Inspection on 08/12/05 for Richmond Court Residential Care Home

This inspection was carried out on 8th December 2005.

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

The inspector 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 Residential Care... 09/04/08

Richmond Court Residential Care... 14/09/06

Richmond Court Residential Care... 24/04/06

Richmond Court Residential Care... 05/01/05

Richmond Court Residential Care... 23/06/04

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Maple Lodge

Heathlands

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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 Residential Care Home Richmond Court 94 Richmond Road Compton Wolverhampton West Midlands WV3 9JJ Lead Inspector Bhag Jassal Unannounced Inspection 08/12/05 13:25 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.V270403.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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.V270403.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Old age, not falling into any other category, including females from the age of 60 years. 22nd June 2005 Date of last inspection Brief Description of the Service: Richmond Court is a large, semi-detached Victorian building, which has been extended to accommodate 30 older people in 28 single bedrooms and 1 double room. Twenty of the bedrooms have en-suite facilities. There is lounge and a dining room on the ground floor. There is a conservatory and a library/visitors’ room on the first floor. There is no communal sitting area on the second floor. The home also has a passenger lift serving all floor used by the residents. The office is located in a separate building at the rear of the premises. The basement/celler contains a staff room, laundry and storerooms. There is a large garden at the rear of the premises and car parking facilities at front of the building. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by the Regulation Inspector and the Regulation Manager - Mrs Teresa Wild and started at 01.25 pm and lasted 4 hours and 35 minutes. The inspection included discussions with the Registered Manager, service users and the staff. The daily routines were observed and service users and staff records, policies and procedures were examined. Inspection of premises both inside and outside and facilities was also undertaken. Discussion was held with the Registered Manager with regard to the progress made by the home in implementing the requirements contained in the last inspection report dated 22 June 2005. It was noted that the Registered Providers have not made any progress in addressing two requirements relating to staffing requirements and the bathrooms facilities in the care home. Subsequent to the inspection, a letter of Cause for Serious Concern dated 12 December 2005 was sent the Registered Provider – Mr Hanif Ladhani expressing our grave concerns regarding insufficient numbers of staff on duty and inadequate bathroom/shower facilities for 29/30 service users currently accommodated at Richmond Court. What the service does well: Richmond Court care home is registered for 30 older people. The staff makes every effort to provide individuals with “satisfactory” standard of care to meet the assessed needs following a care plan. The home has a key worker and supervision system in place. The service users spoken with said that they are content and generally “happy” living at Richmond Court. The service users were in the main lounge engaging in their daily routines/activities and a large number of service users were sitting in their bedrooms. The atmosphere within the home was generally observed to be relaxed and friendly. The friendly rapport was also observed between service users and staff. Meals are varied, well balanced and presented to meet each individual’s choices, preferences and requirements. The home provides satisfactory standard of accommodation and facilities, which are being maintained secure and comfortable for the use of service users and staff. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The home must continue to improve and enhance the quality of care, and daily care recordings. The Registered Manager must ensure that the staff follow the care plan objectives and record all the actions taken to meet the needs of service users. The night care recording format need a radical review and to implement a new and suitable recording format. The staff must be pro-active in offering a range of social and leisure activities. The records of all social and leisure activities enjoyed by the service users must be maintained and also incorporated into individual service users’ care plans. Those members of staff who as yet not received training in safe working topics, and training in safe handling of medication and NVQ Level 2 must do so as a matter of priority. This training would further enable staff to improve their Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 7 care practices and professionalism. There a number of issues identified, which relates to the accommodation, facilities and the environment of the home and these must be implemented to ensure safe and comfortable environment for service users and staff. The Registered Providers must take appropriate and swift action to ensure that the home is staffed in adequate numbers at all times as a matter of priority and urgency. The Inspectors would like to acknowledge the efforts being made by the new registered manager, the staff and the Registered Providers to make improvements in the quality of care for service users at Richmond Court. 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.V270403.R02.