Inspection on 16/10/09 for Richmond Mews Nursing Home

This inspection was carried out on 16th October 2009.

CQC 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 CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richmond Mews Nursing Home 08/06/10

Richmond Mews Nursing Home 18/10/07

Richmond Mews Nursing Home 20/09/06

Richmond Mews Nursing Home 28/10/05

Richmond Mews Nursing Home 23/11/04

Richmond Mews Nursing Home 26/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Richmond Mews Nursing Home Richmond Terrace Shelton Stoke-on-Trent Staffordshire ST1 4ND Lead Inspector Wendy Jones Key Unannounced Inspection 16th October 2009 and 06 November 2009 10:00 Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Richmond Mews Nursing Home Address Richmond Terrace Shelton Stoke-on-Trent Staffordshire ST1 4ND 01782 222310 01782 209800 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) Shelton Care Limited Angela B Warrilow Care Home 48 Category(ies) of Learning disability (48) registration, with number of places Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 48 The maximum number of service users who can be accommodated is: 48 18th October 2007 Date of last inspection Brief Description of the Service: Richmond Mews consists of seven flats that surround a central courtyard as well as an additional semi-independent unit, situated across the road from the home and an eight-bedded bungalow, located across the main car park. Each flat is self-contained in that they each can accommodate between one or up to eight service users, have their own kitchen, bathrooms, lounges and dining room. All of the flats have single bedrooms with 15 of those having ensuite facilities. The home has a central laundry. Each flat, apart from the semiindependent unit, provides both nursing and personal care for young people who have a learning disability. The semi-independent unit provides personal care and support. The service provides care and accommodation for people who have a learning disability, and may have varying degrees of behavioural problems, a physical disability or mental health issues. Each flat on the main site has its own enclosed garden area. There is a car park to the side of the property. Richmond Mews is situated within a residential area of Stoke on Trent that is close to Hanley town centre and all local amenities. People are able to access day facilities at Regent College, part of the Richmond Care Homes Ltd, the newly established Networks group and Café Life. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 5 Prospective users of the service and their supporters should contact the provider for information about the range of fees and costs for the service. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection was carried out by one inspector over two days on 17/10/2009 and 06/11/2009. We were also accompanied by an expert by experience and his mentor on 17/10/09. An expert by experience is someone who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The National minimum standards for Younger Adults were used as the basis of the assessment of the service. Since the last key inspection of 18/10/2007 we have completed an Annual Service Review (ASR) on 11/09/2009. We do an annual service review when there has been no major inspection of the service (we call this a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review. An Annual Quality Assurance Assessment (AQAA) was completed and returned to us prior to the inspection and provided us with information about the service. The AQAA is a legally required self-assessment document containing information about what the service thinks they do well, what progress they have made since the last key inspection. What they think they could do better and their plans for improving the service over the next 12 months. Some information from the AQAA is included in this report. Prior to this inspection we sent out surveys to people using the service, staff, relatives and health and social care professionals. We have received 11 from users of the service, 2 from relatives, 6 from staff and 1 from a health care professional. Their comments are included in this report. During our inspection of the service we looked at a sample of care plans, risk assessments, daily activity records, health and medication records and other documents relevant to the inspection of the service. We spoke to people using the service and staff. The Manager was present during this visit. We were able to feedback a summary at the end of the inspection. We were also able to speak to the Human Resources and the Quality & Performance Managers. The service is divided into 8 flats and a bungalow, providing single person and shared accommodation. The quality rating for this service is assessed as 1 star, this means that people using the service receive ADEQUATE outcomes. We have made 5 requirements and 12 recommendations as a result of this visit. We have asked the service to complete an improvement plan to inform us Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 7 of the action they have taken to address the areas of concern we have identified. What the service does well: What has improved since the last inspection? We have been told in the AQAA that that service has, “Continued to develop Person Centred Plans for all users. Changed staffing hours to support a person who wanted to change his daily routine. Developed an Enterprise Centre that has given some Service Users the opportunity to be involved in work based activities.” Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 8 The organisation has created “café life” a project where users of this service and other services operated by the provider are involved in paid work. The service has developed the garden/patio area at the bungalow and has introduced a vegetable patch. The staff training programme has been improved. What they could do better: There should be improvements in how medication is managed so that people using the service can be confident it is managed safely. Referrals under the Mental Capacity Act must be made, to be sure that people’s needs and wishes are respected and their capacity to consent and make decisions is assessed. Decisions must not be made on behalf of people without proper consultation. Communication systems particularly in the bungalow need to be improved so that important information isn’t missed. The provider needs to be sure that staff respond to people using the service respectfully and as adults. The provider needs to review the service to ensure that routines in the home are not restrictive, that people have real choice and are supported to make decisions about their daily lives. Risk assessments need to be reviewed regularly so that people can be confident that they are up to date. Staff should receive regular one to one supervision sessions a recommended 6 times per year. People using the service say, “I’d like my bedroom decorated and my ceiling done.” “I’d like to be able to do more painting, and writing.” “I’d like to go out on more outings.” Staff said, “We could do with more staff to help with outings for people.” “We could provide more support for staff particularly the nurses.” The expert by experience said, “I was appalled to be told by 2 agency staff, that they didn’t know about people’s support plans. How can they possibly support people appropriately if they don’t know about their care plans?” He also said, “In general the people who live at Richmond Mews do not seem to socialise with anyone outside of the home and do not do many things out in Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 9 the community. All of the flats are behind locked security gates, which I found really strange considering they are people’s homes.” If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service have the information needed to decide if the home can meet their needs. EVIDENCE: The service has told us in the AQAA that, “We develop comprehensive care packages and risk assessments following a thorough assessment of individuals needs. We complete an in depth transition period where possible and all this is documented. Prospective users of the service are given a service user guide and Statement of Purpose prior to admission and opportunity to discuss the contents with staff and other users during the transition process.” We looked at the records of one person who has been admitted since the last key visit. We saw evidence of pre admission information and evidence that the individual had been involved in some aspects of the decision to move into the home. We saw evidence of a review of the placement with a social worker, the person using the service and their supporters. We saw a copy of the Statement of Purpose for the service in the main foyer of the home and have been told that people using the service, have copies of a Service User Guide. We have been told that the Statement of Purpose is being Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 12 developed in a format that is more user friendly using pictures and simple language and an audio copy of the information will be recorded onto a compact disc (CD). The fee range and costs of the service should be included in the Service User Guide. The expert by experience said, “Richmond Mews is home to 48 people with learning disabilities and complex needs. The home is made up of several flats and a bungalow. I didn’t find the location of Richmond Mews particularly easy to find. When I did manage to locate it I found the site rather big and it wasn’t easy to find the way in. When I found the entrance I rang the bell and was greeted by a member of staff. The inside was very big with long corridors and the décor was very plain. It seemed to have a clinical environment rather than a homely environment and I didn’t find it very inviting at all.” Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be involved in making decisions about their lives and play an active part in planning the care they need. They also need to be confident that the staff who support them know what their care needs are. EVIDENCE: The service told us in the AQAA that, “We fully involve people who use the service users appropriate, in monthly reviews of their care plans and risk assessment. Encourage involvement in flat meetings where appropriate. Encourage full participation in making choices and expressing needs and making decisions.” We saw the records of four people living at the home. Care plans are in place and appear to reflect the assessed needs of individuals. In one example we saw how the person has been included in some aspects of care planning, by Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 14 noting that the care plan had been signed by her. But we couldn’t tell from other records if this is a matter of routine. We saw that not all care plans have been reviewed as frequently as the records say they should. There are many examples of this. For one person admitted since the last key inspection the service has yet to complete a 24 hour plan of care, an integral element of PCP. The 24 hour plan details the individuals preferred routines/ events through a day, the nurse in charge confirmed this has yet to be completed for this person who has lived at the home for 9 months. We have been told that the service is reviewing the Person Centred Planning model it uses, to ensure that the plans highlight the goals and aspirations of the individual. This is an element of the process that needs to be improved. The expert by experience said, “I asked two female staff members about the care plans for the people that live there but one of them replied “we are both agency staff so we can’t answer that’’ so she went to fetch the manager. I don’t agree with using agency staff and I was appalled to hear they didn’t know about people’s support plans. How can they possibly support people appropriately if they don’t know about their care plans? Next I went to visit 2 ladies who lived in flats next door to each other. There were 2 female staff members who offer one-to-one support to the two ladies. I spoke to both about care plans. They were not accessible but both ladies had been involved in writing their care plans and they had signed them to say they agreed with them.” We saw risk assessments have been completed most have been reviewed on a monthly basis, but some had not and we couldn’t be sure, because of this if they are up to date. We couldn’t see evidence that people using the service had been involved in the risk assessments we saw. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 15 Lifestyle The intended outcomes for Standards 11 – 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service must be confident that that are able to make real choices about their lives, and feel socially valued. EVIDENCE: The service has told us in the AQAA that, “We encourage full participation in menu planning and food preparation. People using the service have a wide range of activities they can access and encouraged and supported in using local amenities i.e., shops, library, pubs and social groups and encouraged to use public transport to access. We also ensure that people have an opportunity for an annual holiday if they wish to. We support people using the service to maintain relationships with family / friends and employ appropriate staffing levels to support people to participate and appropriate leisure activities.” We looked at the activity records of four people using the service. We could not Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 16 be confident from the information available to us that the service is meeting the needs of people as it says it does in the AQAA. In one example we couldn’t see that the indivdual had been out of the home at anytime other than to attend the day centre or for health appointments. The nurse in charge stated that this person has regular weekly visits from a friend and does go out with the day centre. In another example the records show the individual spends long periods of time listening to music or watching DVDs, this is noted in the assessment for the indivdual, but there aew few records of other activities. We looked at a sample of 1 months records for another individual, we saw that this indivdual had listened to music on 9 occasions, watched a DVD on 3, been in the garden once, attended Networks (the day centre) 6 times, had been swimming and to a disco once, The expert by experience said, “3 of the people who lived in one flat were at home when I visited. They were sat watching the TV when I went in. A member of staff told me that they had been to the pub for lunch and that some of the others who lived there were at a disco that they go to every Friday afternoon. This disco is part of the daycentre that they go too. I found it strange that people go to a disco in the afternoon, why can’t they go in the evening? Also it is a disco just for people with a learning disability, why can’t they go to disco’s with people who haven’t got a learning disability? Whilst I was in this flat a member of staff asked one of the ladies who lives there to dance for me. There was no music playing at the time and the lady clearly did not want to dance. I was really shocked by this. Why would the lady want to dance for me? The member of staff spoke to her like a child and embarrassed her in front of me and my supporter. The same member of staff also asked this lady to give her a kiss. It is totally unacceptable for a staff member to kiss a resident. One person asked for a drink and the same staff member replied “we don’t have drinks until 3 o’ clock”. I think this is terrible as both me and my supporter had been offered drinks and were drinking them in this lady’s home. The residents should be able to have a drink whenever they want to in their own home. This gave me the impression of it being an institutionalised setting rather than a home. I saw the menu which had no pictures on it but the member of staff told me they were going to get pictures to put in it. The menu was done every four weeks which seems like a long time to me? How do you know what you are going to want to eat in 3 weeks time? I was told that people make their own drinks with supervision but after hearing a lady being told she couldn’t have a drink until 3pm I don’t know if this actually happens or not. I was told that Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 17 people help to prepare their meals if they are able and help to clean the flat but I did not see any evidence of this happening. The ladies choose their activities on a weekly basis which is good and they can be flexible if they don’t want to do something. One lady told me she does painting, goes to college, the daycentre and does movement to music which is a form of exercise. The ladies had been to Blackpool and London and one lady showed me some of the things she had bought for her flat whilst she was in London. Both the ladies told me that they socialise with people from the other flats and have takeaways with them. Both these ladies seem very able to me, why can’t they go out and socialise in the community in the evenings? Another person told me he had recently been to Centre parks, which he enjoyed and that he was going to Blackpool the following day. The man told me he cooks his own meals with support and he cleans his own flat. I was pleased to hear this. The man also told me he has a lot of contact with his family and sees them most weekends. I asked the man if he goes out in the evenings and he said no, he does socialise with the people from the other flats though. This man is young and very able he should have the opportunity to go out and socialise in the community in the evenings not just with the people who live in the surrounding flats. In general the people who live there do not seem to socialise with anyone outside of the home and do not do many things out in the community. All of the flats are behind locked security gates, which I found really strange considering they are people’s homes.” Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be sure that their health and medication needs are appropriately managed, to ensure their well being. EVIDENCE: The service told us in the AQAA that, “We follow robust systems to ensure correct administration of medicines, recording and storage and disposal. Support individuals in self-administration of medication. All individuals have a personal health file and that contains all health information and recordings which is taken to all health appointments. Each has a Health Action Plans, Care Plans and Risk Assessments that are reviewed monthly.” We looked at the health records of two people. We saw that staff act to ensure that they receive medical attention and attend hospital appointments. We saw that there is regular liaison with health professionals and district nurses at the bungalow. We saw one person’s care plans regarding diabetes and healthy Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 19 eating that contained conflicting information, and saw that weekly blood sugar levels and blood pressure checks have not always been carried out as frequently as the plan says they should. We saw a record in the care records that one person had been seen by a health professional on 14/10/09 and requires antibiotics. We spoke to the nurse in charge about this. She stated that she wasn’t aware of this. We looked at the diary and couldn’t see a records relating to antibiotics. We asked the nurse in charge to contact the GP surgery to ensure that a prescription had been requested. We found a supply of unnamed paracetamol 500mgs, where 12 tablets were left from a supply of 32. We could not find records for the medication that had been used. The nurse in charge stated that all the service users in the bungalow are prescribed liquid paracetamol; therefore the tablets would be for staff use. We saw that one person is prescribed paracetamol 250mg/5ml suspension but there is none in stock. We looked at medication in Flat 5 and the bungalow. As a concern has been raised around medication, we have not been able to undertake a proper audit of as required medication because the records of medication received in the home and carried forward are insufficient. We saw that as required medication is not always being signed for properly, in one example we saw from care records that as required medication had been administered but the Medication Record (MAR) had not been completed. We saw that out of date medication has been administered to one person, we asked the nurse in charge of the bungalow to dispose of it immediately. We are concerned that medication is not being properly managed at that people may be at risk because of this. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have received training in recognising and reporting suspected abuse but people using the service need to be sure that this is reflected in practise. EVIDENCE: The service told us in the AQAA that, “All staff receive yearly POVA training. CRB Checks are carried out on all staff prior to employment. All staff are issued with a complaints policy / whistle blowing, policy on induction. Pictorial complaint procedures are situated in view of service users around the Home. A copy of the complaints procedure and how to contact CICS is sent out to family and friends on a yearly basis along with a questionnaire.” 8 out of 11 people who returned surveys said they know how to complainant and who to go to if they have any concerns. We are aware that there have been five safeguarding referrals since the last key visit, one related to concerns about the service’s alleged failure ensure that one person had up to date care plans and information in place for one person who was subsequently admitted to hospital allegedly dehydrated. There as also been allegation of abuse by a person using the service and staff failure to recognise and report it under safeguarding procedures, the allegation was investigated and found to be unfounded. But the manager agreed to ensure that staff have training updates. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 21 A member of staff has been dismissed following allegations of inappropriate management of challenging behaviour. An allegation by a health professional of alleged inappropriate restrictions placed upon an individual after exhibiting challenging behaviour has been investigated. An allegation by a relative of alleged abuse of a user of the service has been investigated, outcome unfounded. We have received one complaint about this service, and have made 3 safeguarding referrals because of the information we received. Areas of concern referred under safeguarding procedures include, failure by the service to properly consult with the local authority to establish an individual’s capacity to make decisions, prior to fitting a cctv camera in a single person flat. Concerns about the services alleged failure to follow medical advice for one person who had a change in medication. Alleged excessive restraint for one person in Flat 5. We agreed with the local authority to look at these matters during this visit. We found that the service had fitted a cctv camera without consultation; the manager confirmed that this had been done approximately 6 months earlier. The manager has now made a referral under Mental Capacity Act. We did not find evidence of excessive restraint for the individual in flat 5, but noted that risk assessments had not be reviewed as regularly as they say they should be, therefore we could not be confident that they are up to date. We