Inspection on 23/07/07 for Richmondwood

This inspection was carried out on 23rd July 2007.

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

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

Other inspections for this house

Richmondwood 29/02/08

Richmondwood 02/11/06

Richmondwood 28/04/06

Richmondwood 24/11/05

Richmondwood 28/07/05

Richmondwood 26/01/05

Richmondwood 17/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Richmondwood 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL Lead Inspector Marjorie Richards Unannounced Inspection 23rd July 2007 09:30 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 Richmondwood DS0000003977.V343594.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.V343594.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.V343594.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. 2nd November 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. 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. The range of fees is currently as follows: £425 - £500 per week. This information was confirmed as accurate during the inspection. Hairdressing, chiropody, newspapers, dry-cleaning and personal toiletries are charged extra. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 5 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. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choosing a care home .aspx Richmondwood DS0000003977.V343594.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 9.5 hours on the 19th June 2007. The main purpose of this unannounced inspection was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. The home is currently subject to a multi-agency Safeguarding Adults investigation, with Borough of Poole Social Services taking the lead. The Adult Protection Strategy Meeting, (which includes the Commission for Social Care Inspection) requested that someone from the Borough of Poole should take part in the next inspection of the home. This inspection was therefore conducted jointly with the following monitoring officer, who has agreed to her name and contact details being included below: Lynne Payton Borough of Poole, Service Improvement Officer Tel: 01202 261167 On the 24th July, the Commission for Social Care Inspection’s Pharmacist Inspector, Christine Main, also came to the home to inspect the handling and administration of medicines. On the days of inspection, eighteen residents were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for seven residents. Time was spent observing the daily routine during the inspection, as well as talking with residents and the staff on duty. Discussion also took place with Miss Smee, the registered manager. Mr John Glazer, the registered provider, made himself available for much of the inspection and this was appreciated. The Annual Quality Assurance Assessment (AQAA) form had been completed by Miss Smee and provided to the Commission for Social Care Inspection in advance of the inspection. Recent legislation has made it a legal requirement for all registered services for adults to complete an AQAA every year. The completed assessment is one of the ways in which the Commission for Social Care Inspection will assess how well the service is delivering good outcomes for the people using it. 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 Inspectors were made to feel welcome in the home throughout the inspection. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Three of the five requirements made at the last inspection have been met. The remaining two have been repeated at the end of this report. Two of the five recommendations have also been implemented. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 8 Some improvements to the environment have taken place. The home has completed a programme to fit radiator covers to ensure the protection of residents from contact with hot surfaces. The hot water temperatures were tested and found to be close to the recommended temperature is 43C, to prevent any risk of scalding. New doors have been fitted to the kitchen units and improvements have been made to work surfaces etc in the laundry. Some new items of bedding, bed linen and towels have been purchased. The home is working to achieve the ratio of 50 of care staff trained at National Vocational Qualification level 2. 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. The summary of this inspection report can be made available in other formats on request. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 9 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.V343594.R01.S.doc Version 5.2 Page 10 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. EVIDENCE: The Statement of Purpose and Service User Guide contain a wide range of information 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. Some changes are needed to ensure the information is fully up to date. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 11 The Statement of Purpose and Service Users Guide 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 expanded this file to include further details, e.g., about the services visiting the home, such as hairdressing, chiropody, dentists and opticians, sample menus, the opening hours for the Tuck Shop and information about where residents and visitors may help themselves to refreshments within the home. All of the information is provided in an easy to read style and in large print. A copy of the Office of Fair Trading Fair Terms for Care report is also available. One paragraph in the Terms and Conditions concerning insurance for residents’ possessions was highlighted at the last inspection. Assurances were given that changes would be made, in order to provide better information and clearer terms for residents. This has not yet been achieved but Mr Glazer says he is making arrangements to deal with this shortly. 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. Three files were examined and these showed clear pre-admission assessment information in place for two residents prior to moving to Richmondwood. In the one case where this had not happened, the prospective resident lived a long way from Dorset so a visit was not practicable, but information from other sources had been taken into account. 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. