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Inspection on 05/12/06 for Richmond Lodge Nursing Home

Also see our care home review for Richmond Lodge Nursing Home for more information

This inspection was carried out on 5th December 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

There were 10 requirements made at the last inspection and the majority have been met. The manager has now been in post for a year, and has worked hard to review a number of working practices in the home, as well as manage the refurbishment programme. The home has been significantly refurbished and redecorated, with new high quality furnishings, carpets, lighting and the provision of a coffee room and a shop. Health and safety considerations have been made; door retainers have been placed in all residents` rooms and key areas in the home. These are activated by the fire alarms, when they close to offer increased protection. The manager has reviewed the documentation provided, to offer prospective residents an informed choice about the services provided at the home. Work has been undertaken on the care planning, and these documents have been improved to identify areas of risk and to guide staff in how to minimise risk.

What the care home could do better:

Care planning could be further improved by a more person focused and individual approach. The use of life history information would offer staff better knowledge of each individual resident. A number of residents and their relatives voiced concern via questionnaires and in person, that staffing levels are not always sufficient to offer care to the residents in the way and at the time they would prefer. There has recently been an increased use of agency staff due to long term sickness and absence. This has put a strain on the current staffing arrangements and has not always provided consistency of care. The home has a high number of very dependant residents and the manager should be able to demonstrate via a dependency monitoring tool that there are sufficient staff on duty to meet the needs of the residents. It was noted during the inspection that on occasions, residents were not offered care in a way that enhanced their quality of life and personal dignity, and that staff had a `task orientated` approach to their work.

CARE HOMES FOR OLDER PEOPLE Richmond Lodge Nursing Home Bede Village Goodyers End Bedworth Warwickshire CV12 0PB Lead Inspector Jackie Howe Key Unannounced Inspection 5th December 2006 09:30 X10015.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.V320983.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 Older People. 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.V320983.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond Lodge Nursing Home Address Bede Village Goodyers End Bedworth Warwickshire CV12 0PB 02476 645544 02476 389621 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 Mrs Louise Thompson Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Richmond Lodge may also care for the named person in the application for variation of registration dated 22 March 2006. Within the 51 places Richmond Lodge may provide care for six service users between the age of 55-64 whose nursing needs require palliative care or complex nursing needs. 22nd March 2006 Date of last inspection 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 older people and has specialist registration for care of terminally ill, physical disability and those with learning difficulties over 65, with some places available for residents between the ages of 55 and 64. The home has been recently refurbished and redecorated. New communal areas and a shop have been provided. The accommodation is a single storey building, with easy access to all areas of the home for its residents. The home has an established and well-maintained garden, which is 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 residents. Care is also provided on a short-term basis. Other services are provided with the aim of maintaining service user independence. Information about the home is given to prospective residents and their families via the ‘Statement of Purpose’ and other information brochures. Range of fees: £400 - £620 per week based on a dependency assessment. Additional charges are made for hairdressing, chiropody, and personal items. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the inspection year 2006/07 and was unannounced. It was undertaken over a period of one day, between 09:30 and 18:45 hrs. The inspection focused on the outcome for residents of life in the home, and their views and those of their relatives, of the service provided. The inspection process reviews the home’s ability to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision where improvements may be required. The manager was present through out the day. The inspector was able to tour the home, and spend time speaking with a number of residents, visitors to the home and staff. Some comments from people who use the home had been received prior to the inspection, and the manager has also provided the commission with a Pre Inspection Questionnaire. Information from these has been included in the report. The inspector ate lunch with the residents and was able to observe care practices, and how staff interacted with people currently staying in the home. During the inspection the care of three residents who live in the home was examined. This included reading care plans and documentation, observing care offered to them and that staff have the necessary skills to care for them. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. As part of this unannounced inspection, the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 6 The home has recently been refurbished and now offers a bright, clean and well furnished environment to its residents. The health care support offered to residents is good. There is a GP on site for a weekly surgery, and residents are offered access to chiropody, optician, physiotherapy and dental services. Social activity is available and staff are specifically employed to organise activities to offer residents a variety. A newsletter is produced to keep residents informed about what is going on in the home and the local village and community. Training opportunities available for staff are good, with both external and in house training. This is due to be further improved by an ‘E’ learning training scheme using computer training packages, and the introduction of home trainers. Some residents speak highly of the staff: ‘The nurses are marvellous, there is not one I don’t like’, although a number of residents and their relatives said that there were insufficient staff to meet the needs of the residents currently in the home. A number of residents speak highly of the food: ‘There is a really good breakfast, you can have egg, bacon, fried bread – anything you want, the food is very good’. ‘The food is very good now’. The home has a competent manager and the home has robust systems in place to monitor quality, complaints and staff recruitment. What has improved since the last inspection? There were 10 requirements made at the last inspection and the majority have been met. The manager has now been in post for a year, and has worked hard to review a number of working practices in the home, as well as manage the refurbishment programme. The home has been significantly refurbished and redecorated, with new high quality furnishings, carpets, lighting and the provision of a coffee room and a shop. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 7 Health and safety considerations have been made; door retainers have been placed in all residents’ rooms and key areas in the home. These are activated by the fire alarms, when they close to offer increased protection. The manager has reviewed the documentation provided, to offer prospective residents an informed choice about the services provided at the home. Work has been undertaken on the care planning, and these documents have been improved to identify areas of risk and to guide staff in how to minimise risk. 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 Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 6 Quality in this outcome area is good. Documentation is available to inform prospective residents about the services provided, and residents’ needs are assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 1, 2 and 3 were assessed as part of the ‘themed’ inspection. This focused on the information available for residents about the care home, and the pre admission needs assessment that the home is required to undertake, to demonstrate that it can meet the needs of those residents admitted to the home. Homes are required to produce a ‘Statement of Purpose’ and a ‘Service Users Guide’ to provide information about the services they provide. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 10 Three residents were spoken with for all aspects of the ‘themed’ inspection. Two of the residents could remember receiving a copy of the ‘Users Guide’, one resident said that he probably did but could not really remember. The relative of one resident said that there was a copy in the bedroom. The service users guide has recently been reviewed to reflect the recent changes in the home and as well as each resident receiving a copy, there is one available on display in the reception area. All of the residents spoken with said that they received information on the fees payable. The manager said that the fees charged were based on a dependency assessment undertaken prior to admission. Prospective residents or their families are informed of the charge when the admission is agreed. The home also confirms this with the social worker or referring agent as appropriate. None of the residents spoken with could recall a contract with the home, although one resident said that she thought one was with her daughter. Files show that a contract is available in the home having been recently reviewed by the company, and the administrator is currently ensuring that all residents have an up to date copy of the terms and conditions. Two of the residents confirmed that they had been assessed by someone from the home, prior to admission. Records read show that residents are assessed prior to admission and that the assessment process meets the required standards and allows the home to make an informed judgement about whether or not it can meet the needs of prospective residents. One lady currently using the home for a short respite stay prior to going home was spoken with. She could not remember much about the assessment, but felt happy to stay in the home and felt that it met her needs on a temporary basis. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were assessed at this inspection. Quality in this outcome area is good. Care planning systems have improved and health care needs are well met by the home. Systems and procedures for the safe administration of medication are robust, but staff do not always fully respect the dignity and privacy of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three requirements were made at the last inspection regarding care planning, risk assessments and medication administration. These have been met although more could be done within the care plan to show that residents are being cared for in a way that suits their individual needs and preferences. The use of life histories would also demonstrate that staff have a good understanding of the resident and their individuality. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 12 Care plans read show that residents have been assessed and have a care plan in place that directs staff in meeting assessed needs. Areas of assessed risk are also documented and have been reviewed regularly. Health care needs are well attended to. The home has a visiting GP who comes to the home for a weekly surgery. During the inspection it was noted that residents were being supported to attend out patient appointments, and that there was good communication between the nurses and accompanying relatives. Medication systems in the home have improved. Comments had been received prior to the inspection that reflected concerns about medication administration; tablets found on the floor, residents being unsupervised in taking medication and residents being unsure of what medication they were taking. The manager has undertaken a review of medication systems, and a key nurse is now given some supernumerary time to monitor medication and audit its administration and checks balances. Records seen show that medication is being administered as prescribed, and there were no omissions noted. Some residents are prescribed ‘controlled drugs’, these are being stored and recorded following the home’s medication policies and procedures. On the day of the inspection medication was observed to be administered correctly. The home as part of its care planning procedures, consults where appropriate residents on their ‘end of life’ wishes. On one care plan read it was documented that the resident had expressed a wish not to be resuscitated. Recordings in the care plan to support this decision were not absolutely clear as to the circumstances supporting that decision, and if everyone involved with the resident was aware of the decision. The manager said that the home had followed correct policy, and that it was documented in the residents notes held by the GP. The manager must ensure that requests made by residents or relatives and medical opinion from GP’s and/or Macmillan and district nurses, are formally recorded and are clearly accessible within care planning documents and understood by all relevant parties. Where signatures are used to show that individuals have read and signed the care plan, it must be clear who this signature belongs to and their relationship to the resident. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 13 During a tour of the home, it was noted that some residents are cared for in their rooms with the door left open. The manager said this was so that residents could be observed by staff doing their rounds. A number of residents were notably very frail and their privacy and dignity was compromised using this practice as some residents had uncovered themselves, or were in need of personal assistance. This could be clearly viewed by anyone walking in the corridor. This was discussed with the manager during the inspection. Staff to protect the dignity of residents should be more attentive to their needs and less focused on completing tasks. During lunch a resident who found it difficult to eat his soup with a spoon, picked up his bowl to drink from it, resulting in him getting soup on his chin. This was not noticed or checked by staff and later in the afternoon, the soup was still visible, showing that he had not received a wash following his lunch. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were assessed at this inspection. Quality in this outcome area is good. Residents enjoy a lifestyle, which mostly satisfies their social and recreational needs. Meals are well cooked and presented with a choice available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs activity organisers, who between them work 60 hours per week. This is an increase in hours available since the last inspection and means that activities can be provided in the evening and at the weekend. A weekly activity programme is on display, and a copy is also given to individual residents. Activities available for the week of the inspection included: Music time, The Len Type singers, visits from the salvation army, an exercise session with creative mobility with the Christmas fair due to take place on the Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 15 Sunday. According to the programme there were no activities planned for Wednesday, and Saturday, and on some days there was only one session for the day either in the afternoon, or the morning. The manager said that the hairdresser and aromatherapist visit the home on a Wednesday and these are attended by many residents in the home. The activities organiser sends out a regular newsletter, which not only goes to residents in the home, but in to the Bede village complex. The newsletter informs residents about local events taking place, such as the supper club, the Christmas party and films shows. It also mentions residents who have a birthday coming up, and welcomes new residents. All residents receive a copy of the newsletter, but there is also one available in reception. On the day of the inspection an evening entertainment of singers and a quiz had taken place the night before. A number of residents said how much they enjoyed it, and talked about it together over lunch. Residents enjoyed a music session in the morning, but in the afternoon there was limited activity. Some residents sat together in the lounge / dining area, one resident sat in the library watching TV. A group of the younger residents played a game of dominoes. The senior member of activities staff was not on duty and records kept were unavailable for inspection, so it was not possible to see how residents’ involvement in activities is recorded, and if all staff are aware of how individuals