Inspection on 20/09/06 for Richmond Mews Nursing Home

This inspection was carried out on 20th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 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 16/10/09

Richmond Mews Nursing Home 18/10/07

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 09/07/2008.

CARE HOME ADULTS 18-65 Richmond Mews Nursing Home Richmond Terrace Shelton Stoke-on-Trent Staffordshire ST1 4ND Lead Inspector Ms Wendy Jones Key Unannounced Inspection 20 September 2006 14:00 Richmond Mews Nursing Home DS0000026961.V308338.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.V308338.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 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.V308338.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 223312 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.V308338.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 28 October 2005 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. Richmond Mews Nursing Home DS0000026961.V308338.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 4 days, between 20/09/06 and 23/09/06 a total of 17.30 hours, plus a feedback session to the registered manager on 25/09/06. The inspection methodology included pre inspection details; service user and relative questionnaires and discussion with a practice nurse and health care facilitator. It also included inspection of the environment; discussion with service users, 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. 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.” It provides care for service users 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. At this inspection there were 44 service users in residence, with dependency levels ranging from high to low, 5 service users lived in the semi independent unit, requiring little prompting with personal care and were encouraged to make their own decisions about their every day life. 1 service user had a dementia type condition, 13 had diagnosed mental health problems, 10 had continence management issues, requiring staff support, 16 service users used wheelchairs but only 1 was described as wheelchair dependent, 21 service user required some support with undressing and dressing, 28 with washing and bathing, 16 required support with toileting and 19 required some support at mealtimes. 4 service users require two staff to support them with their personal care, 1 service user was visually impaired and 4 were described as having specialist communication needs and used non-verbal methods such as Makaton and PECS. The service has 8 flats and a bungalow. The manager stated that: Flat 1 accommodated 6 service users with severe learning disabilities and limited communication, aged between 27-55 years and all required support with self-help and personal care. Flat 2, accommodated 8 service users with moderate learning disabilities, some were in receipt of nursing care other were funded as residential. Good verbal communication, support and prompting when meeting personal care needs some intermittent challenging behaviour experienced. Flat 3, accommodated 8 service users, most were funded as residential care, aged 35-50 years with low dependency needs. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 6 Flat 4 offers up to 4 service users with individual units, currently 3 service users are accommodated at the time of the inspection. All service users were described as exhibiting challenging behaviour, dependency was low in relation to self-help and personal care, good levels of communication. Flat 5 accommodates 5 service users aged 19-30years with a diagnosis o autistic spectrum disorder and challenging behaviour, high levels of support were required, communication was variable, some service user used non verbal communication systems others had verbal communication skills. Flat 6 provides accommodation for 1 service user in their own flat as does Flat 7, each service user was of low dependency requiring some prompts and encouragement to meet care needs. Flat 8 was described as the semi-independent unit accommodating 5 service users aged 30-50 years. The Bungalow has 8 beds but was accommodating 7 service user at the time of this visit, service user 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. This visit did not include all flats, the areas inspected on this occasion were Flat 8, flat 5 and flat 4. The fee range for accommodation and care at this service was reported to range from £317 to £2,218 per week. What the service does well: What has improved since the last inspection? The quality audit system has been introduced, the information seen demonstrated that the organisation was determined to continually improve its service delivery. A number of flats had been redecorated and some new furniture purchased. Some of the fire safety issues identified at a previous inspection had been Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 7 resolved satisfactorily. The laundry facilities had been improved and the service was now closely monitoring room temperatures in flat 3 and the temperatures of medication stored in the home. Levels of staff training were reported to have improved, and a new induction programme had been introduced. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 8 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.V308338.