Inspection on 01/06/06 for Richmond Lodge

This inspection was carried out on 1st June 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 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond Lodge 05/01/09

Richmond Lodge 22/11/05

Richmond Lodge 17/05/05

Richmond Lodge 03/02/05

Richmond Lodge 24/08/04

Richmond Lodge 03/02/04

Richmond Lodge 14/08/03

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

CARE HOME ADULTS 18-65 Richmond Lodge Richmond Lodge 27 Bilton Road Rugby Warwickshire CV22 7AN Lead Inspector Deirdre Nash Key Unannounced Inspection 1st June 2006 16:00 Richmond Lodge DS0000004290.V296900.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 Lodge DS0000004290.V296900.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 Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond Lodge Address Richmond Lodge 27 Bilton Road Rugby Warwickshire CV22 7AN 01788 547781 01788 573410 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) RMH Homes Ms Jane Felicity Bacon Care Home 23 Category(ies) of Learning disability (23) registration, with number of places Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The requirements made as a result of the fire risk assessment that was carried out on the premises known as Richmond Lodge 27b Bilton Road, are fully implemented. The accommodation known as Richmond Lodge 27b Bilton Road is used to accommodate a maximum of two service users on a short stay basis only. Once the accommodation known as Richmond Lodge 27b Bilton Rd is ready for occupation, a minimum of two beds within accommodation known as Richmond Lodge The Hostel, Halfway Flat and 27a Bilton Rd are not refilled once they become vacant thus returning the maximum numbers of residents at the care home Richmond Lodge, including a maximum of two short stay residents to twenty one in due course. The accommodation known as Richmond Lodge 27b Bilton Road is not occupied by service users until the Commission for Social Care Inspection has made a further site visit. No new admissions to the home over 65 years of age. 4. 5. Date of last inspection 22nd November 2005 Brief Description of the Service: Richmond Lodge has provides residential care for up to 21 adults with learning disabilities. This home is operated by Rugby Mencap Hostels, which is an organisation led by parents. The care home is made up of what the organisation describes as a hostel, for 14 adults. This is staffed while the residents are present. Part of the care home is two flats, one in a separate building on the first floor the other is accessed through the main building. Three residents occupy one flat and four occupy the other and they receive lower levels of staffing support than people in the main house. The home does now offer a day service although most people use a social services day centre close to the home each weekday. The building has recently been extended to provide two bed-roomed accommodation, with separate access from the main building. There are plans to use this accommodation as a short breaks service in the future. There is some provision for people with physical disability in the main house and a lift serves the first floor. The premises are on the main road close to Rugby town centre. The organisation has offices on the premises and managers use it as a base. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We looked at all of the information that we have received about this home and kept on our records over the past twelve months. The provider organisation has had appropriate contact with us about the home during that time and kept us informed. After the last inspection in November last year, we asked them to send us an action plan detailing how they were going to improve the things that we pointed out as being below standard and they did so. We sent the home a questionnaire in March to fill in and bring us up to date with facts and figures about the home. It was properly filled in and sent back to us in good time. Comment cards were also sent to be distributed to relatives and to the service users to find out their views about the home. Thirty of these have been completed and returned to us and those views are reflected in this report. The Inspector called on the home without notice late afternoon mid week, spoke with some the residents, spoke to staff, spoke to the deputy manager and the general manager of the organisation, looked around parts of the home and looked at records. The care of a sample of five particular residents was ‘tracked’ this way to see if the home is providing a service that meets the national minimum standards. What the service does well: What has improved since the last inspection? Staffing levels have been increased to provide more opportunities for resident’s leisure and occupation and to support one individual to stay living in the home despite her very changed needs. The home now has a dedicated day care worker. The home is commended for the resources that it has put into staffing. Residents living in the main hostel appear more interested than before in the life of the home and in future plans to improve the service and they talk about it. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 6 A number of bedrooms have been redecorated and re carpeted and new furniture has been bought for the main lounge. Staff are recruited properly to make sure that they are suitable people to work with vulnerable residents. The organisation provides a lot of training for staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 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 Lodge DS0000004290.V296900.R01.S.doc Version 5.2 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, 2, 5 The outcome for this group is poor. The home has still not provided residents with a contract or list of terms and conditions for their care and accommodation. Rights and responsibilities between the service user and the provider are not clear. EVIDENCE: Five residents care files were looked at. There was no contract or terms and conditions for care and accommodation in any file. There was no statement of purpose or service user guide in any file. The shift leader and deputy manager reported that there have been no new admissions since the last inspection including on any temporary basis. This was confirmed by residents spoken to. The home is full. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 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, The outcome for this group is good. The home makes sure that peoples needs are assessed and that written care plans are produced to meet most of those needs. Resident’s benefit from a professional approach to looking after them. EVIDENCE: Current charges are £319 per week. Care files for three residents identified as having some dementia and one resident who is over 65years were looked at. All had recent social services community care assessments and a resulting community care plan. Two also had Primary Health Trust assessments of need. This is very positive and the provider organisation has put a lot of work into getting these for residents. Each resident had an individual written plan for everyday/night covering many areas of care and all underpinned by risk assessments. This is very positive. However, for four of these residents the community care plan identified very specific service aims for mental stimulation, leisure, relaxation and activities to promote mental well-being or prevent further cognitive impairment. Many of these service aims were charged to Rugby Mencap Hostels to fulfil yet there Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 10 were no written plans for how these service aims should be met in any individuals file. A key worker to one of these residents was asked what such a plan for this element of care should look like and he was able to describe one in very practical detail. The Inspector could see clear signs of well being in this person and much improvement from 12 months ago. The plan/approach must be put in writing so that all staff understand its importance in a resident’s life and are consistent in their approach to it. A requirement is made to improve this. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 11 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): 11, 12, 13, 14, 15, 16, 17 The outcome for this group is good. The home is providing daily opportunities for residents to enjoy a range of leisure and community activities individually and in small groups. Residents have a fulfilling lifestyle. EVIDENCE: Residents were on a weeks holiday from day centres. They talked about the new day care worker that now comes into the home on Monday to Friday. One resident in particular said that he had been playing games all afternoon and had been taken into town that morning and that he liked that. The Inspector observed clear signs of improved well-being in this resident from 12 months ago. Other residents said that they had been out during the day and one man explained in detail his plans to go to Coventry shopping next day with a member of staff. The deputy reported that residents have improved in their level of alertness since staffing levels were increased from three to five staff on early morning Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 12 and also late afternoon and evening shifts when residents are not on holiday. The Inspector found that residents were much more interested in talking about the home and their lives on this visit than they have been in the past. Residents who no longer want to attend day centres now have structured occupation and entertainment at home with the day care worker. This is a very positive improvement. Residents were seen going in and out of the kitchen helping themselves to food if they did not want the cooked meal that staff were preparing. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 13 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, 21 The outcome for this group is excellent. The home gives residents the level of personal care that they need and helps residents to use community and specialist health care resources. Residents are well looked after. EVIDENCE: Five residents care files were looked at and all contained evidence of specialist health care assessments and or routine general health care appointments. One resident spoken to said that she had been to the opticians that day to pick up her new glasses. Others confirmed that staff help them with appointments and always notice and look after people when they are not well. One resident with a rapidly deteriorating condition is now receiving one to one care through the day and night to keep her in her home with her friends. Storage of medication is appropriate and the records for one resident were inspected and found in good order. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 14 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 The outcome for this group is adequate. The home does investigate complaints that are made but records are poor and some relatives are not aware of a complaint procedure. Residents and others connected with the home cannot be confident that the home would take their concerns seriously. EVIDENCE: The complaints log was looked at. It contained a brief note of only one complaint this year with no explanation of the investigation or outcome. The manager reported in the pre inspection questionnaire that the home had received two complaints since the last inspection and that both were upheld. However there was no proper record of these available. The recording of complaints and concerns must improve so that residents and others associated with the home can have confidence that this is taken seriously. Four relatives who returned a comment card to us said that they don’t know about the homes complaint procedure. A requirement is made to improve this. The training records of two staff looked at showed that they had undertaken Protection of Vulnerable Adult training in the past twelve months. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 15 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, 25, 26, 28, 29, 30 The outcome for this group is adequate. The home was designed and built for large group and temporary living twenty years ago. Most residents have not been able to move on and some are living with other people that can put them under great strain. EVIDENCE: Residents confirmed the report of the deputy manager that a number of bedrooms have been redecorated and carpeted over the last few months. The Inspector was shown one by a resident and lighter colour paint on the walls has provided a balance to the dark wood panelling of fixtures and makes the room look brighter. Rooms remain below standard in their size and are a little cramped with personal belongings. Residents spoke with great enthusiasm about the new furniture for the main lounge that is arriving at the end of June. They confirmed that they had a say in its style and colour. Carpets remain looking dull but the deputy manager reports that they are regularly shampooed. The premises themselves remain largely unsuitable for life long occupation and the communal rooms downstairs are noisy when everyone is at home. Records Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 16 show that this does cause distress and aggression in at least one resident with cognitive impairment. The responsible individual for the home has been in steady contact with the Commission over the past 12 months with plans and strategies to modernise the structure of the service in order to offer service users more individual life styles and households in the future. The home was clean. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 17 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): 31, 32, 33, 34, 35, 36 The outcome for this group is excellent. The home has increased staffing levels in response to the needs of individuals and to compensate for the large group living arrangement imposed by the building. Residents’ well-being has improved as they receive more individual attention and care. EVIDENCE: Staffing rosters support the deputy managers report that there are now five staff on duty in the main hostel on the early morning and also the late afternoon and evening shift as well as staff on duty in each of the two flats. Residents and staff files confirm the appointment of a dedicated day service workers at the home Monday to Friday. This is a significant increase in staffing resources and the home is commended for this. Furthermore the Responsible Individual reports that in order not to discharge a long standing resident who has developed a rapidly deteriorating dementia, the provider organisation is funding 24 hour staff care for her now. Social services were unable to respond to a comprehensively drafted report requesting further funding for this person to keep her this home. The training file of this residents key worker showed that she has undertaken some dementia training recently. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 18 Observation of many residents over three hours saw ‘well being’ rather than ‘ill being’ and this is a significant improvement for some individuals in particular since this Inspector last visited 12 months ago. Two staff files looked at confirmed that the homes recruitment procedure is rigorous and a new member of staff spoken to confirmed that she had been given a structured induction period. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 19 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, 38, 39, 42, 43 The outcome for this group is good. The home is well managed and safety checks are carried out, as they should be. Resident’s views are heard and they are involved in future plans for the service. Residents are secure in a well managed and safe home that is run in their interests by a responsible organisation. EVIDENCE: Fire extinguishers were annually serviced on the day of this inspection. A very new member of staff reported that she is to attend food hygiene training this month. The manager is registered with us and makes notifications to us as required. Most requirements made at the last two inspections have been complied with. Although he is daily in the home and was there during part of this unannounced inspection, the Responsible Individual has not submitted monthly quality check reports on the home to the Commission for some time. This Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 20 must be done to show the Commission that the provider organisation knows what is happening in the home and how residents are. Referred to above the provider organisation has been in regular contact with the Commission about strategies for modernising and restructuring it services. The Commission has not received evidence that any annual quality review of the service provided by the home took place in 2005. Residents did confirm that there are regular residents meetings and some were able to talk about future plans for the service. Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 21 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 2 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 x 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 x x 3 3 Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 22 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 Requirement Amend and issue terms and conditions of residency to service users. Arrange for contracts to be signed by service users and their relatives/advocates. (Ongoing from previous inspections still not met compliance date of 31/01/06). The registered person must ensure that individual service users plans follow all of the service aims set out in community care plans. The registered person must ensure that a log of complaints received is kept in the home and that it contains details of the investigation and the outcome. The registered person must ensure that a review of the quality of care provided by the home is carried out annually and a short report of findings made available to service users and to the Commission for Social Care Inspection. The registered person must visit the home once each month unannounced, talk to residents DS0000004290.V296900.R01.S.doc Timescale for action 01/07/06 3 YA6 15 15/07/06 4 YA22 22 01/07/06 5 YA39 24 31/12/06 6 YA39 26 01/07/06 Richmond Lodge Version 5.2 Page 23 and staff and form an opinion about the quality of care being provided. A short report must be sent monthly to the Commission for Social Care Inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Richmond Lodge DS0000004290.V296900.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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