personally and individually benefit. During the day a number of visitors were seen coming and going from the home. Some visitors spoken with during the inspection said that they were able to visit at any time. One resident spoke about her regular visits from her granddaughter, and how much she enjoyed going out in the car. The inspector ate lunch with a number of resident in the dining room. This has recently been refurbished, but is not yet completed as the kitchen is about to be refitted, and a serving area included into the dining room. The manager said that she was also awaiting the arrival of new tablecloths and napkins, which will improve the general presentation. A menu is displayed outside the dining room, and also in reception. The font used on the menu is very fancy and difficult to read. Lunch on the day of the inspection was: Tomato and beef soup, Liver and onions or a vegetarian mushroom dish, sauté and mash potatoes and fresh vegetables. One resident who did not like the menu choice had opted for a jacket potato and cheese. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 16 Comments about the food included: ‘I enjoyed mine immensely’. ‘The food here is very good’. ‘The food is excellent, varied well cooked and presented’. One resident said that whilst she quite enjoyed the food, it was not like ‘cooking your own, I’d like to see more cabbage and swede’. She said that she had never filled in a questionnaire about the food, or attended a meeting, so had not passed her comments on. The desert on offer was ‘Gypsy Tart’. No one knew what it was, and there was general chat around the table as to what it might be. A member of staff was asked, but she did not know either. On receiving it, one resident said ‘ Its cold and sweet, quite pleasant, but I don’t know what it is’. Residents would be assisted in making an informed choice about their food if staff were fully aware of what was on offer, and if the menu was clearer in presentation. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. Residents and their relatives are supported by procedures in the home that ensure they are protected from abuse. Systems are in place to complain should they need to do so, but not all residents are aware of the procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 16 was inspected as part of the ‘themed’ inspection process to review if residents in the home have enough information to help them make a complaint if they wish to do so. None of the residents spoken with said that they had seen a copy of the complaints procedure, but all said that if they wished to make a complaint that they would speak to one of the nurses and if not resolved would put it in writing to the manager. One visitor said of the manager ‘Louise is great and listens wherever possible’. The complaints procedure is included in the ‘Service Users Guide’. All residents are given a copy of this, and a copy is also displayed in the entrance hall of the home. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 18 The manager keeps good records of complaints received, and there have been three recorded complaints since the last inspection. The manager responds in writing to all concerns, and keeps records of investigations undertaken and the outcomes for the complainant. Formal complaints are sent to the home’s head office for the operational director to oversee and investigate. Procedures and systems for the home to respond to accusations of potential abuse are robust. Staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. A new employees information pack is about to be introduced, which gives staff copies of related policies and procedures, such as ‘whistle blowing’. The home has copies of both the Warwickshire multi agency policy for responding to abuse, and a copy of the Department of Health ‘No Secrets’ document. The manager is currently investigating a complaint received under POVA, and was seen to be handling this professionally and thoroughly. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26. Quality in this outcome area is good. Residents are provided with an environment, which is clean, safe, well maintained and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was one requirement made at the last inspection regarding the environment, and this has been met. Doors have been fitted with closures, which respond to the fire alarm, offering protection to residents. Richmond Lodge care home, has gone through a period of immense change and development since being part of Barchester health care. A significant amount of reorganising, and refurbishment has taken place, including the Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 20 provision of new furniture, carpeting and furnishings, and a change of use for some areas. The home is bright, cheerful and clean. The home employs maintenance and gardening personnel, it is well maintained, and the gardens are well kept and provide good additional outside space for residents to use. The final part of the refurbishment is due to take place in the kitchen in the New Year. The kitchen will be shut down and a new mobile kitchen erected temporarily. Staff in the kitchen are really looking forward to the improvements taking place and feel that it will further improve the food provision. There are mixed feelings from residents, relatives and visitors about the changes made to the home. Some people feel that there was insufficient consultation over colour choices, particularly in bedrooms. A number of people said that they did not like the change of lay out particularly in the dining room, and a number of people feel the home now looks like a hotel. Comments received both on the day of the inspection and in information sent to the commission includes: ‘Now