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The quality outcome for these standards was good. This judgement was made following inspection of the information provided to prospective and current service user, from the information in pre admission assessments and from discussion with service users. EVIDENCE: A statement of purpose and service user guide had been revised, copies were available in the home in service users care records and a copy was provided to the Commission for Social Care Inspection. A sample of service users guide’s showed that the fees were not recorded and the amount of personal allowance allocated was out of date. There was also evidence that service users were not routinely given the guide, although in some examples there was evidence that service users had signed a copy of the guide. Specific areas required by regulation to be included in the Statement of Purpose were bedroom sizes for all flats. The statement of purpose included information about admission to the service in the event of an emergency, this was discussed with the manager as it did not reflect good practice in a service offering a home for life. The manager sated that she would only accept referrals in an emergency if she had a full written history of the needs of the service user and where she had considered Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 10 compatibility with other service users. A revised copy of the admission policy in the event of an emergency referral should be copied to the Commission for Social Care Inspection. In pre inspection feedback, one service user stated that they had not had a choice in moving to the home and had not received adequate information about the service prior to moving in. This issue was discussed with the manager and records of pre admission information were seen they demonstrated that the service provided good transitional arrangements for service users and there was evidence of pre assessment information, pre admission meetings with the previous care provider (if applicable), service user and family. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10 The outcome of this standard was adequate This judgement was based upon inspection of the care records discussion with service users and staff. 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 service user has a care plan, but practice of involving people who use the service in the development and review of the plan is variable. The information in care plans was also variable, with some excellent example. In others the plans did not accurately reflect the current needs of service users. The plan in most cases included the information necessary to plan the resident’s care and included a risk assessment element. When developing the plan the home has complied where possible with relevant social care guidelines and recognises the specialist nature of the care required for some residents. In most cases the records showed that care plans had been reviewed on a regular basis, in others reviews were not carried out regularly and there was Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 12 not always evidence that service user had been involved in care planning or reviews. Some care plans had been signed by the named nurse/ key worker and the service users, in other examples they had not been signed or dated. Pen pictures and “an ordinary day” had been introduced in all flats, the quality of the documents again varied, with some providing a very detailed insight into the preferred routine and lifestyle of the individual. The service has been considering introducing person centred planning for some time but has yet to. It was recommended that person centred planning is introduced and service users are supported to discuss their aims and goals for the coming year and make arrangements to organise their review. Staff must receive training in person centred planning. Risk assessments were included in each individuals care records, the service users a generic format that is adapted to meet the individual needs of the service user. There was discussion about how the risk assessments seen could be improved and concern that in one example the risk assessments for one service user appeared to be providing conflicting information, which may cause confusion. It is important that this type of information is accurate and gives the reader implicit information about the level of risk and the action required to reduce that identified risk. Care plans were stored in each of the flat offices, it was recommended that where appropriate service users are supported to own their care records and be provided with facilities to keep them secure in their bedrooms if they choose to have them. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 The outcome from this standard was good. This judgement was based upon information available from records, discussion with residents and staff. EVIDENCE: There was evidence from discussion with service users in flat 8, that they were able to access local facilities independently, they gave examples of visiting local shops and libraries and confirmed that they use public transport. While the service users do access local facilities the level of community participation and engagement was limited and should be discussed with individuals. Staff should provide service users with opportunities and information about how they could actively participate in the local community to enable them to make an informed decision about their involvement. Access to the local community was limited for some of the service user in flats 4 and 5. They tended to utilise specialist services such as the organisations day centre and college. Samples of activity records while in the home showed that service users spent a lot of time occupied in sedentary or passive activities Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 14 such as watching TV, listening to music. Or are taken out of the home for shopping trips or drives out. There was limited access to socially valued educational, occupational or recreational activities for this group. Information provided from discussion with staff and service users and from the records showed that where service users had family links the service sought to ensure that these links were maintained. During discussion with staff a potential risk area around family contact had been identified, this was discussed with the manager and suggested that an assessment of risk should be undertaken with the family, individual and social worker. The majority of service user had been on a holiday or short break. During this visit some service user were on holiday and the staff from a flat were preparing to support a service user on a short break who had previously not had the opportunity to do so. Discussion with the key staff in this flat showed that they had considered the risks involved and had a sufficiently responsible and flexible approach to ensure they could return in the event of a problem. The service user discussed her planned break and appeared to be looking forward to it. The organisation has produced healthy eating files for each of its homes. The files provided staff and service users with some