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Inspection on 01/11/05 for Richmond Heights Nursing Home

Also see our care home review for Richmond Heights Nursing Home for more information

This inspection was carried out on 1st November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users said they liked living at the home where they were well cared for by staff. The relatives spoken to said that the home provided a good standard of care. Service users were able to visit the home for trial periods and full detailed assessments had been completed prior to their admission. Service users were only admitted once it had been determined that the home could meet their needs and all service users currently living at the home were happy with the arrangements. Each service user had a plan of care that detailed their needs and what the staff had to do to provide the care needed. All health care needs were met and service users received visits from health care professionals e.g. chiropodist, dentist, GP etc. The service users said they enjoyed the activities provided. Meals were thought to be good in the main. There was a complaints procedure that the staff and service users knew about.

What has improved since the last inspection?

Some areas around the home have been redecorated and new carpets fitted, providing a more pleasant environment for the service users. All the fire doors were now closing on their rebates. The manager and staff had worked hard to identify alternative social and leisure activities that could more appropriately meet the service users individual needs. Referrals to the appropriate medical specialists had been identified and were being positively addressed. Service users records were securely stored.

What the care home could do better:

Further redecoration and some carpets need cleaning or replacing. Suitable door locks and lockable facilities must be provided in all the bedrooms. Recruitment procedures did not meet the required standards and need to be improved. A complaint recently made to the CSCI was partially upheld; the complaint was about staffing levels deployed at the home being inadequate to meet the needs of the existing service users. The staffing levels need to be reviewed, as they have not been reviewed for over six years. Hazardous substances must be securely stored at all times and more care is needed with some hygiene practises.

