Inspection on 10/09/09 for Richmond Lodge

This inspection was carried out on 10th September 2009.

CQC found this care home to be providing an Poor service.

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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond Lodge 11/09/08

Richmond Lodge 25/09/07

Richmond Lodge 02/10/06

Richmond Lodge 13/02/06

Richmond Lodge 03/10/05

Richmond Lodge 21/02/05

Richmond Lodge 05/10/04

Richmond Lodge 24/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Richmond Lodge 11-15 Richmond Avenue South Benfleet Essex SS7 5HE Lead Inspector Michelle Love Key Unannounced Inspection 10th September 2009 10:00 Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Richmond Lodge Address 11-15 Richmond Avenue South Benfleet Essex SS7 5HE 01268 566178 F/P 01268 566178 shcrichmondlodge@estuary.co.uk 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) Estuary Housing Association Limited Mr Robert George Hine Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. Excluding any person who is liable to be detained under the provision of the Mental Health Act 1983. 11th September 2008 Date of last inspection Brief Description of the Service: Richmond Lodge is a care home providing nursing care for 12 residents with mental health needs. The weekly cost of care at this home is £989.87. The home is situated in South Benfleet and is very close to local shops, amenities and transport. The premises consist of 12 single bedrooms and one has ensuite facilities. There is a large bright lounge with a variety of comfortable chairs and sofas. There is a kitchen and dining room. The conservatory is used as the smoking room. The premises are surrounded by a large well-kept garden that is secure. There is parking to the front of the premises. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 7.45 hours, with all key standards inspected. In addition, the manager’s progress against previous requirements from the last key inspection, were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment. This is a self-assessment document required by law, detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to people who live at Richmond Lodge, support staff and the general running of the home were examined. In addition a partial tour of the premises was undertaken, people living at Richmond Lodge and staff were spoken with and their comments are used throughout the main text of the report. We requested that surveys for people who live at the home, staff and healthcare professionals be forwarded to the home for distribution however we were advised that these had not been received at the time of the site visit. The registered manager was not present at the time of the site visit and so the inspection was conducted with the qualified staff on shift throughout the day. Feedback on the inspection findings were not given as the qualified person in charge during the afternoon did not feel this was appropriate. As a result of concerns highlighted at the previous key inspection (September 2008) relating to the home’s medication practices and procedures, an Immediate Requirement Notice was issued. It is concerning that this has not been complied with at this site visit and there are a significant number of statutory requirements associated with medication practices and procedures. What the service does well: Overall people living at Richmond Lodge were happy and like living there. Visitors to the home are made to feel welcome. Positive comments were made in relation to the meals provided. There is a varied menu and various alternatives were available. The home provides people with a safe and homely environment that meets their needs. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 6 People at Richmond Lodge are supported to lead an active life, to undertake a variety of activities, which meet their individual needs according to their personal preferences and to use the local community. Support staff, have a good rapport with people who live at Richmond Lodge. Several members of staff have worked at Richmond Lodge for some considerable time. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 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 DS0000015558.V377561.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into Richmond Lodge can be confident that they will be assessed and the home can meet their needs. EVIDENCE: We were advised by the qualified member of staff on duty that no new people have been admitted to Richmond Lodge since the last key inspection. The organisation, have a robust referral and pre admission assessment process. In addition to their own pre admission assessment document, further information is sought from the person’s placing authority and/or previous hospital placement. The AQAA details that prospective people are invited to visit Richmond Lodge and to spend time there, to meet existing people who live at the home, support staff and to have a look around. Current people, who live at Richmond Lodge, have lived there for some considerable time. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are potentially at risk of not having all of their care needs clearly recorded. EVIDENCE: There is a formal care planning system in place so as to include information relating to individual’s assessed needs and how these are to be met by support staff. As part of this site visit, 2 people’s care files were examined in full and 3 people’s care files were partially examined in relation to their specific healthcare needs. Records showed that each person has a plan of care and these have been reviewed and updated since the last key inspection. Each person was observed to have a personal profile relating to family and professional’s involvement, likes and dislikes and a basic assessment detailing Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 10 their strengths and needs. However shortfalls were identified whereby not all areas of