the dining room has been divided, there is not acceptable and easy access for people in wheelchairs’. ‘Not sure if I like the dining room, too many twiddly bits’. ‘They are making the place look like a hotel, the wooden dividers make it difficult for staff to observe the residents’. ‘It looks like a hotel and has lost its homely feel’. Other comments received were more positive: ‘I’m very impressed with it I must say, my room is very good’. ‘I like the library it is very nice with lots of books which is great’. ‘I like it here its lovely’. Personal rooms seen were spacious and had sufficient room for manual handling equipment. One resident spoken with said that she could not use her en-suite shower, but the staff were very helpful and came and assisted her. Some residents do not have a lockable space in their rooms, but those residents spoken with said that this was not a concern as they used the home’s Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 21 safe, and locked the door to their room. One resident spoken with said that she had not been offered a key to her door. The company has employed an interior designer to oversee the changes in decoration to the home. It is very striking with a modern slant particularly in the choice of wall paintings and fabric choices and will not be to everyone’s personal taste, particularly some of the older residents in the home. The loss of photographs of the local area is missed by some of the residents who do not get many opportunities to get out. The company must also consider the high number of residents in the home with a dementia for whom the new surroundings are now unfamiliar and the impressionist artwork and choice of wallpapering may cause visual disturbance and distress. Comments were also received from residents and relatives about the temperature of the building, both on the day of the inspection and the evening prior. One relative said that the home was ‘always cold now’. A number of residents sitting in the lounge in the afternoon complained that it was cold, and felt mistakenly that a window was open. Radiators in the lounge / dining room, are fitted with radiator covers. On investigation, it was noted that there was little heat coming from the main part of the radiator, and minimal heat coming from the top. One resident also complained that the water in her room was only luke warm. Both of these comments were passed on to the manager who informed the maintenance staff. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were assessed at this inspection. Quality in this outcome area is adequate. Staffing levels do not always ensure that residents receive their care in the way they or their relatives prefer. Staff receive a good level of training and are generally competent in their role. Recruitment practices are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents in the home speak positively about the staff group. Comments received include ‘the nurses are marvellous, there is not one I don’t like’ and ‘every one here is confused, but the staff are very patient’. One comment card received reflected on how the staffs’ care had helped in a marked improvement in the health of a resident. Residents and relatives raised concerns, both on the day of the inspection and in comments received, about the staffing levels in the home and how this affects the care they receive. This was also a concern raised at the last inspection and a number of similar comments show that concerns have not been resolved. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 23 Comments received include: ‘Mum often has to wait a considerable time before anyone answers the bell especially at night. She is distressed when they come as she cant get to the bathroom unaided’. ‘There are never enough staff on duty’. They don’t have time to talk or read a book to residents, they are always rushing from one need to another’. ‘Waiting 2 hours for the toilet is a problem, and happens too often’. There were also concerns raised with the inspector, about the use of agency staff and the fact that this affected continuity of care and often created a situation of poor communication, with messages not being passed on. The manager said that the staffing levels agreed for the home are: two qualified nurses and nine carers for the early shift of 8am – 2 or 4pm dropping to seven carers from approx 4pm. The home has one qualified member of staff and four or five carers at night. Rotas checked show that the home aims to keep to these levels but sickness and absence sometimes means that these levels are not achieved. The manager said that there were a number of staffing problems at the moment due to long term absence, which had reduced the number of permanent staff in the home, so that the use of agency staff had increased. She is in the process of reviewing how the staff work. A new 4 week rota has been introduced as well as staff working in teams with allocated key workers and named nurses. The role of senior carers is also being reviewed to allow for more senior hours and accountability. It was noted on the day of the inspection that the levels of dependency in the home are high, with a number of very frail residents being cared for in bed, and using the hoist for manual handling. The use of the hoist will mean that two members of staff are caring for one resident at a time, and it was noted at the inspection that staff were busy and did not have time to interact socially. The home employs staff to undertake catering, laundry, domestic and house keeping duties in sufficient numbers and to cover 7 days per week. This should ensure that the care staff do not have to undertake non-caring duties and have sufficient time available. The manager must ensure that the dependency of the residents is taken into consideration when staffing the home, to provide a good level of care to the residents, which meets their individual needs. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 24 Training for staff in the home is improving. The introduction of the company’s ‘E Learning’ system will assist with ensuring that all staff have achieved mandatory training during the induction programme. A number of staff have commenced National Vocational Qualification (NVQ) in care. The home has an in house trainer in manual handling and first aid. The training matrix seen on the day of inspection was not up to date, but the manager identified where training courses have been attended, and what is planned for the next year. A number of staff have been part of a dementia awareness course via a distance learning programme. Staff files seen show that recruitment procedures are robust, and the required checks to ensure that staff are suitable to work with vulnerable people are undertaken. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is good. The manager is competent, and able to undertake her role. Residents live in a home, which is well managed, and their health, safety is safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for just over a year and is registered with the commission. She is a qualified nurse, and an experienced health care professional and manager. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 26 The manager has made some significant changes since she took up her post, particularly regarding management systems for monitoring quality, and staffing as well as managing the recent refurbishment programme. Some of the changes are still new, and the staff are adapting to the changes made. The home has systems in place to try and find out the opinions of those using the service. An annual audit via a questionnaire is undertaken, and the results of this are sent to head office. A report of the outcomes is sent to the home for the manager to share with staff residents and their families, and compile an action plan for improvements if required. Some of the questionnaires recently completed were read. Those completing the questionnaire are asked to mark areas of the service, good – poor. There were a number of positive responses received. Areas marked ‘poor’ were around access to visitors, food temperatures, and the laundry. The manager said she was aware of the concerns and was reviewing provision accordingly. The manager and heads of department, also complete monthly audits on different aspects of the service, for example health and safety, food and hotel services and the laundry service. The manager holds weekly ‘Heads of Department’ meetings. Residents / relatives meetings are held each quarter, the last one on 9th November 2006. Minutes are taken of these meetings and are made available. The manager keeps a file of thank you cards and comments received, and there were a significant number of positive responses seen, some from local social services. Systems to protect residents’ finances are now in place. Residents are now issued with individual wallets to keep monies held in the safe separate, and individual records and receipt are kept. The home and the company are very proactive in maintaining the health and safety within the building. Records seen show that checks of equipment, gas, electricity and water are undertaken as required. Chemicals and equipment are stored in such a way so as not to constitute a risk. Staff have received training in health and safety, manual handling and control of hazardous substances. Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 27 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 2 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 12 Requirement The registered manager must ensure that residents are cared for in a way that protects their privacy and dignity. The Company must review the policy in regard to palliative care and resuscitation. This must ensure that requests made by residents or relatives and medical opinion, are formally recorded and are clearly accessible within care planning documents. The policy should reflect current practice in regard to the involvement of emergency services. The registered manager must 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. This requirement could not be assessed. Previous timescale 30/06/06 DS0000004408.V320983.R01.S.doc Timescale for action 28/02/07 2. OP11 12 31/01/07 3. OP12 16 31/03/07 Richmond Lodge Nursing Home Version 5.2 Page 29 4. OP24 23 5. OP27 18 The registered manager must ensure that all residents are provided with suitable storage facilities. The registered manager must undertake a review of staffing to confirm that there are always sufficient staff available to meet the needs of the residents. Residents are to be regularly consulted in regard to staffing to ensure they are receiving the care they require. Requirement not met. Previous timescale 31/05/06 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP14 Good Practice Recommendations Wherever possible residents should be given an opportunity to make informed choice, this includes making sure information notices are accessible to all. A regular check of the temperature of the home should be undertaken to ensure that residents are sufficiently warm and comfortable, both in their own rooms and in communal areas. The manager is requested to confirm any plans in regard to the hot surface storage heaters in the home. OP19 3. OP38 Richmond Lodge Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Nursing Home DS0000004408.V320983.R01.S.doc Version 5.2 Page 31 - 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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