Inspection on 14/08/07 for Richmond

This inspection was carried out on 14th August 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Richmond 15/07/08

Richmond 05/06/06

Richmond 15/11/05

Richmond 17/05/05

Richmond 11/01/05

Richmond 17/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Richmond Collington Lane East Bexhill-on-Sea East Sussex TN39 3RJ Lead Inspector Judy Gossedge Key Unannounced Inspection 14th August 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 Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond Address Collington Lane East Bexhill-on-Sea East Sussex TN39 3RJ 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) 01424 217688 01424 210424 home.bex@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Lois Blake Care Home 52 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (31) of places Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th June 2006 Brief Description of the Service: Richmond is a purpose built home providing personal care and accommodation for fifty-two older people. It is owned and managed by Methodist Homes for the Aged (MHA). Service users accommodation consists of fifty-two single rooms situated on the ground and first floor in two units. Heather Bank on the ground floor is for service users living with dementia and on the first floor is a residential unit for older people. Service users accommodation on the residential unit consists of thirty-one single bedrooms all of which have en-suite toilet and hand washing facilities. In addition nine bedrooms also have showers as part of the en-suite facilities and four bedrooms have baths. There are communal assisted bathing facilities. There are small ‘break out’ areas where service users can make hot drinks and a separate dining room and lounge are situated on the ground floor. Access to the upper floor is via a passenger lift and a stair lift is available to access a number of bedrooms only accessible by a further small flight of stairs. Service users accommodation on the Heather Bank unit consists of twenty-one single bedrooms all of which have en-suite toilet and hand washing facilities. In addition seven bedrooms also have showers as part of the en-suite facilities. There are communal assisted bathing facilities. An L shaped conservatory style walkway adjoins both wings of bedrooms on the unit. The walkway is spacious enough to provide a pleasant seating area and provides ramped access to the secure garden. There is a separate lounge, dining room with a kitchen area and a further kitchen area to prepare snacks and hot drinks. Service users on each unit have access to a garden with a patio area. The homes Statement of Purpose and Inspection reports are available to view in the home. The service provides prospective service users with a copy of the Service Users Guide as part of the pre-admission process. At the time of the Inspection fees were documented to be between £442.00 and £540.00 per week. Additional charges are made for hairdressing, toiletries, chiropody, newspapers, and dry cleaning and outside activities such as visits to the theatre. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 5 Intermediate care is not provided. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and a half hours on 14 August 2007. The Registered Manager completed an Annual Quality Assurance Assessment (AQAA) and information detailed is quoted in this report. A tour of the premises took place to look at communal areas and a selection of service user’s bedrooms, rotas and care records were inspected. Twenty-nine service users were resident on the residential unit and five were spoken with individually in their bedroom. Nineteen service users were resident on Heather Bank unit and the opportunity was taken to observe the interaction between staff and service users in the communal areas and a number of service users were spoken with as part of the Inspection process. Of these for four of the service users the care they had received during their stay was reviewed as part of the Inspection process. Fifteen service user surveys were sent out and three completed surveys were returned. The Manager, the deputy manager, two assistant managers, one new care worker, four care workers one of whom also works at night, five members of the housekeeping team, the chef and kitchen assistant and administrative assistant were all spoken with. Ten surveys for relatives, carers and advocates were sent out and four came back completed. One relative was also spoken with on the day. General Practitioners comment cards were not sent out on this occasion. Since the last Inspection an application was received to combine Richmond and Heather Bank the ‘sister’ home within the same building and registered in its own right, to be registered as one home called Richmond, which was agreed. An additional visit was made by the Link Inspector to Richmond on 5 February 2007 to monitor compliance with the requirements following the last Inspection of 5 June 2006. Of concern was the fact that a number of Requirements remained outstanding from the previous inspection and additional Requirements were made in relation to care planning, infection control and medication procedures in the home. The CSCI met with representatives of the organisation and a satisfactory response was received from the provider as to how these issues would be addressed. What the service does well: The atmosphere of the home was comfortable, open and relaxed and service users are encouraged to remain independent and to exercise choice over their daily lives. Staff was observed to deliver care with dignity and respect. The service users service users spoken with felt the care provided respected their privacy and dignity. Feedback from service users and relatives was that they were pleased with the overall care provided in the home. Comments received Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 7 included, ‘ the staff are very kind,’ ‘the staff are all lovely people,’ ‘they are very good,’ ‘it’s a lovely place,’ ‘in general we are very satisfied with the care that our relative receives. We feel that the staff in Heather Bank have an excellent understanding of dementia care,’ and ‘all I can say is the Manager and Methodist homes seemed to have the situation cracked.’ What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is detailed information available for service users and/or their representatives to view, and potential new service users are individually assessed prior to an admission to ensure that their care needs can be met in the home. EVIDENCE: The Statement of Purpose is detailed and is available to read in the home with a copy of the last Inspection report. Each prospective service user is given a copy of the Service Users Guide. Two of the service users surveys stated they had received enough information and one stated they had not, and one commented, ‘I wish someone had discussed it with me.’ One relative confirmed receipt of information on admission and also stated that it would be helpful to know when the home has been Inspected and when the latest Inspection report is available to read. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 11 The AQAA detailed that a full assessment is completed prior to any admission to ensure individual service users care needs can be met in the home and to provide staff with information on the care to be provided. All of the four service user files viewed who had been admitted to the home since the last Inspection had a copy of an initial assessment. Intermediate care is not provided at Richmond. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 12 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 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users were not all protected by a detailed individual plan of care being in place, where all their personal, social and health care needs have been identified and which informs staff of the care, which needs to be provided and with supporting risk assessments completed. Medication policies and procedures are in place, but these should be followed to protect service users. EVIDENCE: The AQAA detailed that there are policies in place to ensure that equality and diversity issues for individual service users are both identified and incorporated into service users individual plans of care. A selection of six of the service user’s individual care plans was viewed, three on each unit. It was not possible to evidence if a number of Requirements made following the last Inspection had been met as staff were in the process of implementing a new detailed care plan and risk assessment format. Not all service users had a completed care plan or risk assessments in place, which detailed all the service Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 13 user’s personal and health care requirements, dietary needs, social and leisure interests and how any identified risks are to be managed and which had been regularly reviewed. One service user was described as having challenging behaviour but there was no guidance for staff as to how to manage this. For two recent admissions to the home the information received as part of the assessment process had not been collated into a plan of care nor were supporting risk assessments in place. This was discussed with the Manager who stated she was unaware of this omission and that a care plan would be drafted with immediate effect. So a Requirement has not been made on this occasion. One service user was seated in a relining chair, which restricted the service users movement and there was no supporting documentation in place. This was discussed with the Manager who stated this would be rectified with immediate effect, so a Requirement has not been made on this occasion. Records were in place to show that service users are weighed regularly. Not all care plans had evidence that service users or their representatives had been involved in compiling and reviewing the plans and service users spoken with were not aware of the contents of their care plan and none could recall being asked about their care. All service users are registered with a local General Practitioner (GP), and have access to other health care professionals, including district nurses, via the surgeries. It was noted, in care plans that were examined, that all appointments with or visits by GP’s and other health care professionals are recorded. Service users spoken were asked about access to a GP, chiropodist optician or a dentist. Not all had required these services, some they stated they had accessed these services. The Manager stated that advice has been sought from an appropriate healthcare professional in respect of continence management and who is due to visit the home the home again to offer further guidance. The AQAA detailed that medication policies and procedures are in place and the administration of medication was observed at lunchtime on the residential unit. Medication for both units is stored in a locked cupboard and sample medication records were viewed for both units and highlighted omissions in the recording of medication administered. Staff confirmed, but the records were not viewed on this occasion, that a pharmacist regularly visits. Staff spoken with, who administer medication confirmed they had received medication training and were due to attend advanced medication training. The service users feedback and one relative commented that they felt that their medical care needs were met. Staff was observed to deliver care with dignity and respect. The service users service users spoken with felt the care provided respected their privacy and dignity. Feedback from service users and relatives was that they were pleased with the overall care provided in the home. Comments received included, ‘ the staff are very kind,’ ‘the staff are all lovely people,’ ‘they are very good,’ ‘it’s a lovely place,’ ‘in general we are very satisfied with the care that our relative Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 14 receives. We feel that the staff in Heather Bank have an excellent understanding of dementia care,’ and ‘all I can say is the Manager and Methodist homes seemed to have the situation cracked.’ Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 15 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 and 15. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Where possible service users are enabled to exercise choice in their lives whist resident in the home, there are opportunities to participate in social and recreational activities provided, but these should continue to be developed on the residential unit, service users are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. EVIDENCE: The AQAA details that two activities co-ordinators works in the home providing activities for the service users seven days a week. An activity plan was available to view on both units. The Heather Bank unit detailed activities were provided morning and afternoon and two activities during the morning on the residential unit. On the morning of the Inspection no activities were facilitated on the residential unit. One co-ordinator was on duty working across both units and only one of the planned activities on the residential unit was facilitated prior to the Inspection. The Manager stated that it is an area which Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 16 it is planned to be improved over the next twelve month particularly on the residential unit to develop the range of social and therapy activities provided. Feedback from service users and relatives on the residential unit was varied, a number stated they did not join in the activities and preferred to be in their own bedroom. Comments received were, ‘I would like more outings which, are now very few and far between to what they used to be,’ ‘the activities are very poor’ ‘when staff are available,’ and ‘we do wish that the staff had time to walk with the service users daily just around the garden. This is sometimes more beneficial than exercises or games especially in the summer months.’ Likes and dislikes and social care needs should continue to be developed on the care plans for service users on the residential unit. During the afternoon on the Heather Bank unit there was a pleasant atmosphere and good interaction between staff and service users was observed. The unit is decorated and personalised with some of the artwork service users have completed. One relative commented when asked what the home does well, ‘plenty of activities.’ All the service users and two relatives confirmed there was flexible visiting, that staff are very welcoming and they could see their relative in private if they wished. One comment received was, ‘staff in Heather Bank are welcoming to relatives/visitors and very helpful.’ The care and support provided was observed to enable service users where possible to exercise choice whilst at Richmond and service user feedback confirmed this. The cook and kitchen assistant working on the day stated they both held a basic food hygiene certificate. A rotating menu is place, which staff stated takes into account service users likes and dislikes. Special diets are catered for. The lunchtime meal was observed served in the dining room of the residential unit and staff were available to offer any assistance to service users if required. Lunch was pork and apple casserole, or beef and onion pie with vegetables with pear sponge to follow. Records had not been maintained on either unit of individual food consumption, to monitor that service users have had an adequate diet. This was discussed with the Manager, who stated this would be addressed. Service user feedback was varied about the meals provided, comments received were, ‘would like more variety,’ ‘ quite good’ and ‘food very good.’ Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable service users or their representatives to raise any concerns about the care being provided and there are policies and procedures in place to protect vulnerable adults, but it should be ensured that all staff are aware of these and have received training/guidance. EVIDENCE: MHA has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. The AQAA detailed that one complaint had been received since the last inspection and the CSCI has not received any concerns in relation to Richmond. The majority of feedback was that service users and relatives knew who to speak to if they had any concerns and the visitor and four service users spoken with during the Inspection confirmed that they would feel comfortable raising any concerns with staff. The AQAA detailed that there is a policy and procedure in place in relation to vulnerable adults and a whistle-blowing policy and that staff had received an update of this training in the last twelve months. Of the five care workers spoken with only one confirmed they had an awareness of adult protection Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 18 procedures and stated they had received training/update. This was discussed with the Manager who has subsequently confirmed that it will be ensured that all staff have received this training/update. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is decorated and furnished in a homely style, but the standard is variable. The maintenance plan and ongoing work to refurbish and improve the facilities in the home ensures that the standard of the environment continues to be improved, but systems in place to ensure a safe environment for staff and service users should be maintained. EVIDENCE: A tour of the building was made. The home is decorated and furnished in a homely style. There is evidence of wear and tear on the residential unit and the Manager confirmed an awareness of this and stated there is an ongoing maintenance programme-taking place in the home to ensure the continual Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 20 improvement of the environment. That the lounge on the Heather Bank unit is to be enlarged, and decor and carpeting in the corridors and communal areas on the residential unit and is due to be renewed. Advice is being sought from a landscape gardener to improve the layout of the garden for the Heather Bank unit. Service users accommodation on the residential unit consists of thirty-one single bedrooms all of which have en-suite toilet and hand washing facilities. In addition nine bedrooms also have showers as part of the en-suite facilities and four bedrooms have baths. There are communal assisted bathing facilities. A Requirement was made following the last Inspection that grab rails and toilet paper holders in the en-suite facilities must be easily accessible to service users. There