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to Richmondwood. Residents are generally treated with respect and the home ensures they have access to a range of health services, such as General Practitioners, District Nurses and chiropodists etc, to ensure their needs are met. However, the administration and recording of medication needs improving to safeguard residents and ensure that their healthcare needs can be fully met. EVIDENCE: The home has a clear admission procedure in place. 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. However, the care plan policy needs updating, as it does not correspond with the way care plans are currently laid out. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 13 The care plans for seven residents were examined. These contain detailed information to enable staff to provide the care required by each resident, including their individual wishes and preferences. In general, care plans are well laid out and easy to follow. However, where the use of any form of restraint is considered, such as the use of lap belts in wheelchairs, risk assessments should always be carried out beforehand. If body maps are used, it is less confusing to staff if these are kept current and not continually added to. Informative daily records are maintained and comprehensive reviews are taking place at least monthly, which clearly detail any changes in care needs that may have occurred. However, where changes have taken place, the care plan and risk assessments have not always been updated. There is still insufficient documentary evidence to demonstrate that residents and/or their representatives are able to contribute to the care planning and review process and this needs to be addressed. Records evidence that residents have access to General Practitioners, District Nurses, Falls Prevention Team, chiropodists, opticians etc., as necessary. This was later confirmed in discussion with residents, manager and staff. Visits by General Practitioners and other professionals are well documented. The Commission for Social Care Inspection Pharmacist Inspector, Miss Christine Main visited Richmondwood on the second day of the inspection and found some matters of concern. At lunchtime the carer started giving medicines using the teatime monitored dosage blister packs, until a resident questioned the medicines they were being given. The home has also recorded this happening on another occasion. An immediate requirement was made that the correct medications must be administered at the time that they are prescribed, ensuring that people living in the home are protected by the home’s procedures for the safe administration of medicines. Medication awareness training is included in staff induction programmes but only the manager has undertaken a medication training course. Staff are recording applying a cream in the morning when it is prescribed for use twice a day. The home stores medicines and Controlled Drugs (CD) securely. There is an audit trail for the medicines sampled, but amounts of some medicines in stock do not agree with the records, indicating errors in administration and/or recording. There are also problems with Controlled Drug records. One resident self-medicates most of their medicines and appropriate records are kept but the risk assessment is in need of updating. There are clear photos of residents to help ensure medicines are given to the correct person but no records of medicine allergies or “none known” as applicable on most Medicine Administration Record (MAR) charts. Medicine details that were handwritten on MAR charts were appropriately countersigned as checked by a second person. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 14 A resident commented, I get on well with all the staff. They are mostly very helpful and kind and make allowances for my lack of speed and failing memory. Staff were seen to knock before entering bedrooms and to offer personal care discreetly, with due regard for the preservation of privacy and dignity. (However, this was not the case in one situation, which was brought to the attention of Miss Smee.) Staff were seen interacting with residents in a considerate manner and observed to be treating residents in a friendly yet courteous way, showing kindness and respect. However, in one situation, a member of care staff made inappropriate comments within the hearing of the resident concerned and failed to demonstrate an understanding of the resident’s needs, as stated in the care plan. Again, this was brought to the attention of Miss Smee. It is most important that all care staff have a good knowledge and understanding of the care plans in place for each resident, so they can fully meet assessed needs. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 15 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. The home is flexible in its approach to the provision of activities and meals, enabling residents to retain control over their lives wherever possible. 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 basic information about each resident’s personal history, hobbies and interests etc. A very informative summary, written as if by the resident, is provided discretely in each resident’s bedroom for the benefit of staff. It is hoped that information about social history, interests etc will be used to provide the focus for the provision of activities to ensure they meet the needs and wishes of residents. A range of activities is currently available in the home, with something arranged every day, including giant dominoes, quizzes, manicures, ball games, sing-a-longs, artwork and bingo. On Saturday, the home provides a film show in the lounge in the “Saturday Home Cinema.” An activities organiser attends Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 16 the home on two afternoons each week to provide a variety of group and individual activities for residents. Residents commented, I enjoy the afternoon activities. They do activities in the afternoons. I go along sometimes. It would be nice to see something different now and then. Can we have more entertainment? I like the singalongs when we have a singer, better than when they just put a record on. Quizzes are fun, they help to keep my brain active. I would like more trips out. It would be nice to go out now and again. There is always something going on in the afternoons. Miss Smee has already identified the need to organise outings for residents in her Annual Quality Assurance Assessment. She is also planning to develop more one-to-one activities with individual residents. Arrangements are made for clergy to visit individual residents upon request. A monthly inter-denominational Christian 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 confirm that staff respect their decisions, for example to spend most of their time in their bedrooms or to go to bed early or late. 