Inspection on 13/02/08 for Richard House

This inspection was carried out on 13th February 2008.

CSCI found this care home to be providing an Adequate 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

Richard House 28/11/06

Richard House 21/02/06

Richard House 15/08/05

Richard House 01/12/04

Richard House 15/06/04

Richard House 03/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Richard House 69-73 Beech Road Cale Green Stockport Cheshire SK3 8HD Lead Inspector Mrs Fiona Bryan Unannounced Inspection 13th February 2008 09:20 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 Richard House DS0000008583.V358877.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. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richard House Address 69-73 Beech Road Cale Green Stockport Cheshire SK3 8HD 0161-429 6877 0161 474 0457 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) Denmax Limited` Joyce McDonald Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 33 OP. Date of last inspection 28th November 2006 Brief Description of the Service: Richard House is situated in a quiet street across from a local school, close to public transport. The home can accommodate up to 29 older people. Residents have the use of three main lounges with an additional sun lounge, conservatory and seating area at the entrance to the home. The home has been upgraded, redecorated and new fittings and fixtures are in place. Bedroom accommodation has been improved and the home offers 21 single and four double rooms for those who wish to share. A stair lift enables access to the upper floors. To the rear of the home is a garden where a decked patio area has been created to offer further outside seating. The accommodation fees range from £330 to £400. There are currently no top-up fees applied. Richard House DS0000008583.V358877.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 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection, which included a site visit, took place on Wednesday, 13th January 2008. The home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, the manager and other members of the staff team. Three people were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and care records was examined, including medication records, employment and training records and staff duty rotas. Before the inspection, we asked for comment cards to be sent out to residents and relatives, asking what they thought about the care at the home. Nine relatives and ten residents returned their comments cards. We also sent some questionnaires to staff at the home and ten replied. Comments from these questionnaires are included in the report. Before the site visit we sent a form called an Annual Quality Assurance Assessment (AQAA), which asks what they think they do well, what they have improved upon and what they need to do better. The manager completed it and had given a reasonable overview of how the home was running but could have put in more detail about how improvements would be made. What the service does well: Residents were assessed to make sure their needs could be met before they came into the home and residents said they had been given enough information about the home before they made a decision to live there. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 6 Residents said staff were generally kind and treated them well. Comments from relatives included “Staff are patient and caring to their residents”, “the support he receives is very good and every effort is made for him”, “they seem to be caring and friendly and to have the best interests of the people living there at heart” and “there is a good relationship between staff and guests”. The internal and external appearance of the home provides a pleasant, comfortable environment for residents to live in and residents and relatives said the home was always very clean and tidy. Visitors said they were always made welcome. Most people said the quality of the meals was good. Comments included “the food is very good – they know my fads”, “Meals are nice” and “the food is good – you can have what you want - it’s first class here”. All the residents that returned surveys said they knew how to make a complaint if they needed to and felt it would be dealt with properly. 75 of care staff are trained to at least NVQ level 2. Staff said the manager was supportive and residents approachable and they often saw her around the home. said she was Other comments included “it’s very good here”, “we’re looked after well” and “there is nothing to complain about”. What has improved since the last inspection? Since the last inspection some of the lighting in the home has been changed to be more domestic in character and the use of strip lighting has been confined to cellar, kitchen and laundry areas. Menus had been recently changed to include individual choices that were asked for by the residents but could be further improved by providing a second choice for the main meal of the day (at lunchtime), as this would offer the residents a clear choice rather than leaving it to them to say they did not want the meal and then be offered alternatives, as is the current practice. It was reported in the AQAA that some residents had said they would like to be taken to a local restaurant for birthdays, instead of having parties in the home and this has been arranged where possible. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Richard House DS0000008583.V358877.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 Richard House DS0000008583.V358877.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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: A statement of purpose and a service user guide are available in the home and copies are given to all new and prospective residents. A copy of the most recent inspection report from the CSCI was displayed in the reception area. Nine of the ten residents that returned surveys stated that they had received enough information prior to their admission for them to make a decision as to whether the home would be able to meet their needs. Three residents were case tracked. Pre-admission assessments, contracts, financial details and archived records were kept in the manager’s office, whilst risk assessments and care plans were kept in separate files, so that staff could use them every day as working documents. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 10 Assessments completed by staff at the home were not always dated, so it was not always possible to determine if they had been completed before or at the time of admission. The manager said that it was generally the policy that she would visit the prospective resident prior to admission and this seemed to be the case. Information obtained at the assessment stage was not always fully used when developing the care plans. However, staff were knowledgeable about the people they were caring for and said that changes to the residents’ needs or information about new residents was provided to them at staff handovers at the beginning of every shift. Richard House DS0000008583.V358877.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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care residents receive is generally based on their individual needs but lack of detail in care plans presents a risk that some needs may be overlooked. EVIDENCE: Three residents were case tracked. Care plans were in place but did not always cover all the care needs for each person, for example, mental, emotional and social needs that were detailed in assessment information were not always addressed. Some care plans were quite person-centred but others contained generic advice, such as “weigh regularly” without stating how often that should be or what weight the resident should maintain. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 12 Care plans were not always dated and although a monthly review and update was recorded, this was quite basic and did not specifically review individual care plans. On one resident’s care plans it was recorded that they had only been reviewed in February and December 2007. One person had been admitted to hospital and changes to their health care needs had been recorded but no care plan had been written and there was no evidence that their existing care plans had been reviewed on their return from hospital. This resident had a pressure mattress in situ but there were no further details about this and there was no care plan to inform staff how often they were to assist the resident to change position, etc. Staff need this information so they can check that any equipment is set correctly and working properly and so they can work to a plan to reduce the risk to the resident of developing pressure ulcers. Risk assessments to assess the risk of falls and to assess potential risks in moving and handling were in place. These were not always dated so it was not possible to assess how relevant they were and it was not clear how often they were reviewed. Most residents were weighed at least once every two months and the body mass index (BMI) had been calculated for some of them. It is recommended that all residents are screened on admission to assess their nutritional status in accordance with Department of Health guidance (Improving Nutritional Care, published October 2007). Despite the shortfalls listed above, residents appeared to be well cared for and content. 100 of residents that returned surveys said that they always or usually received the care and support they needed and that staff listened and acted on what they said. 100 of relatives who responded by survey also said that the staff always or usually met their relative’s needs and they got the support they expected. Staff need to make sure that as much detail as possible is put into people’s care plans and risk assessments so that everyone is clear what help is needed and how care is being monitored. Records showed that health care services, such as the GP, chiropodist, optician and dentist, had been accessed for people living at the home and arrangements were made for people to attend outpatient appointments at the hospital. Relatives spoken to at the time of the site visit and who returned surveys confirmed that they were kept up to date with their relative’s condition and were told about any changes that were needed to their care. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 13 Several relatives who returned surveys commented on the good relationship between staff and residents and said that the support residents received was good. One relative wrote, “They seem to be caring and friendly and to have the best interests of the people living there at heart”. Examination of a number of residents’ medicine administration records indicated that medicines were stored, administered and disposed of satisfactorily. A number of staff were undertaking training in medication. Richard House DS0000008583.V358877.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): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. More person-centred care planning is needed to ensure that people’s social and recreational expectations can be met. EVIDENCE: There is no designated activities organiser in the home, as it is seen as part of the carers’ role that they identify and meet the social needs of residents. At the time of the site visit, a group of residents were sitting in one of the lounges. They were asked how they spent their day and they replied, “We just sit”. One resident said she was able to go out for a walk each day independently and she liked to do this to get some fresh air and exercise. Other residents said bingo was played on a Friday afternoon, which some of them enjoyed; one resident said she could not manage to play bingo as she wasn’t able to hold the paper and pen very easily and mark the numbers off quickly enough. Some residents said they preferred to spend the majority of the time in their own rooms and entertained themselves, watching television or reading. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 15 In the AQAA the manager said they had been trying to arrange more trips out of the home and in response to residents’ requests they had arranged birthday parties to be held at local restaurants rather than always holding them in the home. One resident said she had been to several restaurants for meals recently and looked forward to those occasions. Another resident said that when it was anyone’s birthday, the cook always made a cake and they were “made a fuss of”. Residents said that entertainers, such as a pianist, were sometimes invited to the home. Residents were visited at the home by members of the clergy and were able to receive Communion if they wished. Nine relatives returned surveys before the site visit. Several of these commented that social activities was an area within the home that could be developed and one person queried whether residents were actually watching the televisions that were on most of the day in every lounge. The manager said that residents did like the televisions on but this arrangement should always be kept under review and residents should be regularly offered alternatives, for example, offering music or quiet times in some of the lounges. Residents’ care files provided little information about their interests or about how each resident had spent their day or how their social care needs had been met. The home does have a key worker system and further development of the key worker role could help staff to identify people’s social preferences and meet them according to their individual strengths and abilities, especially for those that do not wish to or are not able to join in with group activities. Visitors said they were made welcome and residents, in the main, felt they had some degree of choice regarding their daily routine. One resident was unsure as to whether they could stay in bed later in the morning if they felt like a liein and another said staff always got him up very early and he would prefer to get up later, although he had not told the staff this. The manager said that the menus had just been reviewed and a new fourweek menu had been started the previous week. Questionnaires had been sent to the residents asking for their suggestions about what food they would like so their preferences could be incorporated. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 16 Examination of the menus showed that typical food for the main meal of the day included stews, pies, roasts, fish, sausages, mince, cottage pie and braised steak. Lighter teas included egg, spaghetti, ravioli, beans and cheese on toast, hash browns, black pudding and beans, tripe and tomatoes, soup, hot dogs, egg and bacon, potato cakes and crumpets. Most residents said the food was good, although no choice was offered for the main meal. The manager said that staff told the residents what the meal would be and if anyone did not want it, they were offered other options. Residents said hot drinks and biscuits were regularly offered between meals and a supper of milky drinks and sandwiches was also served at about 8pm. The resident who got up very early said he did not always get a drink when he got up, until breakfast which was several hours later. The manager said she would speak to the staff about this. The meal on the day of the site visit was a roast pork dinner, which looked appetising and residents said they enjoyed it. Comments from the residents about the food included “the food is good – you can have what you want”, “First class here”, “the meals are nice. There is no choice at lunch but a choice at tea”, “the food is very good – they know my fads” and “the food is quite good really – last week we had fresh salmon on Friday, yesterday we had mince – it wasn’t too bad”. Richard House DS0000008583.V358877.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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents generally felt confident that their complaints would be taken seriously and acted upon. EVIDENCE: The complaints procedure is displayed in the home and all of the ten residents who returned our surveys before the site visit confirmed that they knew how to make a complaint should they need to. A record of complaints received had been maintained, which showed how each complaint had been investigated and resolved. Since the last inspection the CSCI received information from a person who alleged that they worked at the home without having gone through the correct recruitment procedure. They also made allegations about the standards of care within the home and that residents were made to get up very early. The complaint was referred to the safeguarding team employed by the local council who investigated the allegations. The manager and staff co-operated fully with the investigation and no evidence was found that residents were subject to any form of abuse. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 18 Two staff were spoken to who were aware of the procedures to follow if they suspected abuse. One of the staff had attended training in safeguarding adults in 2005 and the other had received some training in this topic as part of their NVQ training. It is recommended that all staff attend the training provided by Stockport Social Services. Richard House DS0000008583.V358877.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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents live in a safe, clean and comfortable environment. EVIDENCE: A tour of the home was conducted. The home was clean, tidy and free from any unpleasant odours. The premises were well maintained, both internally and externally. Residents spoken to said they were satisfied with the cleaning and laundry services. All of the ten residents who returned surveys said the home was always clean and fresh. A number of resident’ rooms were seen, which were furnished and equipped to a comfortable standard. The majority had been personalised by the occupants, with pictures, ornaments and small items of furniture. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 20 A permanent maintenance person is not employed and the manager is responsible for undertaking routine checks of the building and equipment. A gardener visits once a fortnight. The manager forwards any maintenance issues to the owner who arranges for contractors to carry out the work. The manager felt that the service could be improved by employing a part-time maintenance person, so small jobs for the residents and minor repairs, etc., could be carried out with minimal delays. In the AQAA the manager stated that some of the lighting had been changed to be more domestic in character and use of strip lighting had been confined to the cellar, kitchen and laundry areas. She planned to make changes within the garden area of the home and replace the fencing. Richard House DS0000008583.V358877.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): Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Deficient recruitment procedures and training lead to a risk that unsuitable staff may be employed who may not be properly trained to meet the needs of the residents and the service the home offers. EVIDENCE: On the day of the site visit two senior carers and two carers were on duty to care for 25 residents. In addition, the manager works full time and covers variable hours including weekends and bank holidays. It was reported that there were usually one senior and two carers on duty from 8am-10pm and two carers on duty overnight, with a third carer sleeping-in. Additional staff are brought in to meet the needs of residents, for example where a resident is going to hospital and needs an escort. Examination of the staff duty rota for the weeks commencing 4th February 2008 and 11th February 2008 seemed to show that staffing levels had fallen below the norm on several occasions. It was explained that staff had changed shifts or stayed on duty to cover the shortfalls but this was not indicated on the rotas. Duty rotas should reflect accurately which staff worked and what shifts they covered. Residents spoken to said staffing levels were not extravagant but when they needed help someone usually came promptly. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 22 During this site visit the personnel files for two new members of staff were examined. The employment history for one was not fully completed and did not provide the dates when employment had started and stopped. The references for this person were not from their last employer and no CRB or POVA check had been made before the person started employment at the home. A copy of the person’s last CRB was on file and this had been obtained by a care home that was not listed in the employee’s employment history, indicating that they had not provided full details about where they had previously worked. A CRB had been obtained for the second member of staff but only one reference was available. During the investigation by the safeguarding team, referred to in the “Complaints and Protection” section, it was found that staff had worked at the home without having been through a proper recruitment process. We wrote to the owner of the home in September 2007 asking him to confirm that all staff working at the home had all the necessary documents in place and that future staff would be employed via a robust recruitment procedure that adequately protected the residents living at the home and he responded that this was the case. It is of concern that despite the previous incident, recruitment procedures are not robust enough to ensure that people are suitable to work in a care home before they are employed. Information supplied in the AQAA reported that 75 of the care staff at the home had successfully completed NVQ training to level 2 or above, whilst three staff were completing level 3 and two completing level 4. Training and development records need improvement; there was insufficient information on file to identify what training had been completed or planned for. The only up to date evidence that the manager was able to provide were certificates of training for two carers in safe manual handling and urinary catheter care and confirmation that two carers had completed NVQ level 2 in May 2007. 2 carers in safe manual handling and urinary catheter care and confirmation that 2 carers had completed NVQ level 2 in May 2007. A system should be devised whereby the manager can have an overall view of what training had been completed to date for the whole staff team in order to plan future training and to enable her to easily identify when update and refresher training is due. Richard House DS0000008583.V358877.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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Management systems need to be more rigorous to ensure that policies and procedures for the protection and promotion of residents’ health and welfare are established and adhered to. EVIDENCE: There are no changes to the management structure at the home. The registered manager has been at the home for some considerable time and is experienced in caring for older people. She has a NVQ level 4 in management and has successfully completed the Registered Manager’s Award. She said she had undertaken refresher training in the management of medicines with other staff. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 24 The manager said she operated an open door policy and residents said that she was approachable and regularly out and about around the home. Staff said they felt supported to do their job. There were no minutes available of formal staff meetings, as staff said they tended to discuss any issues on a daily basis during the handover sessions. As the staff team is quite small, people felt this form of communication worked well. Minutes of one residents’ meeting that was held in April 2007, were available. The minutes recorded that the residents wanted to continue having meetings on a regular basis but informally, without a chairperson. The manager said she regularly chats with residents informally after meals when they are in dining rooms, or before bingo on a Friday afternoon but these discussions were not recorded anywhere. It would be useful for the manager to keep a record of discussions held with residents as an aide memoire of suggestions made and to enable her to follow