CARE HOMES FOR OLDER PEOPLE
Richmond Heights Woodhouse Road Intake Sheffield S12 2AZ
Lead Inspector Janice Griffin Unannounced 19 April 2005 9:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond Heights Version 1.10 Page 3 SERVICE INFORMATION
Name of service Richmond Heights Address Woodhouse Road Intake Sheffield S12 2AZ 0114 253 1992 0114 253 1994 None Speciality Care (RAIT) Home Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager Position Vacant Care Home with Nursing 54 Category(ies) of OP Old Age 54 registration, with number of places Richmond Heights Version 1.10 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. Date of last inspection 8 December 2004 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over five and a half hours from 9:00am to 14:30pm. Opportunity was taken to make a partial inspection of the home and examine a sample of records. The inspector spoke to seven service users, five relatives and five members of staff. What the service does well: What has improved since the last inspection?
Preadmission assessments were being used by the home for the home to decide whether they could meet service users needs. Improvements had been made to the safe storage of medication and hazardous substances. Some areas around the home had been redecorated making the home more pleasant for service users. The ratio of care staff to service users is now determined according to the assessed needs of the service users. Day care staffing levels have been reorganised to offer better care for service users. There were opportunities for the service users to undertake a number of activities within the home and an activity co-ordinator was employed to coordinate this. Richmond Heights Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Richmond Heights Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Richmond Heights Version 1.10 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 standard(s) 1,3 The homes statement of purpose and service user guide contained sufficient information, this was sufficient for service users to make an informed choice. All the service users spoken to said that they had their needs assessed prior to admission. EVIDENCE: The statement of purpose and service user guide contained a range of information for potential service users to be clear about the services the home provided to meet their needs. Assessments from other professionals who had been involved with the admission of the service users were available. Staff at the home had also completed their own assessment in sufficient detail to determine whether they could meet prospective service users needs. The service users confirmed that they had been involved with this process. Richmond Heights Version 1.10 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 standard(s) 7,8,9 and10 Service users, social and personal care needs were well documented in the care plans checked, to ensure that staff had the information required to meet the service users needs. Improvements had been made to the safe storage of medication. Service users said they were treated with respect and their privacy and dignity was respected by the staff. EVIDENCE: There was no evidence in two care plans checked to confirm that the service users were seeing the dentist and optician, at regular intervals. Records were kept of medication received, and disposed of. The member of staff spoken to confirmed that she had been trained to administer medication. A pharmacist had checked the home’s medication systems at regular intervals. Medication was noted to be securely stored. Richmond Heights Version 1.10 Page 10 Staff were observed to interact well with the service users, furthermore, they closed bedroom and toilet/bathroom doors when attending to service users personal care needs. Service users spoken to said that the staff treated them with respect and their right to privacy was always upheld. The manager stated that service users post was only opened if the service user or their representative requested this. The home had a pay phone, which was situated, in a quiet area in the home, which enable service users to contact family and friends. This protected the privacy of the service users. Richmond Heights Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 14. Service users were generally happy with their lifestyle within the home and they were able to maintain contact with family and friends. The increased staffing has benefited service users, they are supported to exercise more choice and control over their lives. EVIDENCE: An activity co-ordinator is employed which encourages service users to remain active and involved. Service users said they did go out on trips at regular intervals. Relatives said that visiting times were flexible and that they could see the service users in private. Service users confirmed that staff helped them to maintain contact with their family/friends and that they could choose who to see and who not to see. They also said that they could rise and retire at whatever time they wanted and take a bath whenever they want. This supported the service users to exercise control and choice over their daily routines. Service user and relatives meetings took place regularly and all spoken to said that they felt involved in the processes of the home and that they could influence the quality of the care offered. Richmond Heights Version 1.10 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 standard(s) 18 The arrangements for protecting service users and responding to their concerns were satisfactory but some improvements are needed, as one incident which could have effected the well being of service users had not been reported to the CSCI. Staff had a good understanding of the procedures to be followed should they suspect any abuse at the home. EVIDENCE: Discussions with staff demonstrated they were confident in reporting any abuse should they become aware of it. Some staff had received information and formal training on adult abuse . One incident which could affect the well-being of service users had been investigated by the home since the last inspection, the incident had not been reported to the CSCI. Discussions with service users confirmed they were happy and felt well looked after and they would know who to complain to if they needed to complain. Richmond Heights Version 1.10 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 standard(s) 19,20,23,24 and 26. Relatives and service users said that the environment within the home was on the whole well maintained and