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 they prefer to eat or drink and they have the freedom to come and go as they please. Residents confirm that their individual preferences and routines are respected. I am independent, I can come and go when I choose. I can do whatever I want to do during the day. However, a few residents did indicate that they sometimes have to wait for assistance when staff are busy. Lunch on the second day of inspection was steak or vegetarian grill, with chipped or mashed potatoes, broccoli and swede, followed by rice pudding, Angel Delight or cheese and biscuits. A range of alternatives, such as jacket potatoes with a variety of toppings, fish, omelettes, soups, egg/baked beans/cheese on toast or ham/corned beef/tuna/cheese salads etc is available to suit individual taste and preference. For the evening meal, residents could choose from sausage rolls and spaghetti, or sandwiches with assorted fillings and crisps. Residents may choose where to eat their meals and during the inspection, residents were observed to be taking meals in the dining room, lounge and in Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 17 their bedrooms. For those in the lounge and adjoining dining room, this can prove to be a rather noisy experience, with music playing in the dining room and the television also turned on very loudly at the same time. One resident commented, “I cannot hear what anyone is saying.” Miss Smee says that mealtimes are unhurried and can be flexible to fit in with care needs, appointments etc, and this was confirmed by residents. Special diets are catered for and discreet staff assistance is available for those who need help with their food. 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. The menu for the day is displayed a large print on each table in the 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 very good here, we have a good choice of everything. The meals are very good. We can smell it cooking when we are in the lounge and dining room. It always smells good. I had a very good dinner, I think Im putting on a bit of weight. I wasnt very hungry today, so they let me have a very small portion. I couldnt have faced anything more. The food is very good on the whole. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to Richmondwood. There are systems in place to deal with complaints but the administration must be improved to ensure an accurate record is maintained. The arrangements for ensuring a proper response to any suspicion or allegation of abuse are not satisfactory, placing residents at possible risk of harm or 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 two complaints have been received by the home since the last inspection. These were investigated by Miss Smee and appropriate action taken. At the last inspection, it was suggested that the complaints record would benefit from being more structured, clearly setting out the nature of the complaint, the subsequent investigation, the outcome and any action taken as a result. This has not yet been actioned. The home has an Adult Protection policy in place to protect residents from possible abuse. This is not the document seen at the last inspection and is in need of amendment, to ensure it reflects the current situation at Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 19 Richmondwood. (For instance, if abuse is suspected, the policy refers to sending copies of forms to the Operations Manager, and making copies of reports available to Commissioners and local inspection units.) The Adult Protection policy and procedure should follow guidance provided in the Department of Health No Secrets document and in accordance with the Public Interest Disclosure Act 1998. It is not possible to evidence from records that all staff have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. Such training should also include an awareness of the home’s own policies and procedures and ensure that staff understand the different terms used, such as Adult Protection, Protection Of Vulnerable Adults or POVA. Borough of Poole Social Services are currently leading an investigation under safeguarding adults procedures. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to Richmondwood. Some work is now needed to improve the décor, furniture and furnishings and to ensure a safe, clean and well-maintained environment for residents. EVIDENCE: Improvements have taken place since the last inspection. The home has completed a programme to fit radiator covers to ensure the protection of residents from contact with hot surfaces. The hot water temperatures were tested and found to be close to the recommended temperature is 43C, to prevent any risk of scalding. New doors have been fitted to the kitchen units and improvements have been made to work surfaces etc in the laundry. Some new items of bedding, bed linen and towels have been purchased. However, overall, the environmental standard appears to be deteriorating. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 21 There is evidence of a serious damp problem in the ceiling/wall areas adjacent to room 13, which is now affecting the plasterwork. Much of the paintwork is chipped on skirting boards. During the inspection, it was apparent there was a problem with the heating. On a warm day, a few of the radiators could not be turned off, making these areas very hot, whilst in some rooms additional freestanding heaters have been provided because residents say the heating is inadequate. There are currently no risk assessments in place with regard to the additional heaters in bedrooms. Miss Smee confirmed that there is currently no programme in place to improve the décor, fixtures and fittings. However, Mr Glazer later said that a planned refurbishment programme would be implemented. One resident commented, When I first came here I used to think it was rather grand, but I dont think so nowadays. It is getting a bit more run-down, rather like the occupants! 