CARE HOMES FOR OLDER PEOPLE Richmond Heights Nursing Home Woodhouse Road Intake Sheffield South Yorkshire S12 2AZ Lead Inspector Janice Griffin Unannounced Inspection 1st November 2005 07:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richmond Heights Nursing Home DS0000021800.V261103.R01.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 Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Richmond Heights Nursing Home Address Woodhouse Road Intake Sheffield South Yorkshire S12 2AZ 0114 253 1992 0114 253 1994 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) Speciality Care (REIT Homes) Limited Post Vacant Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user named as part of the application to vary registration who is under the age of 65 may reside at the home. 19th April 2005 Date of last inspection Brief Description of the Service: Richmond Heights is a purpose built, 54 bedded home for older people. There are 52 single en-suite rooms and one double room. It is in a residential area of Sheffield with good access to public services and amenities (e.g. bus services, shops, libraries etc). It is built over two floors all accessed by a lift. The home has a suitable number of lounges and dining rooms. The gardens are landscaped and it has a car park. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place from 7:0 am to 2:15 pm. As part of the inspection process twelve-service users, three relatives and six staff, including the manager, were spoken to. A number of records were examined and several areas of the building were inspected. The inspector was pleased to note that throughout the inspection staff interacted positively and sensitively with each service user. The inspector would like to thank service users, the relatives, the manager and staff for their commitment to the inspection process What the service does well: What has improved since the last inspection? Some areas around the home have been redecorated and new carpets fitted, providing a more pleasant environment for the service users. All the fire doors were now closing on their rebates. The manager and staff had worked hard to identify alternative social and leisure activities that could more appropriately meet the service users individual needs. Referrals to the appropriate medical specialists had been identified and were being positively addressed. Service users records were securely stored. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 6 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 Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 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 Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 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): 2,3,4,5 and 6. Service users individual needs had been fully assessed prior to their admission, and they had moved into the home once it had been agreed that the home could meet their needs. Service users were able to have informal introductory visits to the home and at the time of their admission had been provided with a contract containing the relevant information. The home does not provide intermediate care. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 9 EVIDENCE: Detailed full needs assessments had been completed by the referring social worker for all service users prior to being admitted to the home. Their families had been involved in the assessment process as appropriate. The manager confirmed that service users were only admitted to the home once they were sure that they could meet their needs. Service users were able to visit the home for informal visits prior to their admission if they wished. Service users confirmed that this helped them to get to know everyone at the home and made them feel less anxious. Records checked confirmed that service users families had been very involved in decisions regarding the arrangements. An up to date contract/statement of terms and conditions had been provided to service users and signed copies were retained on individual files. These clearly detailed the fees, including any extra charges, and the services and facilities provided by the home. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 10 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 11. Service users received individual personal support that promoted their, dignity and independence. The healthcare needs of service users had been regularly assessed and reviewed and the appropriate action had been taken to ensure that needs were met and that each service user was supported as required. Procedures were in place to closely monitor the health and personal care of each service user. The home had a policy on death and dying. EVIDENCE: Observations and discussions with service users and staff confirmed that each individual’s personal care needs had been identified and met. Preferences regarding personal care routines, and the gender of staff they wished to support them with this, had been recorded. Service users were well dressed and each had their own preferred choice of dress, hairstyle and appearance. Any specialist equipment required had been provided and the levels of support required by each person had been regularly reviewed. This ensured that their needs in relation to dignity, choice and independence were met. Measures were in place to ensure that any issues relating to weight, medication or other health problems were identified and dealt with as a priority. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 11 Staff interviewed said that they would always sit with service users at the time of death if family were not available. They also said that every effort would be made to ensure that the service users receive appropriate medical attention and pain relieve. Staff would attend the funeral of service users. This allowed the staff to pay their respect to the service user and family and friends. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 12 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): 15. The service users said the quality of the food provided was excellent. EVIDENCE: Service users spoken to said the food served was excellent and hot food was served hot and that there was a good choice of food, which they enjoyed. They confirmed they could have drinks and snacks when they wanted and that three full meals a day were offered. This promotes the health and wellbeing of service users. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 13 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 and 17. The homes complaints procedure was clear, accessible and contained all the necessary information. Staff had a good understanding of the procedure and timescales involved. Service users were aware that they could complain. Full records of all complaints made were not available within the home. The CSCI as received one complaint about this home since the last inspection. The service users legal rights were protected. EVIDENCE: The complaints procedure was available for service users, their relatives and staff. Service users said that they knew that they could complain if they were not happy about anything and that they felt able to discuss any issues or concerns that they may have with the manager and staff. They confirmed that staff were always available and that they were encouraged to talk about anything that troubled them or caused them anxiety. The manager kept a record of complaints made but the records did not detail what action had been taken by the manager to investigate the complaint. A complaint was received recently by the CSCI about the staffing levels not being adequate to meet the needs of the service users. This was investigated by the organisation and was found to be partially upheld. The manager said that four-service user had their legal rights protected by the Court of Protection. She also said that if any other service users requested access to advocacy services then she would facilitate the service for them, if requested. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 14 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): 19,20,21,23,24,25 and 26. Some areas need redecorating and some carpets need cleaning or replacing. The bedroom doors were not fitted with locks and a lockable facility was not provided in each bedroom. All the service users said their rooms and the home in general were well maintained and kept clean. One bathroom could not be used. More attention needs to be paid to the hygiene standards at the home. EVIDENCE: On the day of the inspection the home was clean but some areas had damaged/stained decoration and the carpets in two bedrooms smelt offensively. Some bedroom doors were not fitted with suitable door locks and lockable facilities were not provided in all the bedrooms, this does not respect the service users privacy. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 15 The home had an appropriate amount of sitting, recreational and dining space and there were sufficient rooms for a variety of activities to take place, creating a comfortable environment. The dining areas were large enough to cater for all service uses and they were homely and attractively furnished. Service users could choose to meet with their visitors in these rooms or in the privacy of their own bedroom. There were smoke free sitting rooms offering choice to non- smokers. Outdoor space and all areas of the home were accessible to people in wheelchairs. Equipment was noted to be stored in a bathroom this could be a trip hazard for staff and service users. One bathroom was out of order. The appropriate seating had been provided in the garden for those service users wishing to sit outdoors whenever the weather permitted. The teapots used to serve tea from were badly stained and a member of staff was noted to serve tea from a large jug that was not fitted with a lid. This is not hygienic. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 16 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 staffing levels deployed have not been reviewed for over six years and a recent complaint made to the CSCI raised concerns about the number of staff on some shifts and that staff were taking their breaks together. Staff interviewed said that they were not always adequate staff on duty, this was when staff were off sick and at on annual leave. They also said that they no longer take their breaks together. The home had the appropriate recruitment policies and procedures in place although not all of the required information was available on one staff file and therefore the protection of service users could not be ensured. The home had a training and development plan and all staff had completed a range of training relevant to their role. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 17 EVIDENCE: A recent complaint made to the CSCI raised concerns about the number of care staff deployed on some shifts. Staff interviewed said that they were not always adequate staff on duty; this was because replacement staff did not always cover staff sickness and annual leave. The staff also raised concern about some qualified staff that often refused to help them with some caring tasks. The staffing levels at the home have not been reviewed for over six years. Staff were aware of the needs of individual service users and they confirmed that the homes communication systems enabled them to support service users. Staff files and discussions with the staff and the manager confirmed that all staff had completed detailed induction training. Staff were approachable and sensitive to the needs of service users and were able to communicate effectively with each person. Several staff had completed NVQ training in care and this had ensured that more than 50 of the staff team were qualified to level 2. This confirms the organisations commitment to investing in the staff team. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 18 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, 34, 35, 36, 37 and 38. The manager is not yet registered with the CSCI. The service users and staff said the manager was approachable and very professional. The manger had a nursing qualification but she was not qualified to NVQ level 4 in management. A representative from the organisation visits the home on a regular basis a report is submitted following his visits. An auditor had recently undertaken an audit of the homes financial procedures. Records were in the main up to date and well organised. More Care needs to be taken with the storage of hazardous substances Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 19 EVIDENCE: The manager had a job description that clearly defined her roles and responsibilities and staff were aware of her role. Staff and service users said that she was committed to ensuring that the home maintains and develops high standards of care, she had completed regular internal audits on all aspects of the service provided by the home. The manager is currently undertaking training in management at NVQ level 4.An application to register the manger as been submitted to the local office of the CSCI and is being processed. Service users confirmed that they could see the manager when they wished and they said that she was very approachable and supportive. The staff described her as `very good`. Records were securely stored as required and those checked were accurate and up to date and in good order. The responsible individual was visiting the home on a regular basis and talking to staff and service users, a report was written following the visit. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, food safety and infection control. The manager stated that there was a programme for the regular servicing and maintenance of all appliances. No fire exits were blocked and all fire doors were closing on their rebates. The administrator handles money on behalf of some service users, account sheets were kept and an auditor had checked the system recently. Hazardous substances were noted to be insecurely stored in a kitchenette. This does not ensure a safe environment for service users. Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 X 2 3 2 X 3 2 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X 3 3 3 3 2 Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 21 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 OP16 Regulation 22 Requirement A record must be kept of all complaints made; the records must include details of any investigation and action taken. Areas around the home with stained decoration must be redecorated.Stained carpets must be cleaned or replaced.This requirement has been outstanding since 2004. The bathrooms must not be used as store rooms. The bath that is out of order must be repaired. All bedroom doors must be fitted with locks suitable for service users capabilities and accessible to staff in emergencies. A lockable facility must be provided in each bedroom. The stained teapots must be cleaned or replaced. Hot drinks must be served from a container fitted with a secure lid. The staffing levels deployed at the home must be reviewed. The numbers and skill mix of staff must be appropriate to meet the assessed needs of the service DS0000021800.V261103.R01.S.doc Timescale for action 01/12/05 2 OP19 23 01/05/06 3 4 5 OP21 OP21 OP24 12 23 16 01/05/06 01/02/06 01/05/06 6 OP26 23 01/12/05 7 OP27 18 01/02/06 Richmond Heights Nursing Home Version 5.0 Page 22 8 OP29 18 9 10 11 OP31 OP31 OP38 8 8 12 users; the layout and purpose of the home must also be taken into consideration. The qualified staff must have their roles and responsibilities made clear to them. Details kept at the home of the staff members CRB check must detail whether the CRB is clear or not. The manger must be registered with the CSCI. The manager must have a qualification at NVQ level 4 in management. Hazardous substances must be kept in a secure place at all times. 01/12/05 01/01/06 01/06/06 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Richmond Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Heights Nursing Home DS0000021800.V261103.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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