CARE HOMES FOR OLDER PEOPLE
Richmondwood 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL Lead Inspector
Marjorie Richards Key Unannounced Inspection 2nd November 2006 09:50 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 Richmondwood DS0000003977.V317128.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. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Richmondwood Address 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL 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) 01202 511179 01202 256967 georgina.smee@btconnect.com www.richmondwoodresthome.co.uk Mr John Andrew Glazer Miss Georgina Louise Smee Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Miss Smee must complete an NVQ Level 4 in management by August 2007. Evidence of successful completion must be forwarded to the Commission. 28th April 2006 Date of last inspection Brief Description of the Service: Richmondwood is a care home providing personal care and accommodation for up to twenty-two older people. The registered provider is Mr John Glazer and the registered manager is Miss Georgina Smee. Mr Glazer also employs the services of a management company to provide additional support to the home. Richmondwood is situated in a tree-lined avenue in a quiet residential area, within walking distance of the shops at Charminster. The main shopping centre of Bournemouth is less than two miles away. Local amenities include a wide range of shops, cafes and restaurants, as well as places of worship, doctors surgeries, library etc. There is a car parking area to the front of the home and further car parking is available for visitors on surrounding roads. Bus stops are situated on the nearby Charminster Road, providing a service to all areas of Bournemouth, Christchurch, Poole and beyond. Richmondwood is a large, detached property set in attractive and wellmaintained grounds, which are accessible to residents. Accommodation is arranged over two floors, with a passenger lift available to aid access between the floors. There are twenty-two single bedrooms and seventeen have en suite facilities, including baths in some rooms. The home has a large communal lounge with adjoining dining room. There are sufficient bathrooms and W.C.’s, including assisted baths, to meet the needs of residents. Twenty-four hour care is provided. Laundering of personal clothing is carried out on the premises. All meals are prepared and cooked within the home. A choice of menu is offered and a variety of alternatives are available to suit individual taste and preference at mealtimes. Special diets can be catered for. A range of social activities is offered to provide stimulation and interest for residents and each month there is an inter-denominational communion service held in the home. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 5 The range of fees is as follows: £375 - £475 per week. This information was provided in October 2006 and confirmed as still current at the time of this inspection. Hairdressing, chiropody, newspapers, dry-cleaning and personal toiletries are charged extra. A copy of the home’s inspection report is always available to anyone wishing to read it, as part of the Information File in the entrance hall. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.75 hours on the 2nd November 2006. The purpose of this year’s second key unannounced inspection was to again review all of the key National Minimum Standards, check progress in meeting the requirements and recommendations that had been made at the previous inspection and to ensure that the residents living at Richmondwood were safe and properly cared for. On the day of inspection, 20 residents were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with twelve residents. The daily routine was also observed during the inspection. Discussion also took place with Miss Georgina Smee, the registered manager and members of staff on duty. Mr John Glazer, the registered provider and a representative from the management company made themselves available during the inspection and this was appreciated. For the purposes of this report, people who live at Richmondwood are referred to as residents as this is the term generally used within the care home. The Inspector was made to feel very welcome in the home throughout the visit. What the service does well:
When a person moves into the home a thorough assessment of needs is carried out. A letter is then written to the prospective resident confirming that the home is able to meet their needs. Residents’ health, personal and social care needs are supported by detailed plans of individual care. Health care needs are well met, with evidence of good support from community health professionals. Residents say that they enjoy living at Richmondwood. They say that they are treated with care and respect. Residents commented, We are treated so well here. Everyone is so very kind and friendly.” I think we are treated very well, with kindness and respect for old age and infirmity. The lifestyle of those living in the home offers varied individual and shared social and religious opportunities, which reflect people’s interests and
