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Inspection on 11/10/05 for Richmond Residential Care Home

Also see our care home review for Richmond Residential Care Home for more information

This inspection was carried out on 11th October 2005.

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

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

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

What the care home does well

Residents and visitors at Richmond care home were positive about the home, the standards of care and the staff. Residents and visitors were pleased with the social activities offered to residents, including chair-based exercises and trips out. There was a stable staff group at the home, with most staff having worked there for four years or more and a low turnover of staff in the last year. Staff spoken with during the inspection were knowledgeable about the individual needs of residents. The home provided a clean, comfortable, homely environment for residents.

What has improved since the last inspection?

The manager had successfully registered with the Commission for Social Care Inspection and had achieved NVQ Level 4 and the Registered Manager`s Award. Staff had undertaken training in dementia awareness, protection of vulnerable adults, and basic food hygiene.

What the care home could do better:

Prospective residents need written confirmation from the home to assure them that, following assessment, all their needs can be properly met by the home.A fridge is required to store certain medication. This would ensure medication was stored securely and at the correct temperature.

CARE HOMES FOR OLDER PEOPLE Richmond Recreation Road Shirebrook Mansfield Nottinghamshire NG20 8QE Lead Inspector Rose Veale Unannounced Inspection 11th October 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Richmond Address Recreation Road Shirebrook Mansfield Nottinghamshire NG20 8QE (01623) 748474 (01623) 744228 stella.state@richmondcarehome.co.uk 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) Maximise Holdings Limited Stella State Care Home 19 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (19) of places Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Plus Three (3) Day Care Places The home must only accommodate a maximum of 16 residents (OP), including a maximum of 7 (DE), until the planned 4 bedroom extension has been completed. This is to be achieved by the conversion of 3 single rooms on the first floor to become 2 single rooms with en-suite facilities, and the development of 4 new single bedrooms with en-suite facilities in the extension at the side of the home. A newly built garden room and smoking room will be erected adjacent to the south side of the home to resolve the under-provision of communal space at the home. The improvement of bathroom facilities will be resolved by the removal of the upstairs shower room, the creation of a new bathroom in the upstairs of the new build and the creation of a new bathroom in place of the downstairs toilets, (adjacent to the kitchen corridor). The existing access to the laundry, (through the small front lounge), will be closed off and new access created through the new build area. 1st February 2005 Date of last inspection Brief Description of the Service: Richmond Care Home is situated in the village of Shirebrook, near to local shops and facilities and public transport. The home is in an older building which has a long history of care provision. A programme of building work has been undertaken and redevelopment is underway for a newly built extension. Part of the extensive grounds has been made accessible to residents. The home provides personal care for up to 19 older people, including up to 7 people who need care because of dementia. Car parking space is provided. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours on one day. There were 12 residents accommodated in the home on the day of the inspection, including 5 residents whose primary care needs were due to dementia. Residents, visitors and staff were spoken with during the inspection. The care records of two residents were examined, plus other records related to the staffing and management of the home. A tour of the building was undertaken. The owner and the manager of the home were both available for most of the inspection and were very helpful. The home was undergoing extensive building work to provide new bedrooms and lounge space for residents. This will result in improvements to the environment for residents, but was causing some unavoidable noise and disruption. What the service does well: What has improved since the last inspection? What they could do better: Prospective residents need written confirmation from the home to assure them that, following assessment, all their needs can be properly met by the home. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 6 A fridge is required to store certain medication. This would ensure medication was stored securely and at the correct temperature. 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 DS0000020082.V258337.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Assessment information was good, ensuring that residents’ needs could be properly met by the home. However, there was no written confirmation provided to residents to assure them of this. EVIDENCE: The care records of two residents were seen. Both contained assessment information, including the care manager’s care plan and hospital discharge information. There was no confirmation in writing to residents that their needs could be met by the home. Staff at the home had recently completed a dementia awareness course and staff spoken with said they had found this useful in their work. It was a requirement at the last two inspections for staff to have training about the mental health needs of older people and this had therefore been met. Risk assessments had been completed for each of the records seen. It was a requirement at the last inspection that a risk assessment regarding smoking was carried out for a specific resident. This was seen and the requirement had therefore been met. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Residents’ health and personal care needs appeared to be well met, with good liaison with other healthcare professionals and evidence of respecting residents’ privacy and dignity. EVIDENCE: The care plans of two residents were examined. The care plans detailed the assessed needs of residents and the action required by staff to meet those needs. The care plans had been reviewed and updated at least monthly, sometimes more frequently if there had been a change in residents’ needs. Staff spoken with were knowledgeable about the care needs of residents and were familiar with the care plans. There were records of the input of other healthcare professionals, including GP, District Nurse, chiropodist, dentist and optician. It was clear that healthcare was monitored and referral to the appropriate specialist sought as required. For example, a referral through the GP to the Community Psychiatric Nurse to support staff in meeting residents’ mental health needs. It was observed that there were good relationships between staff and residents and their relatives / representatives. Visitors spoken with said that staff respected residents’ privacy and maintained dignity. Staff spoken with were Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 10 able to give examples of how they achieved this. Staff were observed to knock on doors before entering. The preferred name of the resident was noted on the care records. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home offered a range of activities for residents, ensuring that their social, religious and recreational needs were met. Routines at the home were flexible and varied so that residents were able to exercise choice and control in their lives. EVIDENCE: Residents’ preferred daily routines were detailed in the care records. There was evidence that residents and their relatives had been involved in recording the daily routines. Residents and visitors spoken with said that routines were flexible, within the constraints of living in a care home. Activities in the home included a weekly chair-based exercise session, entertainers, bingo nights where local people were invited to come along, dominoes, and trips out. Residents said they enjoyed the trips out, particularly a recent outing to a musical show at a local theatre. A trip to Skegness was planned for the week following the inspection and residents and visitors said they were looking forward to this. There were photographs on display of activities and trips out. Staff spoken with said they had time to spend with residents, sitting in the lounge and chatting or doing manicures. The hairdresser was visiting on the day of the inspection and this was clearly quite Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 12 a social event. Visitors spoken with said they were always made welcome by staff in the home. The dining room in the home, separate from the lounge, was pleasant and comfortable. The new extension being built at the home was directly outside the dining room window, so there was very little natural light. The menu was seen. This was used as a guide with changes being made by the cook in response to residents’ choices. The cook asked residents in the morning what they would like for lunch and again after lunch about tea. The menu for the day was displayed in the entrance hall. Residents and visitors spoken with said the food was good and that residents’ choices and preferences were catered for. Food shopping was done regularly at a local supermarket which allowed for individual choices of food. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff awareness and the home’s policies and procedures ensured that residents were protected from abuse. EVIDENCE: Staff at the home had undertaken training in adult protection issues and awareness. The manager had undertaken the two day course with Derbyshire County Council about the protection of vulnerable adults. Staff spoken with were aware of adult protection issues and procedures. It was a requirement at the last inspection that staff should undertake training regarding protection of vulnerable adults and this had therefore been met. The home had policies promoting the protection of residents, including an adult protection policy, management of residents’ money, and whistle blowing. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 24 The home was clean, well decorated and comfortably furnished providing a pleasant environment for residents. However, the ongoing building work was causing some noise and disruption. EVIDENCE: A tour of the building was carried out, including the ongoing building work. All areas in use in the home were clean and free from offensive odours. The lounge was homely and comfortably furnished. The building work was causing some noise and disruption, although all residents, visitors and staff spoken with said the effects had been kept to a minimum. The bedrooms seen were well decorated, clean and comfortable. Bedrooms had been personalised with residents’ own possessions. Residents had been consulted about the furnishing of their bedrooms and their choices were recorded in the care files. There were extensive grounds to the home. An area had been made accessible to residents to use with garden furniture. This area was not secure for residents with dementia who may wander. Risk assessments were in place Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 15 for residents with dementia who might wander outside. The grounds were untidy and overgrown in parts due to the ongoing building work. The owner said that there were plans to landscape the grounds once the building work was completed. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 There were sufficient staff to meet the needs of residents, and the recruitment procedures in the home ensured that residents were supported and protected. EVIDENCE: The staff rota for the home was seen. There were two care assistants on duty throughout the day and night, plus the manager during the day. Residents and visitors spoken with said that the staff were always available when needed. Staff spoken with said they felt the staffing levels were adequate for the number and needs of residents in the home. The hours worked by the manager were not recorded on the rota. The files of two members of staff were seen. The files contained all the required information, including Criminal Record Bureau disclosures and two written references. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 35 The home was well run with the best interests of residents in mind and with support for staff. EVIDENCE: Since the last inspection, the manager had been registered with the Commission for Social Care Inspection and had recently completed NVQ Level 4 and the Registered Manager’s Award. The manager had worked at the home prior to taking up the manager’s post. Residents, visitors and staff spoke positively about the manager, making comments such as “she’s easy to talk to” and “she helps staff with the residents”. Staff spoken with said they felt well supported by the manager. Records were seen of residents’ personal money kept by the home. The records were clear and detailed with receipts kept and two signatures for all transactions. The money was securely kept. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X 3 X X STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 19 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 OP3 Regulation 14(1)(d) Requirement Timescale for action 30/11/05 2 OP9 13(2) 3 OP9 13(2) 4 OP27 17(2) The registered person must confirm in writing to residents, following assessment and prior to admission, that the home is able to meet their care needs. Medication requiring refrigeration 31/12/05 must be stored securely in a suitable refrigerator. Original timescale 01/05/05 The maximum and minimum 31/12/05 temperatures of the refrigerator used for storing medicines must be recorded. Original timescale 01/05/05 The staff duty rota must include 30/11/05 the hours worked by the manager. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The program of activities offered to residents should be displayed in the home and information given to residents and visitors about forthcoming activities. Richmond DS0000020082.V258337.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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