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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 the following standard(s): 3, 4 and 6 The home has a comprehensive needs assessment procedure providing an effective assessment, suitability evaluation and its ability to meet the assessed care needs of both privately funded service users and those placed by the Local Authorities. EVIDENCE: A sample of three service users’ care plans and files were examined in detail at the inspection. It was evidenced that all service users received the benefit of a comprehensive assessment prior to admission. The Registered Manager stated that she also carryout assessments and these details are documented on care plans. The care plans are drawn up by the senior staff with the assistance from the service users and their relatives and where appropriate other professionals. There was evidence to show that the home has a good admission procedure, which is made available to all prospective service users and their relatives and/or representatives. The service users and/or their relatives can visit the home and if they indicate to the home of their choice, then the home formally Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 10 inform them if Richmond Court can meet the assessed needs of the prospective service users. The home does not offer an intermediate care service. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9 The staff within the home is aware and sensitive to the needs of each and all service users and meet their needs in a professional manner. There is clear and consistent planning system in place, which provides the information the staff requires to meet the service users’ health and care needs. EVIDENCE: It was evidenced that all service users undergo a comprehensive assessment of their needs prior to admission to the home. A care plan is produced, which is based on the assessment of needs. The home operates a key worker system, which helps to ensure that the recommendations arising from the care plans and reviews are implemented. Three service users’ care plans were examined in detail and these were kept up to date and reviewed on a monthly basis. The daily care recording formats were also examined and it was noted that the quality and details of recording need fundamental change and improvement. The daily records need to show the input (staff care interventions) and link with care plans and assessments. The night care recording format is not adequate to records the actual checks carried on which service user and what time of the night. It was evidenced Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 12 that at present the night carers simply records for the whole night shift that “all residents were asleep”. The Registered Manager must redesign the night care recording format, which provides detailed information on the care provided to service users during the night. The Registered Manager confirmed that for the morning shift, there are three carers on duty till 2.00 pm and 2 carers on duty till 1.00 pm, which means it leaves three carers on duty until 2.00 pm to provide care for 29 residents. For the afternoon shift, there are three carers on duty until 5.00 pm to provide care for 29 residents. Another carer comes on duty at 5.00 pm. So there are four carers on duty until 9.00 pm, then two night carers comes on duty at 9.00 pm. The night carers are on wakeful duty to regularly check 29 service users throughout the night on three floors. There are several service users considered to have high dependency levels and accommodated on three floors. So two night carers is insufficient to provide effective care during the night given the layout of the premises and the number of service users with varying and differing needs. The night carers are also expected to undertake laundry duties. The Registered Manager and the staff stated that there are 4/5 service users, who need assistance in feeding at meal times. A senior carer leaves the floor to medicate service users on all three floors, which leave two carers to feed 4/5 residents and in addition supervise others in the main lounge, dining room and those who are confined to their own bedrooms. In addition, we observed that the carers also assist the cook in the kitchen – plating up meals, distributing them throughout the building, clearing away plates and then undertaking loading/unloading of dishwasher and washing pans. The rotas indicated that the cook works from 8.30 am to 4.30 pm. The Fourth carer does not come on duty until 5.00 pm. The staff rota also showed that the Registered Manager is on duty until 4.00 pm daily. The CSCI Inspectors have serious concerns with the above staffing deficiencies which could have adverse impact on the quality of care at Richmond Court and it is also evident that the layout of the home makes it even more difficult for staff to provide effective care across three floors and in individual bedrooms. The staff is so rushed/pushed that they are unable to provide quality time and effective care to service users. In addition, it leaves very little time for carers to do quality care recording on the care input they provided for 29 service users. It was also stated by the staff that they are not able to provide any meaningful activities in the mornings, afternoons and evenings. We did not observe any social stimulation during our time at the care home. It was also noted because there is not enough staff on duty and inadequate baths facilities the service users are not being bathed on a more regular basis. The Registered Providers must take appropriate action to provide adequate staffing levels so that the service users receive high quality of care at Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 13 Richmond Court. (Please also refer to National Minimum Standard OP27 in this report). It was evidenced from the care plans and residents files that the home ensures that nutritional screening is undertaken, including weight gain and loss records are maintained and appropriate action taken if required. The