Inspection on 31/08/06 for Richmond House

This inspection was carried out on 31st August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 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 26/01/06

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 Unannounced Inspection 31st August 2006 16:00 Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 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.V300778.R01.S.doc Version 5.2 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.V300778.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond House Address 31 Richmond Street Heamoor Penzance Cornwall TR18 3ET 01736 331005 F/P 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 Mr David James Flecknor Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration of Mr David James Flecknor as Manager for a maximum of 18 months pending Ms Rachael Lee’s return as Manager 26th January 2006 Date of last inspection 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 and domiciliary care agencies in Cornwall. The current registered manager is on maternity leave, and Mr David Flecknor has been registered as manager for a period of up to 18 months. All service users have their own bedrooms and there are suitable shared facilities. Service users have opportunity to participate in suitable day activities. The building is not suitable for wheelchair users. A copy of the inspection report is available in the dining room, and it is suggested a copy is requested from management or CSCI if required. The range of fees at the time of the inspection is £298 to £1087 per week. There are additional charges e.g. for hairdressing, newspapers etc. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over fourteen and a half hours over two days. All of the key standards were inspected. The methodology used for this inspection was: • To case track three service users. This included, where possible, meeting and discussing with the service users their experiences, and inspecting their records. • Discussing with staff their experiences working in the home. • Discussion with other service users and their representatives. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? The staff team have put a lot of effort to assist service users to practice their skills and become more independent. For example one service user is using public transport on their own, and another service user is able to go to the post office on their own. Other opportunities are currently being investigated. The redecoration of the inside of the home has started. A new lounge carpet and a three-piece suite is going to be purchased. The service users have been involved in the decision-making regarding these developments. Suitable health and safety checks have been completed regarding the fire system and gas appliances. Some staff have received training for example regarding medication, managing aggressive behaviour and infection control. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 6 What they could do better: This inspection has resulted in 11 statutory requirements. The registered persons-Mencap and the home’s manager, are required to address these issues by law, within the timescales set i.e. mostly by the end of the year or sooner if the issues are more urgent. The main issues include improving the handling of medication and improving staffing levels. If these issues are not appropriately addressed service users could be put at risk. The Commission for Social Care Inspection is concerned that staffing levels have not improved to the required minimum standard despite previous requirements to do so, and legal action could follow if this issue is not addressed. Although there have been improvements in staff training, all staff still must receive certain training by law, and the current provision has some gaps. All staff need to have regular fire training, training in moving and handling, infection control, food handling and first aid. Most staff now have attended some or the majority of these courses. All staff should have training regarding the needs of people with dementia and handling aggression. Staff that handle medication need to be trained correctly trained. Improvements need to take place regarding handling service users’ money. Although the inspector had no concerns that any individual’s moneys had gone missing, there are some problems with the current system, which need to be addressed. The inspector was pleased service users are being encouraged to be more independent. However, in some cases, there were concerns that risks were not documented. Also steps were not recorded which may have been taken to minimise risk. Subsequently the risk assessment process needs to be improved. Lastly all service users need to receive a copy of a ‘Statement of Terms and Conditions of Residency.’ This outlines the rights and responsibilities Mencap residents have. A new housing association has recently taken over the home. However no tenancy agreements appear to have been issued. This matter needs to be addressed so service users have legal protection regarding living in their home. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 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 DS0000008912.V300778.R01.S.doc Version 5.2 Page 8 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.V300778.R01.S.doc Version 5.2 Page 9 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): 2, 5 Quality in this area is generally good. The judgement has been made using available evidence including a visit to the service. Most service users receive a copy of the terms and conditions of residency at the time of admission. This enables service users to be aware of their rights and responsibilities. However the registered manager needs to clarify all service users have received a copy of their terms and conditions of residency, as these were absent from some files. Arrangements for the housing association to issue tenancy agreements to all service users needs to be finalised. The pre admission assessment procedure is good. If implemented in full, this will enable the registered persons to ascertain they can meet the needs of new service users, before admission is arranged. EVIDENCE: Mencap’s policy states all service users should be issued with a copy of terms and conditions of residency on admission. A copy of this is maintained on most service users’ files. However this information was absent from at least one service user’s file, and the registered manager needs to check this information has been issued to all service users. The house has recently been transferred to a new housing association. Service users do not appear to have been issued with tenancy agreements. The registered manager needs to clarify arrangements regarding this. Service users should receive at least equal levels of security compared with previous tenancy arrangements. Copies of social services contracts of care are also available for inspection. