Inspection on 11/09/08 for Richmond Lodge

This inspection was carried out on 11th September 2008.

CSCI found this care home to be providing an Adequate 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond Lodge 10/09/09

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 13/03/2009.

CARE HOME ADULTS 18-65 Richmond Lodge 11-15 Richmond Avenue South Benfleet Essex SS7 5HE Lead Inspector Michelle Love Unannounced Inspection 11th September 2008 10:40 Richmond Lodge DS0000015558.V371150.R02.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 DS0000015558.V371150.R02.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 DS0000015558.V371150.R02.S.doc Version 5.2 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.V371150.R02.S.doc Version 5.2 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. 25th September 2007 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.V371150.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 8.5 hours, with all key standards inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment. This is a self-assessment document 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 residents, care staff and the general running of the home were examined. Additionally a full tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the inspection surveys were forwarded from us to the home for distribution to residents next of kin, healthcare professionals and staff who work within the care home. It was disappointing that no surveys were returned to us. The registered manager and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings were given throughout and summarised with the registered manager and the senior person in charge of the afternoon shift. The opportunity for discussion and/or clarification was given. What the service does well: The care home provides people with a safe and homely environment that meets their needs. Visitors to the home are made to feel welcome. Food provided to people is of a good quality and comments from residents relating to meals provided, was positive. There is a varied menu and various alternatives are available if required. People at the home 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. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 6 Staff at Richmond Lodge are motivated and committed to provide a good service to the people who utilise the service. Staff, have a good rapport with residents and interact well. The service is well run and managed. The needs of individual people are clearly documented, with clear guidelines for staff as to how to meet these. Additionally there is a formal and effective method for assessing prospective people’s care needs and ensuring that the care home can meet their needs. People are supported as they wish to be and there is a good system in place to ensure that the healthcare needs of people are paramount. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Richmond Lodge DS0000015558.V371150.R02.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 DS0000015558.V371150.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect that they will be properly assessed prior to admission and assured that their care needs can be met. EVIDENCE: There is a Statement of Purpose and Service Users Guide readily available at the home, detailing the services and facilities provided at Richmond Lodge. There was evidence to show that both documents have been revised and updated to reflect the comments made at the previous key inspection. No new people have been admitted to Richmond Lodge since the last inspection. The manager advised that people are admitted to Richmond Lodge via a robust referral process and following a thorough pre admission assessment being undertaken so as to ensure that the needs of the prospective person can be met. At the last key inspection to the home, the service were in the process of admitting a new person to Richmond Lodge and the inspector found that the management team of the home had undertaken a pre admission assessment and their was evidence to show that the prospective resident had visited the home prior to admission. The AQAA confirms under the heading of `what we do well`, that prospective people are invited to visit the home for a day stay, overnight stay and/or 3 Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 9 night staff. Under the heading of `our plans for improvement in the next 12 months` this details that the vacant room is to be refurbished. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Richmond Lodge can be safe in the knowledge that their individual care needs will be clearly recorded and met by support staff. EVIDENCE: As part of this inspection, 2 peoples care files were examined. Records showed that information recorded was clear and comprehensive, detailing individuals support needs and how these are to be proactively managed by support staff. Information included people’s personal preferences, likes, dislikes and strengths. It was positive to note that records also showed that these had been compiled with the individual person and where the needs of the person had changed, the care plan had been evaluated and updated within 6 months or sooner as required. Both the manager and staff spoken with demonstrated a good understanding and awareness of individual’s care needs/support needs. Four people spoken with on the day of inspection, confirmed to the inspector that Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 11 they felt appropriately supported by staff and that the majority of staff had a good understanding of their specific needs. Records showed that some additional information is required. This was in relation to providing clear and explicit guidelines for staff pertaining to one person’s aggression/inappropriate behaviours and ensuring that there are clear guidelines for staff pertaining to individuals, mental healthcare needs and specifying measures to be undertaken, should their mental health relapse and/or deteriorate. We acknowledge that the majority of the staff team have worked at Richmond Lodge for a number of years and that the support provided to people is intuitive and based upon staff member’s experience and knowledge of the people living at the care home, however clear guidelines relating to the above areas should be devised, they should not be generic but individualised to the person. Risk assessments had been updated since the last inspection. Of those care files case tracked, these were observed to cover all areas of assessed risk and include the measures to minimise the risk to people living within the care home. People living at the home confirmed that they are supported to make decisions about their daily lives and can spend their time as they choose e.g. people are encouraged and supported to go to the bank/post office, to pay their rent and to buy personal shopping. Daily evaluation records were seen to be completed daily and after every shift. Information recorded was seen to be detailed and informative, giving a good account of how people spend their day and staff’s interventions. Staff spoken with during the inspection, demonstrated a good understanding and awareness of individual resident’s care needs and how these are to be met. Staff, were observed to have a good rapport within individual people who live at Richmond Lodge and vice versa. One resident confirmed, “the staff here are good and know my likes and dislikes”. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be assured that their social care needs will be met and that they will receive a varied diet that meets their needs. EVIDENCE: People living at Richmond Lodge are actively encouraged and supported to pursue opportunities to take part in appropriate activities and to pursue hobbies and interests according to their personal preferences. Information about activities are displayed on a notice-board and community events are also announced at resident meetings. Following discussion with 3 people living at Richmond Lodge and from evidence of records, these showed that people are encouraged and given the opportunity to participate with the routines within the home e.g. assisting with the weekly food shop, undertaking personal laundry and tidying their room etc. In the kitchen there is a list of tasks assigned to all people living in the home Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 13 e.g. laying the table, clearing the table etc. People spoken with, confirmed that they were happy with the above arrangements and felt that this was a fair system. Records showed that some people attend adult education classes (Healthy Living Group) and one person undertakes an employment opportunity at a local pet shop. Additionally records showed that people use local shops, library, cinemas, pubs, leisure centres and have enjoyed day trips to the Ideal Home Exhibition, London, Brighton etc. People living at Richmond Lodge have access to a vehicle for transport needs, however people are able to utilise public transport independently or with staff support. The AQAA details under the heading of `what we could do better`, “more in house activities for residents”. The AQAA also details that within the next 12 months it is hoped to explore further, new and innovative ways for social activities and hobbies to be provided for the people living at Richmond Lodge. People spoken with during the inspection confirmed that routines within the home are flexible e.g. rise/go to bed when they choose, breakfast times are flexible, people receive their personal mail etc. One person spoke about enjoying their adult education class and undertaking a degree course. Richmond Lodge operates an `open visiting` policy, whereby people living at the home can receive visitors at any reasonable time. People living in the home can see their visitors in private (own bedroom) or a small communal room can be accessed. People spoken with confirmed that they are supported to maintain friendships and family contact. On inspection of the menu book/diary, there was evidence to show that people receive a varied diet. The inspector was advised that the menu is devised a week in advance, however this is for guidance only and is flexible to reflect people’s choices. Take-away meals are provided, generally once weekly and this is funded from the home’s food budget. Comments in relation to the meals provided were observed to be positive and included, “the food is good”, “the food is fine” and “Yes I enjoy what is provided”. On the day of the inspection, people living in the home were observed to enjoy a meal from the fish and chip shop. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although individuals personal support and healthcare needs are well maintained, shortfalls in medication practices and procedures could potentially have an adverse affect on outcomes for residents and their wellbeing. EVIDENCE: The majority of people at Richmond Lodge manage their own personal care needs and where input is required staff are on hand to provide support. Records showed that the healthcare needs of individual people are clearly recorded detailing appointments undertaken and outcomes. People have access to a range of healthcare professionals as and when required and these include, consultant psychiatrist, GP, dentist, optician, chiropody etc. Where possible, people are encouraged to make their own arrangements for healthcare whilst other people, are supported by the staff team. The practices and procedures for the use of medicines within the care home were examined. Residents are protected, by having secure storage for medicines. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 15 Records showed that there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR (Medication Administration Record) chart had been left blank and not signed/initialled by staff. The MAR record for one resident showed that for one medication (Flucloxacillin), this was recorded as having commenced on 5/8/08, was prescribed to be administered 4 times daily for a period of 5 days. The specific amount of medication received was not recorded on the MAR record, but it is assumed that in relation to the above prescriber’s instructions, that 20 tablets were received (the stock sheet was inspected and did not record the amount of medication received). However, the MAR record recorded 26 staff signatures/initials. Where the precriber’s instructions state 1 or 2 tablets to be administered, the actual dose administered was not always recorded. Estuary Housing Associations medication policy and procedure was examined and it was evident that some aspects of this are not being followed by staff. For example this details, “The administration record chart should be initialled. This would also apply to medication on an `as required` basis and all homely remedies”. It also states, “all staff are to be reassessed annually regarding their competence and knowledge”. The AQAA details under the heading of `what we do well`, “all matters relating to medication are dealt with by qualified staff, ordering checks, administration, recording, disposal. In line with medication policy and procedure plus guidance from the administration and control of medicines in care homes, royal pharmaceutical society”. This does not concur with the inspector’s findings. It was positive to note that one person at Richmond Lodge self medicates their own medication. On inspection of their care file, an assessment to confirm that they had been assessed as competent to undertake this task had been completed. Additionally, there was little evidence in some cases that staff administering medication to people living in the care home, had up to date medication training or evidence that regular competency assessments had been undertaken so as to ensure that staff remain competent and skilled to undertake the task. We recognise that only qualified nurses administer medication, however in light of the above areas of concern, it is recommended that further training relating to the safe administration of medication be undertaken as part of good practice procedures. As a result of the above concerns relating to medication practices and procedures, an Immediate Requirement Notice was issued. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate systems are in place to ensure that any concerns raised by residents are dealt with, however further development is required to ensure that people in the home feel assured they will be safeguarded and that staff have the skills and knowledge to deal with any issues that arise. EVIDENCE: The management team has a corporate complaints policy and procedure in place. Following discussions with both staff and the people who live at Richmond Lodge, it is evident that people know how to make a complaint and are aware of the organisations complaint process. Residents advised that if they were unhappy with an issue or had an area of concern, they would discuss this with a member of staff or the registered manager. Since the last key inspection, the service has received no complaints. Policies and procedures relating to safeguarding are readily available within the home. Three members of staff spoken with and the registered manager demonstrated a good understanding and awareness of safeguarding procedures. Since the last inspection there has been one safeguarding issue. The registered manager was unable to provide the inspector with any documented evidence pertaining to the above as this remains at Estuary Housing Associations head office, however he was able to explain the circumstances surrounding the issues and the outcome of the internal investigation. The registered manager Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 17 could not confirm as to whether or not this was referred to the Local Authority Safeguarding Team. A random sample of staff training records were examined and these showed that the majority of staff have received training relating to safeguarding, all staff have received an internal 1 day training course relating to the Mental Capacity Act and no staff members have undertaken training relating to dealing with challenging behaviour. This is of concern as there are people living in the home who exhibit inappropriate and/or challenging behaviours on occasions. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Richmond Lodge provides a clean, comfortable and safe environment for residents, which meets their needs. EVIDENCE: A full tour of the premises was undertaken as part of the inspection process. Since the last inspection, a programme of internal and external redecoration and refurbishment is underway. On inspection of a random sample of people’s bedrooms, these were seen to be personalised and individualised, reflecting people’s personalities and interests. The AQAA details that new beds and bedding have recently been purchased and it is hoped within the next 12 months for a new lounge suite and dining table and chairs to be bought. On the day of inspection one person’s bedroom was in the process of being redecorated. The home was observed to be odour free, clean and tidy and since the last inspection cleaners have been employed at Richmond Lodge. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 19 The registered manager advised that all, maintenance tasks are undertaken by external contractors. At the time of the inspection the inspector was made aware of some outstanding repairs and these relate to, poor ventilation within one first floor bathroom, a broken shower tray, plaster by one bedroom was observed to be cracked and broken and staff advised that the dishwasher was not fully operational. No health and safety issues were highlighted at this inspection. Records showed that the fire alarm and emergency lighting systems are tested regularly, fire extinguishers were observed to be tested monthly and staff participate in regular fire drills. A fire risk assessment and fire plan was evident and the premises were last visited by a fire officer in February 2008 who deemed the standard of fire safety within the home as satisfactory. Richmond Lodge DS0000015558.V371150.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst outcomes for residents are generally sound, some shortfalls in staff training pertaining to those conditions associated with the needs of older people mean that some staff may not be able to meet the needs of the residents living at the home. EVIDENCE: The registered manager advised the inspector that staffing levels at the home are 1 qualified member of staff and 2 care staff between 07.00 a.m. and 21.00 p.m. and 1 qualified member of staff and 1 care staff (waking) between 20.30 p.m. and 07.00 a.m. each day. The manager advised that he does not have any specific supernumerary shifts, however if required these can be built into his weekly shift pattern. On inspection of 4 weeks staff rosters these evidenced on occasions that the above staffing levels have not been maintained. When questioned as to the staffing shortfalls, the manager confirmed that there had been a reduction of staff on occasions, however “there were no problems so we left it that way”. This is not good practice as it potentially places both staff and people who live Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 21 in the home at risk. The management team of the home must ensure that all reasonable measures are undertaken to staff the home so as to ensure that people’s needs, can be met. Rosters were observed to be clear and identified cover by bank/agency staff on occasions, however the rosters need to include the full names of all staff, including agency staff working at the home on any given shift. The manager advised there is not a high turnover of staff and many members of staff have known the residents for a long time. At the time of the inspection there was 1 full time staff vacancy (37.5 hours) for a support worker. Agency staff used, at the care home are from a local agency and wherever possible, regular staff are utilised so as to provide continuity and stability. The manager advised that Estuary Housing Association, are looking to create their own `bank staff`. Residents commented that they prefer to have the homes own staff providing support as they provide security. A random sample of staff files were examined. It was positive to note that