found that an individual had been prescribed medication and the service had been asked to monitor his pulse weekly. We saw from the records that staff had not recorded the pulse rate as often as they were asked to do. Other concerns raise by the complainant were looked at during this visit, they include an allegation of institutional practise. We found evidence during this visit of examples of this, ie people using the service being told they can’t have a drink until 3pm and being treated as children. Allegations of poor medication practice; we looked at this and found that there are some areas of medication practice that must be improved. See personal and healthcare needs. An allegation that new staff are not being provided with good role models or proper leadership. We spoke to two new staff who stated that they had received an induction into the home and felt able to go to senior staff if they were uncertain about how they should manage situations. But they also confirmed that they haven’t received regular supervision sessions. Alleged poor quality of life issues ie activities, we found despite some improvements in opportunities for people ie Networks and Café life, there are some individuals who are not experiencing good outcomes in this area. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 22 We have liaised with the local authority Safeguarding co-ordinator, who has confirmed that the manager or deputy of the service have attended safeguarding meetings and have acted upon any recommendations that have been made. The expert by experience said, “I asked how people can complain if they are not happy about something? The staff member told me that they have lots of forms to make complaints as they are a big company. I asked who fills the forms in and she said it is the staff. There are not any complaints forms for the residents. I asked the ladies who they would tell if they were not happy about something. They both said they would tell the nurse in charge. I asked one person whether he was happy living there. He told me that he gets annoyed with the noise coming from the people who live in the flat above, as it causes him to lose sleep. Whilst I was there I could hear the people in the flat above and it was very noisy, the ceiling was shaking. During my visit the man became quite upset and he told me that he wanted to move. I was quite concerned about this but his support worker explained that he has mentioned moving before but always changes his mind. I think this should still be looked at again though. I asked the man who he tells when he is not happy and he said the Manager and he tells his Dad. It is good that he can go and tell the Manager but if he is not getting what he wants then he should be able to get help from an independent person like an Advocate.” We spoke to the manager about this individual, she confirmed that he had raised concerns previously and they had been looked into. There is a need to make a referral for a review and assessment of Mental capacity, if this individual is saying that he is not happy at the home and wants to live some where else. And the service should act to resolve his concerns about excessive noise. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a safe environment that is generally well maintained and decorated. EVIDENCE: The service told us in the AQAA that, “We assist individuals in choosing and furnishing their rooms to their own personal choice. Infection control and health and safety training is provided to all staff, and cleaning rotas are easily accessed and regularly reviewed to ensure the environment is safe, clean and hygienic. We have now allocated 2 link nurses for infection.” At the last key inspection visit we said, “All Flats have their own entrance, but access to the main reception and entrance is from the car park, through the garden areas of two Flats. This route potentially has an impact on the security and privacy of residents. Although not ideal, this was discussed with the care manager during the visit.” We observed that no significant changes have been Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 24 made in this area during this visit. We visited The Bungalow and note that a patio area has been developed since the last key visit. This building has been purpose built to provide for people with physical disabilities and use wheelchairs. We saw that the lounge/dining area is open plan; we saw that bedrooms are spacious and bathrooms have adaptations. We saw one person’s bedroom, it is personalised and homely. We visited Flat 5, the main entrance to this flat is from a rear garden, that is surrounded by metal railings. We said at the last key inspection, “The garden area, (as all of the gardens to the rear of the property) had very high metal railings around it, providing residents with a safe, enclosed area. This structure had been created some considerable time ago when the service was intended for residents with quite different needs. Whilst it was accepted that the safety of residents was of paramount concern, it was suggested that efforts could be made to improve the appearance of the railings and to present the area as a garden rather than a secure compound. This recommendation applies to all of the garden areas to the rear of the main building. This has not changed since the previous inspection.” The environment in Flat 5 is not as homely as other flats, and has been audited recently. We have been provided with a copy of the outcome of the quality audit and have spoke to the Quality Manager about it. A number of concerns have been highlighted and an action plan has been developed. The quality manager has stated that some things for prompt action have been addressed. Other improvements are in the process of being undertaken. The expert by experience said, “Richmond Mews is home to 48 people with learning disabilities and complex needs. The