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 10 The home currently has one vacancy for a service user. The registered provider has developed a suitable assessment policy and procedure. This includes the opportunity for potential residents to visit the home before admission is arranged. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 11 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, 9 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. All service users have a care plan and these are regularly reviewed. Care plans ensure staff have suitable information to provide care. Service users are encouraged to make decisions about their lives with suitable assistance as required. However suitable risk assessment procedures must be put in place to document steps taken to help improve service users’ independence, where there may be some level of risk. The registered persons approach to handling service users moneys is adequate although some changes are required to make the system more robust. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. Some service users said they were aware of their care plans and are involved in drawing them up. The care plan format is comprehensive and gives clear guidance to staff regarding service user needs. Service users and staff said service users are encouraged to make decisions regarding their lives. There has been some innovative practices in the last few months to assist service users to become more independent. One service user said they are able to go out on the bus on their own, and regularly stays over with their partner. Another service user now regularly goes to the post office Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 12 on their own. Staff are working with one service user to enable that person to stay in the home for short periods without staff support. This is excellent practice. However regarding these issues, there does not appear to be any risk assessments. For example these should be in place to outline what steps are taken to assess the risks involved, and document any skills assessment. If service users are left in the house without staff support this must be negotiated with the Commission for Social Care Inspection. The home’s approach regarding restrictions on service users having biscuits needs to be examined by management. Service users currently have to go to the office if they want a biscuit. The registered manager said biscuits should not be purchased due to some service users being over weight. However this appears to apply to only a minority of service users, appears an unreasonable restriction and at odds with Mencap’s general approach of encouraging choice. Care staff look after some service users’ moneys. Suitable records (including a risk assessment) are maintained regarding this practice. The registered manager said moneys and records are audited at least each month, and the area manager will also audit a sample of records. However some practices need to improve: • Service user PIN numbers should not be accessible to staff. • One service user appears to have several chequebooks stored in the person’s cash box. If these are for the same account, only one should be maintained. • Consideration needs be made whether one service user’s money needs to be placed under Power of Attorney arrangements due to that person’s decreasing capacity. • One service user had two bank accounts but records were only kept for one account. These matters need to be considered. Failure to do so could result in the fraudulent use of service users moneys. The registered provider has satisfactory policies regarding diversity and equality. There are currently no service users from ethnic minorities, although the registered provider has stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 13 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, 13, 15, 16, 17 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Service users can participate in a suitable range of activities, and are able to mix with the wider community. Service users are encouraged to maintain relationships with friends and relatives. Service users rights are respected, and service users are enabled to take a suitable amount of responsibility in their daily lives. Suitable arrangements are in place so service users can enjoy a healthy and varied diet. EVIDENCE: Service users said they attend a range of day activities including attending day centres and colleges. Some service users also have voluntary jobs and sheltered work placements. Service users and staff said other activities are also arranged sometimes in the evenings and at weekends. Service users can have an annual holiday, which they have to pay for. Service users said they visit friends and relatives regularly, and they are encouraged to maintain contact via the telephone or post. Visiting arrangements are flexible. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 14 Service users said they could get up and go to bed when they wish. However the behaviour of one service user makes it difficult for other service users to spend time in the communal areas, for example in the evening. The person also can be insistent that others must go to bed before the person retires. This issue needs to be addressed, and from conversation staff seem to be trying to address it. However advice may be required from external professionals such as the Cornwall Partnership Trust’s Behavioural Nurse. Service users said staff work with them in a way, which respects their privacy and dignity. Staff knock on bedroom doors, and mail is not opened without service users’ agreement. Locks are fitted to bedroom doors. Service users and staff said service users are involved in household tasks for example doing laundry, cleaning tasks, shopping and cooking. The inspector went food shopping with a member of staff and a service user. The service user was fully involved in choosing what was required, and involved in the financial transaction. The staff member worked with the service user in a respectful manner, and there seemed a very positive relationship between the two people. Interaction between other staff and service users was observed to be positive. The inspector shared a meal with service users, which was to a good standard. The meal consisted of fish pie and vegetables. Ice cream was available as a sweet. Service users said they are involved in choosing the menu and preparing the meals each day. Suitable records are maintained regarding food provided. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 15 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, 20 Quality in this area is poor to adequate. The judgement has been made using available evidence including a visit to the service. Personal care is delivered to a satisfactory standard. There appears to be suitable links with medical professionals. However, the registered manager must check service users have regular appointments with medical professionals such as dentists, chiropodists etc. and the recording of medical interventions is improved. The management of service users medicines is currently poor so service users cannot be assured their medication is suitably looked after. EVIDENCE: Service users said they received suitable care and support from staff. Any personal care needs are documented in care plans. Staff the inspector spoke to seem clear regarding what assistance service users need. Although doctor appointments are recorded, some improvement needs to take place to ensure other medical interventions such as dentists, chiropodists and other professionals are recorded separately rather than within the daily notes. Regarding one service user it did not appear clear whether the person had seen a dentist since 2004 or a chiropodist since March 2006. This needs to be checked by the registered manager. However service users said they regularly saw medical professionals when required. The registered manager and other staff reported no problems with links with medical professionals. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 16 Medication is stored securely, and dispensed via a ‘monitored dosage system’. Staff have begun to work with some service users to administer their own medication, which is a positive move. However some improvements to the system are required: • There were some gaps in medication records for example signing medication sheets regarding the administration of cream for one service user. If the service user does not take some medication, this needs to be recorded and an explanation recorded-for example on the rear of the medication sheet. • There is some excess medication stored in the medication cabinet. This includes some oversupply of medication and medication which needs returning e.g. for a service user no longer resident at the home. The inspector was particularly concerned regarding the management of one service user’s medication. The service user is / was prescribed Rispiridone medication. There appears contradictory information whether this medication was stopped or whether it should be PRN ‘as required’. If the medication is now PRN (as recorded on the medication sheet) there is no guidance under what circumstances it should be administered. Other record keeping regarding this matter was poor. For example contacts with the GP are recorded in the general Communication Book rather than in the individual’s medical notes. A letter from the Consultant Psychiatrist dated 1.8.06 to the service user’s GP states this medication should be stopped and replaced by another type of medication. The inspector was concerned regarding the time lapse regarding the service user’s medication being stopped, and not replaced. The inspector asked a member of staff regarding what action was being taken. The staff member said they were waiting on the Cornwall Partnership Trust’s Behavioural Nurse providing them with further information. However when the inspector spoke to the nurse she said the matter needed to be dealt with by the home’s staff liaising with the GP. The registered persons appear to have failed to deal with the matter appropriately and could have put the service user at serious risk. This matter must be resolved as a matter of urgency, and written confirmation is required regarding the action taken to resolve the matter. A requirement was made in the previous report regarding improving medication training. Most staff now have received training from the pharmacist. However at least two staff still require this training so the requirement is renotified. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 17 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, 23 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. Complaints are dealt with appropriately although the registered provider’s Complaints Procedure does not meet the national minimum standard. Mencap has a satisfactory adult protection policy, however improvement is required in recruitment practices so all staff have a Criminal Records Bureau / Protection of Vulnerable Adults check when they commence employment. This will give service users more assurance they are in safe hands. EVIDENCE: The registered provider has developed a complaints procedure. The registered manager has included a summary of this in the service user guide. The registered manager has provided information to service users’ next of kin how to make a complaint. The inspector read the organisation’s complaints policy in the ‘Operations Manual.’ This requires updating, for example the organisational policy refers to the National Care Standards Commission, which has now been superseded by the Commission for Social Care Inspection. The policy also regards the complainant’s right to contact the Commission as the last stage of the procedure, rather than stating complainants can contact the Commission at any time as outlined in NMS 22.3. The registered provider has been notified regarding this in several CSCI reports for Mencap care homes in Cornwall and now needs to ensure the policy is amended. However, Service users said they would have confidence in staff / management if they had a concern or a complaint, and they felt the matter would be dealt with appropriately. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 18 Mencap has an appropriate adult protection policy. New staff attend the Mencap training regarding abuse (Protect Me) as part of the organisation’s foundation training. Some staff have also attended Cornwall County Council training regarding protection of vulnerable adults. All staff have a Criminal Records Bureau (CRB) check. One member of staff had not had a Protection of Vulnerable Adults (POVA) check since starting employment with Mencap, although a previous employer had completed this check. Staff and service users showed some awareness of the complaints and prevention of abuse procedures. Staff and service users were able to say whom they would approach if they had a complaint or were concerned about abuse. Staff and service users all said they had not witnessed any bad or abusive practices. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 19 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 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Richmond provides a pleasant, homely and clean environment for service users. EVIDENCE: The building was inspected. The home offers a pleasant and homely environment for service users. Bedrooms and communal areas are of suitable size to meet the needs of service users. The home was clean and hygienic on the day of the inspection. Suitable cleaning routines are in place. The inspector raised a concern there was no soap in two of the toilets / bathrooms. The registered manager said he would address the matter. Service user bedrooms are pleasantly decorated according to individual tastes. Furnishings in bedrooms are appropriate. A decorator was at the home on the days of the inspection. The registered manager said the interior of the home would be completely redecorated. The manager also said some of the carpets, and the lounge three-piece suite, are also to be replaced shortly. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 20 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 Quality in this area is poor to adequate. The judgement has been made using available evidence including a visit to the service. Staffing levels are not satisfactory so service users cannot be assured they will get suitable levels of staff support. Recruitment records are adequate. However, improvement is required so information obtained meets regulation, and to assure service users recruitment procedures are rigorous. Staff training needs improvement so staff receive appropriate training as required by regulation and to meet the needs of service users. This will assure service users that staff have suitable skills and knowledge to cater for their needs. Equal opportunities issues regarding recruitment and work practices seem appropriate. EVIDENCE: On the days of inspection there was one member of staff on duty during the 24-hour period. In addition there was a second member of staff. On the first day of the inspection this member of staff was on duty from 11:30 to 18:30, and on the second day of the inspection from 15:00 to 19:00. The previous two inspection reports dated 4/7/2005 and 26/1/2006 raised concerns regarding staffing levels, particularly due to the changing needs of one service user. Following a random ‘follow up’ inspection, an immediate requirement was also issued on 12/8/05 for the registered persons to provide satisfactory staffing levels. Concerns have been expressed particularly regarding staffing cover in the evening. It was subsequently agreed on 24/11/2005 that management would provide at least two members of staff on Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 21 duty during the evenings until 20:00. However there is no evidence from the observation during this inspection, and from staff rotas, that this requirement has been recently complied with. The registered manager said evening staffing had been changed as having two members of staff on duty until 20:00 did not appear effective. The service user concerned also did not get up until later in the morning so an additional member of staff was no longer provided from 08:00 to 09:00, as was previously agreed with the Commission. The registered manager said instead a member of staff is provided throughout the waking day from 07:30 to 22:30, rather than the home being unstaffed from mid morning to mid afternoon. The registered manager said the staffing changes had been agreed with the multi disciplinary team although no documentary evidence was provided regarding this. The inspector has discussed the matter with the appropriate Care Manager at Cornwall County Council. The Care Manager understood Mencap to be providing one to one staffing at all times particularly while a specific service user was at home. Cornwall County Council will be contacting Mencap separately to clarify obligations regarding this individual contract. The inspector stated the registered provider is contractually obliged by Cornwall County Council to provide 24 hour staffing at the home. Any changes to the agreed minimum staffing must be negotiated with the Commission for Social Care Inspection. The inspector said enforcement action could follow if the registered provider failed to comply with the requirement- particularly as concerns had now been expressed on two previous inspections over a period of over one year. The inspector stated continued concerns regarding the number of incidents of an aggressive nature and the