Inspection on 17/10/05 for Richmand House Residential Home Ltd

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Richmand House Residential Home... 27/09/07

Richmand House Residential Home... 18/12/06

Richmand House Residential Home... 13/07/05

Richmand House Residential Home... 14/02/05

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

CARE HOMES FOR OLDER PEOPLE Richmand House Residential Home 88 - 90 Melton Road West Bridgford Nottingham NG2 7NF Lead Inspector Linda Hirst Unannounced Inspection 17th October 2005 10:30 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 Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 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. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Richmand House Residential Home Address 88 - 90 Melton Road West Bridgford Nottingham NG2 7NF 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) 0115 9142609 0115 9455861 richmondhouse88-90@tiscali.co.uk Richmand House Residential Home Ltd Mrs Susan Melanie Godfrey Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13/7/05 Brief Description of the Service: Richmand is a care home providing personal care for up to 14 older people. It is owned by Richmand Care Homes Ltd and managed by one of the providers who plays a very active part in all aspects of service provision. The home is located in West Bridgford on one of the main bus routes running through the area. It is approximately half a mile from the centre of West Bridgford, which offers shops, pubs, cafes, and other facilities. There are also shops, churches and a post office on the main road close to the home. It is an extended Victorian property and provides 12 single and one double bedroom, with all but two rooms having en suite facilities. The first floor is accessed via a lift. There is a small garden to the rear of the home and car parking for a few cars is available at the front of the home. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit involved one inspector who was at the home for half a day, including during lunch. The main method of inspection used was called ‘case tracking’ which involved selecting two residents and tracking the care they receive through checking their records and discussion with them. One of the residents selected was very unwell and sleepy on the day of the inspection but two other residents living at the home were also spoken with. The inspector looked at the records of medication, residents’ finances, complaints and quality assurance. Lunch was also observed. Staff were observed undertaking their duties throughout the visit. What the service does well: What has improved since the last inspection? What they could do better: A fire safety risk assessment for the home needs to be developed to make sure all steps are taken to protect the residents in the event of a fire. Medication must be signed for as it is given, if tablets are taken later than prescribed for whatever reason, the time they are given should be entered on the record. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 6 It is recommended that care charts be utilised for residents who are terminally ill to give evidence of proper care and monitoring. One person has a two way monitor for valid reasons but this should be properly risk assessed and authorised as it infringes the resident’s right to privacy. 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. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 7 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 Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The care plans are not detailed enough to give full guidance to staff on meeting the needs of the residents but this matter is being addressed. Residents health care needs are assessed and provided for, though the use of care charts is recommended for people who are terminally ill. Medication practice needs to improve to make sure that the arrangements are safe and that residents get their tablets as prescribed by their GP. Residents are treated with dignity and respect and their privacy is respected. EVIDENCE: The care plans of the “case tracked” residents were inspected to make sure these were detailed and up to date. A new system for care planning has been identified but this has not yet been put into use. There is an outstanding recommendation to provide more detailed risk assessments and care plans to make sure that staff have proper guidance about how to meet needs. There was evidence of relatives and residents being involved in the development of their care plans and this was confirmed in discussion with residents. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 10 The residents’ health care needs are documented and assessed as part of the care plans. There is good evidence of regular input from the GP, Nurses and Chiropodist and the residents interviewed said their health needs are well catered for and staff provide good care to them if they are not well. Hospital visits are documented and information was held on file about the medication used for treatment of one of the resident’s illnesses. One of the residents is terminally ill and it is recommended that care charts be implemented in such situations to provide evidence that the staff are properly monitoring and providing for the increased care needs of the resident. The medication arrangements were inspected to make sure that these were safe and ensure that residents receive their medication as prescribed by their GP. The storage arrangements for medication are safe and medication is properly stored and secured. The Controlled Drugs are counted down and the records tally with the tablets remaining in the home, the records follow guidance from the Department of Health. Gaps were identified on the Medication Administration Record (MAR) for one resident and when this was queried with the manager it was because the medication is being taken out of the blister pack and redispensed at a later time. This is not safe practice and an alternative must be found. It is also important to record the time medication is given on the MAR if tablets are given later than prescribed as this can be vital information in a medical emergency. The residents said that they can see and telephone people in private, and confirmed that the staff are respectful and preserve their dignity. This was supported by observation as all of the residents look well groomed and they are encouraged to retain pride in their appearance. One lady had her make up applied and jewellery on. One of the residents has a two way monitor in his bedroom for valid reasons. However, because this impacts on his privacy its use should be risk assessed and authorised. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Activities and holidays are provided for the residents at the home. Several residents go out into the community with staff or their family, and existing and new relationships are encouraged and promoted. The routines at the home are very flexible and the residents feel they have freedom to decide their own lifestyle. The residents have a varied and nutritious diet which promotes and maintains their health. EVIDENCE: One of the residents goes out “every day” with her family or else they visit her at the home. She said that trips out are arranged and the home’s minibus is used regularly, especially in Summer. She was observed sitting out with her friends and staff in the garden. Some of the residents have just returned from holiday in Benidorm and one is going to Thoresby Hall for a week shortly. Residents interviewed said they get up when they like, for some this is early but they said the staff do not wake them, they can have a lie in if they choose. They can go to bed when they choose and one resident said that for her this Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 12 was usually around 10 p.m. One resident said she “enjoys” her life at the home. Lunch was observed during the course of this inspection to ensure residents are receiving a nutritious diet. Lunch for the day consisted of sausage, mash, carrots, sweetcorn, parsnips and onion gravy. One resident was having egg sandwiches as an alternative. Pudding consisted of fruit and cinnamon sponge with cream. There are no residents requiring a special diet at the moment. A range of juices are available at lunchtime. The residents sit in small groups to eat and were relaxed, chatting about a recent holiday to Benidorm. The residents commented that they get “plenty” to eat and drink and said that the food is varied and well cooked. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The residents know how to complain and would feel confident to do so if necessary. They feel safe and secure at the home. EVIDENCE: The record of complaints was inspected. None have been received at the home or via the Commission for Social Care Inspection since the last visit. Complaints and incidents are now recorded in separate books enabling easier auditing. None of the residents who were interviewed had ever complained but they knew they have a right to and were clear about the process. They said they feel safe at the home and that staff are very “patient” with more difficult residents. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The staff are competent, caring and able and the residents praised them highly. EVIDENCE: Residents said that the staff are “good” and they feel they get on well together. The residents feel there are enough staff around to meet the needs of those living at the home. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 The residents are properly consulted for their opinions on the service and care provided and comments are acted upon. The health and safety records are generally well maintained, although a fire safety risk assessment is needed for the home. EVIDENCE: Quality assurance questionnaires from the last quality assurance audit were seen. The results of these had been collated and relatives were written to on 6/7/05 with the results and actions being taken to address shortfalls. The questionnaires are sent out every 3 to 4 months and residents’ meetings are also held at the home. The residents confirmed that they are asked for their opinions about the home and the care provided. They commented that they are “very happy” with the care and have “nothing to complain about.” Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 17 The arrangements for residents’ finances were checked to make sure that their interests are properly safeguarded. The proprietor is not the appointee for any of the residents, they do not handle residents money. If residents spend money the proprietors pay and then ask relatives/representatives to reimburse them. No money is held at the home on behalf of residents and this standard is not applicable. The Health and Safety checks and servicing records were checked to make sure that residents and staff are properly protected. The bath hoist and stair lift have been serviced at the required intervals to make sure they are safe. The electrics and gas supplies have been checked and serviced and these are up to date. Checks are undertaken for Legionella every six months and these were all in order. Fire safety checks are being undertaken at the required intervals and the servicing of essential fire fighting equipment is up to date. However, there is no fire safety risk assessment in place in respect of the home at the moment and one must be undertaken to ensure that all reasonable steps are being taken to minimise the risk of fire at the home. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 18 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X N/A X X 2 Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13 Requirement Timescale for action 28/11/05 2 OP38 23 Medication must be signed for as administered. The practice of redispensing medication is not safe and must cease in the case identified. If medication is given later than prescribed the time it is actually given must be entered on the MAR sheet. Develop a fire safety risk 17/12/05 assessment for the home. 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 3 Refer to Standard OP7 OP8 OP10 Good Practice Recommendations Care plans and risk assessments should be more detailed. Care charts should be implemented for residents who are terminally ill. Record and risk assess the use of the two way monitor for the resident identified. Its use should be authorised. Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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 Richmand House Residential Home DS0000061918.V258972.R01.S.doc Version 5.0 Page 21 - 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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