Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 18/10/07 for Richmond Mews Nursing Home

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

This inspection was carried out on 18th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Most of the standards were met with some requirements and minor recommendations to consider in regard to developing the service. There was evidence that a number of environmental and fire safety issues which had previously been identified, had now been resolved

What has improved since the last inspection?

A number of flats had been redecorated and some new furniture purchased. Fire Safety matters identified at a previous inspection had been resolved and addressed, including regular and recorded fire drills undertaken by individual staff members. The Fire alarm system had been updated and a buildings compliance certificate had been issued. The Statement of Purpose and Service User Guide had been reviewed. The organisation undertakes it`s own monthly quality audit of the service.

What the care home could do better:

A quality audit system had been introduced. The information seen demonstrated that the organisation was determined to continually improve its service delivery. However, dates need to be included on the feedback received, to evidence when surveys and audits are actually undertaken. The Care Manager must contact the Fire Officer to confirm Fire compliance since the completion of the work on the Fire alarm system. There had been two incidents reported since the previous inspection, in which the management of medication had been highlighted. It is recommended that update and refresher training is undertaken for all staff. The registered person must ensure that the environment in which service users live is maintained to a satisfactory standard of decoration and furnishing, this applies to Flat 5. The service has been considering introducing Person Centred Planning (PCP) for some time, and will be introducing PCP for all new service users. Some elements of PCP have already been introduced for existing residents. It was recommended that person centred planning is introduced, and that staff should receive training in that area. The appearance of the rear garden areas should be improved to provide a more home like environment.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Richmond Mews Nursing Home Richmond Terrace Shelton Stoke-on-Trent Staffordshire ST1 4ND Lead Inspector Pam Grace Key Unannounced Inspection 18th October 2007 10:00 Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richmond Mews Nursing Home DS0000026961.V347492.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 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) Richmond Care Homes Limited Angela B Warrilow Care Home 48 Category(ies) of Learning disability (48) registration, with number of places Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. LD aged 18-60 years on admission Date of last inspection 20th September 2006 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 service users 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. Service users are able to access day facilities at Regent College, part of the Richmond Care Homes Ltd and the newly established Networks group. Weekly fees range from £333.00 to £2,962, and are subject to annual review. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key unannounced inspection carried out over a period of 3 days between 18th October 2007 and 25th October 2007 this included a feedback session to the registered manager. The inspection methodology included pre-inspection surveys sent to residents and relatives, i.e. Have Your Say documents; The completion of the Annual Quality Assurance Assessment (AQAA) by the care manager. It also included inspection of the environment; discussion with residents, care and nursing staff and the manager; inspection of care records and other documents pertinent to the inspection process. Observation of interactions, care delivery and practice, and medication management systems were also noted. The stated philosophy for this service includes “ a needs led service which is tailored to meet the requirements of each individual,” “to create a therapeutic, safe and stimulating environment, where self-help skills and achievement are actively encouraged.” The service provides care for residents who have mild to profound learning disabilities, a dual diagnosis of learning disability and mental illness, challenging behaviour, physical disabilities and sensory and communication difficulties. Residents living at the home receive assistance and support, which is given in regard to all aspects of everyday living. Residents who have a sensory impairment and or special communication needs have their needs met. At the time of the inspection visit, there were 43 residents living at the home, with dependency levels ranging from high to low. The service has 8 flats and a bungalow. The care manager confirmed that: Flat 1 accommodated 6 residents with severe learning disabilities and limited communication, aged between 27-55 years and all required support with selfhelp and personal care. Flat 2, accommodated 8 residents with moderate learning disabilities, some were in receipt of nursing care others were funded as residential. Good verbal communication, support and prompting when meeting personal care needs some intermittent challenging behaviour experienced. Flat 3, accommodated 8 residents, most were funded as residential care, aged 35-50 years with low dependency needs. Flat 4 offers up to 4 residents with individual units, currently 2 residents are accommodated at the time of the inspection. Those residents were described as exhibiting challenging behaviour. Dependency was low in relation to selfhelp and personal care, good levels of communication. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 6 Flat 5 accommodates 5 residents aged 19-30years with a diagnosis of autistic spectrum disorder and challenging behaviour, high levels of support were required, communication was variable, some residents used non verbal communication systems others had verbal communication skills. Flat 6 provides accommodation for 1 resident in their own flat as does Flat 7, each resident was of low dependency requiring some prompts and encouragement to meet care needs. Flat 8 was described as the semi-independent unit. This unit accommodated 5 residents aged 30-50 years, who required a little prompting with personal care, and were encouraged to make their own decisions about their every day life. The Bungalow has 8 beds but was accommodating 7 residents at the time of this visit, residents living at the bungalow were described as high dependency, with severe learning disabilities and communication difficulties, required a high level of care to meet their personal and support needs. The areas inspected on this occasion were all flats, apart from Flats 6 and 7. Residents spoken with during this visit made a number of comments, such as “It’s a nice place to live”, I can go to my key worker if I need to” “ I can tell staff if I’m not happy and they help me”, “ I like the staff”. The observation of interactions between staff and residents made during this visit, showed good rapport and relationships exist between residents and staff. Care staff were observed working 1:1 and 2:1 with some residents, in a planned way, which reflected the resident’s behavioural care plan. The fee range for accommodation and care at this service was reported to range from £333 to £2,962 per week, and are subject to annual review. What the service does well: Most of the standards were met with some requirements and minor recommendations to consider in regard to developing the service. There was evidence that a number of environmental and fire safety issues which had previously been identified, had now been resolved. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 8 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 Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 4 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people who use this service and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: Copies of the up to date Statement of Purpose and Service User Guide were available in the home in service users’ care records, and a copy was provided to the Commission for Social Care Inspection. The care manager confirmed that social workers and residents’ representatives are also given copies of these documents. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 11 A sample of the service users guide showed that fees are recorded, and also the amount of personal allowance allocated. There was evidence that residents had signed their own copy of the guide. It was highlighted at the previous inspection that bedroom sizes for all flats should be included in the Statement of Purpose. This information has subsequently been added. Pre-inspection feedback was requested via “Have Your Say” surveys sent to individual residents by CSCI. However, there was a poor response, and there was only one comment received by the Commission for Social Care Inspection (CSCI) from a relative. However, care plans sampled showed records of preadmission information. These demonstrated that the service provided good transitional arrangements for residents, and there was evidence of preassessment information, pre-admission meetings with the previous care provider (if applicable), the resident and their family. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives. And play an active role in planning the care and support they receive. EVIDENCE: The aims and objectives of the service recognise the right of individuals to take control of their lives, and have the opportunity to make decisions and choices, supported by the home. Each resident has a care plan, which is focussed on person centred practice. The care manager confirmed that they involve people Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 13 who use the service in the development and review of the plan as much as is possible. Care plans sampled evidenced that residents’ needs were being met. The plan included the information necessary to plan the resident’s care and included appropriate risk assessments. When developing the care plan, the home has complied where possible with relevant social care guidelines this has recognised the specialist nature of the care required for some residents. Care plans sampled showed that they had been reviewed on a regular basis. In some care plans there was not always clear evidence that service users had been involved in care planning or reviews. This was highlighted by the inspector and discussed with the care manager at the time. Care plans seen had been signed, either by the named nurse/ key worker and or the resident. Pen pictures and “an ordinary day” documentation had been introduced for all residents, the quality of the documents varied, with some providing a very detailed insight into the preferred routine and lifestyle of the individual. The inspector discussed the need for consistency in regard to the documentation used. The service has been considering introducing Person Centred Planning (PCP) for some time, and will be introducing PCP for all new service users. Some elements of PCP have already been introduced for existing residents. It was recommended that person centred planning is introduced, and that staff should receive training in that area. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17 - Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 15 People who use these services are able to make choices about their life style, and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: There was evidence from discussion with residents in flat 8, that they were able to access local facilities independently, they gave examples of trips out, visiting local shops, food shopping, and the library, and confirmed that they also use public transport. However, more opportunities for community involvement for residents could be researched by staff, then planned and discussed with residents. Access to the local community was limited for some of the residents in flats 4 and 5. They tended to utilise specialist services such as the organisations day centre and college. Samples of activities records, showed activities undertaken by residents whilst in the home. Those records showed that some residents spend some of their time occupied in sedentary or passive activities such as watching television or listening to music. Or are taken out of the home for shopping trips or drives out. Meal planning, food shopping and cooking also form part of their day. As with residents in Flat 8, more opportunities for community involvement for residents could be researched by staff, then planned and discussed with residents. Information