service users’ health care is also closely monitored and appropriate medical care services are sought as and when required. The Inspectors spoke to majority of the service users, who were able to have meaningful conversation. Generally service users appeared to be content. But one service user said that she complained to a Social Worker that the call bell wasn’t being answered at night. It was evidenced from the staff training records and discussion with the Registered Manager, that three senior carers and three acting senior carers have completed their training in safe handling of medication. The other care staff is still to undergo this mode of training as places becomes available at the local City College. It was noted that there were eye drops and artificial tears stocked in excess of the needs of service users. These additional items must be returned to the Pharmacy and appropriate records maintained. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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 the following standard(s): 12 and 15 The home is striving to provide/promote individual lifestyles for service users in residence. Meals at Richmond Court are of a good homely type offering both choice and variety and catering for special needs. EVIDENCE: The Registered Manager stated that since she has taken charge of the home as a Manager, she has organised more activities for service users – for example visiting local schools, clothes parties and now preparing Christmas presents (bags) for all service users. In-house activities included – exercise with music, bingo, and visiting singers, outing to Asda superstore and a boat trip (12 service users). An outing is planned for Christmas pantomime on 9 December 2005. It was noted that the Registered Manager is putting together a varied programme of social and leisure activities, which would reflect the actual choices, preferences and capacities of the service users. It was also noted that as the home continues to be inadequately staffed, and thus the staff would struggle to actually provide a range of activities for service users. There is also added problem of not having enough communal space areas for individual and/or group activities. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 15 The Registered Manager must ensure that the staff is more pro-active in organising a range of social and leisure activities. The activities enjoyed by the service users must be recorded appropriately, and incorporated into the individual service users’ care plans. The Registered Providers may wish to consider appointing an Activities Coordinator with the responsibility for this area of home’s activity. It was evidenced that the home provided a varied, wholesome and nutritious diet. The meals provided during our inspection were well received by the service users. The Registered Manager and the cook stated that the menu was revised recently to reflect the season of the year and the service users’ choices, preferences and requirements. Several service users told the Inspectors that the food was nice, tasty and well cooked. The catering staff is well trained in food safety and hygiene matters. The kitchen is well equipped and kept clean and tidy. However, it was noted that there are 4/5 service users, who need staff assistance at meal times to feed them. As it has been mentioned in this report, there is an urgent need to provide kitchen/catering assistant to order to assist the cook in the kitchen and release care staff to carryout effectively their care duties at all times. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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 the following standard(s): Not Assessed on this occasion. EVIDENCE: Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 24, 25 and 26 The general standard of the environment is good providing service users with a reasonably safe and comfortable place to live. The good standard of cleanliness reflects the ongoing cleaning schedule, which maintains this standard throughout the home. There is inadequate communal space for dining and lounge/sitting areas, and inadequate assisted bathrooms facilities, which are capable of meeting the varying dependency levels and differing needs of 30 service users. EVIDENCE: The premises were inspected in the company of the Registered Manager. In the previous inspection report dated 22 June 2005 concerns were raised regarding the two “small” bathrooms located on the first and second floors. It was noted that the Registered Providers still have not taken any appropriate action to make these small bathrooms operational to be used by the service users accommodated on these two floors. The Registered Manager, staff and some service users confirmed that these bathrooms are not being used on the first and second floors. The staff has to bring service users to ground or first Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 18 floor to bathe or shower service users, which means that extra staff time and moving and handling of several users across the top floors by two members of staff. There are 9 service users on the second floor and currently there is no assisted bath or shower facility. It was clearly felt by the Registered Manager and staff that these small or reduced sized bathrooms does not meet the needs of current service users within the home. Concerns were expressed that given the small size, once service users were in the baths – they would not be able to get them out. Most service users prefer the full sized bath with a suitable hoist facility. It was clear from the inspection of both of these bathrooms that they were not in use. The CSCI Inspectors were also very concerned to be informed that as these two bathrooms were not in use – this left the use of one shower and an assisted bathroom on the ground floor and an assisted