CARE HOMES FOR OLDER PEOPLE
Richmond House Richmond Road Farsley Leeds LS28 5ST Lead Inspector
Michael Smithson Announced 9.30am 13 October 2005 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 House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Richmond House Address Richmond Road, Farsley, Leeds LS28 5ST 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) 0113 2555010 0113 2477228 Leeds City Council Department of Social Services Mrs Jacqueline Ross Care home only 20 Category(ies) of Old age (20), Physical disability (1) registration, with number of places Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8 March 2005 Brief Description of the Service: Richmond House is a local authority older persons home located in Pudsey which is approximately 3 miles from the centre of Leeds. The home is close to a good range of local amenities and transport links. There are a total of 20 beds available. Accommodation is provided for long stay, respite and intermediate care. However the numbers of long stay beds are being phased out. All the bedrooms are single rooms with en-suite facilities provided in the intermediate care beds. There is very good disability access into the premises and a shaft lift links the ground and first floor. There is outdoor seating provided and car parking is available. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of 2 for this inspection year. The inspection was announced. The next inspection will be unannounced. A poster was displayed informing the service users and visitors of the inspection. Copies of inspection reports for this and previous inspections are available either from the home or on the CSCI website. The inspection focused on the any outstanding requirements and recommendations, care records, staffing records and discussions with service users and staff. The inspector also joined the service users for lunch. The feedback from service users was very positive they felt the home provided a very good standard of care. The service users admitted on both respite and intermediate care felt they benefited from their stay. For many of the service users it was their first experience of a care home. They felt the home gave them a positive view of life in a care home. What the service does well:
The care records were well organised and are kept up to date. Different care record formats are used for long stay; respite and intermediate care service users. The formats include relevant information according to service user needs. The atmosphere is very positive and staff go about their daily task in a professional manner. They were observed to spend time with service users in and amongst their daily routines. The mealtime was an enjoyable experience, the tables were very attractive and the food was well presented. The service users were offered a choice and special diets are catered for. Good levels of training are provided for the staff team. The intermediate care service users are often admitted with a variety of health care needs. The staff felt they had the skills to meets the majority of needs. During discussions with
Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 6 the staff they were found to be very enthusiastic and keen to develop the service offered. What has improved since the last inspection? What they could do better:
The respite care records should include evidence that the service users have been consulted on each re-admission. The service users or their relatives should be asked to sign the information. The respite care plans should include medication on the front sheet. This will allow staff to identify any changes on admission. The copies of the completed CRB checks and the staff identification must be removed from the personnel files. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 6. Service users are provided with information to enable them to make an informed choice about the home. Those service users admitted on intermediate care are provided with an environment, which maximises their independence and ability to return home. EVIDENCE: The statement of purpose and service user guide have been reviewed. The documents include all the information required and give new admissions detailed information regarding the service provided. Only 2 of the service user group are permanent. Both have terms and conditions of residency. The respite admissions are charged £9.71 per night. The intermediate care service users are not charged directly for the service provided. Service users are admitted following an assessment by the placing agent. The respite admissions do have the opportunity to visit the home prior to their first stay. The service users admitted into intermediate care beds do not visit the home prior to admission.
Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 10 The unit currently provides a number of intermediate care beds. An area on the first floor is used for intermediate care beds, however service users are encouraged to use all the communal areas of the home and mix with other service users. An excellent range of facilities are provide to aid the rehabilitation process including physiotherapy and occupational therapy areas. The staff team are very well supported by a team of specialist workers based on the premises. All the staff involved in the rehabilitation of service users are included in any decision making process. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9. The health and personal care needs of service users are well met by the staff at the home. The care records were informative and reflect the progress or deterioration of service users. EVIDENCE: The care plans for a permanent; respite and intermediate care service user were checked during the inspection. The records were very informative and reflect the levels of care required by individual service users. The health care needs of service users are well recorded and risk assessments are included. The intermediate care records are completed by the care staff and the health care team who provide specialist support. The records are reviewed by the multi disciplinary team to monitor progress. The respite care records follow a simple format and are up dated each time the service users is re-admitted. I advised that they should provide evidence that they have discussed any changes to the care plan with the service users and ask them to sign the care plan. I also recommended that they include
Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 12 medication on the care plan front sheet. This will allow staff to identify any changes to the previous admissions. The manager is currently involved in a focus group looking at improving the organisation of the discharge of intermediate care service users. A discharge document is being produced to make sure the appropriate information and facilities are in place to make sure service users are better prepared at discharge. This is very good practice. The medication administration system is maintained in good order. A monitored dosage system is available for the permanent service users. The respite and intermediate care service users bring their medication into the home on admission. The medications are entered onto the drug administration sheets by the senior staff on duty. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 13 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, 14 and 15. Richmond Hose provides a good range of activities geared to both individuals and small groups. The home allows service users to make choices and have a high level of control of their daily lives. EVIDENCE: I spoke to 9 service users during the inspection and also joined the service users for lunch. The feedback from service users was very positive. They felt the home offered an excellent standard of care and the manager and staff team were always available to offer assistance and support. The service users on respite and intermediate care felt the services offered allowed them to maintain and improve their independence and develop new skills. All service users are offered a wide range of choices and are encouraged to maintain interests and hobbies. A good range activities are provided including quizzes, games and outings. A flower arranger has been booked to provide specialist activities. The mealtime was a very enjoyable experience. The menus are available on each of the tables and service users are offered a choice. The meal was very
Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 14 well presented and enjoyable. The service users said they thought the home offered a good variety of meals. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 15 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) 16 and 18. A robust adult protection and complaints policy and procedure ensures that service users are listened to and are protected from abuse. EVIDENCE: The complaints procedure is included in the information provided for service users. No complaints had been made. Adult protection training is provided for the care staff. However the courses are well attended and the manager has had some difficulty making sure all staff can attend. At the last inspection it was required that the night staff are provided with adult protection training. Places have now been booked on the January course. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 16 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) These standards were not checked during this inspection. EVIDENCE: A building inspection was not undertaken during this visit. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 17 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, 29 and 30. The staffing levels were adequate to meet the needs of the service users. A very good level of training has been provided to ensure staff had appropriate skills to meet the differing needs of service users admitted for intermediate care. EVIDENCE: A number of vacancies exist at the home. The registered manager is a job share post and 18.5 hours of the post are vacant. The current manager is working full time to cover the hours. Other vacancies included a fulltime senior care post, 15 hour kitchen domestic and an 18.5 hour domestic post. The recruitment records for the last 2 members of staff employed were checked. All the information required was available; including application forms written references and a CRB check. The manager is reminded that copies of the CRB and forms of identification are now not required to be kept. The home provides a good range of training for all staff. They have made very good progress in improving the numbers of NVQ level 2 qualified staff. They exceed the required levels of 50 . I spoke to a number of the staff during the inspection and interviewed 2 members of staff in private. All the staff demonstrated an excellent knowledge of the day to day routines and the needs of individual service users. The staff
Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 18 were very well motivated and felt they could contribute to the decision making process. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 19 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) 35, 36 and 37. The home is very well run and staff are involved in the decision making process. The records were informative and are kept up to date. EVIDENCE: A small amount of money is held on behalf of service users. Two were checked and were in order. A record was kept of the balance held and income and expenditure. Receipts are available for any purchase made. The staff receive regular supervision from the management team. The supervision includes discussions regarding work performance and training. The records checked during the inspection were very well organised and kept up to date. Secure storage is provided for confidential information. Booklets are available to provide information regarding access to files and records.
Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 3 3 x Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 7 Regulation Reg 15(1) Requirement The respite care plans must include evidence of service user involvement in completion and any up date on re-admission. Timescale for action 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP 7 OP 29 Good Practice Recommendations The respite care records should include medication on the care plan front sheet. This will allow staff to up date the information on admission. The returned CRB checks and staff identification should be removed from the personel files. Richmond House 20051013 Richmond House AN Stage 4 S33217 V237970 J52.doc Version 1.40 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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