up and respond to issues raised by residents. The minutes of the meeting in April 2007 stated that it was agreed to hold another meeting in two weeks but there were no formal records of any meetings since then. It was reported that a survey had just been completed in the home asking for the residents’ views on the food provided. Comments and suggestions had been considered when the menus were reviewed and amended. No other form of quality monitoring had taken place since the last inspection. The manager said she had just obtained new quality assurance surveys and was planning to distribute them. There was no system of audit in the home where the manager formally reviewed whether policies and procedures were being adhered to, as the manager herself was mainly responsible for most of the record keeping. The manager recognised that when she was not at the home, problems could arise, as other staff did not always have the experience or skills to complete the required documentation. She was trying to access training for some staff in care planning and record keeping to ensure that documents were completed correctly when she was not there. The manager said that all the residents were able to manage their own money, or their representatives were invoiced for any goods or services that were purchased on their behalf, so no money was held in safekeeping at the home. Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 25 Since the last inspection the manager has started to undertake supervision with staff. However, she said this needed to be more structured as some staff received more supervision than others. As with the training programme, a proper plan would be beneficial to ensure all staff receive supervision regularly. Staff said there was enough equipment within the home to enable them to carry out their jobs safely and staff were seen to be working using safe working practices, although there was no evidence that any staff other than two carers had received training in health and safety topics within the last year. Fire drills had been recorded but did not state the times at which they were held. Several of the same staff had attended some of them but not all staff on the duty rotas seemed to have been included. The manager was advised to vary and record the times of the fire drills so all staff attend at some point. An environmental health inspection was carried out at the home under the Health Act 2006 and the Smoke Free Regulations 2007 and a high level of compliance was found. Since the last inspection no notifications have been sent to the CSCI under Regulation 37 of the Care Homes Regulations 2001. The manager said this had been an oversight. A discussion was held about the types of incidents that were notifiable under the regulations. The manager completed the AQAA and had given a fair reflection of the services provided, although some of the information could not be substantiated during the site visit, for example, the AQAA stated that they had started to hold resident led meetings to offer residents the opportunity to affect the way they delivered the service. There were also areas where more supporting evidence would have been useful to illustrate what plans were in place to improve. Richard House DS0000008583.V358877.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 X 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 Requirement Staff must not be employed at the home until satisfactory CRB and POVA checks have been made and references obtained to ensure that only suitable people are employed to work at the home. Staff must receive up to date training in moving and handling, fire safety and other health and safety topics relevant to their roles. This will mean that staff work safely at all times. Notice must be given to the CSCI, without delay, of any occurrence listed under Regulation 37 of the Care Homes Regulations 2001 so that we can be sure that any significant event which occurs is appropriately dealt with. Effective quality assurance and quality monitoring systems must be established that are used to develop and improve the service and show how the views of residents are taken into account and how they influence how the manager operates the home. DS0000008583.V358877.R01.S.doc Timescale for action 15/03/08 2 OP38 18 30/04/08 3 OP38 37 15/03/08 4 OP38 24 15/04/08 Richard House Version 5.2 Page 28 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 2 Refer to Standard OP3 OP7 Good Practice Recommendations All information obtained during the assessment process should be considered when developing a plan of care for each resident. Care plans should be as detailed as possible and should be reviewed thoroughly to ensure that staff have enough information about what care they need to provide and how they should monitor its effect. Consideration should be given to developing the key worker role to ensure that people’s leisure needs are considered more individually to meet their capabilities and preferences, particularly for those who do not wish to or are unable to join in with group activities. A record should be kept of how residents’ social needs are met. The lunchtime menu should be developed to provide a second option for residents and increase the opportunity for them to exercise choice. Staff should attend safeguarding training arranged via Stockport local authority. Staff duty rotas should accurately reflect the staff working on each shift and should be updated when changes are made. The manager should develop a training programme so that she can identify when refresher training in mandatory health and safety topics is due and plan training for staff in topics that are specific to the care they need to deliver. All staff should have a minimum of three paid days’ training per year and have an individual training and development assessment. 3 OP12 4 5 6 7 OP15 OP18 OP27 OP30 Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Richard House DS0000008583.V358877.R01.S.doc Version 5.2 Page 30 - 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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