the majority of records as required by regulation were available, however gaps were noted in relation no evidence of employment history for one person and no staff file for one person (transferred to Richmond Lodge from another service within Estuary Housing Association) as held at the provider’s head office. The manager advised that Criminal Record Bureau (CRB) checks are to be reviewed and updated for all staff working at the care home. On inspection of a random sample of induction records and profiles for agency staff utilised at Richmond Lodge, records showed that the majority of records sampled did not include an induction or a profile confirming that all recruitment checks were in place. A random sample of staff training records were inspected and these showed that since the last inspection, some staff have received training relating to safeguarding, manual handling and role of the support worker. Additionally the manager advised that all staff completed a one-day Mental Capacity Act course (approximately 2 years ago). It was evident that there are some gaps relating to both core subject areas and those conditions associated with the needs of people who have a mental disorder. It is of concern that no staff working at Richmond Lodge, have attained training relating to dealing with individual’s aggression and/or inappropriate behaviours, yet there are people living at Richmond Lodge who can exhibit the above on occasions. The manager advised that 2 members of staff have attained NVQ Level 3, however they have also expressed an interest in undertaking NVQ Level 4. The manager advised that all staff should receive regular monthly supervision, however records showed that staff have received no supervision in 2008. This was confirmed with 3 members of staff spoken with. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements in some areas are good, shortfalls identified could potentially affect outcomes for residents. EVIDENCE: The registered manager is a qualified psychiatric nurse who has over 20 years experience in working with people who have a mental disorder, both within a hospital and residential care setting. Robert Hine has previous managerial experience prior to managing Richmond Lodge. The registered manager has completed the Registered Manager’s Award (RMA) and attained NVQ Level 4. Staff spoken with confirmed that they felt the manager was approachable and the staff team supportive and caring of one another. Residents also spoken with stated that they liked the manager and felt that he managed the home well. Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 23 It is of concern that the manager has received no formal supervision for the past 18-24 months and this needs to be addressed. We recognise that on the day of inspection the manager was due to receive supervision, however as a result of the unannounced inspection a decision was made by the registered manager and service manager for this not to go ahead. The inspector was advised that the ethos of Richmond Lodge is to provide long term care to the people living at the care home, within a `family atmosphere`. People within the home are actively encouraged and empowered to be as independent as possible. Although there are some areas as highlighted within the main text of the report, which are good and evidence proactive management and positive outcomes for people, there are some areas, which continue to require, further development and these refer specifically to medication practices and procedures, ensuring that staff receive appropriate training to the work they perform and ensuring that all recruitment checks (permanent staff and agency staff) are undertaken and available for inspection. A `Customer Services` policy was available (Quality Assurance). The inspector was advised that residents and staff surveys have been completed, however this is not solely for Richmond Lodge but for all services within Estuary Housing Association. Records of staff and resident meetings were evident, with minutes available. It was evident that Regulation 26 visits have not been undertaken regularly by the homes service manager and/or representative from Estuary Housing Association. The AQAA was completed and provided to us within the appropriate timescale. Information recorded was seen to be detailed, clear and informative and clearly sets out changes that have occurred since the last inspection and a level of self-awareness and recognises the areas that still require improving. 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.V371150.R02.S.doc Version 5.2 Page 24 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 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 1 X 2 X 2 X X 3 X Richmond Lodge DS0000015558.V371150.R02.S.doc Version 5.2 Page 25 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 YA20 Regulation 13(2) 12(1)(a) Requirement Residents must be protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions so as to ensure their health and wellbeing. Previous timescale of 16.11.07 not met. 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. Previous timescale of 16.11.07 not met. Ensure that all staff who administer medication to residents are appropriately trained and receive regular competency assessments to ensure that they remain able to undertake the above task safely for the welfare of the people in the home. Ensure that all staff at the care home are appropriately trained DS0000015558.V371150.R02.S.doc Timescale for action 13/09/08 2. YA20 17(1)(a), Schedule 3(3)(i) 13/09/08 3. YA20 18(1)(c) 01/12/08 4. YA23 13(6) 01/01/09 Richmond Lodge Version 5.2 Page 26 5. YA32 6. YA34 7. YA35 8. YA36 9. YA42 to deal with residents challenging and/or inappropriate behaviours. 18(1)(a) Ensure there are sufficient staff on duty at all times, and that the deployment of staff is appropriate to meet the needs of residents and to ensure their safety and wellbeing. 19 Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. 18(1)(c)(i) Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people and core areas. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. 18(2) Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. 26 The registered provider must visit the care once a month and prepare a written report of the visit. Previous timescale of 16.11.07 not met. 11/09/08 11/09/08 01/01/09 11/09/08 11/09/08 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 The results of any quality assurance system should be pertinent to Richmond Lodge. DS0000015558.V371150.R02.S.doc Version 5.2 Page 27 Richmond Lodge Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000015558.V371150.R02.S.doc Version 5.2 Page 28 - 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. 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