provided from discussion with staff and residents and from records seen showed that where residents had family links the service sought to ensure that those links were maintained. Residents spoken with during this visit made a number of comments, such as “It’s a nice place to live”, I can go to my key worker if I need to” “ I can tell staff if I’m not happy and they help me”, “ I like the staff”. The observation of interactions between staff and residents made during this visit, showed good rapport and relationships exist between residents and staff. Staff were also observed working 1:1 and 2:1 with some residents, in a planned way, which reflected the resident’s behavioural care plan. During discussion with the care manager about a complaint, a potential risk area around family contact had been identified. This was discussed with the care manager in the light of the complaint, and the actions taken to resolve the issues, given the level of need of the resident. The majority of residents had been on a holiday or for a short break. Some residents spoken with were able to confirm this with the inspector. In conjunction with the local College, the organisation had produced healthy eating files for each of its homes. The files provided staff and service users with some very good information relating to food hygiene, infection control, Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 16 healthy eating and basic nutrition. It also gave examples of healthy meal choices and recipes for some meals. Special dietary needs were also included in the information. The information is provided in each of the flats to educate residents, and to promote good practice guidance for staff. Changes had been made in the way in which residents purchase their food. Residents and staff plan the following weeks menus, they shop daily with residents for fresh food, and also order dry foodstuffs and tins via the Internet for delivery at a pre arranged time. This saves residents and staff from needing to carry large and heavy food items, and enables a more focussed learning opportunity. Residents and staff work together, they continue to shop for specific items of food i.e. fresh food, vegetables and meat as required. Feedback from residents and staff in relation to this way of planning, shopping, preparing and cooking meals was positive. Wherever possible residents are actively involved in all aspects of food planning, food shopping, food preparation, cooking and clearing away following a meal. The inspector noted that not all residents enjoy doing chores, i.e. washing up and clearing away. Some residents have the opportunity to participate in food preparation and cooking on a 1:1 ratio. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 - Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: There was a poor response to the “Have Your Say” Documents that were sent out pre-inspection by CSCI. There had been only 1 comment card received from a relative, which had been very positive. However, verbal feedback received from residents and staff during the inspection visit was very positive. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 18 A sample of residents’ health records showed that their health and nursing needs were being met. The records showed regular health appointments with primary health providers and input from other specialist health services. The nursing staff arrangements in the newest unit were discussed with the care manager. It was suggested that this situation is kept under review to ensure that the nursing needs of residents can be met. The manager stated that the current nursing needs of residents on this unit were being met. The organisation employs it’s own behavioural specialist nurse to offer advice and guidance to staff re appropriate behavioural management. Behavioural management plans were in place for some residents, plans seen had been subject to reviews. The service also provides staff with training in techniques for crisis prevention intervention, including de-escalation and diversion techniques. Where these strategies are used, each resident has a risk assessment and management plan in place. Staff had received training in Crisis Prevention, which included strategies for diversion or using non-confrontational techniques. Where the risk to the resident or others was assessed as too high, some control strategies had been taught, the manager and staff described the techniques used for individuals. It was understood that the British Institute for Learning Disability accredits the training provided. Examples of medication storage, medication procedures, policies and records were seen during this visit. A spot check of medication in Flat 1 was undertaken and was found to be in order. The records of administration were accurately maintained. The service uses a monitored dosage system for administering medication. There had been two incidents reported to CSCI since the previous inspection, in which errors in relation to the management of medication had been highlighted. It is recommended that update and refresher training is undertaken for all staff responsible for administering medication. The appropriate storage of medication was discussed with the care manager, and the CSCI Pharmacy Inspector was subsequently contacted for advice. The care manager confirmed that individuals who self medicate have a lockable facility provided for the safe storage of their medication. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 - Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: The service has a complaints procedure and policy, the procedure is displayed in the home and is included in the service user guide. A copy of the procedure has also been provided in a user-friendly format. As stated previously there had been a poor response in relation to the “Have Your Say” feedback documents sent out prior to the inspection. The Commission for Social Care Inspection (CSCI) had received 1 complaint, 2 concerns, and were made aware of 1 referral under the Protocol for Safeguarding Adults in relation to this service since the previous inspection. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 20 The complaint had been appropriately dealt with by the care manager, and had resulted in the complaint not being upheld. The 2 concerns were discussed at the time with the care manager and resolved. The referral under the Protocol for Safeguarding Adults had been appropriately responded to and resolved. There is a robust policy and procedure relating to the protection of vulnerable adults. Staff spoken with confirmed that they had received training in recognising and reporting abuse. A whistle blowing procedure is also in place. Residents spoken with during this visit made a number of comments, such as “It’s a nice place to live”, I can go to my key worker if I need to” “ I can tell staff if I’m not happy and they help me”, “ I like the staff”. The observation of interactions between staff and residents made during this visit, showed good rapport and relationships exist between residents and staff. Staff were also observed working 1:1 and 2:1 with some residents, in a planned way, which reflected the resident’s behavioural care plan. Additional staffing for key periods of the day continues to be provided for residents in Flat 8. Residents in Flat 8 had previously been concerned that they felt isolated on occasions, as this Flat is situated away from the main building. This was discussed with the care manager and has reportedly been resolved. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 - Quality in this outcome are is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well – maintained and comfortable environment, which encourages independence. EVIDENCE: Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 22 All flats were inspected during this visit, in addition to other areas of the home such as the laundry and the gardens. The sinks in the laundry area needed a heavy duty clean, as well as the corners of the laundry room, which were dirty and full of fluff. This was discussed during the visit and resolved straight away. Soiled linen was safely and appropriately dealt with using infection control methods and good practice. 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. There are no clear options available for changing this. However, this still needs to be taken into consideration, suggestions were made during the visit by the inspector, e.g. net curtains/vertical blinds for the windows, partitioning off of the shared garden space by use of trellis/planting etc… Flat 5 is located on the first floor of the home, and provides for up to 5 service users. There was evidence of repairs needed to walls and doors and a general need for redecoration. The care manager is aware of the need to reinstate the plasterwork and general décor. She confirmed that there is a rolling programme for the improvement of the environment throughout the home, and that there have been positive changes made to improve the surroundings in the flat, including changes to the communal areas. Access to the garden area for this flat was via a covered walkway to the rear of the property. 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. Bedroom sizes are now included in the Statement of Purpose document. The inspector noted that bedroom sizes in the new building did not comply to the 15 square metre minimum for wheelchair users. The care manager confirmed that the rooms in question were not currently occupied by residents who used wheelchairs. Flat 8, is a semi-independent unit located across the road from the main building and is not distinguishable from the other residential houses in that area. The flat provides for 5 residents receiving residential level of care and the inspector noted it was in a good state of repair and decoration. Individual bedrooms seen were pleasant and spacious, residents had been supported to personalise them, with good effect. The impression was of a comfortable and Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 23 well maintained home. Each resident had a front door and bedroom door key of their own. Communal areas included a large well-equipped kitchen/dining room and a lounge. Bathing facilities were adequate for the numbers of residents. The inspector noted during the visit that one of the bathrooms and one of the bedrooms were in the process of being re-decorated. Flat 4: is divided into 4 single occupancy units each having it’s own lounge, kitchen, bathroom and toilet. The general standard of the environment was good, with modern furnishings and appearance created by the use of laminated flooring. Residents from two of the units were happy to show the inspector their unit, and said that they were very satisfied with their home. The final building completion certificate has now been issued for the flat in question. However, changes have been made to the Fire alarm system, and the inspector requested that the care manager must provide CSCI with confirmation in writing to show that works carried out under Fire Regulations, have been completed to a satisfactory standard. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 - Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: Staffing levels throughout the service had been maintained, and more staff input continues to be provided for the residents in Flat 8 at identified key times. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 25 Staff spoken with confirmed that they had not experienced difficulties in those areas where 1:1 staffing was provided. Flat 1, operated with 2 support workers through out the waking day with additional input for periods and the management from a nurse. Flat 2, operated with 2 support workers throughout the waking day, again with additional input at times. Flat 3 operated with 3 support staff during the waking day, although this dropped to 2 at the weekends, additional staff were reportedly brought in for specific events. Flat 4, operated on a 1: 1 basis for 3 service users, additional support was provided from the nurse, who was also responsible for flat 5 and if necessary additional support was provided as required. Flat 5, operated with 4 staff through out the waking day, again additional staff were deployed as required, a nurse was also responsible for the management of this unit. Flat 6 and 7 had 1 support worker throughout the waking day, providing 1:1 support for the residents. Flat 8, operated on 1 support worker throughout the waking day and a sleep-in at night. Additional input from the nurse in charge at key periods has been implemented with a very positive outcome. Residents now feel less isolated and more included overall. The bungalow operated on 2 support workers throughout the waking day and with additional support from a nurse between the hours of 8am-6pm. Additional staff included 95 hours per week domestic, 37.5 maintenance, 30 reception or administration. The organisation also has a regular contract with contractors, to undertake the rolling programme of redecoration. The care manager confirmed in the Annual Quality Assurance Assessment document (AQAA), that the levels of NVQ trained staff have reached approximately 61 . This has met the minimum requirement of 50 of the work force. The care manager confirmed that nurse meetings were planned and held every 3 months, senior meetings were planned monthly, flat meetings planned monthly, and health and safety meetings planned monthly. Staff spoken with confirmed that they had received formal supervision, and that the frequency of their supervision had improved in the past few months. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 26 Line management responsibilities for supervision had also been clarified since the previous inspection. New staff have a comprehensive staff induction that includes a basic introduction to the service, mandatory and values based training, vulnerable adults guidance and Crisis prevention training. They receive an induction pack that they work through, with support from senior staff and human resources staff. They also have an opportunity to provide feedback on the quality of the induction with one of the human resources managers. The organisation provides a continual rolling programme of training. Managers have responsibilities to ensure that staff are nominated for courses for updates to ensure their continued development. Information provided in pre inspection information and following discussion with staff indicated that the levels of staff training were adequate. Recruitment records are maintained in the central headquarters of the organisation. A sample of staff records showed evidence of a robust recruitment procedure, including application forms, evidence of POVA and Criminal Records Bureau checks, evidence of identity, and two references. The current practice is for nursing staff to handover information relating to their shift to the nurses taking over. This information is then relayed to support staff on each of the units. Support workers would also pass on information to their colleagues. On each of the units a handover file and communication book were used. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 - Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 28 The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The inspector was pleased to note that the organisation has a “quality manager”, who continues to audit the quality of the service by visiting the home regularly to monitor the delivery of care and other aspects of the service, linking them to the Department of Health National Minimum Standards for Younger Adults. Reports of all the audits were available in the home for inspection purposes and there was evidence that any areas of deficit identified were acted upon within the timescale given for resolving them. The care manager distributes questionnaires to relatives and service users annually to encourage comments about the quality of service provided. The next survey was due to be sent out at the end of October. A sample of last year’s questionnaires was available for the inspector to view during this inspection. The inspector suggested that a date for the survey should be included on each form sent out. It is intended that the outcomes of the audits contribute towards the service’s annual development plan. The inspector requested that a copy of the next plan is forwarded to the Commission for Social Care Inspection. The registered care manager has a nursing qualification RNMH and had achieved the Registered Care Managers Award. The AQAA pre inspection document, confirmed that policies and procedures required by regulation were in place, and had been reviewed. However, it was unclear how residents were involved in the review and implementation of policies and procedures from the information available, and further thought should be given to involving residents with this. At the time of the inspection work in relation to the fitting of the fire alarm system had been completed. The need for a more up to date system had been identified during an unannounced random inspection in June 2006. The care manager confirmed that building work had now been completed. The building compliance certificate has been issued and was available for the inspector to view. Fire drills were carried out regularly. The care manager confirmed that all staff are involved in a minimum of 2 fire training sessions per year. Residents spoken with confirmed that they were aware of the need to have a fire drill, and procedure for evacuation for their flat. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 29 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 X 42 3 43 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Richmond Mews Nursing Home Score 3 3 2 X DS0000026961.V347492.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2)(d) Requirement The registered person must ensure that the environment in which service users live is maintained to a satisfactory standard of decoration and furnishing, this applies to Flat 5. Timescale for action 30/01/08 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. Refer to Standard YA6 YA13 YA20 YA24 Good Practice Recommendations The service should continue their introduction of person centred planning for residents, and ensure that staff have received training in its implementation. More opportunities for community involvement for residents could be researched by staff, then planned and discussed with residents. Staff should receive update and refresher training for the safe Management and Administration of Medication. The appearance of the rear garden areas should be DS0000026961.V347492.R01.S.doc Version 5.2 Page 31 Richmond Mews Nursing Home 5. YA39 6. YA42 improved to provide a more home like environment The registered person should provide a copy of the annual development plan based upon the quality audits and outcomes of the service to the Commission for Social Care Inspection. The registered person should contact the Fire Officer in relation to Fire Compliance and written confirmation. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Richmond Mews Nursing Home DS0000026961.V347492.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!