Inspection on 22/03/06 for Richmond Lodge Nursing Home

This inspection was carried out on 22nd March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Richmond Lodge Nursing Home 13/11/08

Richmond Lodge Nursing Home 05/12/06

Richmond Lodge Nursing Home 01/09/05

Richmond Lodge Nursing Home 14/03/05

Richmond Lodge Nursing Home 15/11/04

Richmond Lodge Nursing Home 17/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Richmond Lodge Nursing Home Bede Village Goodyers End Bedworth Warwickshire CV12 0PB Lead Inspector Sandra Wade Unannounced Inspection 22nd March 2006 09:00 X10029.doc Version 1.40 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 Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 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 Older People and 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 Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Richmond Lodge Nursing Home Address Bede Village Goodyers End Bedworth Warwickshire CV12 0PB 02476 645544 02476 360758 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) Richmond Health Care Limited Care Home 62 Category(ies) of Learning disability over 65 years of age (3), Old registration, with number age, not falling within any other category (62), of places Physical disability (1), Terminally ill (3) Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2005 Brief Description of the Service: Richmond Lodge is a purpose built care home, situated at Bede Village in Bedworth. The home is registered to provide care with nursing for the older person and has specialist registration for care of terminally ill, physical disability and those with learning difficulties over 65. The accommodation is single storey with easy access to all areas of the home for its residents. The home has established and well maintained gardens, which are accessible to residents. In addition residents can also access the garden areas and bowling green in the surrounding Bede Village accommodation. Richmond Lodge Care home provides personal and nursing care to service users. Intermediate care is also provided on a short-term basis. Other services are provided with the aim of maintaining service user independence. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection to Richmond Lodge and commenced at 9.00am. The inspection was carried out over a full day and for a period of time was attended by two inspectors to enable a review of nursing, younger adult and older people standards. The inspection focused on actions taken to address issues from the last inspection as well as those standards not assessed. Comments received by the Commission from residents, relatives and visitors were taken into consideration and discussions took place during the inspection with residents, staff and the management of the home. A review of policies and procedures was carried out as appropriate and a full tour of the building was undertaken. Some of the residents were in the communal areas of the home and others were in their rooms. It was established during this inspection that although the home is registered for 62 residents, there were only 40 in the home. The manager advised that the categories of registration as well as the numbers the home cater for are currently under review by the company. At the time of this inspection the home was still in the process of refurbishment. What the service does well: The younger adults in the home felt they were being well cared for and spoke positively of their lifestyle in the home. Comments from other residents were also on the whole positive. The Head of Home who has been in post since 7 November 2006 has instigated regular staff meetings. This has enabled staff to be kept informed of the plans for upgrading the home as well discuss issues relating to the care standards and what is required of them in terms of meeting these. Three of the staff have completed their conversion training successfully and are now first level Registered nurses. Those areas of the home which have been refurbished have been done to a high standard there are plans in place for further improvements to the home. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 6 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. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home undertakes a thorough assessment to satisfy themselves that the home is suitable for meeting prospective residents needs. EVIDENCE: The home has recently changed to a new reporting format and this includes an assessment for all areas identified in the standards, and a prompt to identify potential areas of risk for each individual. During the inspection the assessment notes for two residents were read. The two systems of recording assessment were seen and the second was observed to be far more thorough and informative. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 9 The manager said that the new system was far more robust, and allowed the home to make a fully informed judgement. Residents spoken with confirmed that they had been assessed prior to admission to the home, and felt the home met their needs. One lady on a respite stay said that she was looking forward to going home, but the home staff had ensured that she received physiotherapy during her stay and this made her feel stronger and more prepared. The manager confirmed that no residents had been referred to the home for intermediate care. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 9, YA 16,18,19 The home is meeting the health needs of the residents although there are aspects of care planning and record keeping that need improvement. Without this improvement there is the chance that aspects of residents’ care may not be fully attended to. The manager and her staff have made significant improvement in the systems and procedures related to the storage, recording and administration of medication, and this is generally well managed. Residents feel they are treated with respect and their right to privacy and independence is being upheld. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 11 EVIDENCE: The manager is new in post and has undertaken a full audit into care planning systems within the home. Care plans have been reviewed and some changes have been and are continuing to be made; but the care plan does not clearly give direction to staff on how to deliver care to each individual resident and in some cases risk assessments have not been completed. Language used within the care plans is not always person centred and phrases such as ‘can be demanding’ are not respectful of individual needs. A training day for all qualified staff has been organised and the manager hopes that recording and care planning will improve following this training. The company is currently reviewing different care plan models with a hope to developing a ‘Barchester model’. The manager is playing an active part in this review team. Entries in the care plan regarding the health care of residents confirmed that the GP visits regularly, and that residents had been seen by a chiropodist, physiotherapist and dietician. Photographs were seen in care plans documenting wounds and the required care. This is good practice as it assists staff to monitor improvements made or any sign of deterioration. During the inspection two of the younger adults in the home were spoken with. Both have lived at the home for a number of years and spoke very positively of their life there. One resident has improved so much, that at a recent review it was decided that she could begin to consider supported living back in the community, to be able to lead a more independent life. The home is organising for her to have an advocate and be supported emotionally with this big change. Both of the residents spoken with said that Richmond Lodge was a ‘nice place to be’, and ‘we laugh a lot’. They spoke about their life style, and the social activities they attended such as ‘ Bingo, dominoes, Snakes and ladders, boat trips, trips to the zoo and Bedworth Civic hall’. The grounds around the home are suitable for wheel chair access and those spoken with confirmed that they went outside a great deal in warmer weather. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 12 The current refurbishment programme is providing a level of entertainment, and some residents spoke about how they enjoyed the added activity and watching things change around the home. Generally comments from other residents in the home were positive, residents confirmed that they had plenty of choice, that they were looked after well, and felt well cared for. Comment cards received by the inspector from relatives raised concerns about staffing which were impacting on resident care. One person stated that they had observed residents needing to go to the toilet and the request being ignored. Another relative said that there were not enough carers to take residents to the toilet. One felt that for the amount of money being paid their relative should be able to have a least on bath per week. These matters were discussed with staff on duty and they said that sometimes they were asked to take residents to the toilet but because they were dealing with another resident had no choice but to let others wait. The manager advised that some issues concerning the working patterns of staff had been identified and these were still being reviewed. A privacy and dignity policy is in place for the home and the manager advised this is discussed with staff as part of their induction. The manager also advised that the arrangements for residents to receive their mail are confirmed in the Welcome Pack for the home. All residents clothing is requested to be labelled upon admission or when new items are purchased so that there are reduced risks of clothes not being returned following washing or being returned to the wrong person. The manager advised the home would label items of clothing if necessary. None of the residents reported any concerns in regard to their laundry being returned. The manager has undertaken a full and thorough medication audit and created an action plan based on the finding of the audit, and of the requirements made at the last inspection. A meeting has been held with the pharmacist supplying medication to the home, and significant improvements have been made to the ordering, receipt and labelling of medications in the home. Meetings have been held with qualified staff to ensure that they are fully aware of medication procedures. Under the programme of refurbishment currently underway in the home, areas identified to store medication, creams and other clinical items will be more suitable. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 13 Since the last inspection a new policy and procedure regarding residents who choose to self medicate has been introduced. A risk assessment is in place and is regularly reviewed to ensure that residents are safe and happy to continue to self medicate. Administration of medication is generally good but three omissions in the records were noted which meant it was not possible to confirm medications had or had not been given. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 Residents find the lifestyle in the home mostly matches their expectations and preferences and residents are able to maintain contact with family and friends. Residents are able to exercise some choice and control over their lives. EVIDENCE: An activities programme is in place but this is limited in terms of the range of activities being provided. The home employs an Activity Organiser for 35 hours per week but this person was not available in the home at the time of inspection due to ill health. The manager confirmed that plans were in place to expand the range of activities provided and it has been subsequently Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 15 confirmed that an additional activity organiser has been interviewed and appointed to the home. The manager confirmed that it is planned the activity organiser will talk with residents about their preferences to ensure