Inspection on 25/09/07 for Richmond Lodge

This inspection was carried out on 25th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 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 11/09/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Richmond Lodge 11-15 Richmond Avenue South Benfleet Essex SS7 5HE Lead Inspector Nicola Dowling Unannounced Inspection 25th September 2007 10:00 Richmond Lodge DS0000015558.V351481.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 DS0000015558.V351481.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 DS0000015558.V351481.R01.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 Name of registered manager 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.V351481.R01.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. 2nd October 2006 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.V351481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection site visit took place over a six-hour period on one day. The site visit consisted of a tour of the home, talking with staff and residents, observing the care given and reading of documents. Most of the residents were seen and three were spoken to. The deputy manager was present in the afternoon. In addition nine survey forms were received back from service users and the Annual Quality Assurance Assessment (AQAA) form also contributed to the report. The inspector would like to thank the staff and residents for their help and hospitality during the visit. What the service does well: What has improved since the last inspection? Staffing levels at the home have remained constant to ensure service users needs can be met. The ventilation system in the home has been improved. Also new beds and bedding have been purchased for the general comfort of the service users. Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 6 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.V351481.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 DS0000015558.V351481.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have sufficient information about the home and have an opportunity to try the home before they move in. A professional assessment is undertaken with the service user to ensure their needs can be met. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. The Service User Guide needs some amendments made to it, as some information is out of date. For example the home have residents that are over the age of 70 whereas the Service User Guide states that service users are up to the age of 70. This information is presented in a text format and can be translated if required. Of the nine questionnaires received five of the service users said they received enough information about the home. Two other service users were unable to remember and two did not know. As reported in the Annual Quality Assurance Assessment (AQAA) the home is continuing to update their information brochures. The home has one vacancy. Seven service users said that they remembered visiting the home before moving in. A prospective service user has had an introductory visit to the home. The home is now waiting for funding before admission can take place. Staff spoken with are aware that an assessment Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 9 had taken place by a qualified nurse, however they were unable to find records relating to this referral. The manager should make sure that qualified staff have access to this information. All service users have a contract and care files checked evidence that service users had signed them. Estuary Housing Association (EHA) had also informed service users by letter of a rent increase. This letter was individually addressed to the service users and was clear and easy to understand. Richmond Lodge DS0000015558.V351481.R01.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, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Confidentiality is managed well and residents are supported by staff to make daily decisions. However future goals have not been addressed and lack of guidance on smoking is an area of risk. EVIDENCE: Two service users plans were checked. Both contained a care plan with risk assessments. Both the care plans had been updated and showed evidence of the service users involvement. For example they were written with the service users own words. The care plans explained daily care but did not identify future aspirations or goals for the service users. This is an area that has been identified for improvement in the AQAA form. There were risk assessment forms with the care plans. However some risk assessment forms had not been evaluated for example one assessment that refers to smoking had not been updated since November 2006. There was a lack of general guidance in the home on smoking and is an area that should be addressed. Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 11 Feedback from the questionnaires and from service users on the day of inspection indicate that residents can spend their time as they choose and are supported to make decisions about their daily lives. For example one service user spoken with said that they manage their own money, whilst another preferred the support of staff with this. Staff spoken with were aware of confidentiality and how this is practiced in the home. Records are kept securely and EHA has a policy for staff to adhere to on this subject. Richmond Lodge DS0000015558.V351481.R01.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, 14, 15, 16, & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Purposeful activities are minimal and the lifestyle is routine, with individual activities provided by the home. The food is good. EVIDENCE: Service users are encouraged to take up valued activities and staff explore this area with them. For example some service users joined a local leisure centre. This was well supported initially however over time attendance has tailed off. From one service users care plan it was recommended that they go to a day centre, this has not come into effect yet. It was reported that staffing and closing down of centres was the reason why. Most service users spend their time at the home and staff arrange things to do with them. For example going shopping, out to lunch with a game of pool. Service users undertake chores in the home and are responsible for cleaning their room. The home also operates a garden club for service users to participate in and arranges BBQ’s and get Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 13 together’s, with other homes in the Estuary group. One service user attends a Rethink centre. Another has weekly overnight stays to their family. Those that are able use public transport otherwise the home has a vehicle to transport service users. The home has arranged to take service users away on holiday for a week. At the service users meeting trips out and parties are discussed. Service users confirmed that they have outings and this is also recorded in the meeting book. The daily routine of the home is flexible to suit residents. For example residents are able to sleep-in and have breakfast late. Shower when they choose and go out when they want. Mail is always handed directly to the resident and most residents have a lockable room. Residents spoken with were happy with their rooms saying that they are “comfortable”. Family contact is maintained and staff facilitate contact where possible. For example where agreed service users can stay overnight with relatives. Through the day service users were observed helping themselves to drinks in the kitchen and one service user commented that there was always fresh fruit available. Today there was a large bowl of tangerines in the lounge. Service users’ reported that they liked the food. There is a daily diary kept in the kitchen where the meal of the day is written. If service users do not like what is offered they write their alternate meal into the diary. Generally this system works well in the home and all service users spoken with were aware of it. Richmond Lodge DS0000015558.V351481.R01.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, & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mental and physical healthcare is managed well. Medication administration is not robust enough. EVIDENCE: Most residents at this home manage their own personal care. The home ensure that a female worker is on shift to maintain dignity for the female service users. Each service user is treated as an individual and their personal support is tailored to their needs. Service users spoken with knew their keyworkers name and said how they helped them. For example taking them shopping for clothes. Health is generally well monitored and good records are kept. One service user described a recent visit to a hospital and how staff stayed with them through this visit. Service users that are able, take themselves to various clinics and feedback information to staff. Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 15 Medication is stored correctly and one service user manages their own medication. There were gaps in service users medication administration record sheets (MARS). This was brought to the attention and discussed with the deputy manager who agreed to address this. Richmond Lodge DS0000015558.V351481.R01.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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff listen to Service users however, the communication of how service users can complain could be better. EVIDENCE: Over the past inspection year there have not been any complaints or safeguarding adult referrals made about this home to the Commission for Social Care Inspection. Feedback from the questionnaires sent out to service users indicated that they felt listened to by staff. Also when they are unhappy about something they feel comfortable to approach the staff. This was observed through the day as service users talked to staff about various matters. Although service users felt comfortable to approach staff about issues. Five of the nine surveys returned indicated that they did not know how to complain. There is complaints information by the telephone and there are regular service users meetings. However there are still some service users that are unsure of the homes complaints procedure. For the benefit of all the service users at the home this area should be made more accessible. There was evidence that staff had attended a safeguarding adults course. Staff spoken to confirmed this and said that they were updated yearly on this area. The home also has the Essex Vulnerable Adults Protection Committee Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 17 booklets available in the home. Service users spoken to say that staff treated them well and that they felt safe in the home. Richmond Lodge DS0000015558.V351481.R01.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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment meets the needs of the service users. Provision of basic equipment is poor. EVIDENCE: The home is warm and comfortable with no unpleasant odours. Since the last inspection the ventilation system has been improved and service users have received new beds and bedding. Service users spoken with were happy with their rooms and with the home. There was evidence that service users smoke in their rooms. There was no guidance for staff regarding residents smoking in their rooms or the conservatory that is a designated smoking area. Because of the smoke some bedrooms had nicotine stained walls. Also some vanity units were in a poor state. Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 19 Some basic equipment was missing from bathrooms and toilets for example hand soap and paper towels. This does not enable good hand hygiene and was noticed at the last inspection on 2nd October 2006. Also there was no slip mat available in the shower room and doors that were labelled to be kept “locked” were open. The laundry area is maintained, clean and uncluttered. Service users confirmed that on their laundry day staff will help them when they need it Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough qualified and competent staff to meet the needs of the service users. EVIDENCE: Agency staff are used at the home on a regular basis. The agency staff are regular and familiar to the home. On the day of inspection an agency nurse was on duty with two regular members of staff. The reason for the agency worker was to cover sick leave. Service users confirmed that they were familiar with the agency worker. Service users spoken to say that they liked the staff, this was also fed back via the service user surveys. Since the last inspection the duty rota indicates that staff numbers have been maintained. So that there are three staff on in the morning and afternoon and two on at night. There is a staff nurse on every shift and four staff have a national vocational qualification in care. Staff spoken with confirmed that they receive supervision from the manager and that there are regular staff meetings. Staff are provided with basic Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 21 training such as fire, food hygiene and safeguarding adults amongst others. Mental health awareness training is offered along with other courses for example in diabetic care. A random sample of recruitment records were checked and contained the appropriate documents. Richmond Lodge DS0000015558.V351481.R01.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, 40 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is experienced and able to run the home well. EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. EHA seek the views of service users in all of their homes and this is called their Quality Review Network. The home also undertake their own quality assurance reviews and use questionnaires and service user meetings to gain information. Unfortunately on the day of inspection the findings of the quality assurance work were unable to be located. So it is unknown what the outcome of this review is for the service users. Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 23 The policy on smoking was very brief and there was no guidance for staff regarding how smoking should be managed in the home. As many service users smoke, their views should be collected to inform the homes policy. Other policies are available and accessible to staff who knew where they were kept. EHA have a health and safety officer that visits annually and provides a report about the home. A recommendation from this report was that the manager receive a 4 day first aid training course. This was actioned quickly following this report. During the inspection, control of substances hazardous to health (COSSH) items were found around the home and were not held securely. There is also a lack of monitoring the running of the home from senior managers. The last regulation 26 report was in February 2007. A random sample of safety certificates was checked and these were all up to date. A service users financial record was checked and this tallied exactly. Richmond Lodge DS0000015558.V351481.R01.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 3 2 3 3 x 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 3 LIFESTYLES Standard No Score 11 x 12 1 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 2 x 2 x Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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. 2. 3. Standard YA9 YA12 YA20 Regulation 13(4)(b) 16(2)(n) 13(2) Requirement The registered person must update risk assessments. The registered person must explore purposeful activities for service users. The registered person must monitor the recording of the administration of medication in the home. The Registered person must ensure that resident’s furnishings are kept in good repair. The registered person must ensure that hand-wash and towels are provided in the service users bathrooms/toilets for the purpose of good hand hygiene. The registered provider must visit the care once a month and prepare a written report of the visit. Timescale for action 16/11/07 16/11/07 16/11/07 4. 5. YA24 YA30 23(2)(d) 16(2)(c) 13(3) 16/11/07 16/11/07 6. YA42 26 16/11/07 Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 26 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. 3. 4 5 Refer to Standard YA1 YA6 YA22 YA39 YA40 Good Practice Recommendations The registered person should update the Service User Guide. The registered person should record service users aspirations and future goals in the care plan. The registered person should ensure that service users know how to use the complaints process. The registered person should collate the feedback from questionnaires to establish service users views of the home. The registered person should involve service users in the development of smoking guidance to be followed in the home. Richmond Lodge DS0000015558.V351481.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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.V351481.R01.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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