CARE HOMES FOR OLDER PEOPLE
Richmond Court Residential Care Home Richmond Court 94 Richmond Road Compton Wolverhampton West Midlands WV3 9JJ Lead Inspector
Keith Salmon Unannounced Inspection 24th April 2006 09:45 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 Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 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 Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Richmond Court Residential Care Home Address Richmond Court 94 Richmond Road Compton Wolverhampton West Midlands WV3 9JJ 01902 421381 01902 427761 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) Rosecare Limited Ms Carolyn O`Brien Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Old age, not falling into any other category, including females from the age of 60 years. 8th December 2005 Date of last inspection Brief Description of the Service: Richmond Court is a large, semi-detached, Victorian building with a modern extension. Accommodation is provided over three floors, accessed by a passenger lift, and comprises 28 single bedrooms and 1 double room with 20 bedrooms having en-suite facilities. There is a lounge and dining room on the ground floor, plus a conservatory and library/visitors’ room on the first floor. The Home benefits from a large, well-maintained garden to the rear of the premises and car parking facilities to the front. At the time of this Inspection fees for care ranged from a minimum of £335 per week up-to a maximum of £447 per week. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Unannounced Inspection commenced at 09.30 am and concluded at 3.45 pm, a total of 6.25 hours. Initially conducted by Mr Keith Salmon, who was later joined by Mr Brian Lock, Regulation Manager for CSCI. Present for were Mr. H. Ladhani (Responsible Person) and Ms. Carolyn O’Brien (Registered Manager). Being the first Inspection of 2006/07 it centred on ‘Requirements’ cited at the previous Inspection, held in December 2005, plus all ‘Key’ National Minimum Standards. This Report is based on observations made during a tour of the Home, a review of care related documentation, staff duty rotas, and staff files, plus a range of other documents/records reflecting the general operation of the Home. The Inspectors also held 1:1 discussions with Mr. Ladhani, Ms. O’Brien, 8 Residents, 2 Visitors and several members of Staff. What the service does well: What has improved since the last inspection?
A number of ‘Requirements,’ cited at the previous Inspection (December 2005), and relating to the following aspects of care have all been fully met: − The level of detail in care records − Removal of portable heaters which presented potential hazards − Overstocking of some medicinal products − Encouragement, and recording, of Residents uptake of leisure opportunities − Provision of handrails in corridors − Attention to some aspects of décor
Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 6 − Provision of personal lockers for Staff A number of other ‘Requirements’ made were reviewed and discussed at this Inspection. In the light of that discussion, it was agreed the issues underpinning those particular ‘Requirements’, did not adversely affect the quality of care received by Residents. Specifically these were in relation to: − The range/nature of communal space − Provision of furniture − Staffing levels/skill-mix The Inspectors agreed the quality of life ‘Outcomes’ for Residents, which were directly linked to these areas, were seen to be met. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. EVIDENCE: ‘Case Tracking’ involving the review of 5 Residents’ Care Plans/Files, (i.e. those relating to the two most recently admitted Residents, plus 3 selected at random), demonstrated all potential Residents have their care needs assessed by the Registered Manager prior to taking up residence. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The model of Care Plan, utilised by the Home, is of a design, which is easy to read and comprehensive. The care provided by the Home is effective in meeting the Residents’ assessed care needs, and is delivered considerately and effectively. The storage, administration and disposal of medicines are in accordance with accepted good practice. EVIDENCE: At the previous Inspection a number of ‘Requirements’ were cited under Standards covering Health and Personal Care. These being: − The need for entries to Residents’ care records to be made in greater detail − To ensure that Residents were able to avail themselves of frequency of baths/showers in keeping with their individual needs/desires − To reduce (excessive) stocks of eye medications As a component part of the ‘Case Tracking’, 5 Residents’ Care Plans/Files were reviewed and discussions held with the respective Residents. This process provided evidence of the Requirements having been fully met.
Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure opportunities are provided, which are consistent with Residents’ capabilities. The Home facilitates achievement of desired lifestyle through Residents conducting the pattern of their day, where possible, as they wish, including contact with family and friends, and continuation of religious practices. There is a daily choice of attractive and nutritious meals. EVIDENCE: At the previous Inspection two ‘Requirements’ were cited under Standards covering ‘Daily Life and Social Activity’ - these being: − The need to encourage Residents to partake in leisure/social activities made available − The individual involvement of Residents in leisure/social activities to be recorded − Individual care records, and discussions with Residents, demonstrated Residents are able to choose which of the programmed ‘events’ they wished to partake in. In addition, the Inspector was shown an ‘Activities Log’ which recorded attendance/involvement by Residents.
Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 11 The Home has a full and varied programme of activities, which are planned and organised jointly by Residents and Staff. This process is facilitated by use of a ‘Key Worker’ system, and through regular Residents’ meetings, which are supported directly by Staff and the Minutes of these meetings was reviewed by the Inspector. Residents, who were able, informed the Inspector they enjoyed and valued these Meetings whilst also recognising “…. they are difficult to arrange, and even more difficult to get people to speak about what they would like.” Activities include local trips out, with Relatives and/or Staff, traditional games such as cards, dominoes, bingo and skittles, music and dancing, entertainment by visiting musicians and singers - including old-time sing-alongs, which the Residents informed the Inspector they particularly enjoy, musical chairs, quizzes and seasonal celebrations. Birthday celebrations for individual Residents are a regular feature. The general consensus of Residents was the range, quality and choice of food provided was very good and the Home caters for those Residents who have individual preferences/dislikes. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interests of Residents are protected through ready access to information relating to advocacy services and the Home’s Complaints Procedure. Staff are aware of their role in protecting Residents from abuse. EVIDENCE: Complaints Procedure details are included in the Service User Guide and are displayed prominently for the benefit of visitors. There are policies and procedures in place intended to provide protection for vulnerable people. These fully meet the requirements of this Standard and staff training files confirm the topic is covered both at induction and through on-going staff training. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home provides a generally safe, well-maintained environment with communal rooms, and bedrooms, which are well decorated with furnishings being in good order and presenting a ‘domestic’ ambience. The gardens are easily accessible at all times of year. Specialist equipment, consistent with meeting the assessed care needs of Service Users and the demands of tasks carried out by Care Staff are provided and appropriately serviced and maintained. The cleanliness and general state of repair in the Home is good. EVIDENCE: At the previous Inspection two ‘Requirements’ were cited under Standards covering ‘Environment’ - these related to:− Concerns about the extent of provision of communal rooms − The provision of bathing facilities, i.e. specifically two small bathrooms/baths − The need to provide personal lockers for Staff
Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 14 The tour of the Home showed it has a main lounge, and separate dining room, both on the ground floor, plus a conservatory and a library/sitting area on the first floor. At first viewing, this provision may seem insufficient to meet the needs of up-to 30 Residents. However, it was clear from observations made during the tour, and from discussion with Residents, Visitors and Staff that due to many Residents taking their meals in their rooms, choosing to spend time in their rooms, or in the first floor sitting room, there is, in fact, sufficient communal room provision. The rooms all have a pleasant outlook onto the gardens and are generally well decorated with furnishings being in good order and presenting a ‘domestic’ ambience. With regard to the two small bathrooms/baths – these are unsuitable for the client group due to the small size of the baths, and limited room for use of hoists and access by Care Staff. Therefore, it was agreed with the ‘Responsible Person’ that both bathrooms are formally to be taken ‘out of use’. This will mean the Home is at variance with the Care Homes Regulations in that the Home is one bathing facility short of the minimum required for 30 Residents. In order to remedy this an additional, and appropriate, replacement bathing/showering facility must be installed on one of the two upper floors. It is possible the larger of the two upstairs bathrooms may be converted to a shower room. Plans must be submitted to CSCI for agreement. During the tour of the Home the Inspectors noted the bathrooms become excessively humid/steamy due to the absence of extractor fans. It is a ‘Requirement’ the Responsible Person ensures effective extractor fans are installed in all bathrooms. (It is accepted this work may be undertaken as part of work to install an additional bathing/showering facility). A visit to the Staff Room confirmed Staff now have access to a locker for personal use. Lighting provision in some of the corridors is rather gloomy, although improvement has been effected by beginning the process of replacing all light fittings of a type which is more domestic in character and which afford better light provision. It will be a Requirement of this Report the light replacement process is carried through to completion. The Inspector also noted that in the upstairs corridors, and in some toilets, pipes carrying hot water had recently been installed. In some instances these pipes become hot enough to present a risk to Residents of burning. The Home must carry out an audit of all such pipes and, were risk of possible burning is identified, remedial action taken. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers on duty and skill-mix were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are consistent with the safeguarding of Residents. The commitment of the Home in providing training for Care Staff is satisfactory, and in accordance with individual Staff Member’s learning needs. EVIDENCE: The current staffing rota and those from the immediately preceding weeks were examined and compared with the Home’s daily ‘signing-on’ sheet. These demonstrated Staffing numbers and skill-mix enable a service provision, which meets the care needs of the Service Users. A ‘Requirement’ cited at the previous Inspection instructed the Responsible Person to ensure that in addition to the Registered Manager, there was to be a minimum of one Senior Carer and four Carers on duty throughout day shifts (i.e. morning/afternoon/evening). Following discussion, it was agreed by the Inspectors the staffing requirement was overstated. This revising decision was based on observations made and discussion with Residents, Relatives/Visitors, and Staff. There was clear evidence that Staff were able to deliver a very good quality of care to the numbers of Service Users in residence, i.e. 22 on the day of the Inspection (with evidence of an average occupancy of 25). Furthermore, it was considered that even with an increase to the maximum
Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 16 occupancy of 30, and assuming levels of dependency do not increase markedly, Staff would still be able to maintain such standards. A further contributory factor in this decision is although the Manager is counted as supernumerary to the duty rota, her style of management is very ‘hands-on’. It is accepted the Manager is fully aware of her responsibilities in ensuring any necessary increase in staffing to meet increased dependency levels. As a collective result of this it was agreed that the minimum level of staff on duty may be reset to a minimum of one Senior Carer and three Carers on duty throughout the day with adjustments to allow Staff to take their lunch breaks. It was agreed that the manager would keep the staffing levels under regular review and arrange staffing to meet the needs of service users. A review of employment files for 5 members of Staff, (i.e. those relating to the 2 most recently employed, plus 3 selected at random), provided evidence of full compliance with the Standard, and Schedule 2, of the Regulations. A review of ‘Training’ records evidenced Staff are subject to a thorough and relevant orientation/induction programme, a comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’ followed by access to NVQ Training. A ‘Requirement’, cited at the previous Inspection, related to the Home working towards the target of 50 of Care Staff attaining a minimum of NVQ Level 2. Historically the Home’s achievement in this area has been poor and has recently been exacerbated by Staff with NVQ Level 2 moving on to other employment or retirement. However, in recent times the Home has worked well in obtaining training places for Care Staff on NVQ Level 2 courses, to the degree that at the time of this Report, 15 out of a complement of 17 Care Staff are undertaking such training, and expect completion by Autumn 2006. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is well managed by the Registered Manager, Ms. Carolyn O’Brien, and provides an ambience, which is warm, friendly, and inclusive with the central purpose being ‘the best interests of Residents’. Operationally, it is well organised with lines of accountability being clearly defined and observed. The views of Residents and other interested parties are sought by the Home and acted upon. Service Users are safeguarded by the financial procedures operated in the Home. All Staff are subject to effective support with regular supervision, and appeared involved and happy in their work. Health and Safety Policies/Procedures/Practices were satisfactory. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 18 EVIDENCE: Observation by the Inspector, together with comments from Residents, Visitors and Staff suggest the Home is currently being well managed. Written reports from regular attendance at the Home by the Proprietor demonstrate evidence of good support for the Manager. The Home conducts financial management of small amounts of cash for a few Residents, and records of transactions are maintained in accordance with the Standard. All other records were seen to be secure and well maintained. The Home’s practices in the context of health, safety and welfare of Residents, Visitors and Staff were seen to be in accordance with the Regulations, i.e. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. Records are maintained for hot water supply to baths, and water tested during the Inspection was satisfactory. Evidence was also seen which showed all bedrooms have a general ‘health and safety check’ undertaken every Monday morning. ‘Requirements’ cited at the previous Inspection relating to the closure mechanisms on interconnecting doors and some bedroom doors, plus effective lighting outside the building have been addressed and are fully met. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 19 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 3 2 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 20 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 OP1919 Regulation 23. – (2)(p) Requirement The process of replacing light fittings in corridors of a type which is more domestic in character and which afford better light provision must be carried through to completion. The Home must carry out an audit of all exposed hot water pipes and where risk of possible burning is identified appropriate remedial action taken. The Responsible Person must introduce an on-going redecoration/refurbishment programme, complete with planned ‘action’ dates. The two “small baths” located on each of the upper floors must be taken out of use. An additional, and appropriate, replacement bathing/showering facility must be installed on one of the two upper floors. Plans must be submitted to CSCI for agreement.
DS0000030036.V290521.R02.S.doc Timescale for action 31/08/06 2. OP1919 13. – (4)(a)(c) 30/05/06 3. OP1919 23. – (2)(b)(c) 30/06/06 4. OP21 23. – (2)(j) 23. – (2)(j) 30/06/06 5. OP21 31/08/06 Richmond Court Residential Care Home Version 5.1 Page 21 6. 7. OP21 OP28 23. – (2)(j) 18. – (1) All bathrooms must have effective extractor fans installed. The Registered Providers must ensure a minimum ratio of 50 trained members of Care Staff achieve NVQ Level 2 or equivalent. 31/08/06 30/09/06 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 OP12 Good Practice Recommendations The Registered Providers may wish to consider appointing an Activities Organiser for the Home. Richmond Court Residential Care Home DS0000030036.V290521.R02.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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