Inspection on 12/09/06 for Richmond Residential Care Home

This inspection was carried out on 12th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Richmond Residential Care Home 02/09/08

Richmond Residential Care Home 27/01/06

Richmond Residential Care Home 11/10/05

Richmond Residential Care Home 01/02/05

Richmond Residential Care Home 17/08/04

Richmond Residential Care Home 24/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Richmond Recreation Road Shirebrook Mansfield Nottinghamshire NG20 8QE Lead Inspector Rose Veale Unannounced Inspection 12th September 2006 9:45 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.V310169.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 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.V310169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: Richmond Care Home is situated in the village of Shirebrook, near to local shops, facilities and public transport. The home is in an older building that has a long history of care provision. A programme of building work has been undertaken and a newly built extension is now completed. 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 8 people who need care because of dementia. Car parking space is provided. The fees at the home range from £298.20 to £338.50 per week. The fees do not include hairdressing, chiropody and personal toiletries. This information was provided by the manager at the inspection visit on 12/09/06. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 6 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 14 residents accommodated in the home on the day of the inspection, including 3 residents assessed as needing dementia care. Residents, visitors and staff were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire and surveys had been completed and returned prior to the inspection and information from these has been included in the body of this report. The manager was available throughout the inspection and was very helpful. What the service does well: What has improved since the last inspection? All of the requirements and recommendations made at the last inspection had been met. This had resulted in improvements to the medication system, the complaints procedure, the quality assurance system, and to health and safety. The new extension was almost completed, providing 4 new bedrooms and 2 new bathrooms. The new bedrooms were all single with en-suite toilet. A new clinical room had been created in the old building and some bedrooms had been improved and refurbished. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 6 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 DS0000020082.V310169.R01.S.doc Version 5.2 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.V310169.R01.S.doc Version 5.2 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 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There was a good range of assessment information so that residents/ their representatives were confident that residents’ needs could be met at the home. EVIDENCE: The care records of 3 residents were examined. There was pre-admission information from the care manager or hospital and also from a pre-admission assessment by the home’s manager. Residents received a letter from the home confirming that their needs could be met. Following admission, there was a range of assessment information, including a brief assessment of the resident’s needs regarding activities of daily living. There was a ‘preferences’ assessment that included the resident’s preferred name, food likes and dislikes, and the resident’s preferred daily routine. There was information about the resident’s family and other people important to them, and their family, social and work history. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 9 Residents and relatives spoken with during the visit and those surveyed prior to the visit said the home was meeting the needs of the residents. There was a care plan produced for each resident from the assessment information. The care plans did not always include all the assessed needs of the resident, (see Standard 7). Standard 6 does not apply to this service. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 10 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, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans were not produced to a consistent standard so that residents’ needs did not always appear to be fully met. There were robust systems in place for the safe handling and administration of medication so that residents were protected. EVIDENCE: The 3 care plans examined were of variable standards. One of the care plans seen was detailed and included all the assessed needs of the resident. This care plan had been reviewed regularly and updated to take account of the changing needs of the resident. Two of the care plans seen did not include all the assessed needs of the residents. One did not include the social and psychological needs of the resident who had a diagnosis of dementia. The manager explained that the other care plan was to be reviewed and updated when the resident was discharged from hospital. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 11 The 3 care plans seen did not include evidence that residents/their representatives had been involved in care planning. 2 other care plans sampled had the signature of the resident to show their involvement in the care plan. Through discussion with residents, visitors and staff and from observation it appeared that residents’ care needs were met at the home. Records were seen of the input of GPs, district nurses, community psychiatric nurses, chiropodist, dentist and optician. It was seen that residents were referred promptly and appropriately to ensure their healthcare needs were met. For example, a resident with swallowing difficulties referred to the speech and language therapist, and a resident who had lost weight referred to the dietician. Residents and relatives confirmed that the home called the GP promptly when needed. Visitors spoken with said that residents’ privacy and dignity were maintained giving examples such as residents always dressed suitably and in their own clothes, and staff speaking to residents in an appropriate way. Staff spoken with were aware of the need to protect residents’ privacy and dignity and demonstrated this, for example by knocking on doors before entering bedrooms and bathrooms, and by addressing residents by their preferred names. A new clinical room had been made as part of the ongoing improvements to the home. Medication was securely stored. A domestic fridge had been provided in the clinical room for the storage of medication. The minimum and maximum temperatures of this fridge had not been checked and recorded daily to ensure medication was being kept at the correct temperature. The medication administration records seen were correctly completed. Records were seen of the receipt and disposal of all medication, including when residents were admitted to hospital or went home following respite care. Staff administering medication had received appropriate training. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home provided an adequate range of activities to meet the social and recreational needs of residents. Visitors were made to feel welcome so that important contacts for residents were maintained. There was a varied menu and pleasant atmosphere at mealtimes so that residents enjoyed their meals. EVIDENCE: Details of residents’ social, work and family history were included in their care records. There were details of residents’ preferences, likes and dislikes. Staff spoken with were aware of residents’ individual preferences. Records were seen of daily activities for residents. Activities included trips out to Matlock and a local garden centre, a regular church service, entertainers, dominoes, music, and watching films. Residents and relatives spoken with said there were enough activities offered to residents. The surveys completed prior to the inspection visit had mixed responses to the provision of activities. Most Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 13 responses were satisfied with the activities offered, though some indicated that there should be a wider choice of activities. It was not clear from the records kept that there were activities offered specifically to meet the needs of people with dementia. Visitors spoken with said they were always made welcome and offered refreshments. One visitor commented that there was “always a good atmosphere” in the home. Discussions with visitors and staff and observation during the inspection visit showed that residents were encouraged to exercise control and choice over their lives where possible. For example, the bedrooms seen were personalised with residents’ own belongings; one resident did not want to go into the dining room for lunch and staff respected this choice; residents were encouraged to help with some tasks such as laying tables and folding laundry; residents were given choices at meal times. The menus for the home were seen and appeared varied and balanced. The lunch served on the day of the inspection visit looked appetising and a choice of main courses was offered. The meal included fresh vegetables and a homemade pudding. It was noted from the surveys, from observation and in discussion with staff that residents’ nutritional needs and preferences were catered for. For example, food was blended for a resident with swallowing problems; several residents were supplied with nutritional supplements. Residents and visitors spoken with said the meals provided were always good. There was a calm atmosphere at lunchtime on the day of the inspection visit. Residents ate in the main dining room or in the lounge. The main dining room was pleasant and welcoming, although in need of redecoration. The lighting in the dining room needed to be brighter as the natural light was restricted. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 14 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There was a robust complaints procedure and good staff awareness and attitudes regarding safeguarding adults so that residents felt safe and were well protected. EVIDENCE: The complaints procedure was displayed in the entrance hall of the home and was included in the residents’ guide. Visitors spoken with and the survey responses indicated that they knew how to complain if necessary. Residents and relatives spoken with were confident that any complaints would be properly dealt with and action taken. Since the last inspection the manager had introduced a complaints book and a compliments book. There had been no complaints recorded in the book and no complaints received by CSCI about the home. The home had a suitable safeguarding adults policy/procedure in place that included the Derbyshire County Council multi-agency guidelines. Staff spoken with were aware of the right procedure to follow. Staff had received training in adult abuse issues and safeguarding adults procedures. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 15 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 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of the environment within the home was generally good so that residents enjoyed a safe, pleasant and comfortable place to live. EVIDENCE: The new extension at the home was almost completed, providing 4 new bedrooms and 2 bathrooms. A new clinical room had been created within the existing home as part of the building work. The new bedrooms were all single with en-suite toilet. The new bathrooms each had a bath and a shower. Work was continuing to finish the new bedrooms and to comply with the requirements of the fire officer. The home was mostly well maintained and well decorated. The dining room was in need of redecoration. There was no natural ventilation in the dining room since the new lounge had been built. It was reported that the dining room became very hot in warm weather. The lighting in the dining room Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 16 needed to be brighter as the natural light had been restricted by the addition of the new lounge. The lounges were bright and comfortably furnished. The bedrooms seen were pleasant, comfortable and personalised with residents’ own possessions. The outside of the home was cluttered, untidy and overgrown because of the ongoing building work. There was limited space for the residents to use and the outside area was not welcoming for residents to enjoy. The manager said that future plans include making a safe and pleasant garden area accessible to residents. The home was very clean throughout with no offensive odours. Residents and visitors spoken with, and the survey responses, said the home was always clean. Staff had received training in the control of infection and were aware of actions to take to ensure proper hygiene. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 17 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, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The recruitment procedures and induction training for staff were not sufficiently robust so that residents were not fully protected. EVIDENCE: The staff rota was seen and showed that there were always 2 care staff on duty, plus the manager during the day. Care staff were supported by kitchen, domestic and maintenance staff. For the assessed dependency of residents, the current staffing levels were in line with the guidance of the Residential Forum for care staffing in care homes for older people. The manager said that staffing levels were to be reviewed when a resident returned from hospital to ensure that their needs were met. The surveys received, and residents and visitors spoken with indicated that staff were usually available when needed. Staff spoken with said that there were times when it would be safer and useful to have another care assistant on duty. An example given was that a resident fell going from the lounge to the toilet when both care staff on duty were occupied with other residents elsewhere. There were positive comments about the staff on the surveys received and from residents and visitors spoken with. Comments included “The staff are Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 18 excellent and it is quite clear they have each residents welfare at heart”, and the staff “show respect” to the residents. The records of 4 members of staff were seen. 2 of the records were of recently recruited staff and did not include a Criminal Records Bureau, (CRB), disclosure, photograph, or recent form of identification. The CRBs had been applied for and the manager said that these staff were working under supervision at all times. The application forms for 2 members of staff did not have full details of previous employment and there was no evidence that this had been explored at interview. 2 records did not include the date that employment commenced. 1 record of a member of staff recruited several years ago did not include references. Staff training records were seen and showed that staff had received the required training, such as manual handling, first aid and fire safety. Staff had received training in safeguarding adults, dementia awareness, and senior staff had received training about the safe handling of medication. Staff spoken with were pleased with the training provided at the home. Most of the care staff had achieved National Vocational Qualification, (NVQ), in care at level 2 or 3. A recent inspection by the fire officer had highlighted that night staff had not had fire safety training twice a year as recommended. The manager said that in-house training was to be arranged to address this. The home’s induction programme was based around orientation to the home’s routines and procedures and did not follow the specification of the Skills for Care induction. There was no written evidence that the new members of staff had completed an induction. The manager said that a new induction programme was to be developed and showed an example of a programme that met the Skills for Care specifications. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 19 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was well managed so that residents were protected and their best interests were promoted by the systems in place. EVIDENCE: The manager was experienced and had achieved NVQ Level 4 in care. Residents, visitors, staff and the surveys received were all positive about the manager. She was described as “approachable”, “supportive”, “firm but fair”, and “always available to discuss concerns”. The manager did not have the support of a deputy or an administrator which would have been helpful in keeping up with records such as recruitment and training, and in helping with tasks such as ordering supplies and organising training. As the owners are planning further development of the home, consideration should be given to providing support for the manager. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 20 Since the last inspection, the manager had sent out satisfaction surveys to residents/their representatives. The responses had been received but no analysis or report had been produced. The survey responses were generally positive indicating that residents/their representatives were satisfied with the service provided. The records were seen of resident’s personal money held by the home. The records were up to date and had two signatures for all transactions. The manager carried out a regular audit of the money held and the money was kept securely in a safe. Health and safety records were sampled, including the fire log book, maintenance and servicing records. All the records seen were up to date. The home employed maintenance staff. It was not clear from the records seen that hot water temperatures were regularly checked and that the risk of Legionella had been assessed. The manager was advised to contact the local environmental health department for further guidance and clarification. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 21 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP7 OP19 OP29 Regulation 15(1) 23(2)(d) (p) 17(2) Requirement Care plans must include details of how all of the assessed needs of the resident are to be met. The dining room must be redecorated and adequate ventilation provided. Staff records must include all the required items. Timescale for action 31/10/06 31/12/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Richmond Refer to Standard OP7 OP9 Good Practice Recommendations Residents/their representatives should be more formally involved in care planning. The minimum and maximum temperature of the fridge used to store medication must be recorded daily to ensure medication is stored at the correct temperature. The lighting in the dining room should be improved so that the room is brighter. Interview notes should be kept to improve the recruitment procedure. The induction programme for staff should meet the DS0000020082.V310169.R01.S.doc Version 5.2 Page 23 OP19 OP29 OP30 6. 7. 8. OP31 OP33 OP38 specifications of Skills for Care. The manager should be provided with administrative support. The quality assurance system should be further developed to include an analysis and report of the satisfaction survey. Advice and guidance should be sought and followed regarding the maintenance of the water system with regard to the risk of scalding and the risk of Legionella. Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Richmond DS0000020082.V310169.R01.S.doc Version 5.2 Page 25 - 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. 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