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 7 preferences. Residents are also supported to maintain contact with family and friends and to make choices and enjoy an independent lifestyle. Residents confirmed that their individual preferences and routines are respected. “You can do what you like here. This place is very friendly. There are no rules and regulations; after all, this is my home.” Residents enjoy a varied, nutritious and appealing diet, in surroundings of their choice and at times which are convenient to them. Only positive comments were received from residents: The food is excellent, it could not be better. We have a marvellous cook.” If we dont like what is on the menu, the cook will ask us what we like and then we have a meal we enjoy. The food here is very good, second to none.” We have a lovely cook, she knows just what we like. The food is always steaming hot. Residents spoken to say that they feel able to raise any issues of concern. We are very well looked after here. I have no complaints about anything.” I raised an issue once and it was dealt with immediately. The home has a comprehensive Adult Protection policy in place and staff have received training to ensure residents are protected from possible abuse. Residents live in comfortable surroundings and have access to pleasant communal areas, including gardens. These communal areas are well used by residents. Facilities are provided where residents and visitors can make themselves a drink of tea or coffee at any time. Bedrooms are generally well equipped, comfortably furnished and individually personalised to suit their occupants. The home is clean and there are no unpleasant odours, ensuring that residents live in a pleasant environment. Residents commented, The girls clean my room very well. Everything is spotlessly clean.” This place is always clean and there are no nasty smells. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. Staff showed a warm and caring approach when dealing with residents. Residents commented, This is a lovely place, they are so kind here. The staff are very good to us.” Everyone here is very friendly. The staff work hard to look after us, but they seem happy in their work. I think they are very dedicated. Robust employment and recruiting procedures are in place to ensure the protection of residents when employing new staff. Staff are provided with suitable training, so they will have the skills necessary to meet the needs of residents. During the inspection, the manager demonstrated effective management skills in the organisation of the daily routine in the home and a good rapport was observed between residents, staff and management. Residents commented, I
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 8 think the new manager is very good. I like speaking with her. Everything seems to run very smoothly here.” I think this place is very well run, it always seems well organised.” Richmondwood has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. Three residents have their own pets in the home and Miss Smee is willing to discuss the admission of pets with any prospective resident. Residents are assured of sound management of their financial interests. A detailed system for listening to and seeking the views of people involved in the life of Richmondwood ensures that the home is run in the best interests of the residents. What has improved since the last inspection? What they could do better:
Care planning documentation is comprehensive. It includes questions about how the resident likes to be addressed, their wishes regarding the gender of staff caring for them, religion, ethnicity and language. Care must be taken to ensure that this documentation is always fully completed so that all this information is obtained and made available to staff. Wherever possible, care plans should be agreed and signed by the resident themselves, or by a relative or representative. This could only be evidenced on one of the care plans examined. A number of issues regarding medication were raised during the previous inspection. Although this inspection shows that considerable improvements
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 9 have taken place, the Commission still has concerns about two recent events where the home’s policy concerning the administration of medication was not followed. This has the potential to put residents at risk. Staff training should be reviewed and further training arranged, as necessary, to ensure staff always adhere to the home’s medication policy for the receipt, recording, safe handling and administration of medicines. The record of complaints investigations is well maintained, but care must be taken to ensure the outcome is always fully recorded and includes details of any actions taken as a result. Residents live in comfortable surroundings. However, the completion of the programme to fit radiator covers will help promote greater safety within the environment. During the inspection, a potentially hazardous situation was observed in one bedroom where an unguarded radiator was situated alongside the resident’s bed. Immediate steps were taken to ensure the resident’s safety. The manager confirmed that thermostatic control valves have been fitted to bath and wash hand basin hot water outlets. However, when temperatures were checked during the inspection, the hot water temperature at some wash hand basins was found to be as high as 55.2C. The recommended temperature is 43C, to prevent any risk of scalding. Miss Smee agreed to take immediate action to have the thermostatic valves checked. Some of the cupboards and kitchen units would benefit from repair and/or replacement, as they are showing signs of damage or wear. 50 of care staff should be qualified at NVQ level 2 and qualifications gained by the extended date of 2006. 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. The summary of this inspection report can be made available in other formats on request. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 10 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 Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Standard 6 is not applicable at Richmondwood Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Richmondwood. Information provided about Richmondwood and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. The home assures prospective residents in writing that their needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities. The Service User Guide gives a good indication of what a resident can expect from the home and includes details of the complaints procedure. A copy is provided in every residents bedroom. These documents are also included in an Information File placed in the entrance hall at Richmondwood, where a copy of the current inspection report can also be viewed. Miss Smee has recently updated and expanded this file to include further details, e.g., about the services visiting the