bathroom on the first floor. The bathing facilities do not meet the National Minimum Standard OP 21.3 and Regulation 23 of the Care Homes Regulations 2001. The Inspectors were also informed that due to shortage of staff, and the location and demand for assisted bathrooms - the service users are restricted to no more than one bath per week. Given that many service users are heavily dependent and incontinent this is unacceptable. The Inspectors were also very concerned about the condition of the bathrooms containing the assisted hoists. There was no current service record for the hoists in the bathrooms. The last service was carried out in June 2004. There are no extractor fans in the bathrooms on the ground, first and second floors. The assisted bathroom on the first floor need an extractor fan, a mirror and the light above the bath was out of order, which must be repaired; cistern to toilet needs repairing/replacing, the new flooring has not been laid correctly and is uneven, which must be correctly relayed, the pipe work must be covered properly so that it is safe. The surface of the bath is such that it cannot be effectively cleaned. The side panel of the bath is warped and requires replacement. The small bathroom on this floor, which is not used need an extractor fan and a new plug. The Registered Provider needs to have an action plan to make the unused “small” bathroom operational on the second floor. The bathroom on the ground floor need an extractor fan, and must repair/replace the bath panel, which is falling off. The Registered Providers must ensure that all service users are assisted to bathe/shower as regularly as needed or requested by service users, and that their bathing preferences are recorded in care plans. The Registered Providers must provide assisted bath/shower facilities suitable to meet the needs of all current service users in the bathrooms currently housing the “small baths”, which are not usable by the current service users. The door to second floor (keep locked shut in error) does not close properly to its rebate, must be rectified appropriately. The portable electric heater placed Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 19 on the floor in the conservatory poses risks of service users falling over it. The Registered Providers must take appropriate action to ensure a suitable means of providing heating in the conservatory is implemented as a matter of priority. The second floor corridor is too dark and need additional lighting, which must meet the required level of lighting in all the areas used by the service users. The portable electric heater in bedroom 30 must be removed as it poses fire and safety risks to the service user. The Registered Providers must provide adequate level of heating in bedroom 30 to meet the need of the current service user. The staff also stated that the “staff room” in the cellar is not satisfactory to use for breaks and thus nobody uses it, and also there is no suitable staff changing facility and no provision for personal lockers. The Registered Providers, in consultation with the staff must resolve these issues to the satisfaction of all parties concerned. The staff was also concerned about personal safety in the dark evenings and at night time because of the faulty lights outside the building and in particular behind the bins outside. The lounge, conservatory and dining room (referred to collectively as communal space) at Richmond Court are not big enough to accommodate all 29/30 service users, and not adequate to meet the needs of current service users. The conservatory only can accommodate up to 6/7 service users, and the main lounge can only accommodate up to 14 service users and it is tight as many of service users now use zimmer frames and/or wheelchairs. The dining room can only accommodate up to 20 service users and the remaining service users are not able to use this facility and they are served their meals in their own bedrooms. Main entrance and landing/lobby areas are not suitable, and comfortable to use as sitting and recreational facilities as this could pose obstructions in case of fire and other safety considerations. The Library room is also used as a visitors’ room for private meetings by the service users and their relatives/friends. The Registered Providers must have an action plan in place as to how and when additional and suitable communal space could be provided for the use of all the current service users accommodated at Richmond Court. During the inspection, the home was found to be generally clean and free from any unpleasant odour. The home has put in place policies and procedures regarding infection control. It was evidenced from the staff training records that 14 members of staff have received training in infection control. However, those members of staff who as yet not received this mode of training must do so as a matter of priority. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 20 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 and 30 The home is not adequately staffed, which could have impact on the quality of care and the ability of the home to meet the needs of 29 service users with varying and differing dependency levels and needs. The home continues to support staff to complete training. The home has good staff recruitment policies and procedures in place. EVIDENCE: The information provided by the Registered Manager and the available staff rotas indicated that the home does not meet the National Minimum Standard OP 27 and Regulation 18 of the Care Homes Regulations 2001. During the Inspectors’ meetings with staff on duty, they also stated that they are “rushed/pushed” at peak times and during the part of the afternoon when the number of carers reduced to three. The carers are also expected to cover laundry duties and assisting the cook in the kitchen lunchtime and evening teatime to undertake plating up meals, distributing them throughout the building, clearing away plates and then undertaking loading/unloading the dishwasher and washing pans. During our inspection tour of the premises three carers were witnessed to be in the kitchen carrying duties of a kitchen assistant and a catering assistant. The cook actually told the Inspectors during the meeting with the staff on duty that carers assisted her in these duties. It was also observed that four service users who required assistance in eating/feeding had to wait over an hour after they having been served the meal. This practice is not acceptable. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 21 It was also noted that the 29 service users are accommodated on three floors with varying degrees of dependency levels and differing needs. From speaking with staff, and records examined, there are 7 service users that are currently considered ‘high dependency’. These service users require the assistance of two carers at a time for mobility/toileting or hoisting. There are also 4 service users that require one-to-one assistance at mealtimes with supervision or feeding. In addition, the layout of the building also makes it difficult for staff to provide effective care across 3 floors and in individual service users’ bedrooms. Staff currently has to cover kitchen assistant and catering duties and thus they are not available to provide the assistance needed to service users. The current staffing levels are failing to meet the identified care needs of the existing service users. It was also evidenced that the care recording is poor quality and there is little or no real opportunity for staff to engage in meaningful activities individually or collectively with service users. There is a major concern that almost 30 of the service users spend the vast majority of their time socially isolated within their own bedrooms – partly due to lack of adequate and suitable communal space available in the home. Because the staff are in low numbers on duty in the afternoons and in the evenings and top of that they having to cover duties across 3 floors, it makes impossible for care staff to have any quality time with individuals or in small groups of service users on each floor. There is another added problem in that there is no communal sitting area available on the second floor. The above issues were discussed in detail with the Registered Manager - Ms Carolyn O’Brien, who stated that she understands what is required in order to provide a good quality of care – in regard to care planning documentation and allocation of care hours throughout the day and night and throughout the home to meet the identified care needs of all service users. The above staffing deficiencies at Richmond Court are not acceptable and are a serious concern for the Commission for Social Care Inspection (CSCI). Subsequent to this inspection, a letter of Cause for Concern dated 12 December 2005 was sent to the Registered Provider – Mr Hanif Ladhani requesting him to notify the CSCI by 23 December 2005 as to what action he has taken to address the requirements made in the this letter relating to staffing levels and bathrooms facilities at Richmond Court. The Registered Providers must ensure that there are four carers and a senior carer on duty throughout the day (i.e. morning and afternoon shifts) and three night carers on wakeful duty and a senior carer/manager on call, and sufficient numbers of ancillary staff to cover laundry, domestic and catering duties. This is a minimum staffing requirement in order to meet the varying and differing needs of 29 service users accommodated on three floors. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 22 The Registered Providers must ensure that care staff do not engage in catering/laundry/domestic duties during their shift unless they are shown on the staff rota for those specific duties and additional care hours must be covered by additional staff. This is to ensure that care staff is able to meet the varying and differing needs of all service users throughout the care home. The Registered Providers must ensure that additional cook/catering assistant hours are provided to ensure that meals for 29 service users are plated and distributed throughout the home, and then plates collected and cleaned away without reliance on care staff. Registered Manager’s hours are in addition to the above staff hours and should be considered supernumerary to allow her to manage the care home registered for 30 service users effectively and efficiently. It was also noted that there is a 17 and half years old trainee who assist the staff in making beds. This trainee member of staff can not be counted on the staff rota as a carer and she must be supervised at all times and she must be registered on a TOPSS – certified training programme. It was evidenced from staff training records that two carers have completed their NVQ Level 2 training out of over 20 carers. The Registered Manager stated that all carers had commenced their NVQ Level 2 training in April 2005, but, problems have been experienced with the Assessor and have waited over three months to return the carers’ NVQ work completed, which now have been collected and waiting for the new Assessor to assess the units completed by the carers. Three newly enrolled members of staff would complete their NVQ Level 2 training in March 2006. The Registered Manager provided staff training records and stated that all new members of staff have received the TOPSS induction and Foundation training. It was also noted from the training records updated in mid- November 2005 that up to 90 of staff have received training in safe working practice topics i.e. moving and handling, basic first-aid, food hygiene, infection control, fire and health and safety. It was also noted that 18 members