clean and a comfortable environment to live. One relatives only concern was that some carpets were badly stained the inspectors observations confirmed this. EVIDENCE: The grounds were very well kept, attractive and accessible. Some areas had damaged decoration and stained carpets. There was an appropriate amount of sitting, recreational and dining space creating sufficient rooms for a variety of activities to take place. The dining areas were large enough to cater for all service users. There was a smoke-free sitting room. Outdoor space and all areas of the home were accessible to people in wheelchairs. Furnishings and fittings were domestic in design. Richmond Heights Version 1.10 Page 14 Three bedrooms were checked in detail. All had a suitable bed with clean bed linen, curtains, mirror, overhead lighting, drawer and wardrobe space, a bedside table and a washbasin. All the rooms were carpeted. The bedrooms seen were clean, they were well personalised and provided with homely touches. One bedroom had stained decoration and not all of the bedrooms seen were provided with the door locks and lockable facilities this some service users thought did not allow maximum privacy for them. Richmond Heights Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 29. Rotas checked indicated that staff are employed in sufficient numbers to meet the needs of service users in accordance with agreed staffing levels. Service users said they felt safe and that the staff are competent and knowledgeable. Recruitment procedures did not fully protect the service users gaps were noted in the employment history of some staff. EVIDENCE: Since the last inspection a review of the staffing levels has been undertaken and the day care staffing levels have been reorganised. Above 40 of the staff are trained to NVQ at level 2 this ensures that service users receive good care which meets their individual needs. The induction programme met required standards and staff spoken to said it covered such things as safe working practices, the organisation, the workers role and the needs of the service user group. Training needs of staff were identified by supervision and appraisal sessions. Staff confirmed that they receive three days paid training per year, this demonstrates the providers commitment to investing in the staff. Richmond Heights Version 1.10 Page 16 Three staff files were checked and the staff members had completed an application form and that they were subject to an interview. Each contained the staff’s date of birth, two written references, start date of employment and details of weekly contracted hours to be worked. Two of the files had no details of the persons employment history. The manager confirmed that CRB checks had been done on all new staff appointed since April 2002, One staff members CRB recorded a past offence. A risk assessment had not been produced to protect the service users from abuse. However the staff member had worked at the home some months and nothing untoward had happened. Richmond Heights Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,37 and 38. Service users said that they were benefiting from care given by well trained staff. They also said that the increased training staff had received had resulted in improvements in the service provided to them to maintain their health, safety and welfare. A safe environment is not provided in all parts of the home which could affect the wellbeing and safety of service users. Some service users personal files were insecurely stored. EVIDENCE: The manager has several years experience in senior management and she also has a RGN qualification, she has commenced a level 4 National Vocational Qualification in management. The manager is not yet registered with the CSCI, an application to register her has been received at the local office, but it was not completed correctly and despite the organisation being sent two reminder letters, the application form has not been returned. Richmond Heights Version 1.10 Page 18 Staff 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 gas appliances. Fire exits were clear and hazardous substances were securely stored maintaining service users safety. One fire door was not fully closing on its rebate. Confidential information about the service users was not securely stored in some areas around the home, this is a breach of service users confidentiality. Richmond Heights Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 1 3 x x 3 2 x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 x x x x x 2 2 Richmond Heights Version 1.10 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 7,8 Regulation 12 Requirement Service users must be offered access to dental services. Details of appointments with health care specialists must be recorded in the service users care plan as should the name and address of the specialist. This requirement has been outstanding since 2004. All bedrooms 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.This requirement has been outstanding since 2004. Areas around the home with stained decoration must be redecorated.Stained carpets must be cleaned or replaced.This requirement has been outstanding since 2004. Gaps in staffs employment history must be explored.This requirement has been outstanding since 2004. An application to register the new manager must but be submitted to the local office of the CSCI.This requirement has been outstanding since 2004.
Version 1.10 Timescale for action 30/6/05 2. 24 23 1/6/05 3. 19 23 1/6/05 4. 29 19 Immediatel 5. 31 9 14/5/05 Richmond Heights Page 21 6. 7. 8. 38 37 7 23 17 12 9. 18 37 10. 29 19 All fire doors must fully close on their rebates. Service users records must be kept in a secure place at all times. The gender choice of staff assisting service users with personal care tasks must be recorded in service users care plans. Any incident that could effect the wellbeing of service users must be reported to the local office of the CSCI within 24 hours of the occurance. A risk assessment must be undertaken for any staff member who has offences on their CRB. Immediatel Immediatel 1/6/05 Immediatel Immediatel 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 28 31 Good Practice Recommendations 50 of the staff must be trained to NVQ Level 2. the registered manager must obtain a qualification in management at NVQ Level 4 or equivalent. Richmond Heights Version 1.10 Page 22 Commission for Social Care Inspection 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
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