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 12 home, such as hairdressing, chiropody, dentists and opticians, the daily opening hours for the “Tuck Shop,” information about where residents and visitors may help themselves to refreshments within the home. Sample menus and the results of Quality Assurance surveys in the home are also provided. A copy of the home’s Terms and Conditions is included, alongside the Office of Fair Trading’s report, “Fair Terms for Care.” All of the information is provided in an easy to read style and in large print. One paragraph in the Terms and Conditions concerning insurance is being re-written to provide better information for residents. Clear pre-admission assessment information has been recorded for two residents who had moved into Richmondwood since the last inspection. Miss Smee says that she always endeavours to visit prospective residents, prior to making a decision as to whether the home is able to meet their needs. A comprehensive form has been developed for this purpose. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs can be met. A copy of this letter is retained on file. The information contained in pre-admission assessments and also any assessments supplied by Social Services, is then used to help draw up a detailed plan of care. It was noted on one resident’s Terms and Conditions (contract) that specific wishes with regard to religious needs were set out. During the inspection, it was evidenced that these wishes have been incorporated into the care plan and are being implemented. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 13 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. 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 Richmondwood. Richmondwood has a good care planning system in place, which ensures that staff have the information they need to meet the needs of residents. However, more needs to be done to ensure residents or their representatives are fully involved in planning, agreeing and reviewing their care. Health care needs are well met, with evidence of good support from community health professionals. Significant improvements in dealing with medication have taken place since the last inspection. However, the home’s procedures for managing residents’ medication are not always followed, so this has the potential to place residents at risk. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 14 EVIDENCE: Following admission to the home, further assessments are carried out and a care plan is drawn up, identifying the needs of each resident and how staff are to meet these needs. To aid correct identification, each record contains a recent photograph of the resident. Care planning documentation is comprehensive. It includes questions about how the resident likes to be addressed, their wishes regarding the gender of staff caring for them, religion, ethnicity and language. Care must be taken to ensure that the documentation is always fully completed so that all of this information is obtained and made available to staff. Care plans for three residents were examined. They inform how care is to be delivered to meet residents’ personal, social and healthcare needs. Detailed assessments, including general and specific risks are recorded. Corresponding care plans have been produced outlining how these risks are to be minimised. For instance, one resident admitted to the home has a history of falls. Appropriate risk assessments were put in place and a falls diary commenced. The General Practitioner was contacted and referrals made to the Occupational Therapist (for assistance with walking aids) and also to the Falls Clinic. Hip protectors have also been provided. Subsequent meetings and discussions with the three residents concerned demonstrate that care is being delivered as detailed in the care plans. Miss Smee says that, where possible, care plans are agreed and signed by the resident themselves, or, if this is not possible, by a relative or representative. This could only be evidenced on one of the care plans examined. Care plans give personalised information to assist staff in the provision of good quality care. For example, ….Likes to be in fresh air and have windows open.” Detailed daily records are written by staff to evidence the care being provided. Members of staff are able to demonstrate that they have a good knowledge of residents’ individual care needs. Residents commented, They look after me really well here.” I feel very settled and content with life now. I never thought I would say it, but I am happy to be in a place like this.” Care plans are regularly reviewed, at least monthly and updated as necessary to reflect any changing needs. Good daily records are written by staff to evidence the care being provided. Records show that residents have access to General Practitioners, district nurses, dentists, chiropodists, opticians etc and attend hospital appointments as necessary. This was confirmed in discussion with residents and staff. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 15 The home has systems in place for managing medicines. Only senior staff deal with medication and they first have to undertake a course of related training. Medicines are stored securely, to ensure the protection of residents. Those Medicine Administration Records (MAR) examined were well maintained. A Monitored Dosage System is in use. Samples of the cassettes were checked to confirm that the quantity left agreed with the MAR charts, indicating that they had been administered correctly, as prescribed. A number of issues regarding medication were raised during the previous inspection. Although this inspection shows that considerable improvements have taken place, the Commission still has concerns about two recent events where the home’s policy concerning the administration of medication was not followed. This has the potential to put residents at risk. Staff training should be reviewed and further training arranged, as necessary, to ensure staff always adhere to the home’s medication policy for the receipt, recording, safe handling and administration of medicines. Staff were observed knocking at bedroom doors and offering personal care in a sensitive and discreet manner. Staff interact with residents in a friendly and caring way and it was good to hear residents sharing conversations as well as laughter and a joke with staff. From observation and the time spent with residents it is clear that they feel comfortable and very at ease with staff. Staff were seen throughout the inspection to be treating residents with patience, courtesy, kindness and respect. Residents commented, We are treated so well here. Everyone is so very kind and friendly.” The staff are so kind and always courteous. I think we are treated very well, with kindness and respect for old age and infirmity. Residents confirm that they are able to go to their own bedrooms whenever they wish, thereby offering an opportunity to be on their own or allowing privacy for any visitors or personal care needs. A resident commented, I like to go down to the lounge sometimes, but I also spend a lot of time in my bedroom. The staff say it is up to me what I do and where I go, no one minds. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Richmondwood. Residents at Richmondwood are offered varied individual and shared social and religious opportunities, which reflect their interests and preferences. Residents are supported to maintain contact with family and friends and to make choices and enjoy an independent lifestyle. Residents enjoy a varied, nutritious and appealing diet, in surroundings of their choice and at times which are convenient to them. EVIDENCE: The social, cultural and religious needs of people moving into the home are reflected in assessments and care plans. Residents, their relatives and staff have been invited to be involved in the preparation of “Life Histories,” giving information about each resident’s personal history, hobbies and interests etc. A range of activities is available in the home, with something arranged every day, including gentle armchair exercises, quizzes, reminiscence, ball games,
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 17 sing-a-longs and bingo. On Saturday, the home provides a film show in the lounge in the “Saturday Home Cinema” and on Sundays, residents enjoy artwork. During the afternoon of the inspection, a group of residents were sitting in the lounge taking part in a general knowledge quiz with staff. This was a social occasion, with plenty of conversation and then refreshments afterwards. Discussion with residents during this inspection shows that they are pleased with the activities being provided. Comments include, “We have lots of quizzes. I really enjoy that, it helps to keep my brain active.” “The staff always bring me down to the lounge for the activities. They know I like to join in.” “You dont have to take part if you dont want to. I like some things, but not all. I choose if I want to join in or not.” “There is always something going on here, which is nice.” The arrangements for Christmas are well in hand, including a sherry and mince pie party for residents and their relatives, with entertainment also planned. A local church choir will be visiting to sing carols. Arrangements are made for clergy to visit individual residents upon request. A monthly inter-denominational communion service is held within the home. Miss Smee says that visitors are welcome to visit the home at any time. Residents and staff confirm that visiting times at Richmondwood are unrestricted. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Some residents are able to go out of the home alone or with their visitors or with staff. A telephone is always available to residents so they may make or receive calls from family and friends. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirmed that their decisions, for example to spend most of their time in their bedrooms, to go to bed early or late, were respected by staff. Residents are able to bring their own possessions into the home to personalise their bedrooms. They are encouraged to make choices, e.g., about what to wear and what to eat or drink and they have the freedom to come and go as they please. On the day of inspection, one resident was going out to make a regular visit to the hairdresser. Residents confirmed that their individual preferences and routines are respected. “You can do what you like here. This place is very friendly. There are no rules and regulations; after all, this is my home.” No-one interferes, you can do what you like. Lunch on the day of inspection was roast gammon or homemade vegetable lasagne, with roast or mashed potatoes, carrots, peas and cauliflower, followed by banana crunch, or Angel Delight, cheese and biscuits or yogurt. A range of alternatives, such as jacket potatoes with a variety of toppings, fish,