of staff have received awareness training on adult protection from abuse. The Registered Manager stated that no training in dementia care and disability awareness has been provided yet but she would look at this training provision in consultation with the Registered Providers. The Registered Providers must ensure that those members of staff who as yet not received safe working practice topics training must do so as a matter of priority. Discussion with the Registered Manager and examination of the most recently recruited members of staff files demonstrated that thorough recruitment procedures had been followed in line with the home’s recruitment policy. Two Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 23 written references and Enhanced CRB and POVA checked are being obtained before new members of staff are appointed. The Registered Manager is very aware that any member of staff with criminal records would not be employed in accordance with the Department of Health Guidance issued in July 2004. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38 The home is managed by a newly appointed and Registered Manager, who lead the group of with great deal of confidence. The staff is clear of their roles and responsibilities. Staff is regularly supervised to enable them to carry out their work professionally. Health, safety and welfare of service users and staff are promoted by safe working systems put in place by the Registered Providers and the Manager. EVIDENCE: The Registered Manager has completed her NVQ Level 4 in care and management qualification. Ms Carolyn O’Brien has worked at Richmond Court as deputy manager over three years and she was appointed as an acting care manager in August 2005. She was registered by the CSCI as the Registered Manager in October 2005. Since taking over her new role, she has changed Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 25 the staff files and paperwork introduced new care recording formats, and organisation of more activities for service users. It was evidenced that now all members of staff receive formal supervision at the required intervals. Records of supervision were examined during the inspection. The Registered Manager has held meetings with staff. Accidents and fire prevention records were examined, which found to be appropriately maintained. Matters pertaining to fire safety and environmental health were found to be satisfactory and all issues were appropriately addressed. However, the Registered Providers must ensure that the lighting outside the building, which at night is poor and staff is concerned about personal safety is appropriately installed; and that the closure mechanisms on interconnecting doors and bedroom doors must be checked on a more regular basis to ensure that they properly closes to their rebates. (See NMS OP19 above). The Registered Providers must ensure that the baths/showers hoists are serviced at the required intervals and appropriate documentation is made available in the home and for inspection at all times. Those members of staff who as yet NOT received training in safe working practice topics must do so as a matter of priority, including to ensure that a member of staff, who is fully qualified in First-Aid is on duty at each shift (i.e. day and night shifts). (See NMS OP30 above). Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 26 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 1 1 x X 2 3 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 1 Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 & 17 Requirement Timescale for action 31/01/06 2 OP8 12, 13 & 17 The Registered Manager must take appropriate action to ensure that all care provided by the staff to all service users during the day and night must be recorded in some detail and in suitable formats, and the quality of recording must also be improved. The Registered Manager must 15/01/06 ensure that the service users are not restricted to one bath per week, and they must be assisted to bathe/shower as regularly as needed or requested by the them, and their bathing preferences are clearly recorded in the care plans. The Registered Manager must ensure that eye drops and artificial tears stocked in excess of need must be returned to the Pharmacy and appropriate records maintained; and that those members of staff who as yet not received training in safe handling of medication must do so as soon as places becomes available at the local City DS0000030036.V270403.R02.S.doc 3 OP9 13 & 17 31/01/06 Richmond Court Residential Care Home Version 5.0 Page 28 4 OP12 16 &17 5 OP12 23 (2)(h) 6 OP15 12 7 OP19 23 College. The Registered Manager must ensure that the staff are proactive in positively encouraging the service users to take part in a range of social and leisure activities both indoor and outdoor of the home; and the activities must be varied in range and appropriate, and in accordance with the service users’ choices, preferences and capacities, and suitably displayed in the prominent places throughout the home so that all service users are aware of all the activities programme. The Registered Manager must maintain records of all the activities enjoyed by the service users, and must also be incorporated into the individual service users’ care plans. The Registered Providers must have regard to the number and needs of the service users and ensure that the communal space provided for service users is suitable for the provision of social, cultural and religious activities and appropriate to the circumstances of service users. The Registered Providers must ensure that there are enough members of staff on duty, and are ready at all times to offer assistance in eating, where necessary, discreetly, sensitivity, and individually, while independent eating is encouraged for service users as long as possible. The Registered Providers must take appropriate action to ensure that the door to second floor (labelled keep locked shut in error) properly closes to its rebate; the portable electric DS0000030036.V270403.R02.S.doc 31/01/06 31/01/06 15/01/06 15/01/06 Richmond Court Residential Care Home Version 5.0 Page 29 heater placed on the floor in the conservatory must be removed as it poses risks to service users, who could fall over it; additional lighting must be provided in the corridor on the second floor; a portable electric heater placed on the floor in bedroom 30 must be removed as it poses high risk to the service user living in this bedroom; the faulty lights outside the building and in particular behind the bins must be repaired for the staff personal safety in the evenings and night times. 