Inspection on 07/09/05 for Richmond Court Dudley

This inspection was carried out on 7th September 2005.

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

Richmond Court Dudley 26/09/07

Richmond Court Dudley 26/02/07

Richmond Court Dudley 28/03/06

Richmond Court Dudley 16/11/04

Richmond Court Dudley 25/06/04

Richmond Court Dudley 02/12/03

Similar services:

Maple Lodge

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Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Richmond Court 16 St James Road Dudley West Midlands DY1 3JD Lead Inspector Yvonne South Unannounced 7 September 2005 10:30am th 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 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 Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Richmond Court Address 16 St James road Dudley West Midlands DY1 3JD 01384 254442 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Dharam Pal Sahni Mrs Sangeeta Sahni Care Home 14 Category(ies) of DE (E) - Dementia - over 65 (5) registration, with number OP - Old People (13) of places PD (E) - Physical Disability (6) Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 14 OP, 6 PD(E) and up to 5 DE (E) 2. That the service user named in the variation report dated 3 June 2004 must be moved to a room that meets the requirements of the National Minimum Standards as soon as the new extension is registered. 3. That the room is used soley for the purpose of accommodating the service user named in the variation report dated 3 June 2004. When that person is reaccommodated the room must not be used until it meets National Minimum Standards. 4. One Service user identified in the variation report dated 14th June 2005 who is 61 years and over may be accommodated at the home in the category OP. This will remain until such time that the service user,s placement is terminated. Date of last inspection 16th November 2005 Brief Description of the Service: Richmond Court is located in the centre of Dudley, on a main road which is mostly residential. There is a variety of services and amenities nearby in the town centre, including shops, a library and churches. The main ‘bus terminal in the centre provides access to neighbouring towns and places of interest. The home is a traditional, detached house with extensions, which comprises 12 single bedrooms, one double bedroom (there are no en-suite facilities), a lounge, dining room, two bathrooms and seven WCs. There is a large kitchen and small laundry. There is car parking space at the front of the property and a large garden at the rear. Unfortunately, the rear garden is not accessible to the residents because it is much lower than the house and the steps are steep. However, residents have a view over the garden. The owners are in the process of improving the physical environment and have received planning permission to have an extension built that provides seven or eight new single bedrooms with en-suite facilities, a new laundry, kitchen and shower room. Office facilities, storage and parking will also be improved. They also have plans to make the garden more accessible. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection commenced at 10:30am and extended over six hours. Initially when she arrived the inspector was assisted by the Lead Care on duty. Later the registered providers Mr and Mrs Sahni joined them. A tour of the premises was undertaken and the inspector spoke to four residents and one relative. She inspected records, documents and policies and procedures. The inspection focused on the standards that had triggered requirements and recommendations during the last inspection. Not all requirements and recommendations were checked for compliance during this inspection. Many of the requirements had been for information to be provided to the Commission for Social Care Inspection and the manager informed the inspector that such requirements had been met. What the service does well: This home has a lovely homely atmosphere and the staff relate respectfully and sensitively to the residents who live there. They can be observed providing care in a kind friendly way which is appreciated by the recipient. Although the registered providers have not had the home long they are committed to improving the environment and the care structures in the home and continue to make good progress. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Good progress has been made to improve the home since the previous inspection and the owners plan to make further improvement to the house when the extension is built. However to reduce the risk of a resident scalding themselves a temperature restructure valve must be fitted to a washbasin upstairs. This cannot wait until the building work is done. During the previous inspections it was found that recruiting practice and staff records needed to be improved. These were not checked during this inspection but will be checked during the next inspection Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 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. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 Staff are able to meet the needs of the people who live in the home. EVIDENCE: At the time of the last inspection concerns were identified relating to the care provided for specific people. The manager confirmed that these concerns had been addressed and the Commission for Social Care Inspection had been provided with the documentation requested. At the beginning of this inspection the manager was undertaking the assessment of a prospective resident who was a patient in hospital. On her return she was able to demonstrate that she had gathered and documented a quantity of information. A few suggestions were made as to how the format in use could be improved further and it was recommended that more detail and family history be included. Other records seen contained risk assessments relating to the use of oxygen, nutritional assessments, pressure care, falls and mobility. Guidance and training had been obtained regarding the use of oxygen and the equipment to be used. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 10 Staff were observed to be helping residents in a calm, supportive manner. An excellent daily document had been designed and implemented that enabled records to be made of every person’s care and activities each day and night. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, Residents have plans that describe how their care needs should be met thus communicating information and guidance to staff. Health is closely monitored and appropriate action taken when necessary to ensure the well being of the residents. Good medication management ensures residents safely receive the medicines they are prescribed from trained staff. EVIDENCE: Two care plans were assessed. A good clear computer format was in use and risk assessments and guidance had been drawn up. Advice was given where it was considered more detail would be useful. The records indicated that care plans were being regularly evaluated. These could be improved by more detail and should indicate that all risk assessments including pressure care and nutrition were included in the review. Positive discussion took place as to how this could be achieved. The manager confirmed that there was good communication with staff when care plans were being drawn up and reviewed. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 12 The signatures of relatives indicated that they had been involved in the care planning and it was suggested that this should also be reflected in the reviews. Care plans identified when assistance was necessary with dental care. Pressure care equipment was in use and the manager indicated that the advice of the district nurses was sought when necessary. The manager confirmed that the continence adviser had assessed all residents and equipment was in use as needed. Training for staff in continence management was scheduled to take place in October this year. One person was under the care of the mental health team. Advice was given as to how this should be incorporated into the care plan. Exercise was encouraged around the house and some people were able to go out for walks with the staff and their visitors. Access to the garden was not possible. Residents were registered with doctors in one of four local surgeries Nutritional needs were assessed and people were regularly weighed. A requirement had been made that if a resident was unable to use the scales in the home alternative arrangements should be made. It was agreed during this inspection that as part of the nutritional assessment each month such people would be systematically assessed regarding indicators that would point to a weight change, for example a change in the fit of their clothes, a change in appetite and/or a period of ill health. The residents had access to dental care, sight and hearing consultations. Residents told the inspector that the staff were ‘lovely’ and they considered that they were well looked after. There was a policy and procedure relating to medication however references to ‘nurses’ still needed to be removed. Residents had lockable storage in their bedrooms but only one person managed any part of her medication herself. The residents told the inspector that they preferred the staff to look after their ‘tablets’ for them. Consent and assessment documents had been completed and were in the files seen. Medicines were stored in an acceptable medicine trolley that was kept in the lounge, and a wall cupboard in the kitchen. The inside of this cupboard was warm as a hot pipe ran through it. The manager was advised that this was not acceptable. A cupboard that meets the criteria of the Royal Pharmaceutical Society’s guidance is needed and must only contain medication when in use. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 13 All senior staff had received or were receiving medication training through Dudley College. The manager was able to describe incidents where advice and guidance had been sought from the pharmacy and doctors regarding medication. Medication records were well maintained. Policies and procedures were available to guide staff when residents were terminally ill/died and the wishes of individual residents had been sought and recorded. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14,15, Residents are happy with their life style and staff have access to information regarding individual choices. A variety of meals are offered from which residents can make their selection. Special diets can be provided when needed and meals can be taken wherever the resident prefers. EVIDENCE: The manager described a range of activities that the resident were able to participate in if they chose. She was aware that many people had a limited concentration span and this was taken into account. Social events and activities took place in the home and some people were able to go out for short walks with the staff and their families. Some ladies attended local clubs. The residents said that they were happy with their lives and enjoyed what ‘went on’ in the home. A visiting relative told the inspector that she believed her relative received good care and was happy in the home. The care plans contained information regarding residents’ likes and dislikes. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 15 The registered persons do not act as agent or appointee for any of the residents. Currently everyone has a supportive relative willing to help them if required. Monies were held in lockable storage and good records were maintained. Only senior staff had access and they had authority to manage the finances according to the wishes and needs of the residents concerned. The manager was advised to insert in the service users’ guide information regarding their rights under the Data Protection Act 1998 and their right of access to their personal records. No one has an advocate. Information was given to the manager about an advocacy service from where she could obtain further leaflets and guidance and be ready to advise others when necessary. Opinions regarding the food were mixed. Two people said that it was ‘so so’ and two others said that it was ‘great’, ‘superb’. A range of menus was seen that indicated a good varied diet was offered and a choice of the main meal or baked potatoes with various fillings or a salad was provided. One person said that there was no choice provided but she did acknowledge that she would not ‘go hungry’ as if she did not like the main course as she was always offered an alternative. The manager showed the inspector menus that were to go on each table indicating the choice available each mealtime. She also had plans to develop pictorial menus to assist those who had difficulties in comprehension. No special diets were currently required. The manager was aware that detailed records must be maintained for people who need special diets. A record of food provided was being maintained and the manager confirmed that when concerns arose a more detailed individual record was kept of food and fluids consumed. Snacks and drinks were always available and in the hot weather extra drinks were encouraged and fluid intake charts were maintained. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 16 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 standard(s) EVIDENCE: These standards were not assessed in full. The manager said that no complaints had been received since the last inspection. Therefore it was not possible to assess if the quality of the recording met the requirement that had been made. This will be done during a future inspection. A complaints procedure had been included in the statement of purpose. This must be copied into the service users guide. Information was available in the procedure regarding the name address and phone number of the Commission for Social Care Inspection. The manager confirmed that all residents were registered on the electoral roll and would receive postal votes that they could use at election time. A record of this was in their files. Information must be obtained and made available to residents regarding advocacy services. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 17 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 standard(s) EVIDENCE: These standards were not assessed in full. The inspector had not previously visited the home and so was shown around by the lead carer. The bedrooms were seen to be decorated with personal treasures and the furniture and fittings were appropriate and homely. Residents were able to indicate what furniture they wanted in their rooms and a record of this was maintained. It was clear that work had been undertaken to improve the environment and the manager confirmed that new curtains would be hung throughout two days after this inspection. The registered providers had not owned the home for very long and were understandably reluctant to spend on areas that would be changed by the planned building work. It was hoped that the work would take place before the end of the year. Then the pressure on space in the current Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 18 building would be eased and more suitable office space and storage would be provided. None the less matters that have an affect on the health, safety and welfare of residents will need to be addressed without delay and the registered providers accepted this. The hot water flow at the washbasin in a toilet upstairs was tested by hand and was considered to be excessively hot. A warning notice was displayed and the registered provider said that this area would be affected by the planned building work. Therefore a temperature restrictor valve was not fitted. Nonetheless it is considered to be a significant risk, as the room will continue in use for some time. Therefore a valve should be fitted as soon as possible. The standard bathroom upstairs was being used for storage. The lead carer said that no one liked to use the bathroom and they had no one able to use a standard bath. Residents preferred to use the one on the ground floor, which had a hoist. The manager said that it was planned that the bath would be removed and the room converted to a shower room when the building work was carried out. The hand basin in the staff toilet had come away from the wall. Many doors squeaked. The Yale type locks on bedroom doors had been disabled and two residents had had new locks fitted to their doors as requested. The manager said that all residents were given the choice of having a new lock fitted. It is important the locks are fitted to bedroom doors so that they can be used by the occupant when they wish. However they must meet safety requirements and it is important that the locks that are fitted to bedroom doors are suitable for the residents and conform to the recommendations of the Fire Authority. Everywhere was clean or being cleaned to good effect. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standard were not assessed in full during this inspection. However the manager confirmed that the requirements made during the last inspection concerning recruitment and staffing had been met. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed in full during this inspection. However in response to the requirements in the previous inspection report a deputy manager had been appointed but the post was currently vacant again and recruitment was underway. A manager’s job description was being drawn up. The manager said that she had undertaken moving and handling training in June this year. The registered provider confirmed that a business and financial plan had been drawn up and the business accounts had just been submitted for auditing. Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 Requirement Acceptable storage must be provided for medication. The references to nurses in the medication policy must be removed. Timescale for action 30th September 2005 2. 3. 25 23 The radiators in all bedrooms must be individually adjustable to meet the needs of the rooms occupant. 31st March 2006 4. 26 23 Adequate sluice facilities must be 31st March provided for the home in the 2006 extension, preferably a sluicing disinfector. A temperature valve restrictor must be fitted to the hand basin in the residents toilet upstairs and the hot water temperature supplied at a safe level. 30th September 2005 5. 26 23 Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 23 6. 28 18 The manager must supply The 31st Commission for Social Care December Inspection with an action plan 2005 outlining how the manager will ensure that 50 of care staff will acheive NVQ level 2 qualifications by the end of this year. This requirement was not assessed during this inspection. 7. 30 18 A training analysis and plan must 30th be drawn up, based on the December individual training records that 2005 must be kept for each of staff. Induction training and foundation training must be provided for all new staff according to the National Minimum Standards. These requirements were not assessed during this inspection. 8. 36 18 All care staff must receive recorded supervision at a minimum of six times a year. This requirement was not assessed during this inspection. 30th December 2005 9. 24 13 10. 22 23 Locks fitted to bedroom doors must be suitable for the resident to use, have an emergency access facility and conform to the requirements of the Fire Authority. Sufficient storage facilities must be available for large pieces of equipment so that bathroom facilities are availble for their designed purpose. 31st March 2006 31st March 2006 Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 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 Good Practice Recommendations Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Ground Floor - West Point Mucklow Office Park Mucklow Hill Halesowen, West Midlands. B62 8DA 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 Richmond Court E55 S47902 Richmond Court V246448 070905 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!