Inspection on 05/01/09 for Richmond Lodge

This inspection was carried out on 5th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond Lodge 01/06/06

Richmond Lodge 22/11/05

Richmond Lodge 17/05/05

Richmond Lodge 03/02/05

Richmond Lodge 24/08/04

Richmond Lodge 03/02/04

Richmond Lodge 14/08/03

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Richmond Lodge 27 Bilton Road Rugby Warwickshire CV22 7AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Justine Poulton     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Richmond Lodge 27 Bilton Road Rugby Warwickshire CV22 7AN 01788547781 01788573410 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : New Directions (Rugby) Ltd care home 21 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 21 No new admissions to the home over 65 years of age. The maximum number of service users to be accommodated is 21. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:- learning disability, LD, 21. Date of last inspection Brief description of the care home Richmond Lodge provides residential care for up to 21 adults with learning disabilities. The home is run by an organisation called New Directions. The home is made up of what the organisation describes as a hostel, for 14 adults and two flats. One flat is in a separate building on the first floor and the other is accessed through the main building. Three residents occupy one flat and four occupy the other. They require lower levels of staffing support than people in the main house. The home offers a day service as an alternative to a local social service run day centre close to the home. There is some provision for people with physical disability in the main house and a lift serves the first floor. The premises are on the main road close to Rugby town centre. The organisation also has offices on the site which senior managers use as a base. Care Homes for Adults (18-65 years) Page 4 of 29 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a Key Unannounced Inspection, this means that we did not tell the management that we were visiting. The purpose of this visit was to establish that the people living at the home received good care and their expereinces of using this service remain good. We also ensure that legal requirements are met such as employment of staff, health and safety and management of system. Before visiting the service we examined any information we already had such as incidents and accidents that had occurred in the last 12 months and concerns and complaints. We also asked the people who use the service, their relatives, staff and other professionals to complete a survey for us. Twenty four surveys were returned and we considered the information when formulating our plan and when making our Care Homes for Adults (18-65 years) Page 6 of 29 judgement about the activity of this service. During the visit we talked to the people using the service, the staff and management to clarify their views. We also examined various written information. We case tracked four people, this involves reading the information held by the home, plans of care, risk assessments and any other information. We then discuss the care with the staff to ensure that they understand what assistance is required. We also spoke to each person to establish their personal experiences. We also requested that the management completed the Annual Quality Assurance Assessment [AQAA]. This is a self assessment form where the management can tell us what they do well, where they have made improvments and barriers to improvements. We consider this information throughout the process. At the end of the visit general feed back was given to the manager about ares that were working well and where improvements are required. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose, which gives information about the service, does not contain up to date information, it is important that this is accurate as people wishing to use this service are given this document to assist them in making that choice. Each person should havea health care plan which clearly states what health issues they have and actions to be taken to maintain good health. Care Homes for Adults (18-65 years) Page 8 of 29 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 assured that their needs will be assessed prior to admission to ensure that the staff can meet all their needs. Evidence: Four people were case tracked and this told us that there are pre-assessments carried out prior to admission to ensure that their needs can be met. All people are invited to visit, stay for tea and can have an overnight stay if they wish. This helps the person to decide if they wish to be admitted and live at this service. The organisation have up dated the contracts and these are being given to the people who live there, these are also in pictorial format to assist understanding. Statement of Purpose needs up dating as the information in this document is out of date. The manager told us that this would be addressed. From the surveys sent to the people using the service four told us that they did not receive enough informaiton Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: before moving in and three told us that they did. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 confident that their needs will be met and they will be supported to make choices and take reasonable risks. Evidence: Four people were case tracked [This involves looking at written records, discussing care with staff and the individual and checking their experience of the environment and care received.] The records told us that all the risk assessments and appropriate plans of care were in place, which will assist the staff to meet each persons needs. These were not being evaluated to ensure that they remain current as required by the organisations policies and current regulation. This was discussed with the manager who provided evidence after the visit to demonstrate that this has been addressed and actions put into place to ensure that this improvement is sustained. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: The care plans seen were detailed and gave staff the information required to meet needs such as for one person with epilepsy, the care plan was clear and consise. The manager encourages each person to maintain independance and this is clearly stated in the care plans, taking into account what the person can do and where assistance is needed. Each person is encouraged and assisted to make day to day choices about how they spend their day and live their life. Records are maintained in each persons files to show what choices have been made and the outcome. This enables each person to have control over their life and creates good outcomes. Form example one person told us he did not like going to day services and therefore choose not to. Instead he spends his day doing puzzels, word searches and going out with staff. Another person told us, in the survey, that they make decisions about when to have a shower, going out to dinner, and about going to college. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that their social, lesuire, cultural and spiritual needs will be met. Evidence: Records, observation and discussion with staff and peole who live at this service told us that there are a variety of activities available on a daily basis. Most people who live at this home choose to use the in-house day service that offers a wide range of activities such as computer skills, arts and crafts, jewelery making and music. Two people go to a Farm Placement during the week and there are others who attend a local college. There are also other lesuire activities available. Visit to the cinema are popular and Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: visiting family, eating out and going to Church are all supported. Evening trips out are also supported. Each person has the option to go on holiday each year. This is decided between the person and the home and can be short or longer holidays and can be in England or abroad. There are always staff available to support them during these trips. There is transport available from the company and this needs to be booked prior to use. The home has a suitable kitchen that is domestic, clean and tidy and contains all the equipment required. The peole at the home have access to this area and can help themselves to food they want. The staff do the main cooking with assistance from anyone who wishes and is able to help. The menus are agreed during resident meetings and there are always alternatives to the main menu if required. Some local shopping is done where any individual can assist if they wish. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that their health care needs are met and that medication is managed safely. Evidence: Four peoples health and personal care plans were examined and it was noted that all people have access to other professionals such as speach and laungage therapist, behavioural therapist and also support to attend routine health care appointments at the recommended intervals or when required. Care plans and risk assessments although in place needed reviewing, which the manager has completed. It is important that all information related to health care is clearly recorded to ensure that staff meet these need consistently and safely. We were told by a professional who has contact with this home that This is a good service, dedicated to the clients, which has made significant changes in recent years. They also told us that In recent months, staff have needed more guidance regarding medication then was needed previously. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Medication management and administration is robust. There is one identified Team Leader who has overall responsibility for the ordering, booking in and disposal of the medication. All team leaders are trained and competent to administer medication, and some of the support workers also have training and will administer medication in the absence of the team leader. Annual undate training is given to all staff who have responsibility for mediaction management and administration. Storage of medication is appropriate and safe, a controlled drug cupboard is available although not in use at the time of this visit. There is also suitable books available for the staff to refer to in relaiton to medication, this informs them of the type of medication, regular dosages and common side effects. Medication is supplied by Boots Pharmacy in blister packs for 28 days or the original packaging where blistering is not appropriate. There is a seperate sheet to audit the amount of medication available and to check what has been administered for none blistered medication. There is a sample signature sheet for all staff who administer medication. There is a photo of each person at the beginning of the Medication Administration Records [MAR] to assist with identification and minimise the risk of errors. The MAR was completed appropriately after administration of medication and the codes were used correctly and there were no gaps, this shows that the staff administer medication safely and appropriately. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 confident that their concerns will be listened to and acted upon and that they are safe from harm. Evidence: From discusion with the manager and examining records it was confirmed that there is a suitable concerns and complaints policy in place. The process for making complaints was also in picture format to assist the people in the service. The records of complaints made to the service told us that these were dealt with in accordance with their own policies. People in the home told us that they knew how to complain and who they would talk to if needed. All the support workers spoke to told us that they had received training in safeguarding, this was confirmed from the training records. They also gave informtion that indicated that they understood what consitutes abuse and how they would report this. The home policies and procedures in place including a whistle blowing policy. The home is currently under safeguarding, lead by Social Services, for an alleged finacial abuse. The manager, who initially discovered this alleged abuse, reported it appropriately demonstrating his awarness, understanding and willingness to coCare Homes for Adults (18-65 years) Page 19 of 29 Evidence: operate with others to keep individuals safe. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that they live in a comfortable, safe home that meets their needs. Evidence: The home consists of the residential area and an ajoining flat. The building is listed and this restricts environmental changes to the structure. The communal and private areas are nicely decorated, which the people who live there were consulted about. The home is clean, tidy, well organised with a warm and homely feel. There are adequate bathing and toilet facilities that are appropriate for use, and there is appropriate equipment available to assist with care and mobility. There is a seperate laundry area that is away from the kitchen and food storage areas. This was tidy and well organised, there is a policy for infection control. There are suitable out door facilities which all have access to. The home is situated close to local facilities and amenities. Care Homes for Adults (18-65 years) Page 21 of 29 Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peopel can be confident that there are well trained competent staff to assist them in their daily lives and that they are safe and appropriate to work with them. Evidence: The manager carrys out robust staff employment this ensure that only people who are appropriate work at the home. There are sufficeint staff on duty who are well trained and competent to carry out their roles and assist the people they care for. Four staff records were examined of recently employed staff. This confirmed that all checks are made and records were available as required. There is induction training which includes a basic induction into the home followed by a Learning Disability Qualification which consists of a six week induction training followed by a six month foundation course. Training records are in place and these told us that all staff have completed mandatory training in the last twelve months. There is other training available to ensure that staff are equipt to carry out their roles, such as dementia care training, challenging Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: behaviour, care planning, epilepsey and mental capacity training. Staff returned surveys and these told us that some staff felt that they did not receive sufficient support from the management. They also told us that generally there is sufficent training to assist them to meet the needs of the people they care for. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 who use this service can be confident that it is managed to their best interest and that checks are made to ensure that the home and equipment used is safe. Evidence: In the last twelve months a new manager has been employed and is registered with us. He previously worked for the same organisation as a team leader and due to a change in the management structure was given promotion. He is appropriately qualified and experienced. He has completed his Registered Managers Award and has worked in care for many years. The staff told us that he is good manager and supportive. There are suitable quality assurance system in place this has been completed and the report and action plan is being developed. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: There is an open door ethos to the home, staff, people who live there and others are able to discuss their concerns and ideas with him and feel listened to. There are monthly staff meetings and regular supervision sessions to ensure that the staff are involved and consulted. The staff use communication books on a day to day basis. There are regular meetings on a monthly basis for the peole who livwe at the home, these are used to discuss activities,, menus, concerns and share ideas for improvments. Regulation 26 visits [these are visits that the provider is required to undertake to ensure that the service is managed in accordance with regulations and legislation] are sporadic, however, we have since been notified and the organisation has reviewed this process and steps have been put into place to ensure that these visits are under taken monthly. There is a clear policy and procedure in relation to Health and Safety. There are also generic risk assessments, these ensure that actions are taken to reduce risks in the home. Checks for equipment are undertaken as required to ensure that they are safe to use. For example the electrical, lighting and fire were all up to date. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Health care plans must be available for all assessed health care needs with accompanying risk assessments. This will ensure that there is consisten, safe care given. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be up dated and available for people living at the home and their representatives. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!