Inspection on 22/01/09 for Richmond Painswick Care Centre

This is the latest available inspection report for this service, carried out on 22nd January 2009.

CSCI 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

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Richmond Painswick Care Centre Stroud Road Painswick Gloucestershire GL6 6UL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 2 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Richmond Painswick Care Centre Stroud Road Painswick Gloucestershire GL6 6UL 01452813902 01452813902 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richmond Painswick Ltd Name of registered manager (if applicable) Mrs Allison Mercie De Wet Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 24. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Richmond Painswick Care Centre is situated within the Richmond Painswick Village on the southern outskirts of Painswick. As well as the care centre the Richmond Village consists of village apartments and serviced apartments a restaurant, a wellness spa and other communal facilities. The Care Centre provides nursing care and a qualified nurse is on duty at all times who is responsible for managing the care staff. There are communal rooms and bedrooms, which are single with ensuite facilities. A Care Homes for Older People Page 4 of 26 care home 24 Over 65 24 0 Brief description of the care home shaft lift offers access to floors of the Richmond Village. Current fees for the care centre where not checked at this inspection vsit. Copies of the statement of purpose and service users guide are displayed in the main entrance to the care centre. Care Homes for Older People Page 5 of 26 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: The inspection visit was carried out by one inspector on one day in January 2009. The Head of Care of the home was present for the inspection visit, which consisted of a tour of the premises and examination of care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. Samples of records were selected for inspection against a number of outcome areas as a case tracking exercise. During the inspection visit three people using the care centre were spoken to, to gain their views of the service. The inspector also spoke to the Village General Manager. Survey forms were received from four people who had used the care centre and some of these had been completed with help from relatives. An Annual Quality Assurance Care Homes for Older People Page 6 of 26 Assessment (AQAA) form was completed by the home and forwarded to the Commission prior to the inspection.This gave us the information we asked for. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure ensures that people are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require. Information about the service in the form of the statement of purpose and the service users guide has now been widely distributed. Evidence: The statement of purpose had been updated since the previous inspection with a number of errors corrected. In addition, this document and the service users guide were more readily available and a number of copies were noted in individual rooms during a tour of the premises. The assessment documentation for a number of residents recently admitted to the home was looked at. Although information had been recorded regarding a residents needs, some of the documents looked at were incomplete and one had not been Care Homes for Older People Page 10 of 26 Evidence: signed or dated. The Head of Care reported that she was looking at updating the pre admission assessment document and this should include areas to record information about any history of falls and if there are any gender preferences regarding personal care. In addition the Village Manager had undertaken a number of pre admission assessments. The Village manager is not a qualified nurse and should not undertake any assessments for prospective residents who may be admitted to the home for nursing care. The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 11 of 26 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. The care centre works well to meet residents health and personal care needs whilst maintaining good storage and administration arrangements for their medication. Evidence: Care Plans for residents that were case tracked were detailed and individualised and gave clear instructions for staff to follow to meet residents needs. Some of the care plans were linked to risk assessments such as for moving and handling and preventing pressure sores. One care plan relating to nutritional needs was detailed showing evidence of individualised assessment used with a recognised nutritional assessment tool. The care plan described the residents food preferences and how meals should be presented to promote independence with eating. In addition the resident had been weighed with records kept. Care plans looked at had been reviewed on a monthly basis. There was evidence of residents receiving visits from General Practitioners (GP) and other health care professionals such as a chiropodist and a physiotherapist. Medication storage and administration systems were looked at. Medication was stored Care Homes for Older People Page 12 of 26 Evidence: securely with temperature control through an air conditioning unit. Appropriate temperatures were being maintained in the storage room as well as in the medication refrigerator. It was reported that weekly checks are carried out on medication stock levels. Medication administration records (MAR) had no gaps in recording and any hand written entries generally had two staff signatures and had been dated. However in two instances where medication had been stopped the words Discon had been written on the administration record. Any such directions should not only be signed and checked but should be more descriptive regarding the situation where a course medication has been stopped. Codes had been used to clarify any occasion when medication had not been administered. A homely remedies policy was in place and a letter from a GP was seen regarding this. All medication administration is carried out by registered nurses. Two residents spoken to confirmed that staff knocked on doors before entering and were polite to them. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a choice of social activities and suitable meals all in a variety of settings. Evidence: Care plans had been prepared to direct staff in meeting residents needs in respect of social interests and hobbies as well as spiritual and cultural needs. some residents had information recorded regarding their life history that had been completed by relatives. At the time of the inspection visit recent activities had included sessions where a dog visits the home entitled Pat a Dog and film shows. As well as activities organised in the care centre ( which included a number of one-to-one activities) residents could also choose to take part in events organised in the care village and even further afield such as bowling in the Town Hall in Painswick. The care centre had recently linked up with a local school who were working on a project about the Second World War with school children visiting the residents. Christian Holy Communion is held once a week in the care centre and it was reported that arrangements could be made for residents to visit local churches. Information about advocacy services was available in the entrance to the care centre. Care Homes for Older People Page 14 of 26 Evidence: Anyone staying in the care centre may bring in personal possessions including furniture within certain limits. Since the previous inspection visit, new menus have been brought into use with a three weekly rotation. Lunch on the day of the inspection visit was a choice of sausage and mashed potato or a pasta dish. A vegetarian option is also available if desired. One resident spoken to described how the order of meals had been changed to suit their preferences and was able to eat a cooked meal in the evening instead of at lunchtime. they also commented on how low fat yogurt had been provided at their request. Residents can eat their meals in the dining room in the care centre or in the restaurant in the care village. It was noted that more residents were making use of the dining room than previously and an extra member of staff has been recruited to provide hospitality during meal times on week days. Another resident spoken to commented on how they were eating well and had put on some weight since being in the care centre. Three out of four residents who returned surveys indicated that they always liked the meals provided. Care Homes for Older People Page 15 of 26 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. Information about how to make a complaint is more readily available in the care centre than previously this combined with appropriate investigation into any complaints made should give residents confidence that any concerns will be acted upon. In addition the homes approach to training staff should ensure that residents are protected from abuse. Evidence: The homes AQAA document told us that the home had received three complaints in the twelve months up to December 2008. There were documents kept on file for all the complaints received showing how the investigations were conducted and of any findings. One complaint was partly about call bell response times and it was noted that these were being monitored through the monthly unannounced visits carried out by a representative of the registered provider. All four residents who returned completed survey forms indicated that they knew how to make a complaint. No training had been carried out by staff in the home in relation to the Mental Capacity Act 2005. This should be considered in the interests of upholding residents legal rights. All staff receive training in protecting residents from abuse and how to deal with any allegation of abuse. There was a policy for staff to follow about protecting people who use the care centre from abuse as well as a whistle blowing policy to guide staff who Care Homes for Older People Page 16 of 26 Evidence: may wish to raise any concerns. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have the benefit of living in a clean and well-maintained environment carefully designed to meet their needs. Evidence: A tour of the environment of the care centre was conducted and as at previous inspections, the impression given was more that of a high quality hotel than a care home. All areas were found to be clean and well maintained. All four residents who returned survey forms indicated that the home was always fresh and clean. Communal areas consist of attractively presented and furnished dining room, and lounge with additional seating areas directly adjoining corridors. There is also a roof garden accessible directly from the care centre as well as an enclosed courtyard area that can be accessed through the lounge and through some of the individual rooms. Any person staying in the care centre can use any of the other facilities in the village such as the library, which is situated close to the entrance to the care centre and it was reported that some people had been making use of the restaurant. All individual rooms have ensuite facilities in the form of a wet room with shower, toilet and washbasin these are large enough to accommodate wheelchairs and hoists. In addition there are two bathrooms and toilets located close to communal areas. Care Homes for Older People Page 18 of 26 Evidence: There are two shaft lifts for people to access one close to the entrance of the care centre and another situated at the end near the communal areas. The call system is such that staff carry a pager that is activated when it is used. The system covers the whole village and the use of pagers prevents the noise nuisance evident from the use of a more traditional call system arrangement. The home has a dedicated equipment storage room where wheelchairs and hoists can be stored out of the way. Beds are all full profiling with electric control and suitable for residents receiving nursing care.They are all fitted with integral bed rails that are locked when out of use and subject to routine