have been no changes to the positioning of these, but the Manager stated that each en-suite had been individually checked to ensure accessibility. A number of bedrooms viewed displayed service users individual styles and interests. All the service users spoken with and the relative spoke well of the bedroom facilities provided. There are small ‘break out’ areas where service users can make hot drinks and a separate dining room and lounge are situated on the ground floor. Access to the upper floor is via a passenger lift and a stair lift is available to access a number of bedrooms only accessible by a further small flight of stairs. Service users accommodation on the Heather Bank unit consists of twenty-one single bedrooms all of which have en-suite toilet and hand washing facilities. In addition seven bedrooms also have showers as part of the en-suite facilities. There are communal assisted bathing facilities. A number of bedrooms viewed displayed service users individual styles and interests. Work that has been undertaken to provide an L shaped conservatory style walkway, which adjoins both wings of bedrooms on the unit. The walkway is spacious enough to provide a pleasant seating area and provides ramped access to the secure garden. There is a lounge for service users use, which the Manager stated is due to be further enlarged to provide more spacious accommodation. There is a separate dining room with a kitchen area and a further kitchen area to prepare snacks and hot drinks. Records were viewed of regular checks of the hot water temperature at outlets accessed by service users. The Manager stated there was still a fluctuation in the water temperatures to be in excess or lower than the recommended safe temperature of 43° C, particularly in certain parts of the building and that this is being monitored. Work is due to commence on the system after April 2008 to rectify this and ensure individual service users can adjust the temperature in their bedroom. So further Requirements have not been made on this occasion. The AQAA details that there are policies and procedures for managing infection control. The Manager stated that these are due to be reviewed. Four members of the housekeeping team were spoken with. It was not possible to ascertain Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 21 from all the staff due to a language barrier the training that had been undertaken, but all demonstrated there was good access to protective clothing. Manager stated that it had been ensured that all housekeeping staff had received the required health and safety training/guidance as part of their induction. But that this would be revisited and refresher training provided as required. During the tour of the building a trolley of cleaning fluids had been left unattended. This was discussed with the assistant manager who rectified the situation immediately, so a Requirement was not left on this occasion. Feedback from the service users and relatives was that the home was fresh and clean. Comments included, ‘very clean,’ and ‘ my room and bathroom is cleaned regularly. The bathroom every day and bedroom vacumned twice a week, more if required by a very kind and friendly young lady.’ Recording of routine fire checks undertaken were seen, but evidenced they had not been maintained. This was discussed with the Manager who stated these checks had not been undertaken due to the handyperson leaving, but would now be addressed by the new handyperson who had just started to work in the home. A Requirement has not been made on this occasion, but it should be ensured that these checks are regularly maintained Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 22 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 and 30. People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care staffing levels must be sufficient to ensure that service users needs are always appropriately met and an ongoing reliance on agency and relief staff has a direct impact on service users and the consistency and continuity of their care and support. Robust recruitment procedures need to be followed to ensure service users are in safe hands at all times. EVIDENCE: Staff spoken with confirmed that five care workers are deployed to work in the home during the morning and four during the afternoon on the Heather Bank unit and three care workers are deployed to work on the residential unit, with the an assistant manager on duty covering both units. Two members of care staff undertake ‘waking night’ duties on each of the units. The Manager and deputy manager were also on duty. Feedback from staff, service users and relatives and observations on the day indicates that there are not always enough staff on duty throughout the day on the residential unit to meet the number and care needs of the service users resident. Staff was observed to be and spoke of being very busy. Four service users resident each required two care workers to assist them with their personal care. This was discussed with the Manager during the Inspection, who stated that since the last Inspection there had been difficulties in recruiting staff to work in the home. This had Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 23 lead to a high level of agency staff working in the home, but that the agency supplies staff that is familiar with the home and the service users. That work continues to try to recruit staff to work in the home and improve the staff turnover and reduce the use of agency staff. The staffing rota was being reviewed with a view to using staff hours more flexibly and provide more staff at busy times during the day. There are also ancillary staff that work in the home and who cover catering, domestic and laundry tasks. Service users spoken with confirmed staff were very kind and caring and that they felt they were treated with respect. The AQAA detailed that nineteen of the thirty-one care staff hold an NVQ Level 2 in care or above, which equates to 46.9 percent of the care staff. Seven further members of staff are currently working towards this qualification. All recruitment of staff is co-ordinated by the organisations head office. The documentation for the six staff employed since the last inspection was viewed and only three had evidence of two written references, all had a Criminal Records Bureau (CRB) check completed and a Protection of Vulnerable Adults POVA check. The Manager stated that staff do not start work prior to receipt of a POVA First check which was evidenced on some documentation. Ancillary staff has a Standard CRB check completed and not an Enhanced and this should be kept under review to ensure that this continues to be adequate. The AQAA detailed that induction training meets the requirements of the General Skills for Care. The organisation has a yearly appraisal process in place for staff, which the Manager stated were due to be completed with staff. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 24 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 and 38. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management team have strived to create an atmosphere within the home, which is open, relaxed, homely and caring. Quality assurance systems have been developed to enable ongoing feedback about the care provided in the home and systems are in place to ensure a safe environment for staff and service users. EVIDENCE: The Manager was appointed to the home in September 2006, is a fist level nurse and has completed the Registered Managers Award in Management. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 25 There are opportunities to undertake further training and clear lines of line management and accountability within the organisation. The organisation has a quality assurance plan in place. There are opportunities for service users and carers to put forward their views about the care that they receive through service users forums. Two service users confirmed attendance at these forums. The minutes from the last few meeting were not available to view as had not been typed up and this was discussed with the Manager to ensure availability so all service users can reference what has been discussed and agreed. A newsletter is also circulated to service users in the home. The Manager confirmed that the outcome of the quality assurance was not available to view as is undertaken by senior advisors within the organisation and is currently in the process of being collated. The AQAA detailed that policies and procedures were in place, which had been subject to or due to be reviewed. Also that regular quality assurance visits by a representative of the organisation are completed and recorded to meet the requirement under Regulation 26. Where a small ‘float’ of money is held for some service users and a sample of the financial records to support this activity were adequate. The AQAA detailed that regular supervision and team meetings are facilitated to meet requirements. But although staff spoken with confirmed these forums, they did not confirm the meetings were held at the required frequency. This was discussed with the Manager who stated this had been due to staffing issues within the home and that they were working to resolve this and provide supervision as required. So a Requirement has not been made on this occasion. The Staff spoken with had attended a range of training opportunities, that they had received moving and handling and basic food hygiene training and spoke of good access to training opportunities for personal development. One care worker stated they had missed their moving and handling update, which was passed to the Manager who stated this would be addressed. Staff training records was in the process of being completed at the time of the Inspection, so it was not possible to evidence that all staff had received the required training to meet requirements. The Manager stated that they try to ensure that a first aid qualified staff are on duty on each shift and that further first aid training for all care staff is currently being looked in to. A fire risk assessment is in place. Staff spoken with confirmed they had attended fire training as required. There were records of regular fire drills, but not all staff spoken with stated they had attended at the frequency required. This was discussed with the Manager who stated it would be checked and ensured that staff has received this training. Stairwells were being used to store equipment. The Manager stated this would be addressed with immediate effect, so a Requirement has not been made on this occasion. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 26 Samples of accident records were viewed and were detailed. Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 27 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 1 8 2 9 2 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 2 2 X X X X X 2 3 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 28 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 13(4bc) (c) (5) Requirement Detailed risk assessments need to be undertaken in respect of those service users at risk of falls and for moving and handling, to protect service users and staff. This issue is outstanding since 15/01/06, 05/07/06 and 15/03/07. Timescale for action 14/08/07 2. OP7 15(1) (2bc) All parts of service users care 14/08/07 plans need to include clear direction to staff as to how needs will be met. This issue is outstanding since 15/01/06, 05/07/06 and 15/03/07. All risk assessments need to be reviewed monthly for those service users who are most dependent, to protect service users and staff. This issue is outstanding since 15/07/06 and 15/03/07. Staffing levels must be reviewed with a view to providing additional care time. This issue is outstanding since 31/07/05, 15/12/05 and DS0000021194.V345912.R01.S.doc 3. OP7 13 (c)15 (2b) 14/08/07 4. OP27 18 (1) (a) 14/08/07 Richmond Version 5.2 Page 29 05/07/06. 5. OP7 15 (1) That all service users have a 14/08/07 comprehensive plan of care demonstrating how the home will meet their needs. This issue is outstanding since 15/07/06 and 15/03/07. That medication administration records are accurate, appropriately signed and up-todate. This issue is outstanding since 15/07/06 and 15/03/07. 14/08/07 6. OP9 13 (2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Richmond DS0000021194.V345912.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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