assessed need or risk were documented within the plan of care. Further development of the home’s care planning and risk assessment processes is required to ensure positive outcomes for people and to guarantee consistency in recording. This will also ensure that staff working at the care home, have the necessary information they need in order to meet people’s health, personal and social care needs. The care plan for one person made reference to them displaying aggression and/or threatening behaviours towards others. Whilst actions/guidelines were recorded as to how best to support the person during periods of crises, there was no evidence as to the steps to be taken should the aggression and/or threatening behaviour escalate to a level that was unacceptable and/or not manageable. One qualified member of staff spoken with advised that deescalation methods and distraction are used initially, however if the person’s behaviours escalate the police are contacted. Specific information relating to the ‘de-escalation’ methods and ‘distraction’ used with this person are not identified and/or recorded within their plan of care and there are no clear guidelines for staff as to at what point the police should be contacted. The qualified member of staff confirmed that they have not got up to date training pertaining to dealing with people’s aggression and/or challenging behaviour. Another care file (risk assessment) made reference to the individual’s specific mental healthcare issues and their inappropriate behaviours manifested at times of crises. While this is noted to be positive, no plan of care was available detailing the specific actions to be taken by staff and the interventions required. What was recorded was seen to be generalised and ambiguous. This refers specifically to “intervene where necessary should they confront others”. Daily care records recorded occasions whereby the person experienced a period of good mental wellbeing and periods of crises, with the latter culminating with the person experiencing thoughts of paranoid feelings and threatening behaviour towards other people living at Richmond Lodge. We looked at one care file in relation to the person’s diabetes (tablet controlled). While a weight chart was in place and an entry in their daily care records confirmed they had recently been seen by the diabetic nurse and their medication had been increased, no care plan was devised as to how their diabetes should be monitored or the average blood sugar levels that should be attained, so as to ensure their wellbeing and safety. A blood glucose monitoring chart was in place however there was no obvious pattern to the frequency of testing and although their blood sugars were generally recorded between 6-10, recently this was noted to be as high as 17. In addition no risk assessment had been compiled. The care file for one person who is an insulin dependent diabetic was also examined. A care plan was devised in relation to their diabetes and this recorded them as being able to manage some aspects of their own medical Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 11 condition, refusal to eat on some occasions, the frequency of testing their blood sugar levels, the wish to purchase items with a high sugar content and their blood sugar levels should be maintained between 4-7 to ensure their health and wellbeing. A risk assessment was in place and this recorded the person’s diabetes as being unstable and their blood sugar levels being “very high”. Their blood glucose monitoring record showed consistently their blood sugar levels were tested twice daily, however their blood sugars were rarely between 4-7 and within a one week period records showed that these had been as high as 28.9 on two occasions. There was little evidence within daily care records or healthcare records to show that staff within the home had identified this as a potential risk and taken proactive action, including prompt referral to an appropriate healthcare professional. Daily evaluation records were observed to be completed each day and after every shift. In general terms information recorded was seen to be informative, however additional information is required to evidence staff interventions and/or specific support provided to individual people. We spoke with 2 qualified staff and 2 support members of staff during the site visit. All were able to demonstrate a good understanding and awareness of individual people’s care needs. As stated previously we are aware that a number of staff, have worked at Richmond Lodge for a number of years and that the support provided to people is intuitive and based upon staff’s experience and knowledge of the people living at the home. Staff, were observed to have a good rapport with individual people and vice versa. People spoken with confirmed this and comments noted included, “the staff know my likes and dislikes” and “oh yes, they know my needs”. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that their social care needs and dietary needs will be met. EVIDENCE: Although a plan of care relating to individual’s social care needs was not recorded and/or evident for each person, there was sufficient evidence within daily care records and following discussion with people, to confirm that people living at Richmond Lodge are actively encouraged and supported to pursue opportunities to take part in appropriate activities and to engage in hobbies and interests according to their personal preferences. This refers specifically to adult education classes (Healthy Living Group and Art), accessing the local community (local town centre for shopping, swimming, cinema, cafes) and pursing individual interests e.g. reading, watching sport on television, Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 13 gardening. A notice board in the small sitting room displays information about activities and/or local events. There was also evidence to show that people