Inspection on 26/01/06 for Richmond House

This inspection was carried out on 26th January 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond House 23/07/07

Richmond House 31/08/06

Richmond House 04/07/05

Richmond House 02/11/04

Richmond House 09/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Richmond House 31 Richmond Street Heamoor Penzance Cornwall TR18 3ET Lead Inspector Ian Wright Announced Inspection 26th January 2006 13:00 Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 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 House DS0000008912.V264163.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 DS0000008912.V264163.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Richmond House Address 31 Richmond Street Heamoor Penzance Cornwall TR18 3ET 01736 331005 01736 331005 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) www.mencap.org.uk Royal Mencap Society Miss Rachael Lee Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2005 Brief Description of the Service: Richmond provides care for up to 5 adults with learning disabilities. The home is situated in Heamoor, Nr Penzance. The registered provider is Mencap, which operates several care homes in Cornwall. An application for the registered manager is currently being determined by the Commission for Social Care Inspection. All service users have their own bedrooms and there are suitable shared facilities. Service users have suitable day activities. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over five and quarter hours. The inspection was carried out on an announced basis. The inspector was able to speak to the majority of service users, and the staff members on duty. The inspector examined care, staff and business records, and inspected the building. The inspector met with the manager David Flecknor. An application for him to be the Registered Manager is currently being processed. The usual post holder is currently on maternity leave. What the service does well: What has improved since the last inspection? What they could do better: Although improved, staffing levels do not reflect what has been agreed with the Commission for Social Care Inspection. For example there must be a second member of staff on duty each weekday evening until 2000, and at weekends between 1200 and 2000. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 6 Training must also be improved. For example staff must have training in infection control. Medication training needs improvement. Staff also need training in diffusing, and / or, dealing with challenging / aggressive and violent behaviour. Health and safety precautions also need to be improved. For example testing of fire equipment and gas appliances must be completed at prescribed intervals recommended by the appropriate regulatory authority. 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 DS0000008912.V264163.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 The registered provider supplies suitable information to assist service users, and their representatives, to make an informed choice about moving to the home. Suitable links are maintained between staff and other external professionals so service user needs are met. EVIDENCE: A suitable statement of purpose / service user guide was inspected. The manager said the service user guide is issued to service users. However due to many of the users poor literacy skills, it is suggested a copy of the service user guide is also issued to next of kin / service user representatives. The manager said the staff team have developed suitable links with external professionals such as community nurses, general practitioners and social workers. Specialist services for example from a dementia nurse, and neurology services are also used. Advocacy services are also available. The manager said staff have access to comprehensive training provided by Mencap, for example to National Vocational Qualifications. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 All service users have a care plan and a risk assessment. There are suitable arrangements for service user participation. Information regarding service users is treated confidentially. EVIDENCE: Service users have an appropriate care plan and risk assessment. These are reviewed regularly. There is evidence of regular residents meetings. Service users are involved in cooking, and day-to-day tasks. The manager wishes to explore further opportunities to enable service users to maximise their independence. This would be a good development but needs to be completed through a risk assessment framework. Any current restrictive practices should also be kept under review and minimised where possible. Appropriate systems are in place so information is stored confidentially. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15, 16 Suitable opportunities are provided for service users to have a wide range of day activities available to them. Contact with service users family and friends is encouraged. EVIDENCE: The manager said service users are given suitable opportunities to participate in the community, for example work placements or attending college courses. There are also suitable leisure opportunities such as service users being able to attend leisure centres, pubs, cinemas and clubs. All service users have comprehensive day activity plans. Service users all had at least one holiday in the last year. Daily routines are flexible and tailored according to individual needs. Independence and choices are encouraged. Service users stated they felt supported appropriately by staff. Service users said they have appropriate opportunities to maintain links with their families and friends. Visiting arrangements are appropriate. Service users said they felt their rights are respected. Service users have a lock on their bedroom doors and are supplied with a key to their bedroom, and to the front door. Service users open their own mail with support where necessary. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 21 Service users receive personal care in a manner, which respects their privacy and dignity. There are appropriate links with relevant professionals so service users physical and emotional health needs are met. Ageing, illness and death of service users is handled appropriately. EVIDENCE: Service users said they were happy with how personal care and support is provided. The inspector observed staff working with service users in an appropriate manner. Service users can get up and go to bed when they wish. Care interventions are appropriately documented in care plans. Since the last inspection there have been no major accidents, which have resulted in hospital admission. Accident and incident records are appropriately maintained. Staff stated links with general practitioners, and other professionals such as social workers are satisfactory. Suitable records are maintained regarding hospital and other health care appointments. The registered provider has developed a policy regarding ageing, illness, death and dying. Although basic, this is satisfactory. Service user care plans satisfactorily address issues regarding ageing, and service users receive appropriate care and support in this area. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The registered provider has suitable complaints procedure, which is implemented as appropriate. Suitable measures are taken to inform and train service users and staff. EVIDENCE: The registered provider has developed an appropriate complaints procedure, and a user-friendly version is issued to service users. The registered persons have received no formal complaints since the last inspection. However a relative expressed a ‘concern’ about personal care of one service user. Although the complaint’s procedure was not used, the matter appears to have been dealt with appropriately. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The home is a suitable environment for service users accommodated there. EVIDENCE: The building was inspected. The home offers a pleasant and homely environment for service users. The home was clean and hygienic on the day of the inspection. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, Staffing must be improved in the evenings so service users receive appropriate support. Staff appear to be recruited appropriately. There is an appropriate training policy although training regarding infection control and medication needs improvement. EVIDENCE: The manager outlined a suitable approach so staff can obtain a National Vocational Qualification in care. At the previous inspection on 4.7.2005 concerns were raised regarding staffing levels. It was agreed with the registered provider on 24.11.2005 that two members of staff would be on duty at least: • Each morning between 0800 and 0900 • Weekday evenings between 1600 and 2000 • Weekends between 1200 and 2000 It was also agreed at least one member of staff would be on duty at all other times when service users were present. This would include one member of staff sleeping in. However recent rotas record staff sometimes finishing at 1900, and there not being two members of staff on duty in the evening at weekends. Staffing levels must be maintained to at least the level agreed on 24.11.2005 e.g. two members of staff on duty during the evenings. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 15 Recruitment and staffing records inspected are satisfactory. Mencap operates a suitable training programme including induction and foundation training, and other training required by regulation. The manager also said staff are given the opportunity to complete a national vocational qualification. Records show 3 staff currently have at least an NVQ 2. Staff have also attended a training course regarding dementia to assist them to meet the needs of service users with this condition. However there is no record of staff receiving training in infection control. Staff complete training in handling medication. The manager (who is a registered nurse) has taken it upon himself to assess staff competence administering medication as he said this is not covered in the medication course. Technically this practical training must be completed by a qualified external professional such as a pharmacist. Mencap needs to address this issue. One service user presents some violent and aggressive behaviour. Staff need sufficient training to be able to diffuse such situations, and manage them should they occur. The registered provider must arrange this. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 41, 42, 43 The Commission for Social Care Inspection is currently determining the manager’s registration application. Records are maintained to a satisfactory standard. Management maintain suitable financial records. Health and safety precautions require some improvement so service users can be assured they live in a safe environment. EVIDENCE: The Commission for Social Care Inspection is currently determining the application for a temporary registered manager (for up to 18 months) as the person in the substantive post is on maternity leave. The Commission is awaiting references and a Criminal Records Bureau check disclosure. Records are maintained to a satisfactory standard. This includes financial records, which show the home is financially viable. Mencap has a suitable policy to manage health and safety. However there are some problems regarding implementation of this. Testing of fire alarms is erratic. For example call points were last recorded as tested on 21.12.05. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 17 These must be tested at a suitable interval as recommended by the fire officer (usually weekly). Emergency lighting must also be checked at intervals recommended by the fire officer (usually weekly). The gas safety certificate has expired in the last week, and this must be renewed as a matter of priority. Testing of the electrical hardwire circuit and portable electrical appliances is satisfactory. Suitable health and safety risk assessments are completed. Appropriate checks appear to be in place regarding the prevention of Legionella. Suitable contracts are in place to service fire extinguishers and the fire system. The environmental health department visited the home twice in 2004 to check requirements were satisfactory in regard to food hygiene, and health and safety. Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X X X 3 2 3 Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 19 NO 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 YA33 Regulation 18 Requirement Staffing levels must be maintained to meet the changing needs of service users. For example two members of staff must be on duty at least at the times agreed with the Commission for Social Care Inspection. All staff must receive training in infection control. Staff who administer medication must receive practical training regarding handling medication from an external professional e.g. a pharmacist. Staff must receive training in managing challenging, aggressive and violent behaviour. Suitable health and safety checks must be maintained at frequencies agreed with the appropriate regulatory authority. For example: • Call points and emergency lighting. • Gas appliances and boilers. Timescale for action 28/02/06 2 3 YA35 YA35 18 18 01/06/06 01/06/06 4 YA35 18 01/06/06 5 YA42 12, 13 28/02/06 Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations A copy of the service user guide should be issued to service users’ next of kin / representatives Richmond House DS0000008912.V264163.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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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