need for two staff to be on duty in case of an incident. The inspector was also concerned staffing levels are currently inadequate in the evenings to enable suitable activities for service users inside and outside the home. As a consequence most service users are retiring to their bedrooms, and one service user will not go to bed until everybody else has. These matters need to be addressed, and the Commission believes an improvement in staffing levels in the evening could assist the situation. It has subsequently been agreed that the registered provider will provide one member of staff on duty from 07:30 to 22:30 (with a sleep in). During weekdays an additional member of staff is on duty from 16:00 to 20:00. At weekends an additional member of staff will work between 11:00-20:00. This will be implemented no later than 8/9/06. Written confirmation is required that this requirement has been implemented. The registered persons should consider whether additional double cover is provided both earlier and later in the day. Care also needs to be taken that the registered provider is complying with the Working Time Regulations for example regarding rest breaks. The registered provider also should consider whether the current length of some shifts are appropriate. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 22 The inspector said that weekend staffing levels must be reviewed when the service user vacancy was filled, and a second member of staff should be provided between 09:00 and 20:00 at weekends. This should be the minimum staffing required. The registered persons must note any changes below the minimum level of staffing must be agreed with the Commission for Social Care Inspection. Failure to comply with this requirement could result in enforcement action. It is essential the registered provider keeps staffing levels under review. The registered provider is currently recruiting an additional 60 hours between Richmond and it’s sister house Lyndhurst, which is situated nearby. Where necessary additional staffing may need to be provided to meet the changing needs of service users. The inspector observed information kept on staff files. Information regarding the recruitment of staff is generally adequate. This includes an application form, two references and information confirming the person’s identity. However one member of staff recruited in July 2004 had no work history on her application form. The person had not had a Criminal Records Bureau (CRB) check / Protection of Vulnerable Adults (POVA) check recompleted when they commenced employment (although both checks were completed by a previous employer). On the day of the inspection interviews were being held at the home for new staff. Service users were able to ask questions to the candidates, and show the potential new staff around the home. The manager intended to consult with service users regarding who would be suitable to fill the posts at the home. This seems excellent practice. There is suitable evidence that newer staff have completed Mencap’s staff induction package. However there needs to be an induction checklist regarding matters relating to working at the specific home (e.g. demonstrating staff have been inducted regarding specific service user needs, household procedures and routines). The induction should include regular staff supervision during the induction period (e.g. weekly or fortnightly). Mencap has a suitable training programme. There are however some gaps in training received as required by regulation. This includes recent fire training (for at least two members of staff) , first aid (for at least one member of staff), food hygiene (for at least one member of staff), manual handling (for at least two members of staff), medication (for at least two members of staff) and infection control (for at least one member of staff). There is evidence that some staff have attended training regarding dementia and training regarding managing aggression. However further work needs to take place regarding Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 23 ensuring all staff receive this training- particularly as staff are working for significant periods of time on their own. Records of staff training need to be improvement. Staff currently have two files containing training records, and it proved considerably difficult for the inspector to ascertain an accurate audit of training that had been provided. Mencap has a suitable approach to ensuring staff have the opportunity to obtain a National Vocational Qualification in care. Currently 60 of staff have either a NVQ 2 or 3. The inspector read a suitable equal opportunities policy regarding staff recruitment and selection. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 24 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, 39, 42 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered manager has been assessed as having suitable experience and skills to manage the home. However additional care needs to be taken by management to check regulatory requirements are being met, for example, as outlined elsewhere in this report. There is a suitable quality assurance system in place to enable service users and other stakeholders to be consulted about their views. The management of health and safety issues is good so service users can be generally assured they live in a safe environment. However some concerns have been expressed elsewhere in the report particularly regarding staffing and medication, which could put service users and staff at risk. EVIDENCE: Mr David Flecknor is a registered nurse to work with people with learning disabilities. He is currently completing the Registered Manager’s Award, which he has stated he will complete in the autumn of 2006. Mr Flecknor is the registered manager for both Richmond, and its sister home, Lyndhurst, which is in walking distance of this home. Staff were very positive about Mr Flecknor’s management approach. They said he assisted them to be involved in Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 25 the running of the home, and consulted them about decisions that needed to be made. They were also very