very good information relating to 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, as was basic food hygiene and safety. It was envisaged that the information would be provided in each of the flats to educate service users and staff and top provide them with some guidance and meal options. Changes to the way in which service users purchase their food have been implemented since the last inspection. Service users and staff plan the following weeks menus and put in an order to the company headquarters where the food is ordered via the Internet for delivery at a pre arranged time. Service users continue to shop for specific items of food i.e. fresh food, vegetables and meat as required. Feedback relating to this new method of shopping was positive and staff felt that they were able to purchase better quality food and service users had a better choice of foods. Service users in flat 8 plan their meals over a period of six weeks, it was suggested that this model could be reviewed and that service users should be supported to make choices daily. It was accepted that some preplanning is necessary to devise the weekly shopping list. Service users in flat 8 were actively involved in food preparation and cooking and operated a rota system for these chores. Service user I other flats also had opportunities to participate in food preparation and cooking on a 1:1 ratio. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 15 Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The outcome for this outcome group was adequate, this judgement was based upon information provided from discussion with staff, and service user and from the records provided. EVIDENCE: In the pre inspection feedback from service users, they indicated that they were happy with the care they received at the home. This was also confirmed this from discussion during the inspection visit. Since the last inspection the service has contacted the local community health facilitator and have received training for staff in the implementation of health action plans, these have now been introduced on nursing units. A sample of health records showed that health and nursing needs were being met. The records showed regular health appointments with primary health providers and input from specialist health services. The nursing staff arrangements in the newest unit were discussed with the care manager, the reported agreed practice is for non-nursing staff to be on duty for the period from 6pm in the evening. It was suggested that this situation is kept under review to ensure that the nursing needs of service users can be met. The manager stated that the current nursing needs of service user on this unit were being met. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 17 Pre inspection feedback from one GP practice raised concerns that on occasions service users had been accompanied for health appointments by staff who had little or limited knowledge of them. This matter was discussed with the manager who indicated that the health information recorded for each person should eliminate this problem in the future. It was accepted by the manager that where possible key workers or named nurses should accompany service user to these important health appointments. 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 where needed the majority of these had been subject to reviews. The service also provides staff with training in techniques for crisis prevention intervention, including de-escalation and diversional techniques. Where these strategies are to be used, each service user has a risk assessment and management plan in place. Examples of behavioural management strategies were observed during this visit. The practice of protected mealtimes had been introduced in one unit, this means that when dining there is no conversation. This strategy had been introduced to resolve problematic behaviours during mealtimes and was reported to have been successful. The experience of a protected mealtime was not a very comfortable one and should be reconsidered now the reason for it being implemented had been resolved. It was also not clear from the information available if this approach for managing service users behaviour had been agreed with behavioural specialists and was also not included in the care records of service users. Staff had received training in Crisis prevention, which included strategies for redirected service user or using non-confrontational techniques. Where the risk to the service user 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. Medication: Examples of medication storage, medication procedures, policies and records were seen during this visit. In flat 5 and 4 the medication was stored in metal wall mounted locked cupboards, the records of administration were accurately maintained. The service uses a monitored dose system for administering medication. Protocols for the administration of as required medication were in place, but there was no evidence that they had been agreed with the prescribing GP practice. The manager stated that they had made efforts to involve the GP’s but they had declined to participate or sign the protocols. Advice was given to assist the manager to resolve the matter. It was recommended that all medication that is not packed into the MDS system must be organised so that each resident’s medication is kept Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 18 separately. During the discussion with the care manager information regarding best practice in medication administration in care homes was provided. In flat 8 one of the service users self medicated it was suggested that to further promote independence, efforts should be made to support service users with self-medication. In addition individuals who self medicate must have a lockable facility provided for the safe storage of their medication. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The outcome for this outcome group was good. This judgement was based upon information provided from the records seen and from discussion with the manager service users and staff. 