Inspection on 27/09/07 for Richmand House Residential Home Ltd

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

Richmand House Residential Home... 17/10/05

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 Ltd 88 - 90 Melton Road West Bridgford Nottingham NG2 7NF Lead Inspector Lee West Key Unannounced Inspection 27th September 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richmand House Residential Home Ltd DS0000061918.V348170.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. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmand House Residential Home Ltd 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 cedrica@tiscali.co.uk Richmand House Residential Home Ltd Mrs Susan Melanie Godfrey, Cedric Anthony Godfrey Mrs Susan Melanie Godfrey Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No one falling with category OP maybe admitted into Richmand House where there are 13 of category OP already accommodated within this home. 18th December 2006 Date of last inspection Brief Description of the Service: Richmand is a care home providing personal care for up to 13 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 13 single rooms, 11 having en suite facilities. 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. At the time of inspection fees quoted by the registered manager was £1,482.00 to £2,139.00 per calendar month, dependent on level of care required. The service user guide, explaining the service provided and statement of purpose, together with a copy of the last report by the Commission, are available on request. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit carried out by one inspector. The focus of the inspection undertaken by the Commission for Social Care Inspection is upon outcomes for service users, and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that require further development. This was an unannounced key inspection undertaken by one inspector. The main method of inspection used is called ‘case tracking’ which involves selecting four residents and tracking the care they receive through checking their records and discussion with them, and observations of the care received and asking staff about their needs. A number of other residents, staff and visitors to the home where also spoken with to obtain views about the service. Documents and policies were examined as part of the inspection to gain evidence and form an opinion about the residents’ health and safety. A partial tour of the premises was undertaken which included communal areas, and a sample of bedrooms to ensure that the environment was pleasant, homely and safe. The annual quality assurance assessment, and a review of all other information about the home received by the Commission since the last inspection was taken into consideration in planning this inspection and helped in deciding what areas of care were looked at. What the service does well: Richmand provides an excellent, high standard of accommodation, with residents’ rooms individually decorated and furnished to their personal preferences. The large rooms, eleven of which are en-suite, are very clean and well maintained. “My room has an excellent view from its large windows,” said a resident. “My room is as big as a flat and my family can visit me privately, and be comfortable,” said another resident. Residents said they are supported in whatever they wish to do and one has recently returned from a holiday abroad, which residents said helps them keep control of their lives. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 6 Residents said they were happy and well cared for and enjoyed the homely atmosphere of the home. They said the staff always treat them with respect and are very helpful. They also said the food was excellent. The home has a staff team who have worked at the home for a number of years and who are aware of the needs of the residents. The manager is also involved with the day-to-day care of the residents, supporting the small staff team. Visitors spoken with said they are made to feel welcome whatever time they visit and are always offered refreshments. What has improved since the last inspection? What they could do better: Although they have improved since the last key inspection, the care plans require further development. The actions to meet care needs must be identified with moving and handling, or other necessary risk assessments recorded in the plans, to enable staff to carry out their roles safely and competently. To maintain the dignity and comfort of residents, a review of staffing levels is required to meet the needs of the residents. In particular, at mealtimes, when a number of residents may require assistance with eating, and avoiding the practice of assisting more than one resident at the same time, enabling them and staff to support unhurried and dignified mealtimes. Training in moving and handling and basic first aid practices should be updated to ensure current practices are being used when assisting residents. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 7 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. Richmand House Residential Home Ltd DS0000061918.V348170.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 Richmand House Residential Home Ltd DS0000061918.V348170.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): 3, 5, 6, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed and if the manager assures them that their needs can be met at the home they are provided with enough information to enable them to make a decision about where to live. EVIDENCE: Pre-admission assessments, which contained personal information, personal and medical history, preferences and any help required, were seen in the files case tracked. Staff spoken with said they were aware of the care needs of all their residents, including new ones, because the manager, “makes sure we know about everyone, so we can help them,” said one carer. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 10 Residents said they had the opportunity to visit the home on a number of occasions before making the final decision to move into the home. One resident said, “I wasn’t rushed in any way, and everyone here was friendly and kind when I visited. That helped me to make up my mind.” There are no service users who are admitted for intermediate care at the home, and this standard is not applicable. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care planning documentation has improved and a person centred approach to care is used, with inputs from residents, but there are still some areas, which require improvement to help ensure care needs are met in the most appropriate way. EVIDENCE: Residents spoken with were all very satisfied with the level of care they receive, and confirmed they were treated with respect, “it’s like a family and everyone has a part to play,” said one resident. They also confirmed they were involved with the preparation of care plans and their opinions about their care needs and preferences were always respected. Care plans contained informative, person centred, assessments of personal and medical history, care requirements, personal preferences and wishes, but did Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 12 not clearly identify the specific actions the staff were required to carry out to meet the needs. Risk assessments, particularly for moving and handling people with increasing mobility difficulties were also missing records of the actions required to support residents and staff to carry out this role. Staff were observed assisting residents who wanted to move, in a safe manner and in accordance with current moving and handling practices. Staff spoken with, were able to demonstrate their knowledge of the actions required to support each of the residents whose care was being case tracked, by describing what actions they carried out for each of them during a shift. Medication records were checked and were accurately completed. Medication was stored appropriately and the lunchtime medication was administered in accordance with the home’s procedures. No residents were self-administering medication at this time. Residents spoken with about medication said they preferred staff to deal with this. “I feel safer having my medication given to me,” said one resident. A resident who prefers to rise late, was observed eating breakfast, without being hurried, at 11:00am. Interactions between staff and residents were observed to be positive and helped promote their wellbeing. There was spontaneous conversation and laughter between everyone in the lounge area, residents and staff. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported to live their own lifestyle, with flexible routines, group and individual activities. Meals are home cooked, varied and nutritious to help promote good health. EVIDENCE: Residents said they can go to bed and get up whenever they wish, and one resident, who preferred this, got up this morning at 11:00am. A small group had recently been over to the theatre in the nearby town of Mansfield, and another resident had returned from a holiday in Benidorm, supported by two carers. This resident said, “I have always had wanderlust and could not settle if I couldn’t get over to Spain regularly. This was my third holiday since coming into the home.” There was a film showing during the afternoon from the large selection of DVDs and videos in the home’s collection, which a number of residents were watching. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 14 Newpapers, delivered from local newsagents, were being read, and residents said they were delivered daily if requested. One visitor spoken with said the resident being visited was very happy at the home and that, “ a vast change for the better has been seen.” Also, “staff are very caring and always provide cups of tea and anything else I need.” Residents said they have visitors whenever they wish and there are private areas available, but the rooms were large enough to entertain families. A landline telephone was observed in one resident’s room and the resident was happy with this as it, “helps me keep in touch with my family.” Lunch of chicken, potatoes and carrots was being served. This was well presented, looked appetising and menus were well balanced and provided a variety of foods, with alternatives for everyone’s personal choices. Residents said they enjoyed the food provided as it was, “well cooked and there is plenty of it.” Another said there were always alternatives if required. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s procedures to safeguard adults, and any concerns or complaints are taken seriously and acted upon. EVIDENCE: Records were inspected and neither the home nor the Commission had received any complaints, since the last visit and residents said they would speak to the manager, or any member of staff, if they had any cause to complain. Staff spoken with were aware of their role with safeguarding adults procedures and training had recently been attended and certificates of attendance seen. They said they would immediately let the manager know if there was any bad practice, or any other safeguarding issue, to protect the residents. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25, 26, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is clean and has a high standard of furnishings, is very well maintained and individual rooms are decorated to individual tastes, with personal possessions, providing a comfortable, safe and pleasant environment. EVIDENCE: The home was very well maintained inside and out, with a well-kept garden which could be seen through the conservatory windows. The garden was accessible to everyone who wished and had a selection of new garden furniture. All areas of the home were clean, well decorated and furnished to a high standard. The residents chose the colour schemes for their individual rooms and have their personal possessions around them. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 17 One resident said, “I am delighted with my room, I have an exceptional view from my window, and I have everything I need.” During the inspection, the residents were sitting in the lounges, and dining area, near the kitchen. At lunchtime they sat in small groups to eat and the interactions between residents, staff and visitors was cheerful and positive. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staffing levels generally meet resident’s needs, however at time of high activity this was not the case for all residents, some of whose dignity and respect was compromised by the delivery of their care. Resident’s are protected by robust recruitment, selection and training practices of the service, although some updates are required. EVIDENCE: Staff spoken with indicated a good level of knowledge about the resident’s needs. “They know what they are meant to do. I don’t have to keep explaining what help I need,” commented one resident. Another said, “They are there to help whenever I need them.” Due to illness there was insufficient staff working to meet the needs of individual residents who required assistance with eating. The manager and carer were observed sitting at the lunch table assisting two residents each, at the same time, to eat lunch. Recruitment procedures had been improved and staff files contained all the relevant documentation required to ensure staff are eligible to work in the establishment. These included copies of professional references, individual identification and Criminal Records Bureau checks. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 19 Training records were seen, indicating training had been carried out, including Health and Safety, Basic Food Hygiene, and National Vocational Qualifications, but Moving and Handling and basic first aid training was not up to date. Staff said they had attended training, but had not had moving and handling training for some time, but felt they were still competent in their role. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 20 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, 32, 33, 35, 36, 38, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is well run and managed to support their wellbeing, with systems in place to safeguard residents’ finances as well as procedures to protect their health, safety and welfare. EVIDENCE: Residents said they were very happy with the staff and particularly the manager, who, “does everything she can to make things happen for me,” commented one resident. Another said, “Sue has a very kind, warm and caring attitude to us all.” Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 21 Another said, “I am sure I wouldn’t be alive today if it hadn’t been for the care provided by this home, but Sue in particular. Nothing is too much trouble for her.” Policies, procedures and record keeping, including financial records, were in place to support the health, safety and welfare of the residents and staff. As required in the last inspection, the recruitment procedures had been reviewed and improved. Staff files contained evidence of supervision and staff confirmed this was carried out, but that Sue was also always available for any immediate concerns. Records submitted to the Commission by the manager, prior to the visit, showed health and safety servicing of equipment, and safety measures, including fire alarm testing, are regularly carried out and sampling of records at the home during the visit supported this information as accurate. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 22 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 3 x 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement To ensure resident’s needs are met care plans must provide comprehensive information of actions for staff to follow to assist residents. This must include arrangements for moving and handling, to make sure they provide the assistance needed to meet individual care needs safely. This requirement was set during the previous inspection visit on 18/12/06) A review of staffing levels must be undertaken to ensure there are sufficient numbers of staff on duty, at times of high activity, particularly meal times, to support residents who require assistance with eating to be supported individually to help them eat in a manner, which maintains dignity. Timescale for action 10/12/07 2. OP27 18(1) 10/12/07 Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations Ensure care staff training, including moving and handling procedures is maintained up to date. Richmand House Residential Home Ltd DS0000061918.V348170.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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