8 OP20 23 (1)(2) The Registered Providers must 31/01/06 ensure there is adequate communal space – (i.e. lounge. recreational and dining rooms) apart from service users’ private accommodation and excluding corridors and lobby/landing areas, and entrance hall. The communal space must be available, which includes rooms in which a variety of social, leisure, cultural and religious activities can take place, and service users can meet visitors in private, and dining room (s) to cater for all 29/30 service users. The Registered Providers must 31/01/06 ensure that there is suitable staff accommodation for the purpose of changing and rest during breaks and provision of storage (i.e. personal lockers) of their personal belongings. 31/01/06 The Registered Providers must provide assisted bath/shower facilities suitable to meet the needs of current service users in bedrooms currently housing the “small baths”, which are not able to be used by the current service users. DS0000030036.V270403.R02.S.doc Version 5.0 Page 30 9 OP20 23 (3)(a)(b) 10 OP21 23 Richmond Court Residential Care Home 11 OP21 23 12 OP22 14, 16, & 23 13 OP27 18 The Registered Providers take 31/01/06 appropriate action to replace the bath in the assisted bathroom on the first floor to ensure that it can be cleaned effectively, and the side panel is replaced, and must provide an extractor fan, a mirror, repair the light above the bath, cistern to the toilet be replaced, new floor covering is properly relayed, pipe work must be covered appropriately so that it is safe, The “small bath” on this floor also need an extractor fan, and a new plug. The bathroom on the ground floor must have an extractor fan and a new bath panel. The bathroom on the second floor, which is currently not in use must be made operational as a matter of priority as there is no bath/shower facility for service users accommodated on this floor. The Registered Providers must 31/01/06 provide suitable handrails or other aids in the corridors throughout the premises; and to install suitable hoists in two “small bathrooms”, which are currently not in use, which are capable of meeting the assessed needs of service users. 15/01/05 The Registered Providers must ensure that there are four carers and a senior carer on duty throughout the day (i.e. day, afternoon and evening shifts) and three night carers on wakeful duty and a senior carer/manager on call, and sufficient numbers of ancillary staff to cover laundry, domestic, cook and kitchen assistant duties throughout the week and at all times. The Registered Manager’s hours are in addition to the DS0000030036.V270403.R02.S.doc Version 5.0 Page 31 Richmond Court Residential Care Home 14 OP27 18 15 OP28 18 16 OP30 18 17 OP38 4, 12,13, & 23 above minimum staff hours and should be considered supernumerary, and she be left to manage the home effectively and efficiently for 30 service users. The Registered Providers must ensure that care staff does not engage in catering/laundry/domestic duties during their shifts unless they are shown on the staff rota for those specific duties and additional care hours covered by additional staff; and that additional cook/catering assistant hours are provided to ensure that meals are plated and distributed throughout the home, and then collected and cleaned away without reliance on care staff. The Registered Providers must ensure that a minimum ratio of 50 trained members of care staff NVQ Level 2 or equivalent is achieved by the home. A trainee member of staff, who is under the age of 18 must be registered on a TOPSS – certified training programme. The Registered Providers must ensure that all those members of staff, who as yet NOT received training in safe working practice topics, must do so as a matter of priority. (See NMS OP38 below). The Registered Providers must ensure that the door closure mechanisms on interconnecting doors, and several bedroom doors must be checked on regular basis to ensure that they actually close to their rebates; and that the baths/showers hoists are serviced at the required intervals and appropriate documentation is DS0000030036.V270403.R02.S.doc 15/01/05 28/02/05 31/01/06 31/01/05 Richmond Court Residential Care Home Version 5.0 Page 32 made available in the home and for inspection at all times; and that all those members of staff, who as yet not received training in safe working practice topics must do so as a matter of priority; and that a member of staff, who is fully qualified in First- Aid must be on duty at each shift (i.e. day and night shifts). (See NMS OP30 above). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP30 OP12 Good Practice Recommendations The Registered Providers should consider making provision for training for staff in adult protection from abuse, dementia care and disability awareness. The Registered Providers may wish to consider appointing a part-time Activities Organiser for the home. Richmond Court Residential Care Home DS0000030036.V270403.R02.S.doc Version 5.0 Page 33 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. 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