inspections. Where bed rails were in use, a risk assessment had been completed with additional checks being made in the interests of the residents safety. Doors to individual rooms are fitted with suitable locks. Flat screen televisions are provided in all rooms and there is a lockable drawer in the bedside furniture. The laundry was viewed although this is situated away from the care centre in another part of the Richmond Village. The Head of Housekeeping explained the procedures in the laundry and how these related to the care centre in managing any potential infection control risks. Care Homes for Older People Page 19 of 26 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. Sufficient staff are deployed and training is undertaken in a number of areas to meet the needs of people using the care centre with robust recruitment practices in place. Evidence: At the time of the inspection visit, staffing in the home consisted of two care staff on the morning shift and two on the afternoon shift. A registered nurse is on duty during the day and night. Increases in staffing numbers had been decided with an extra member of care staff in the morning. At night as well as the registered nurse there is one member of care staff and it was planned to increase this to two. The care centre receives support from the care village with administration, laundry, maintenance and catering although has its own dedicated cleaner and member of staff to assist at meal times. Out of eight care staff employed at the time of the inspection visit, five have achieved an NVQ at level two. Two of these staff were working towards an NVQ level three with another three due to start this. Recruitment records for members of staff were examined. All the required information and documentation had been obtained including checks against the Protection of Vulnerable Adults list and the Criminal Records Bureau. In addition were registered Care Homes for Older People Page 20 of 26 Evidence: nurses had been employed their registration had been verified with the Nursing and Midwifery Council. The head of care demonstrated an awareness of using thorough recruitment practices to ensure that suitable staff were working with residents. All new care and nursing staff that start work in the care centre receive induction training specifically linked to the nationally recognised Common Induction Standards. This covers such areas as confidentiality, customer care, equality and diversity and infection control. The homes annual training programme includes such topics as communication skills, confidentiality and equality and diversity. Care Homes for Older People Page 21 of 26 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 care centre is well managed with a number of checks in place to ensure residents safety and the quality of the service provided for them. Evidence: At the time of the inspection visit the Head of Care was in the process of applying for registration as manager of the home. She is a first level registered nurse with many years experience in working with older people in care home settings. She had recently commenced an NVQ level four and had completed training in moving and handling that would enable her to train other staff. A variety of methods were in use to check the quality of the service provided. Satisfaction surveys are sent to residents that have returned home after a respite stay and the findings are collected and analysed. It was reported that there had been a number of comments about the laundry system and improvements had been made which were explained during the inspection visit. Informal feedback was also received Care Homes for Older People Page 22 of 26 Evidence: from residents and their relatives during social events. Reports of visits made by representatives of the registered provider under the Care Homes Regulations were examined. These showed where residents and staff had been interviewed to gain their views about the care centre and gave information about how issues raised at inspections were being addressed. The reports were of good quality and also described checks on the cleanliness of the environment, privacy of residents and medication records. The arrangements for looking after residents money was looked at and satisfactory arrangements were in place with records kept. Since the previous key inspection, a safe had been obtained and was in use. Staff have received training in safe working practices in the areas of fire safety, first aid, food hygiene,health and safety, infection control and moving and handling. The home has a system of water treatment for managing the risk of Legionella and the maintenance team carry out weekly checks in relation to this. Regular temperature checks are made on hot water outlets and these are recorded and were within safe and comfortable limits. Portable electrical appliance testing was due to be done in February 2009. The heating system had been serviced in July 2008. Six monthly checks were made on window restrictors and a Fire risk assessment had been completed. Care Homes for Older People Page 23 of 26 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 24 of 26 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 3 Staff who undertake pre admission assessments for prospective residents who may be admitted for nursing care should be suitably qualified. Pre admission assessment forms should include areas to record information about any history of falls and if the prospective resident has any preferences regarding the gender of staff providing personal care. Pre admission assessment forms should be signed and dated by the person undertaking the assessment and be completed in full. The practice of signing and checking handwritten directions on medication administration records should be extended to entries that indicate when when medication is stopped or a course of medication is completed. Consideration should be given to staff receiving training in the Mental Capacity Act 2005 in the interests of upholding residents legal rights. 2 3 3 3 4 9 5 17 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!