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 more user-friendly format. In the pre inspection feedback service user stated that they knew how to complain if they needed to and knew who to go to. Commission has received no complaints for Social Care Inspection in relation to this service since the last inspection. There is a robust policy and procedure relating to the protection of vulnerable adults. All new staff received training in recognising and reporting abuse during the induction. Other staff have attended similar training and updates. A whistle blowing procedure is also in place. There have been no Vulnerable Adults referrals since the last inspection. Service users spoken to during this visit made a number of observations such as “ I like it here”, I can go to named key staff if I have concerns” “ I’ve been able to tell staff when I’m not happy and they help me”, “ I get on with staff”, “ I have a problem with another service user”. “I sometimes don’t think staff spend enough time with me”. All matters were discussed with individuals, staff and the manager. The observation of interactions during this visit appeared to show good relationships between service user and staff. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 20 Staff in flat 8 were concerned that they felt isolated on occasions in their unit, and described how they did not feel properly supported when they had experienced some behavioural difficulties with service users. This was discussed with the behavioural specialist and the manager and a recommendation that more efforts are made to ensure staff were properly supported and if necessary additional staffing provided for key periods of the day. It was of concern that the strategy to manage the behaviour of one service user had been agreed that she could be accommodated in other flats for periods of the day. The manager stated that this had been discussed with all concerned parties. It was felt that this was not an appropriate method of behavioural management and should be reviewed. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, and 30 The outcome for this standard was poor. This is based upon an inspection of the premises, from the information provided regarding the changes required to the environment following the last random inspection visit. The concerns relating to fire safety and lack of building regulations compliance certificate remains an issue. EVIDENCE: Three flats were inspected during this visit in addition to other areas of the home such as the laundry and the gardens. All units 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 service users. At every visit during this inspection, front doors to the two flats were left open and visitors could see into a service users bedroom through a window. It was suggested that the access to the main entrance and reception should be reconsidered so that service user privacy is respected and their gardens are not used as a general thoroughfare for visitors. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 22 Flat 5 is located on the first floor of the home, and provides for up to 5 service users. The general environment was in a poor state of repair with evidence of damage to walls and doors and a general need for redecoration. The unit manager stated that the service had started a rolling programme for the improvement of the environment throughout the home and there were plans to further 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 service users with a safe, enclosed area. This structure had been created some considerable time ago when the service was intended for a service user group with quite different needs. While it was accepted that the safety of service users 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. General discussion regarding the information in the Statement of Purpose identified that some bed room sizes were not included in the document and that all bedroom sizes in the new building did not comply to the 15 square metre minimum for wheelchair users, it was understood from discussion with the manager that these rooms were not currently occupied by persons who used wheelchairs. It was agreed that the Commission for Social Care Inspection would write separately to the provider regarding this issue. Flat 8, is a semi-independent unit located across the road from the main building and is not distinguishable from the other residential housing stock in that area. The home provides for 5 service users receiving residential not nursing care and was in a good state of repair and decoration. Individual bedrooms were pleasant and spacious, it was clear that service users had been supported to personalise them, with good effect. The impression was of a comfortable and well maintained home. Each service user had a front door and bedroom door key of their own. Communal areas included a large wellequipped kitchen/dining room and a lounge. Bathing facilities were adequate for the numbers of service users. Since the last inspection the flat has been redecorated and some refurbishment has taken place. All internal doors had been repainted; some did not self-close properly and required adjustment. One of the organisations maintenance workers had been allocated this work to do. Also during this visit the stairs were being re-carpeted. The home has a cellar, which wasn’t used by service users but was full of old furniture and paint tins and appeared to be quite damp. It was recommended that these items were disposed of and the old bed base and mattress stored in the ground floor hallway for approximately two Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 23 weeks should also to be removed. The main stairs were also being re carpeted during the inspection visit. Flat 4: is divided into 4 single occupancy units each having it’s own lounge, kitchen, bathroom and wc, three of the units were occupied during this visit. The general standard of environment was good with modern furnishings and appearance created by the use of laminated flooring. All three service users were willing to show their unit for inspection purposes and were satisfied with their home. The final building completion certificate has not yet been issued for this flat, the findings of the last random inspection carried out with the fire officer, evidenced that not all works had been completed to a satisfactory standard, in consultation with the building planning officer it was determined that the majority of work required was fairly minor and therefore the environment was not unsafe. However because of additional concerns about the need to make changes to the fire alarm system a certificate could not be issued until the work to improve the system had been completed. This work was being undertaken during this visit. The provider must inform the Commission for Social Care Inspection when the work has been completed and provide evidence of receipt of a final building completion certificate. At the last random inspection some improvements were required to ensure the fire safety in the laundry and in other areas of the home. The work had been carried out in the laundry area creating a more user friendly and safe environment for all staff using it. Other action taken included a rolling programme of repairs to fire doors to ensure that they self closed where appropriate and were fitted with in tumescent strips. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 The outcome for these standards was adequate. This judgement was based upon the information provided regarding staffing levels, numbers, trainings and supervision and recruitment practice and from discussion with staff. EVIDENCE: Staff levels were good in the main building of the home, staff discussed difficulties in those areas where 1:1 staffing was provided and where 1 staff was on duty throughout the waking day. These issues were discussed with the manager and recommended that the staffing levels and ratios be reviewed as necessary to ensure that staff are not put at risk. In particular where there is a known risk due to unpredictable or challenging behaviours. Flat 1, operated on 2 support workers through out the waking day with additional input for periods and the management from a nurse. Flat 2, operated on 2 support workers throughout the waking day, again with additional input at times. Flat 3 operated on 3 support staff during the waking day, although this dropped to 2 at the weekends, additional staff were reported for specific events. Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 25 Flat 4, operated on a 1: 1 basis for the 3 service users, additional support was provided from the nurse also responsible for flat 5 and if necessary additional support provided as required. Flat 5, operated on 4 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 service users. Flat 8, operated on 1 support worker throughout the waking day and a sleep in at night. The bungalow operated on 2 support workers throughout the waking day and with additional support from a nurse between the hours of 8am-6pm. Night staffing arrangements were reported to include 2 qualified staff and 7 support staff plus a sleep in. The records available for week commencing he 18/09/06 did not reflect these reported numbers an all occasions. It was accepted that the service continued to use some agency staff to fill gaps. In the pre inspection information the manager identified that for the period 19/06/06-13/08/06. 569 hours agency hours were used. She also indicated that staff turnover since the last announced inspection had been minimal. 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 levels of NVQ trained staff did not meet the minimum requirement of 50 of the work force, but the manager stated that more staff had enrolled on the training and that by the next inspection they would have exceeded this target. The manager safe that nurse meeting were planned every 3 months, senior meetings were planned monthly, flat meetings planned monthly and health and safety meetings planned monthly. Records of staff meetings indicated that the set standard regarding frequency of meetings was not always achieved and varied from flat to flat. More difficult areas in which to arrange meetings include flat 8 and flat 4, because staff worked on a 1:1 basis or on their own. Similarly the frequency of staff supervision varied from flat to flat, it was of concern that there was some confusion about line management responsibilities for flat 8, which had resulted in poor levels of individual supervision. The Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 26 senior support staff in this unit had yet to undertake supervision training and the lines of management responsibility where unclear. This was discussed with the care manager. The organisation has introduced a comprehensive staff induction that includes a basic introduction to the service, mandatory and values based training, vulnerable adults guidance and Crisis prevention training. Each new staff receives an induction pack that they work through with support from the 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 the records showed some good recruitment practice including, application forms, evidence of POVA checks and Criminal Records Bureau checks, evidence of identity, in two out of the sample of records there was only 1 written reference. The requirement of regulation is for two written references to be received and to be maintained on each file. Since the last announced inspection the Care Homes Regulations have been amended and previous requirements for the service to keep a copy of birth certificates and passports has been revoked. Additional requirements have been included in the regulations under schedule 2. During this inspection a staff handover was observed, the current practice is for nursing staff to handover information relating to their shift to the nurses taking over. It was understood that this information is then relayed to support staff on each of the units. It was also accepted that 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.V308338.