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 18 omelettes, soups, egg/baked beans/cheese on toast or ham/corned beef/tuna/cheese salads etc is always available to suit individual taste and preference. Residents may choose where to eat their meals and mealtimes can be flexible to fit in with care needs, appointments etc. Special diets are catered for and discreet staff assistance is available for those who need help with their food. The cook demonstrated an excellent knowledge of residents’ dietary needs, likes and dislikes. Good supplies of fresh, frozen, tinned and dry foods are available. Residents and their visitors may help themselves to tea and coffee at any time from a refreshment area adjacent to the lounge and dining room. Mealtimes are unhurried and residents clearly enjoyed their lunch on the day of inspection. The following comments were received from residents: The food is excellent, it could not be better. We have a marvellous cook.” If we dont like what is on the menu, the cook will ask us what we like and then we have a meal we enjoy. The food here is very good, second to none.” We have a lovely cook, she knows just what we like. The food is always steaming hot. The food is very good, you could not ask for better. It’s home-from-home cooking. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 19 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. 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 Richmondwood. A system is in place for dealing with any complaints. Residents are confident complaints would be listened to and dealt with appropriately. The home has a comprehensive Adult Protection policy in place to ensure residents are protected from possible abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints policy is also available to visitors in the Information File in the entrance hall. The complaints record shows that four complaints have been received by the home since the last inspection. These were investigated by Miss Smee and appropriate action taken. The record of investigations is well maintained, but care must be taken to ensure the outcome is always fully recorded and includes details of any actions taken as a result. Discussion with residents demonstrates they feel able to voice a complaint if necessary and their concerns are taken seriously, and acted upon. Comments include: The staff are very friendly. You can talk to them about anything.”
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 20 We are very well looked after here. I have no complaints about anything.” I raised an issue once and it was dealt with immediately. If I had any concerns I would tell the manager. I feel sure she would sort it out.” The home has a comprehensive and recently updated Adult Protection policy in place to protect residents from possible abuse. This makes reference to the Department of Health No Secrets document, which is also available to staff. All staff have now received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. The staff on duty confirmed that they had benefited from training in the Protection Of Vulnerable Adults. An Adult Protection referral was recently investigated by Borough of Poole Social Services regarding respite care. A number of recommendations were made as a result and these are being implemented. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in comfortable surroundings. The completion of the programme to fit radiator covers and checking of thermostatic valves at wash hand basins, to ensure there is no risk of scalding, will help promote greater safety within the environment. Residents have access to pleasant communal areas, including gardens. Bedrooms are generally well equipped, comfortably furnished and individually personalised to suit their occupants. Richmondwood is clean and there are no unpleasant odours, ensuring that residents live in a pleasant environment. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 22 EVIDENCE: Inspection of the premises confirmed that routine maintenance is being carried out and plans are in place for improvements to some areas of the home. Detailed maintenance records are kept and prompt attention is paid to any minor defects and repairs whenever necessary. The home has almost completed a programme to fit radiator covers to ensure the safety of residents. However, a potentially hazardous situation was observed in one bedroom where an unguarded radiator was situated alongside a resident’s bed. The last inspection report stated, “The home has made progress with the fitting of radiator covers to those radiators which present a risk of scalding. The programme is being completed, with areas of highest risk scheduled first.” Clearly, this radiator presented a very high risk but had not received priority attention. It was later evidenced that arrangements were planned to rectify this situation and immediate action was taken to ensure the resident’s safety. The manager confirmed that thermostatic control valves have been fitted to bath and wash hand basin hot water outlets. However, when temperatures were checked during the inspection, although bath temperatures were satisfactory, the hot water temperature at some wash hand basins was found to be as high as 55.2C. The recommended temperature is 43C, to prevent any risk of scalding. Miss Smee agreed to take immediate action to have the thermostatic valves checked and to monitor water temperatures in future. Some of the cupboards and kitchen units would benefit from repair and/or replacement, as they are showing signs of damage or wear. One cupboard door is missing. Some improvements have taken place since the last inspection. The ground floor WC has been enlarged and will now easily accommodate residents in wheelchairs. A small area in the dining room has been set aside for parking wheelchairs and hoists when not in use. Portable ramps have been provided at the entrance to the front door and the door from the dining room into the rear garden to aid access. Eight new armchairs have been purchased for the lounge. The lounge and adjoining dining room are situated on the ground floor and provide comfortable communal space. There is also a small sitting area off the hallway. These communal areas are well used by residents. Facilities are provided where residents and visitors can make themselves a drink of tea or coffee at any time. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 23 The home has attractive gardens to the front and rear of the property, which are accessible to residents. These include a terrace area with fishpond. Garden furniture is available. One resident commented, “I think the gardens are a real tonic. They look lovely all year round and give me a lot of pleasure.” A tour of the building confirmed that bedrooms are comfortably furnished and personalised to varying degrees. In a few bedrooms, bed linen and towels have become rather worn and/or frayed and need replacement. This also applies to some pillows and one of the duvets seen, which have become very “lumpy” and potentially uncomfortable. Residents spoken with said that their bedrooms suited their needs. Residents commented, I think I have the best room in the house with a lovely view over the garden.” I have a very comfy bed and armchair. I like my room, I am well satisfied.” The home is clean and there are no unpleasant smells, making life within the home more pleasurable. A planned refurbishment of the laundry is about to commence to improve the facilities and storage. Residents felt the laundry service was good. An infection control policy is in place, but staff have yet to complete training in infection control. This was highlighted at the last inspection, but evidence was seen to confirm that training has now been booked to take place early in 2007. The home has suitable facilities and procedures in respect of the disposal of clinical waste. Residents commented, The girls clean my room very well. Everything is spotlessly clean.” This place is always clean and there are no nasty smells. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working towards the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are in place to ensure the protection of residents. Staff are provided with suitable training, so they will have the skills necessary to meet the assessed needs of residents. EVIDENCE: Examination of the staffing roster, feedback from those living in the home and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the current needs of residents. Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to needs appropriately, working to protect the residents’ needs for privacy and
Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 25 dignity. Staff showed a warm and caring approach when dealing with residents. Residents commented, This is a lovely place, they are so kind here. The staff are very good to us.” The girls are lovely. I love them all.” Everyone here is very friendly. The staff work hard to look after us, but they seem happy in their work. I think they are very dedicated. The home is working to achieve the target of at least 50 trained members of care staff with National Vocational Qualification (NVQ) level 2, to ensure residents at Richmondwood are in safe hands. Three members of staff have now attained NVQ level 2 and one more is currently studying for the NVQ level 2. Two members of staff are studying for NVQ level 3 and one more is about to commence NVQ level 3 training. Miss Smee is hoping to encourage further staff to undertake NVQ training. The two staff files examined demonstrate that the home is operating a thorough recruitment procedure, to ensure the protection of residents. With regards to the two written references for new applicants, Miss Smee was reminded of the need to now include, where applicable, a reference relating to the person’s last period of employment (if this involved work with children or vulnerable adults of not less than three months duration.) An equal opportunities policy underpins the employment practice of the home. The home takes staff training seriously as a means of improving the standard of care provided and ensuring residents safety. All new staff receive induction training. This includes a four-day introduction to the home and a six-week induction, which is now based on the Skills for Care Common Induction Standards. Since the last inspection, an audit of staff training has been carried out and a document produced which clearly identifies the training achieved by all staff in the home and where further input is needed. Further training has been arranged to ensure all staff receive appropriate training in moving and handling, fire safety, first aid, Protection of Vulnerable Adults, basic food hygiene and health and safety. Infection control training has also been arranged. Copies of training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 26 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. 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 Richmondwood. Miss Smee demonstrates a good knowledge of the operation of the care home and the needs of its residents. The home regularly reviews its performance and actively seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Residents are assured of sound management of their financial interests. Richmondwood works to ensure the general health, safety and welfare of residents. Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 27 EVIDENCE: Since the last inspection, a new registered manager has been appointed. Miss Smee has experience in caring for older persons. She has attained the National Vocational Qualification (NVQ) level 4 in care and is currently studying for her Registered Managers Award. Richmondwood has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. Three residents have their own pets in the home and Miss Smee is willing to discuss the admission of pets with any prospective resident. Richmondwood provides a supportive and caring environment where residents say they feel comfortable and secure. Miss Smee has a good rapport with residents, visitors and members of staff. This was demonstrated throughout the inspection, with many residents and visitors stopping at the office door to have a chat with the manager and discuss care issues etc. Residents commented, I think the new manager is very good. I like speaking with her. Everything seems to run very smoothly here.” I think this place is very well run, it always seems well organised.” The lady in the office is lovely. You can always talk to her, she is very helpful and never makes me hurry.” Staff commented, “This is a good place to work. We are well supported by the manager.” “She (manager) knows what she is doing. She has brought in some good changes here.” Miss Smee says she always feels well supported by the registered provider, and the management company. Quality Assurance questionnaires are sent out annually to residents, staff, relatives and other visitors to the home to obtain their views. Feedback from these is available in the Information File in the entrance hall. Regular audits also take place within the home and policies and procedures are reviewed to ensure best practice. A number of new and updated policies and procedures have been recently introduced to offer guidance to staff. Comments in Quality Assurance questionnaires received by the home include, “There is a warm, pleasant atmosphere, with friendly approachable and professional staff. “The home is very well run, with a very friendly atmosphere.” Miss Smee confirms that, in order to protect residents it is the policy of the home, where possible, not to have any involvement in their personal finances. Therefore, all residents who are unable or do not wish to handle their own affairs, have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment each month. However, small amounts of money are held for five (occasionally Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 28 six) residents. Detailed records are kept and monies are held securely. One record was checked at random and the amounts held found to be correct. Information about advocacy services is available to residents within the home and policies are in place precluding staff acceptance of gifts or involvement in residents wills. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, gas appliances, hoists etc are regularly serviced and maintained. All substances that could be potentially hazardous to health are handled and stored safely and restrictors are fitted to windows. The majority of staff have received first aid and health and safety training. All but one member of staff have received moving and handling training. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and staff confirm this. Staff fire training, including induction training for new staff, is taking place and fire drills are arranged so that staff are fully aware of the action to take in the event of a fire. Richmondwood DS0000003977.V317128.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 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 3 X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Richmondwood DS0000003977.V317128.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 OP7 Regulation 15(1) and 15(2) Requirement Timescale for action 01/02/07 2 OP9 13 3 OP19 13(4)(a) (c) 4 OP19 13(4)(a) (c) All aspects of each resident s health and welfare needs must be recorded. Care plans are to be agreed and signed by the resident or their representative wherever possible The registered person shall make 01/02/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: (Previous timescales of 14/03/06 and 28/04/06 not fully met.) Hot water temperatures at wash 01/02/07 hand basins must be checked and steps taken to ensure the water temperature is close to the recommended 43C, to prevent any risk of scalding. Where radiators do not have low 01/02/07 temperature surfaces, steps must be taken to ensure that they are guarded to minimise the risks to residents. Beds must not be positioned next to unguarded radiators. Written confirmation is required that this
DS0000003977.V317128.R01.S.doc Version 5.2 Richmondwood Page 31 5 OP24 16(2)(c) situation has been rectified. (Previous timescales of 24 /02/06 and 31/08/06 not fully met.) The registered person must ensure that adequate bedding, bed linen and towels etc., are made available to residents. Items that are worn and/or frayed should be replaced. 01/02/07 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 OP9 Good Practice Recommendations It is recommended that staff training be reviewed and further training arranged, as necessary, to ensure staff adhere to the home’s medication policy for the receipt, recording, safe handling and administration of medicines. Repeated in part. The complaints log should include all details of the course of complaints investigations, including outcomes and any actions taken as a result. Repeated in part. It is recommended that hot water temperatures are monitored to ensure the safety of residents. It is recommended that kitchen cupboards and units are repaired and/or replaced where they are showing signs of damage or wear. It is recommended that a minimum of 50 of care staff achieve NVQ level 2 training. 2 OP16 3 4 5 OP19 OP19 OP28 Richmondwood DS0000003977.V317128.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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