are encouraged and supported to participate within the routines of the home. Records showed that people are supported to undertake their own personal laundry, to tidy and clean their bedroom and to assist with the weekly food shop. In addition in the kitchen there is a list of tasks assigned to each person for the week e.g. laying the table, clearing the table etc. People confirmed that they continue to be happy with the above arrangements and this remains a fair system. People spoken with confirmed that routines within the home remain flexible and that their rights are respected. This refers specifically to staff only entering a person’s bedroom with their permission, people are provided with a key to their bedroom, staff do not open people’s private mail without their agreement, people can choose whether or not to join in an activity or attend adult education classes, people can choose when to rise/go to bed and breakfast times are flexible. There is an ‘open visiting’ policy whereby people living at Richmond Lodge can receive visitors at any reasonable time. People spoken with confirmed they are supported and enabled to maintain friendships and family contact. The AQAA details that people may see their visitors in the privacy of their own room or a small communal room can be accessed. On inspection of the menu book/diary, there was evidence to show that people receive a varied diet. We were advised that the menu is planned one week in advance by staff and people who live at the home however the menu is flexible to reflect people’s individual choices. The quality and quantity of meals provided to people was observed to be appropriate. Comments in relation to the meals provided were positive and included, “the meals are generally fine, depends which staff are cooking” and “the food is fine”. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current medication practices and procedures do not support the health and well being of people within the home and potentially places them at risk. EVIDENCE: From discussion with people who live at the care home, support staff and from examination of records, the majority of people at Richmond Lodge continue to manage their own personal care. In addition where assistance is required, support staff, are available to provide help. Records showed that the healthcare needs of people are clearly recorded, including information relating to specific appointments undertaken and outcomes. People have access to a range of healthcare professionals as and when required and these include GP, dentist, consultant psychiatrist, optician and the Mental Health Team. Where possible, people are encouraged to make their own arrangements for healthcare whilst other people are supported by Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 15 members of the staff team. On the day of the site visit, one person was observed to have sustained an injury to one of their limbs and this restricted their mobility. Although neither the resident or support staff, were able to state how the injury had occurred, records showed that appropriate measures were undertaken to ensure that the person’s healthcare needs were met. The care file for one person made reference to them having a specific healthcare need (epilepsy). In addition their records made reference to them having a specific allergy. However no plan of care or risk assessment was devised for either area. The practices and procedures for the use of medicines within the service were examined. At the time of the last key inspection to the service in September 2008, we left an Immediate Requirement Notice as we were concerned about medication records not being up to date and poor medication practices by some staff which could place people at risk of harm. We received an action plan detailing what the registered provider and manager were going to do to improve medication practices in the home and at the time this was seen to be satisfactory. As part of this key inspection we found a number of concerns and evidence to show that medication practices and procedures within Richmond Lodge remain poor and potentially place people at risk. Shortly after our arrival at Richmond Lodge we requested to see the Medication Administration Records (MAR) for people who live there. Records showed that the medication records for some people were not signed at the time that medication was administered. We were advised that the majority of people living at Richmond Lodge had received their medication at 08.00 a.m. The qualified person in charge of the shift provided an unprompted rationale for this and stated, “needs must, we have a lot of baths to be done. I know this should have been done”. During the site visit the nurse confirmed that she had assisted 2 people to have a bath. The nurse was then observed to sign the medication records for some people retrospectively and to sign 2 people’s records to show that they had received their lunchtime medication. The time for the latter was 10.10 a.m. and their medication had not been dispensed or administered. In addition records showed that records made when medicines were given to people were not completed accurately. This refers to the MAR record showing that people are to receive their medication at 09.00 a.m., 1.00 p.m. and 18.00 p.m., however some people were observed to receive their medication at 11.00 a.m./11.05 a.m., 11.30 a.m. and 4.55 p.m. and the MAR records did not reflect these times. Gaps in records were noted and it was not clear as to whether or not people had been administered their medication or the medication omitted. Where a variable dose of medication could be administered, the specific dose was not recorded. This potentially means that Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 16 people could be at risk of receiving too much or too little medication. Medication was observed to be given in an unsafe manner. This referred specifically