activities provided are both suitable and appropriate for them. The manager advised that the Salvation Army visit the home once a month to have coffee with the residents and reminisce about old times. Posters were on display in the home advertising a Friday ‘Fish and Chip’ event in the restaurant with the ‘Queen’. The manager advised that arrangements had been made for the lady who looks like the queen to visit the home. The activity schedule confirms that board games, bingo, quizzes and communion take place. This home have the advantage of their own minibus which means outside visits for residents can be arranged. Residents are able to exercise their choice over some matters relating to the home but not others. Resident meetings have taken place but with so many changes occurring in the home the frequency of these has not enabled residents to be kept updated or consulted on changes taking place in the home. The décor of the home was agreed with an Interior Designer so residents did not have the opportunity to comment on this. Although no residents raised any concerns about this during the inspection, one comment received from a relative was that the décor was not appropriate to the client group of the home. The manager confirmed that if a resident did not like the particular décor of the room other choices would be offered where possible. Residents are afforded the choice of a bath or shower and the manager advised she is looking at how staff teams can be organised to ensure bathing requests can be met effectively. Doors in the home are lockable and residents can have their own keys if they wish. All the doors in the home are being changed so that residents can leave them open without compromising the fire safety of the home. Residents have a choice of meals and this is confirmed on menus available in the home. During the tour of the home it was evident that residents had their own personal possessions around them to make their rooms more homely. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Complaints are listened to, taken seriously and acted upon. Some work is required in updating the Policies and procedures on abuse to ensure service users are fully protected. EVIDENCE: A complaints procedure is in place and a complaints book is kept to record any concerns raised. One complaint had been received by the home in January 06 regarding the care of a resident not being as prompt as it should have been. Records confirmed this had been fully investigated by the manager and a response prepared for the complainant confirming the outcome as inconclusive. A copy of the complaints policy is provided in the Service User Guide for the home which has recently been updated. The manager confirmed that copies of the updated Service User Guide will be issued to residents as appropriate. A policy on abuse is available in the home but it was evident this does not fully reflect the local Adult Protection Procedures. The policy is also not clear in Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 17 confirming the reporting process to outside bodies if abuse has been identified. The manager advised that new policies were in the process of being implemented by the company. A policy is in place in regard to Challenging Behaviour which covers issues relating to physical and verbal aggression so that staff know how they should manage this within the home. Records seen confirm that vulnerable adults training has been completed by both care staff and nursing staff so they know how to recognise abuse and know their responsibilities for reporting this to senior staff within the organisation. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents live in a generally well decorated comfortably furnished home. Systems are in place to ensure the home is safe for the residents but some work is required before this can be fully confirmed. EVIDENCE: Richmond Lodge has a large dining room, a coffee lounge, a TV lounge and a library. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 19 All of the rooms have an ensuite bathroom which consists of either a shower or a bath. There are 12 communal toilets and three communal bathrooms which have an assisted bath. Rooms are accessible by wheelchairs and there is level access around the home. Plans are in place for the home to have a village shop which has been created but is not yet operational. The home is spacious and has a pleasantly decorated reception area, there are parking areas indicated upon entrance to Bede Village where the home is based. There is a garden area which did have a pool but this has been drained as it is planned that the garden is redesigned. The home is subject to an ongoing refurbishment programme and at the time of inspection there were decorators in the home working in various areas. This in itself presents some risks to residents as there are decorating materials dust and decorating rubbish which is generated as they work. The manager advised that risk assessments had been done for each area as the decorators worked but she was to complete one for the new area that they had moved to on the day of inspection. Those areas of the home which have been decorated have been done to a high standard. New furniture, carpets and soft furnishings have been provided in rooms as well as new light fittings. There are still areas of the home to be completed and the manager advised that the rooms which are occupied by residents will be addressed once other areas have been completed. The manager said that the residents will be given the choice if they wish to keep their room the way it currently is. During the tour of the home it was noted that one of the toilets did not have a seat and door wedges were being used in various areas of the home. This compromises fire safety as the doors would not close in the event of a fire. The manager acknowledges that storage of items in some places of the home including the areas outside of the laundry is not ideal but until the refurbishment is complete it is not possible to locate the items elsewhere. Corridor lighting has been much improved in the newly decorated areas. Lighting in other corridor areas is being addressed as the decorating is completed. The storage heaters in the home are electrical and the temperatures cannot therefore be regulated. The manager has identified areas of risk and has devised risk assessments to help prevent burn risks to residents. The cost of low surface radiators is to be explored by the home to enable risks to be managed more effectively. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Service user needs are not being met consistently by the numbers of staff available. EVIDENCE: 24 Comment cards were received by the Commission from relatives of residents in this home. Three comment cards were received from residents. The majority of these comment cards were received in January 2006. All residents said that staff treated them well but there were many comments made regarding staffing levels from relatives. The majority felt that there were insufficient staff to meet the needs of the residents. Issues raised included staff not being available to take residents to the toilet, not enough contact with residents, residents being kept waiting and “things being very slack”. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 21 During the inspection residents spoken to said that although staff were very caring there were not enough of them. One resident said that staff were “good” and if they rang the call bell staff would come “eventually”. Another resident said they liked the staff and the home. The inspection process identified that the issues relating to staff availability are not all due to staffing levels but also linked to the way staff work within the home and how the work is allocated and completed. Staff spoken to did at times feel pressurised and acknowledged that sometimes they had several requests from residents at the same time making it difficult to provide care to all as they would like. Staff also confirmed that they could not always spend as much time as they would like with residents and if staff were off ill they were sometimes pushed for time. At the time of the inspection there were 40 residents in the home. The manager confirmed that the home aims to provide two nurses between 8am and 8pm with nine carers between 7.30am/8am until 2pm. From 2pm to 8pm the home aims to have seven care assistants on duty and at night one nurse and four care assistants. In addition to these staff there is one Hospitality Manager, one Senior Cook and six catering assistants. Domestic staff are available during the day and evening and there are five administration staff to support the manager. Duty rotas do not show all staff working in the home. Time sheets were seen to confirm laundry hours being provided are 81.25hrs per week. The managers hours were not indicated on duty rotas seen to confirm supernumerary hours worked. The manager advised that she had already taken actions to restructure the way staff work and copies of proposed duty rotas were made available to the inspector. The manager advised that the new teams and rotas are to commence on 7 May 2006. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37,38 Residents live in a home which is run by a manager of good character and who is able to discharge her responsibilities as required. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 23 Quality monitoring has not been fully developed to confirm that the home is being run in the best interests of the service users. Systems are in place for managing residents monies but some actions are required to ensure residents financial interests are fully safeguarded. Further work is required in regard to record keeping and health and safety matters to ensure residents are fully safeguarded. EVIDENCE: The manager of the home has been in post since 7 November 2005. At the time of inspection the managers registration with the Commission had not been confirmed. The manager is both qualified and experienced to manage the home and has experience of working in care settings. The manager advised that a quality survey has been planned for the Summer which would allow for resident and relative views on care and services provided at the home. The results of any quality survey completed previously were not available to confirm outcomes or any actions taken by the organisation as a result of these. Monthly audits are completed by staff which cover various aspects of the home and those completed included medication management, nutrition and dining, record keeping, etc. Following these audits actions various actions had been taken for example, the home had identified a review was required of the risk assessment tool used for determining a residents nutritional needs to maintain their health. The last residents meeting was held at Christmas and plans are in place for further meetings to be held. Comments forwarded to the Commission from relatives in regard to the home confirm that the majority are satisfied with the overall care provided and most feel that they are being kept informed of important matters relating to their relative in the home. The residents who responded stated that they liked living at Richmond Lodge and were treated well by staff. Almost all of the relatives stated they did not have access to a copy of the inspection report for the home. Actions will need to be taken by the home to ensure this is addressed. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 24 There were some comments linked to communication between staff and relatives with a request for this to be improved so that care plans and the wellbeing of residents could be discussed. A review of health and safety was carried out. The manager advised that a full health and safety audit of the home was carried out on 9 September 2005. It was evident from this audit that there were some issues requiring action. The manager confirmed that actions identified would be fully discussed and addressed within a new Health and Safety Committee which she is in the process of setting up and which is due to have its first meeting on 29 March 2006. This Committee will consist of key members of the home who are both responsible and involved in health and safety matters. Records were viewed of safety checks carried out and these are confirmed as follows:• • • 5 Year Electrical Wiring Certificate – 24.6.04 Hoists and bath chairs – November 2005 Legionella risk assessment – February 2004 – this report identified some recommendations to be carried out. It was not clear from records these had been addressed. The manager advised that new contractors were now in place and it was evident that arrangements are in place for water checks to be done. Fire officer checks (including fire extinguishers) – December 2005 Air mattresses serviced 26 May 2005 The home is mostly electric and the gas equipment in the home was checked on 1 March 2006. Electrical portable appliance checks had been completed. • • • • Hot water checks were being carried out but not all water outlets were being done monthly which is recommended so that any changes in the hot water temperatures can be identified promptly to reduce any scald risks to residents. Statutory training is being addressed on an ongoing basis. All staff spoken to said that they had done moving and handling training and training certificates were available to confirm this. The manager advised that some staff are still to complete this training but dates had been planned for this. All staff have completed fire training. Some staff are to do first aid training but a trainer is available within the home to provide this. Food hygiene has also been done by most staff but there are some staff who are still to complete this. There is a trainer available within the home who can provide this training. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 X 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 X STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 2 36 X 37 2 38 2 Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 26 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7OP37 Regulation 12,13,15 Timescale for action Care plans must set out in detail, 30/04/06 the action needed to be carried out by staff to ensure all aspects of the health; personal and social care needs of the service user are met. Care plans must be up to date and reflect the current needs of individual service users. An action plan detailing timescales to address this is to be forwarded to the Commission. (Outstanding from September 05 inspection) 2 OP8OP37 13,15 Risk assessments must be consistently carried out and implemented for all residents and an appropriate plan of care developed. (Outstanding from September 05 inspection) 3 OP9OP37 17(1)(a) Records must demonstrate that medications have/have not been given consistently. DS0000004408.V286993.R01.S.doc Requirement 30/04/06 30/04/06 Richmond Lodge Nursing Home Version 5.1 Page 27 4 OP12 16 The manager is to demonstrate that residents have been consulted on their preference for social activities and interests. Any activities programme devised is to show that resident needs and capacities have been taken into account. Records of participation are to be maintained accordingly. The Policy on Prevention of Abuse is in need of review to reflect the local Adult Protection Procedures. The manager is to confirm a date for this to be completed. 30/06/06 5 OP18OP37 13 31/05/06 6 OP19OP38 23 13 The manager is to forward a plan 30/04/06 with dates for the remainder of decoration works to be completed and confirm that risk assessments are in place for all areas where decorators are working. The manager must ensure that doors are not held open with devices which could prevent them from closing in the event of fire. A date to address new doors is to be confirmed. (Issue outstanding from September 05 inspection) A toilet seat is to be fitted to the toilet as identified during the inspection. 7 OP27 18 The manager is to undertake a review of staffing to confirm that there are sufficient staff to meet the needs of the residents. Residents are to be regularly 31/05/06 Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 28 consulted in regard to staffing to ensure they are receiving the care they require. Systems are to be devised to monitor staff available for residents in communal areas to ensure their needs are being met. 8 OP33OP37 24 The manager is to implement a quality system which involves consultation with residents and their representatives. The outcomes of this survey are to be published and made available to service users detailing any actions the home propose as a result. 9 OP35 20 The registered person shall not pay money belonging to any service user into a bank account unless the account is in the name of the service user, or any of the service users, to which the money belongs; and (b) the account is not used by the registered person in connection with the carrying on or management of the care home. In regard to the above regulation the manager is to review current systems for managing residents monies in regard to the “float” to ensure this is not made up of money from residents accounts. Receipts must be available for all transactions made for each resident. 10 OP38 13 The manager is to confirm a date 31/05/06 for the Legionella Risk DS0000004408.V286993.R01.S.doc Version 5.1 Page 29 30/06/06 31/05/06 Richmond Lodge Nursing Home Assessment to be completed. The manager is to confirm a date for the remaining areas of the home with poor lighting to be addressed. The manager is to confirm that all staff have completed statutory training within the required timescales. 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 OP25 OP38 Good Practice Recommendations The manager is requested to confirm any plans in regard to the hot surface storage heaters in the home. Richmond Lodge Nursing Home DS0000004408.V286993.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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