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 The outcome of these standards was adequate, this judgement was based upon the information provided from the pre inspection questionnaire, from discussion with the care manger, from inspection of records and from checks of compliance with previous requirements. EVIDENCE: Since the last inspection the organisation has made considerable efforts to audit the quality of the service, by recruiting a quality manager, who visits 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 manager distributes questionnaires to relatives and service users annually to encourage comments about the quality of service provided. A sample of the questionnaires was available during this inspection and some comments have been included in this report. In summary 13 relative questionnaires were Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 28 sampled all made positive comments about the service as did 6 service user questionnaires. It is intended that the outcomes of the audits contribute towards the services annual development plan. Copies of this plan will be made available to the Commission for Social Care Inspection. The manager has a nursing qualification RNMH and reported that she had undertaken the Registered Care Managers Award. Unfortunately she reported that due to some delays at the college she has not yet received her certificate to evidence completion of the training. Policies and procedures required by regulation were in place, there was evidence in the pre inspection information that they had been reviewed periodically, the manager stated that the management team for the organisation undertook regular reviews of all policies and procedures. It was unclear how service users were involved in the review and implementation of policies and procedures from the information available and further thought should be given to involving service users with this. At the time of the inspection a new fire alarm system was being fitted, the need for a more up to date system had been identified during an unannounced random inspection in June 2006. The manager stated that the work would be completed within two weeks, the building planning officer is then to be consulted to issue a final completion certificate for the structural changes to the home undertaken in 2005. The majority of requirements relating to fire safety had been completed since the last inspection, outstanding items were linked to the work being undertaken at the time of the inspection including work to ensure that fire doors self close properly. Fire drills were not always carried out as regularly as they should be the manager was asked to ensure that all staff are involved in a minimum of 2 fire drills per year. Following discussion with some service users it was established that they were aware of the procedure for evacuation for their flat. Richmond Mews Nursing Home DS0000026961.V308338.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. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 3 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 1 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 2 2 3 X 1 X Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5(1)(bb) Requirement The registered person must ensure that the fees payable are included in each individual’s service user guide and the information is up to date. The registered person must provide a copy of the service user guide to each individual. The registered person must include all bedroom sizes in the Statement of Purpose. 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 registered person must provide evidence of a completion certificate from Building Planning Services.(previous time scale 13/07/06). The registered person must ensure that service users are consulted about their care plans and any reviews of their plans. The registered person must ensure that care plans accurately reflect the needs of the DS0000026961.V308338.R01.S.doc Timescale for action 20/12/06 2 3 YA1 YA1 5(2) 4(1)© schedule 1, Para 16. 23(2)(d) 20/11/06 20/12/06 4 YA24 20/11/06 5 YA42 YA24 23(4) 20/10/06 6 YA6 15(1)(2) 20/10/06 7 YA6 15 20/10/06 Richmond Mews Nursing Home Version 5.2 Page 31 individual. 8 YA42 23(4) Checks must be carried out and action taken to ensure fire doors self close properly (previous time scale 13/06/06). In tumescent fire and smoke strips must be fitted to all fire doors. (previous time scale 16/06/06) Supervision must be carried out at least six times a year. (previous time scale 31/01/06) The registered person must ensure that two written references are sought for all new employees, one must be from the last employer where the applicant worked with vulnerable adults or children and of no less than a 3-month duration. The manager must continually review the staff deployment for flat 8 to ensure that sufficient support is provided at all times. The registered manager must provide evidence of satisfactory completion of the Registered Care Managers Award. When service users self medicate a lockable storage facility must be provided in their bedrooms to allow for the safe storage of medication. All staff must be involved in fire drills 20/10/06 9. YA42 23(4) 20/10/06 10 YA36 18(2) 20/10/06 11 YA34 19 schedule 2, Para 3 20/10/06 12 YA33 23 20/10/06 13 YA37 9 20/12/06 14 YA20 13 20/10/06 15 YA42 23 20/10/06 Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA2 Provide copies of admission and emergency admission policy to the Commission for Social Care Inspection. 3 4 5 6 7 8 9 YA6 YA6 YA10 YA26 YA19 YA20 YA23 YA39 The service should introduce person centred planning, and ensure that staff have received training in its implementation. Ensure that care plans are reviewed regularly. Lockable facilities should be provided in all service user bedrooms. Keep under review the deployment of nursing staff in the bungalow to ensure that the nursing needs of service user are met at all times, Medication not stored in the MDS system should be arranged so that individual’s medications are stored separately from others. A review of the behavioural management strategy identified for one service user should be reviewed. The registered person must 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. Record the names of staff who attend fire drills, the time location and any concerns arising from each drill The access route to the main reception area of the home should be reconsidered to ensure that is does not impact on the privacy of service users. The appearance of the rear garden areas should be improved to provide a more home like environment Good Practice Recommendations Information outlining the individual’s personal allowance should be up to date. 10 11 12 YA42 YA24 YA24 Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Richmond Mews Nursing Home DS0000026961.V308338.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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