positive regarding what was seen as an increasing emphasis on encouraging service users to be more independent; for example enabling service users to go out on their own. They stated Mr Flecknor ‘had lots of new ideas’. Service users said they were also happy with Mr Flecknor’s management style and found him approachable. The Commission for Social Care Inspection is encouraged by these developments. However the inspector is concerned regarding the number of requirements in this report, and the nature of some of them. Additional care must be taken to ensure such issues are addressed. It is suggested that Mencap provide the registered manager with appropriate support and guidance to address these issues of concern. Mencap has a suitable approach to quality assurance. A survey of service user views was recently completed, and the results of the survey were positive. A summary report of the findings, and a development plan was subsequently produced. A representative from the registered provider visits the home on a monthly basis. It is however of concern that at least some of the issues addressed in this report, have not been picked up by the registered manager or the organisation. It is suggested management regularly check compliance regarding the issues raised in this report. The registered provider has a suitable health and safety policy. Regular health and safety checks are completed. Other records kept of checks required by regulation are satisfactory. For example there are suitable records of the testing of fire equipment, the central heating system, portable electrical appliances and the electrical hardwire circuit. Accident records are minimalalthough the registered manager confirmed this was because there had not been any accidents. However there is a significant number of incident reportsparticularly regarding one service user. Health and safety risk assessments are satisfactory. There is a suitable fire risk assessment. Suitable insurance cover appears to be in place. The report has raised concerns regarding medication, training and staffing which could negatively impact on the health and safety of staff and service users. Suitable requirements have been made regarding these issues. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 26 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 X 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 1 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 3 X X 3 X Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 27 YES 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 YA5 Regulation 5, 7 Requirement Timescale for action 01/12/06 2. YA7 YA9 12, 13 3. 4. YA7 YA20 12 12, 13 The registered provider must ensure: • Service users are issued with a suitable tenancy agreement. • All service users are issued with a suitable terms and conditions of residency. Suitable risk assessment 01/12/06 procedures must be in place to document steps taken to assist service users to increase their independence. Consultation and negotiation with relevant parties needs to take place where appropriate. The registered manager’s system 01/10/06 of managing service user moneys must be more robust. The registered manager must 01/10/06 ensure service users receive the correct medication, and this must be recorded appropriately. The Commission for Social Care Inspection must have written confirmation when the particular concern highlighted in the report is resolved, giving detail what action was taken to resolve the matter. DS0000008912.V300778.R01.S.doc Version 5.2 Richmond House Page 28 5. YA20 13 The operation of the medication system needs to be improved in line with professional guidance such as Royal Pharmaceutical Society Guidelines. This should include the recording, ordering and return of medication. Staff who administer medication must receive practical training regarding handling medication from an external professional e.g. a pharmacist. Previous deadline of 01/06/06 not met 2nd Notification 01/10/06 6. YA20 YA35 13, 18 01/12/06 7. YA19 YA20 12, 13, 8. YA23 9. YA33 The registered manager must 01/10/06 ensure: • Service users have regular appointments with relevant medical professionals according to their needs e.g. chiropodists, dentists etc. • Suitable records are maintained regarding all medical interventions. 10, 12, 13 The registered persons must 01/10/06 ensure all staff have a Criminal Records Bureau / Protection of Vulnerable Adults check when they commence employment. 08/09/06 18 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. Previous deadline of 28/02/06 not met 2nd Notification Written confirmation is required that this requirement has been Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 29 implemented by the ‘Timescale for Action’ date. 10. OP34 OP35 OP36 18, 19, The registered persons must provide evidence of in house induction. (For example regarding service user needs, the homes routines, policies and procedures.) 12, 13, 18 The registered manager must ensure staff receive training required by regulation and according to the needs of service users accommodated at the home: • All staff must receive training in infection control. Previous deadline of 01/06/06 not met 2nd Notification. • Staff must receive training in managing challenging, aggressive and violent behaviour. Previous deadline of 01/06/06 not met 2nd Notification • Staff must receive fire training, manual handling, food handling, and first aid training. • Staff need to receive training regarding an awareness of the needs of people with dementia. Suitable training records must be maintained and there must be suitable evidence of training received e.g. copies of certificates of attendance. 01/12/06 11. YA42 01/12/06 Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 30 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 YA39 Good Practice Recommendations An improved system of management checks is introduced for example to address the issues highlighted in this report. Richmond House DS0000008912.V300778.R01.S.doc Version 5.2 Page 31 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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