to medication given to people to take, but not witnessed by the qualified person in charge to ensure that medication had been actually taken. In addition we observed 3 people’s lunchtime medication to be dispensed into individual pots (not named), however the qualified member of staff was seen to stack these one on top of the other and to take these to people. This means that people are at risk of receiving the wrong medication. One person’s liquid medication was pre dispensed (between 08.00 and 10.00 a.m.) and placed in the medication cupboard so as to be taken later. The medication was provided to the person to take at 11.05 a.m. Stock discrepancies were found which may indicate records are inaccurate or medication may not be administered as prescribed. The temperature of the room where medication is stored on the ground floor is not monitored and/or recorded, so as to ensure that medication remains effective. Qualified staff spoken with did not know the range of temperature that medication should be stored at and the importance of keeping a record. A record is maintained for medication that requires cold storage (refrigeration) and these showed that these fall within the recommended guidelines. As a result of the above concerns an Immediate Requirement Notice was issued. We made a statutory requirement at the previous key inspection, that all staff who administer medication must be appropriately trained and receive regular assessment as to their continued competence to undertake the task safely by 1/12/2008. The improvement plan submitted by the registered provider and manager detailed that staff training was planned for 10/12/2008 and that regular inspection of the medication records would be undertaken by the manager. We looked at the staff training files for all permanent qualified staff working at Richmond Lodge. Records showed no evidence that qualified staff had received updated training and this requirement remains outstanding. In addition records showed that 6 members of support staff and 1 qualified member of staff had received an annual assessment update of administration of medicines in November/December 2008 and March 2009. The AQAA details, “All staff receive, annual medication training”. This did not concur with our findings on the day of the site visit. Under the heading of ‘our plans for improvement in the next 12 months’, this recorded “Assessment of staff in the home, on administration of medicines”. On inspection of reports undertaken as part of Regulation 26 visits by a representative of the organisation, records showed that the registered manager has implemented a management tool to ensure that MAR records are completed appropriately. We asked the qualified member of staff on duty in the morning for evidence of this and they stated “I am not aware of this”. A Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 17 search was conducted at the time of the site visit however no records could be located. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be listened to and able to express concerns. However they cannot be confident that staff will have the skills and knowledge to deal with abuse and/or challenging behaviour effectively so as to ensure their safety and wellbeing. EVIDENCE: There is a corporate complaints policy and procedure in place. On the day of inspection we examined the home’s complaints log. Records showed that since the last key inspection there have been no complaints. Following discussion with both staff and people who live at the home, it was evident that people know how to make a complaint and are aware of the organisations complaint process. People stated that if they were unhappy with an issue or had an area of concern, they would discuss this with a member of staff. Policies and procedures relating to safeguarding were available within the home. Two members of staff spoken with demonstrated a good understanding and awareness of safeguarding procedures. The AQAA details that in the past 12 months no safeguarding referrals have been made, however there has been one incident whereby restraint was used. We asked the qualified member of staff on duty in the afternoon to provide us with details relating to the type of restraint used and the name of the person this was connected to. The member of staff was unable to provide us with any details. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 19 On inspection of 6 people’s staff training records, these showed that not all staff had up to date safeguarding training. The AQAA details that training has been provided on the Deprivation of Liberty Safeguards, although there was limited evidence to confirm this within the staff files examined. The registered manager’s file showed that he received this training in March 2009. As stated at the previous key inspection to the home, there are people who live at Richmond Lodge who exhibit both verbal and physical aggression towards others. Of those staff training records examined, there was no evidence to show that staff had received training relating to dealing with challenging behaviours. The home’s action plan following the last key inspection recorded that the manager would liaise with their service manager and Human Resources Department to source appropriate training and this would be completed by January 2009. This remains outstanding from the previous key inspection to the home. The AQAA details under the heading of ‘our plans for improvement in the next 12 months’, “have requested training for staff in challenging behaviour….” Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Richmond Lodge live in a safe and homely environment which meets their needs. EVIDENCE: A partial tour of the premises was undertaken as part of this inspection process. The home is pleasantly decorated and the communal areas within the home were observed to be clean, tidy and odour free. On inspection of a random sample of people’s bedrooms, these were seen to be personalised and individualised, reflecting people’s personalities and interests. We noted that the stair carpet and first floor landing carpet are in need of replacing as they are dirty and heavily stained. We were advised that this is in hand and the carpets will be replaced shortly. No health and safety issues were highlighted at this inspection. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 21 Maintenance tasks are undertaken by external contractors. On the day of the site visit, issues relating to poor ventilation within one first floor bathroom were being investigated by the organisation and an outside contractor. Records showed that the fire alarm and emergency lighting systems are tested regularly. There is a fire plan and fire risk assessment in place for the home. Fire drills are conducted at the home however the record does not include the names of staff who have participated. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls identified in relation to staff training, means that some people may not have the skill and competence to provide good care to people at Richmond Lodge. EVIDENCE: We were advised by the qualified person in charge of the shift during the morning that staffing levels have changed since the last key inspection to the home. We were advised that staffing levels are now 1 qualified member of staff and 1 member of support staff between 07.00 a.m. to 21.00 p.m., 1 support member of staff between 09.00 a.m. and 16.30 p.m. and 1 qualified member of staff and 1 member of support staff (waking night) between 20.30 p.m. and 07.00 a.m. each day. On inspection of 4 weeks staff rosters records showed that the above staffing levels have been maintained. In general terms the staff rosters are well maintained, however on occasions only the person’s first name (agency) is Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 23 recorded. The full names of staff working at the home must be clearly recorded. We were advised by the qualified person in charge on the morning shift that no new people have been recruited since the last key inspection. Therefore we have not looked at staff recruitment records. We requested to see the profile and record of induction for 2 people who were working at Richmond Lodge on the day of the site visit from an external agency. No profile/record of induction was available for one person and for the other agency member of staff there was only evidence of their induction. The latter was able to provide us with evidence of their training which was up to date in core subject areas (manual handling, emergency first aid, safeguarding, infection control, effective communication, health and safety, food hygiene and fire safety). We looked at a random sample of staff training records and these showed gaps in the training programme for individual member’s of staff with some training being out of date in both core and specialist subject areas. For example the training file for one qualified member of staff showed that the only training in date related to food safety and moving and handling. The training files for a member of staff who transferred to Richmond Lodge from another ‘sister’ home within the organisation showed that their up to date training related to basic first aid, moving and handling and customer service skills. The AQAA details that in the next 12 months it is hoped that staff will receive training in diabetes, dealing with challenging behaviour, older people and mental health awareness. The AQAA details that 3 out of 7 permanent member’s of staff, had attained NVQ Level 2 or above. We looked at a random sample of 4 people’s supervision records (including the manager). Records showed that these are not being undertaken regularly or in line with National Minimum Standard guidelines. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While there are some good outcome areas, shortfalls and deficits identified could potentially mean poor outcomes for people. EVIDENCE: On the day of the site visit the registered manager was not present and so the inspection was undertaken with the 2 qualified members of staff on duty throughout the day. One qualified member of staff spoken with who is employed through an external agency stated that they believe the staff at Richmond Lodge work very well and they enjoy working at Richmond Lodge. They also felt that the home was well managed and run efficiently for the wellbeing of people who live there. People who live at the home confirmed they were happy at Richmond Lodge. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 25 Evidence at this site visit showed there are several areas whereby significant improvement and development is required so as to ensure positive outcomes for people living at Richmond Lodge. These relate specifically to medication practices and procedures, ensuring that care plans and risk assessments are devised for all areas of assessed need and risk, ensuring that staff, receive appropriate training to the work they perform and staff receive regular formal supervision. All sections of the AQAA were completed. The evidence to support the comments made is satisfactory in places, however some information does not provide a reliable and accurate portrayal of the service. The AQAA does record the areas that still require improving. Records of staff and resident meetings were available and these show that these are held regularly. We looked at records of Regulation 26 visits by a representative of the organisation. Records showed that these are not conducted each month. Records showed that the last visit was undertaken in August 2009, however the previous record related to May 2009. We were unable to verify if there has been a quality assurance survey completed for service users, staff and other stakeholders, as neither of the qualified members of staff on duty knew if this had been undertaken since the last key inspection. There is a health and safety policy and procedure readily available and the management team of the home have access to a health and safety officer. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 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 3 3 X 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 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 X 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 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 2 X 1 X X 3 X Version 5.3 Page 27 Richmond Lodge DS0000015558.V377561.R01.S.doc Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 14 Requirement There is a plan of care, clearly identifying all aspects of the person’s care needs and how these are to be met by staff. This will ensure that staff, have the information they need so as to provide appropriate care to meet the individual’s care needs. Where the person’s care needs have changed, the plan of care must be regularly updated and reviewed to reflect the most up to date information. Timescale for action 01/11/09 2. YA6 15 01/11/09 3. YA9 13(4) This will ensure that staff have the most up to date information and can provide appropriate care to meet their needs. Risk assessments must be 15/10/09 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and the steps to be taken to reduce the risk. So as to ensure people’s safety and wellbeing. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 28 4. YA19 12(1)(a) Make proper provision for the health and welfare of people in the care home. So as to ensure people’s safety, health and welfare. Medication Administration Records (MAR) must be signed at the time that medication is administered and not retrospectively. So as to ensure people’s safety, health and wellbeing. MAR records must not be signed in advance of medication being administered. So as to ensure people’s safety, health and wellbeing. Where medication is administered outside of the times recorded on the MAR record (09.00 a.m., 1.00 p.m., 18.00 p.m. and 22.00 p.m.) the specific time that it is given by staff must be recorded on the MAR. So as to ensure people’s safety, health and wellbeing and to ensure that there is an accurate record at all times. Ensure that when medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. So as to ensure people’s safety, health and wellbeing. Previous timescale of 13/9/08 not met. Where a variable dose of medication can be administered, the specific dose given must be DS0000015558.V377561.R01.S.doc 15/10/09 5. YA20 13(2) 12/09/09 6. YA20 13(2) 12/09/09 7. YA20 13(2) 12/09/09 8. YA20 13(2) 12/09/09 9. YA20 13(2) 12/09/09 Richmond Lodge Version 5.3 Page 29 recorded on the MAR record. So as to ensure people’s safety, health and wellbeing. People’s medication must not be pre dispensed and left in the medication cupboard for later. Medication must only be dispensed at the time it is to be given. 10. YA20 13(2) 12/09/09 11. YA20 13(2) This will ensure the quality of medicines in use. When medication is administered 12/09/09 to people, this must be witnessed to ensure that the medication has been taken. So as to ensure people’s safety, health and wellbeing. Residents must be protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions. So as to ensure people’s safety, health and wellbeing. Previous timescale of 13/9/08 not met. Medicines must be stored under suitable environmental conditions and records must be kept to demonstrate this. This will ensure the quality of medicines in use. Ensure that all staff who administer medication are appropriately trained and undertake regular competency assessments. So that staff remain competent and able to undertake the above task safely for the welfare of the people in the home. 12. YA20 13(2) 12/09/09 13. YA20 13(2) 12/09/09 14. YA20 13(2) 21/10/09 Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 30 15. YA23 13(6) Previous timescale of 1/12/08 not met. Ensure that all staff receive training relating to dealing with people’s challenging behaviours and/or inappropriate behaviours. So as to ensure people’s safety, health and wellbeing. For staff to feel confident and competent to deal with any issues. Previous timescale of 1/1/09 not met. Ensure where restraint is used, a record is maintained detailing the type of restraint, the timeframe, staff involved and the outcome. So as to ensure people’s safety, health and wellbeing. Ensure that all staff receive training relating to safeguarding. 01/12/09 16. YA23 13(8) 15/10/09 17. YA23 13(6) 01/12/09 18. YA35 So as to ensure people’s safety, health and wellbeing. 18(1)(c)(i) Ensure that staff, receive appropriate training to the work they perform. This refers specifically to both core and specialist areas related to people who have a mental health disorder. This will ensure that staff, have the competence, confidence and ability to meet people’s care needs. Previous timescale of 1/1/09 not met. Ensure that staff, receive regular supervision. So that staff feel valued and the management team of the home 31/12/09 19. YA36 18(2) 15/10/09 Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 31 are able to discuss both good and poor care practices in a formalised way. Previous timescale of 11/9/08 not met. Ensure there is a quality assurance system in place to seek the views of people who live at Richmond Lodge, their representatives and other stakeholders regarding the quality of the services and facilities provided at the home. 20. YA39 24 01/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA32 YA34 Good Practice Recommendations The staff roster should include the full names of agency staff who work at Richmond Lodge on any given shift/day. A profile and record of induction should be available for all agency staff who work at Richmond Lodge. Richmond Lodge DS0000015558.V377561.R01.S.doc Version 5.3 Page 32 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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