home is made up of several flats and a bungalow. I didn’t find the location of Richmond Mews particularly easy to find. When I did manage to locate it I found the site rather big and it wasn’t easy to find the way in. When I found the entrance I rang the bell and was greeted by a member of staff. The inside was very big with long corridors and the décor was very plain. It seemed to have a clinical environment rather than a homely environment and I didn’t find it very inviting at all. The home is very big and although it is split into smaller flats it still appears to be treated as one home, which concerns me. I went to visit 2 ladies who lived in flats next door to each other. Both ladies told me that they chose their own décor and their flats were really personalised. Finally I visited a young man who has his own flat. To get to his flat I had to go through lots of gates that were locked and you needed a swipe card to get into them. This felt very strange and did not feel like someone’s home at all. When I entered the man’s flat I was pleased to see that his surroundings were Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 25 much personalised. He said that he had chosen all of the décor himself, which is good. He also had lots of Manchester United things, which is the team he supports.” Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff who have received the training they need to provide the support people need, but can’t be sure that this translates into practice. EVIDENCE: The service has told us in the AQAA that, “When recruiting staff, consideration is given to the balance of skill mix within the team. We provide new staff with induction to the Home and service users and an induction booklet to work through over 13 week probationary period. We provide all staff with ongoing rolling training programmes. Staff are offered the opportunity to complete NVQ and 75 of staff have achieved or are working towards NVQ. Monthly staff meetings held to discuss any clients needs identified, issues, concerns and to share ideas for improvement. We follow robust recruitment procedures. All staff are CRB and POVA checked. Staffing levels are appropriate to the needs of the service users.” Staff have told us in surveys, “ We provide a good standard of support and Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 27 proactively act to anure people receive the care they need.” “We could do with more staff to help with taking people on outings.” We spoke to staff in flat 5 about staffing levels they said, “It would be better if we had an extra staff during the day, so that we can take people out more often and for longer.” The manager said that there are a number of vacanies at the home and agency staff have been used recently. A recruitment drive has resulted in 4 applicants who are awaiting pre employment checks before thay can start.” We spoke to staff in Flat 5 about one to one supervision sessions, and have been told that supervisions have not taken place as frequently as we recommend they should or as often the provider expects them to. One member of staff said, “My last supervision session was 7-8 months ago, but I’ve been told I’m having one soon.” We have been provided with a record of staff training and supervision this confirms that supervisions have not routinely taken place . We looked at the staff training matrix and spoke to the manager about training, there is evidence that improvements have been made to the training opportunities staff have access to. We checked 4 staff recruitment records and found that they are properly maintained, with evidence that all pre employment checks are carried out before new staff commence working in the service. We commented that there could be improvements in how people are interviwed as three records show that individuals have been interviewed by one manager. We could not be certain that this complies with statutory legislation regarding equality. There is no evidence in the records that people using the service are involved in the recruitment of staff. The Human Resources Manager informed us that improvements have been made to recruitment procedures since the last key inpsection, including requiring agencies to confirm that all per employment checks have been carries out for the agency staff the service uses. And asking the manager of the service to provide evidence that nurses are maintaining their professional registration. A checklist is completed for each new staff and copied to the manager on completion to evicend that all pre employment checks have been received. The expert by experience said, “During my visit the phone rang in one person’s flat and I was surprised to see that his support worker answered the phone rather than the man himself. I would expect to see his support worker to encourage him to answer his own phone. The support worker handed the phone over to him as it was his relative on the line. The support worker was Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 28 trying to cut his conversation short by saying ‘’tell your relative that you are busy and that you will call him back later’’. The support worker then put the phone in his pocket and said “you can have that back when you have finished”. This gave me the impression that the support worker may have control over the man who lives there. At one point the support worker said to him “be quiet and talk to your visitor not me”; the man should not be spoken to like that. I was shocked to see the support worker from the flat next door walk into the man’s flat without even knocking the door which I felt was very ignorant as he wasn’t respecting the privacy of the man who lives there. The man’s support worker replied “hey get out of my flat’’. I was surprised that the support worker was referring to the flat as his own and not the man’s who lives there. I would expect him to respect this.” Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be know that policies and procedures are acted upon to be confident that their needs are satisfactorily met. EVIDENCE: The registered care manager has a nursing qualification RNMH and had achieved the Registered Care Managers Award. She has managed the service for a number of years and is very experienced. The AQAA was received when we asked for it, and contained information about what the service does well and how it intends to develop. It confirms that policies and procedures required by regulation are in place, and had been reviewed. But we have found that information in the AQAA does not always reflect what the service is actually doing. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 30 The organisation has introduced a Quality Cycle approach to driving forward improvements in its services. A quality team undertake audits of services and produces a plan of action to improve each home based upon the outcome of the audit. An Audit of flat 5, Richmond Mews was undertaken on 22/09/2009, significant concerns were identified around Medication Management, Environment, Infection Control and Record Keeping. We have been provided with copies of action plans and evidenced through this visit that some progress has been made in addressing the deficits identified. We saw that risk assessments are in place for individuals, that person centred planning has been introduced and the service continues to think of ways to make this more user friendly. But we are concerned that person centred approaches are not always understood and put into practice by staff. We saw in the AQAA that policies and procedure are in place and have been reviewed this year. Safeguarding procedures are in place and staff have received training, MCA and DOLS training is being provided. There is a need to ensure that staff understand their responsibilities to recognise and report suspected or allegations of abuse and make referrals under MCA when necessary. We saw in the bungalow that a cross corridor fir door was not closing too properly. We asked the nurse in charge when it was last checked, but she said she didn’t know. We asked where the records of fire alarm checks are kept, but she didn’t know. We asked the manager to take immediate action to ensure that the fire door closed properly, she stated that the fire alarms are checked by the maintenance person. Following this visit we consulted the fire officer, he has visited the home and has confirmed that he is satisfied that fire safety procedures are now being followed at the home. We looked at financial records during the visit to the bungalow, and found them to be accurately maintained. The service has reported most incidents and accidents to us since the last key inspection. We have asked that the manager ensure that accidents that result in an individual receiving medical treatment are also reported to us. We found a record of one such accident that we haven’t been notified of. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 4 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 3 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 3 2 3 x x 2 3 Version 5.3 Page 32 Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The provider must ensure that medication is managed safely. To be confident that people using the service are not at risk. 2. YA20 13(2) The provider must ensure that medication is accurately recorded. To be confident that medication is administered as prescribed. The provider must ensure that out of date medication is disposed of. 16/01/10 Timescale for action 16/01/10 3. YA20 13(2) 16/01/10 4. YA23 12 5. YA6 12 To be confident that it is not administered. The provider must ensure that 16/01/10 referrals are made under the Mental Capacity Act, to ensure that people’s wishes listened to and acted upon. The provider must ensure that 16/01/10 all staff know what people’s care plans say. To be sure that people are being provided with the support they need. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Refer to Standard YA20 YA13 YA16 YA7 YA34 YA36 YA23 YA42 YA24 YA19 YA9 YA6 Good Practice Recommendations Staff should receive update and refresher training for the safe Management and Administration of Medication. The service should continue to develop opportunities for people using the service to be involved in meaningful activities both in and out of the home. The service should ensure that staff receive guidance re valuing people and promoting people’s rights as individuals. To be sure the people are treated with respect. The service should provide staff with refresher training in relation to person centred planning and implementation. The service should be more proactive about how people using the service can be involved in the recruitment of staff. The service should ensure that staff receive regular one to one supervision. To be sure that have the support they need to carry out their role. The service should ensure that we (CQC) are notified of all significant events in the home, including accidents requiring medical intervention. The service should ensure that weekly fire checks are carried out and any problems reported and actioned promptly. The service should continue to look at how the appearance of the exterior of the home ie the railings can be improved. The service should ensure that health checks are carried out as often as they are instructed. To be sure that people’s health is being monitored properly. The service should ensure that all risk assessments are reviewed regularly. To be confident that they are up to date. The service should ensure that care plans are reviewed regularly. To be sure they provide an accurate account of the individuals needs. Richmond Mews Nursing Home DS0000026961.V378657.R02.S.doc Version 5.3 Page 34 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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