of residents with high dependency levels which really would benefit if we had the staff at critical times to be able to cope better’ and ‘evening shift is the worst, when we are full it’s horrendous. Sometimes would be nice to have three on’. The manager agreed that staffing levels were not always as high as they should be. She also said that despite continuously recruiting staff, it was difficult to maintain staff levels and that agency staff sometimes had to be used. However, there were plans to increase the numbers of staff on duty at particular times and the manager was in the process of working out how to make the best use of these additional hours. The two staff who completed surveys said that their employer had completed the appropriate checks before they started work. We checked the recruitment records for three members of staff. These records confirmed that two references and a Criminal Records Bureau disclosure had been obtained before staff started work. The council’s personnel department supports the home’s staff in recruiting staff. Staff who returned surveys and who we spoke to thought that they were provided with the training they needed. Comments made by staff included ‘excellent training – skills for care which covers general caring skills’, ‘good general training in cultural, religious and sexual beliefs and preferences with skills for care and NVQ’ and ‘good overall training’. In the home’s selfassessment, they told us that thirteen (53 ) of their permanent care staff had completed a National Vocational Qualification (NVQ), in Care. We looked at the records that showed the training that had been completed by the home’s staff. However, the records provided were not up to date, making it difficult to know what training staff had completed and when training up dates were due. The manager assured us that training was up to date and provided information about training that had recently been completed and planned for the near future. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. There is an appropriate management system in place and people are consulted and involved in some decisions about the home. Maintenance and health and safety checks are completed and where issues were raised the manager took prompt action to put them right. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has a manager, who is registered with CSCI. She is experienced in managing care services and has an appropriate management qualification. At the time of this inspection the manager was also temporarily managing a home care service. This meant that she wasn’t in full time, day to day control of the home. However, she is supported in her management role by a number of team managers. The team managers have National Vocational Qualifications (NVQs) at levels 3 or 4 and there is a team manager on duty every day and evening. This means that people and staff have good access to Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 24 managerial support. Staff said they felt well supported by the manager and team leaders. Comments included ‘I receive excellent support from my team manager through regular supervisions and appraisals’. In their self-assessment the home told us, ‘we have an annual Service Improvement Plan, which is formulated from quality assurance checks, feed back from service users, informal carers, staff and from CSCI inspections’. The home also told us about some of the changes they had made as a result of listening to the people who live at Richmond House. People we spoke to confirmed that they have regular ‘residents’ meetings’, making comments like ‘we have a residents meeting every two months. It’s up on the (notice) board. You can talk to them, very good, and if you want to talk privately you can do’. People generally thought that the staff and management were approachable and would act on what people told them. The home has a system to help people manage and have access to small amounts of personal money. We checked the records for two people and found them to be accurate, up to date and included appropriate receipts. Where possible the person concerned had agreed and signed the financial transactions that were recorded. The records and people’s money was stored securely in a safe, which only certain staff had access to. In their self-assessment the home told us that they ‘maintain very comprehensive Health and Safety records, these are easily identified by having colour coded files and are kept up to date with excellent assistance from our identified Health and Safety person’. We looked at some of the information and records in these files and identified that important maintenance and health and safety checks are being carried out. However, at the time of this inspection the home didn’t have a maintenance person. This had resulted in the weekly fire alarm checks not being completed since 23rd May 2008. These checks are important, because they make sure that the fire alarm system is working correctly and allow any faults to be identified and put right. We brought this to the manager’s attention and by the second day of our inspection these checks had been carried out and put in the home’s diary, to make sure that they are completed regularly. We also noticed that some people like to prop open their bedroom doors. One person’s door was held open with a folded newspaper. We discussed this with the manager, who told us that self-closing devices are being ordered and will be fitted to bedroom doors. Self-closing devises hold the door open, but will allow the door to close automatically if the fire alarm goes off. This is important, because if fire doors are wedged open people will not be adequately protected in the event of a fire. In meantime the manager said that she would contact the fire officer and discuss how people can be kept safe until the self-closing devices are fitted. Some of the issues raised in this report have also been raised in previous inspection reports. For example, staffing levels. It is important that the council and the home’s management make sure that any requirements are Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 25 addressed by the required date. Recommendations should be given serious consideration. In future, if a requirement is repeated, it is likely that enforcement action will be considered and the homes quality rating will be effected. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement A review of the staffing levels and the deployment of staff must take place, in order to ensure that staffing levels always meet the needs of the service users. This requirement was made in the last inspection report and the previous timescale of 31/12/06 has not been met. Timescale for action 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations NYCC should review the information it provides about terms and conditions and fees, to make ensure that people are provided with timely, clear and transparent information. The OFT’s report on ‘fair terms for care’ has been provided to assist with this. Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 28 2. OP7 Care records and plans should include nutritional assessments and if identified people should be weighed regularly as necessary. This information should be reviewed regularly to identify any changes in people’s needs and any action that staff need to take to promote people’s wellbeing should be included in their care plan. Care records and plans should include assessments of peoples skin integrity (for example, braden or waterlow). This information should be reviewed regularly to identify any changes in people’s needs and any action, that staff need to take to promote people’s wellbeing, should be recorded in their care plan. Each persons care records and care plans should be reviewed regularly and kept up to date. They should provide enough detail about people’s care needs and preferences, for staff (including agency staff) to provide a consistent and person centred service. 3. OP9 When medication is carried over from one monthly period to the next staff should ensure that the amount of medication carried over is entered onto the new MAR. This makes it possible to check that the recording on the MAR and the medication stock balances add up and are correct. Medication that requires refrigeration should be stored in the home’s dedicated medication fridge, rather than in the fridges that are used to store food and drink and are not secure. 4. OP14 More information should be included in people’s care records about their individual preferences and wishes (e.g. preferred times for getting up, going to bed, frequency and timing of baths or showers etc). This information should be used to amend bathing rotas, other routines and staff deployment in the home as necessary. Abuse and safeguarding adults training and training up dates should be arranged for new staff and existing staff. NYCC should facilitate the transfer to the new extra care housing scheme as soon as possible, to counteract the problems with the current building. The toilets and some of the bathrooms should be refurbished, so that they provide more pleasant and 5. 6. OP18 OP19 Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 29 homely facilities for people to use. 7. OP26 The provision of laundry and domestic staff should be reviewed to ensure that sufficient ancillary support is provided. Staff training records should be kept up to date, so that clear information is available about the training staff have completed and when up date training is due. Systems should be put in place to ensure that maintenance and safety checks are completed regularly, even in the absence of a specialist maintenance person. The advice of the Fire Authority should be sought and implemented, regarding how people who want their doors propped open can be kept safe until self-closing devices can be fitted to their doors. 8. OP30 9. OP38 Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Richmond House - North Yorkshire County Council DS0000034414.V371647.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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