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. The Annual Quality Assurance Assessment provided to the Commission by Miss Smee refers to planned improvements to the lounge, dining room and refreshment area in the coming year. The home has attractive and colourful 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 love to go outside for a walk in the gardens. They are lovely.” Bedrooms are situated on the ground and first floor at Richmondwood. A tour of the building confirms that bedrooms are comfortably furnished and personalised to varying degrees. However, in some rooms the furniture is showing signs of wear and is in need of repair or replacement. Some rooms appear very cluttered. For instance, in one larger bedroom, there is only a single sized wardrobe provided, resulting in much of the resident’s clothing having to remain in suitcases on the floor. Apart from the inconvenience this causes, the suitcases also create a tripping hazard. In some bedrooms, the walls are marked and would benefit from redecoration. A number of bedroom carpets are stained and very dirty. Many of the extractor fans in ensuite facilities are not in working order. The wardrobes in some bedrooms are not very stable and have the potential to be pulled over when opening the doors. One bedroom has a broken windowpane; in another bedroom, the window restrictor is loose. Several rooms have curtains coming off their tracks. Regular hot and cold drinks are served during the day, but few water jugs are available in individual rooms so that residents can help themselves or have a regular glass of juice. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 22 Improvements are needed in the standard of cleanliness. For instance, a number of bedrooms have cobwebs in evidence and there is a build-up of lime scale in ensuite WCs. This is not intended as a criticism of the standard of work undertaken by cleaning staff, which was seen to be thorough during the inspection, but is perhaps more an indication that the total cleaning hours available each week in the home are not sufficient. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 23 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 poor. This judgement has been made using available evidence including a visit to Richmondwood. Staffing levels have been increased recently, but some residents still feel there are insufficient staff on duty to meet their needs. Practices in relation to recruitment of staff require improvement as residents are potentially placed at risk through a failure to carry out appropriate employment checks. Some shortfalls in staff training may result in staff not being fully competent in their work and therefore residents cannot be assured they are always in safe hands. EVIDENCE: The home has a weekly staffing roster, which is clearly laid out with the full names of staff, their status, the times of shifts and any subsequent changes. Miss Smee says that the care needs of residents are increasing and five of them now need two staff to assist with their care, day and night. Accordingly, staffing levels have recently been increased from two to three staff during the 2 p.m. to 8 p.m. shift, so there are now three care staff on duty all day from 8 a.m. until 8 p.m. and two wakeful care staff on duty overnight. Residents are generally very complimentary about staff, although some feel that staff are sometimes too busy to assist them when needed or to spend sufficient meaningful time with them. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 24 Residents commented: The staff always do their best for you. I think we have very good staff on the whole. Most are kind and considerate. The staff are always so busy, I dont like to bother them. The one who looks after me is very nice and very kind. It is sometimes difficult to get the attention of the staff when you are in the lounge. They are off doing other things. I have been waiting here for an hour to get up. I manage most things myself, but the staff are there when I need them. The staff never have the time to talk to you any more. After looking at the staffing rosters, concern was expressed to Miss Smee about the number of days being worked without a break by one member of staff. There has been a high staff turnover in the last year or so, with 16 staff leaving employment at Richmondwood. Staff indicated that the pressure of work had eased somewhat since the employment of an additional staff member in the afternoons. However, a relative recently contacted the Commission to say, The staff are always busy and have no time to chat to residents or take them out like they used to do. The care staff say that they feel frustrated as they cant do what they would like to do because they are always rushed off their feet. Most residents now need a lot of assistance. The home is still 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. At present, only two members of staff have attained NVQ level 2 but three more are now studying for NVQ level 2. One member of staff is studying for NVQ level 3 and one for NVQ level 4. Miss Smee says two further staff will commence NVQ level 2 training shortly. An equal opportunities policy is in place at Richmondwood. Seven staff files were examined and these demonstrated gaps in the documentation obtained prior to the employee commencing work at Richmondwood. The home is therefore not operating a thorough recruitment procedure to ensure the protection of residents and an Immediate Requirement was issued. The application form currently being used does not allow sufficient space to detail previous employment. It was not possible to evidence that all staff had a Criminal Records Bureau (CRB) disclosure, full employment history, sufficient proof of identity, a statement by the person as to his/her mental and physical health and satisfactory written references. Where references have been obtained, these are not always dated and are sometimes provided by the applicant, addressed “To whom it may concern.” These are not acceptable and the home must take responsibility for obtaining references directly wherever possible. Miss Smee was again reminded of the need to 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.) To ensure the safety of residents, it is essential that all of the required documentation be in place prior to the commencement of employment. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 25 All new staff receive induction training, which includes a four-day introduction to Richmondwood. This is followed by a six-week induction, which is based on the Skills for Care Common Induction Standards. One of the files examined demonstrates that important sections such as fire safety and Adult Protection have not been signed off as completed. It is important to ensure that all relevant parts of this induction are completed and signed off appropriately by the supervisor/trainer. The home has a training matrix, but this was not able to demonstrate that all staff have received suitable training, including mandatory training such as moving and handling and protection of vulnerable adults. Miss Smee was able to provide evidence that further training has been booked during 2007. When completing the Annual Quality Assurance Assessment, Miss Smee identified five residents with dementia and five with other mental health needs. The home must provide appropriate training in order to ensure that staff can meet these needs. Copies of all training certificates should be retained to evidence that staff receive a minimum of three paid days training per year. Richmondwood DS0000003977.V343594.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 adequate. This judgement has been made using available evidence including a visit to Richmondwood. Richmondwood works to ensure the general health and welfare of residents and actively seeks their views and those of staff and relatives to ensure the home is run in their best interests. However, some improvements are needed to ensure the management of the home always operates with due regard for the safety and protection of residents. EVIDENCE: Miss Smee has experience in caring for older persons. She has attained the National Vocational Qualification (NVQ) level 4 in care and, since the last inspection, has achieved her Registered Managers Award. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 27 Richmondwood has a “homely” 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. Miss Smee was seen to have a good rapport with residents and visitors. Residents commented, I think the staff are very good. The manager keeps everyone well organised. The manager is very good, you can talk to her.” Staff commented, I enjoy working in the home. This is a good place to work. Miss Smee says that she is hoping to appoint a clerical assistant shortly. This will release more of her time to spend in dealing with management tasks, including the regular internal auditing of systems and the updating of policies and procedures etc. It is also most important that Miss Smee concentrates on ensuring the safety of residents e.g., by implementing robust recruitment and Adult Protection procedures. Quality Assurance questionnaires are sent out annually to residents, staff, relatives and other visitors to the home to obtain their views. Feedback to the specific questions from the November 2006 survey is available in the Information File in the entrance hall. However, feedback does not include responses to some of the comments made in questionnaires. For instance, relatives commented, The home is ready for redecoration and The staff sometimes seem busy and overcommitted. Resident feedback included, I find it hard to get the attention of staff and feel I have to wait too long. The home is understaffed so I sometimes feel neglected. (It is recognised that these comments were made last November, prior to the employment of an additional member of care staff during the afternoons, but similar comments were still being re-iterated during this inspection.) However, much of the feedback is very positive. For example, George (Miss Smee) is very approachable and a very adaptable manager who I am able to gain knowledge from. (Staff) My relative could not be in a better place. (Relative) 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 not wishing 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 eight 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. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 28 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, call bell system, hoists etc are regularly serviced and maintained. Routine checking of fire systems is taking place. A fire risk assessment is in place, but there is no evidence to show that this document has been reviewed. This should be carried out annually or, for example, if there are any changes in layout or a resident is admitted with serious mobility problems, to ensure it is kept fully up to date. Substances that could be potentially hazardous to health are stored safely in a locked cupboard. However, care must be taken to ensure that cleaning products are not left unattended whilst in use or left accessible in the laundry. The majority of staff have received first aid, health and safety and moving and handling training to help ensure the safety of all in the home. Richmondwood DS0000003977.V343594.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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 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 2 17 X 18 1 1 3 X X X 1 X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Richmondwood DS0000003977.V343594.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. Standard Regulation 4 and 5 Requirement It is a requirement that the Statement of Purpose and Service Users Guide be updated and amended as necessary, including the document giving the terms and conditions of residence. The registered persons must ensure that care plans are agreed and signed by the resident or their representative wherever possible. (Previous timescale of 01/02/07 not fully met.) Assessments must be in place whenever there is any possibility of risk to a resident, e.g., when using a form of restraint such as a lap belt. As reviews take place, the care plan and any risk assessments must be updated, as necessary. All care staff must be made aware of each resident’s care needs, as detailed in individual care plans, to ensure that these needs can be fully met. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 31 1. OP1 Timescale for action 30/09/07 2. OP7 15(1) and 15(2) 13(4)(c) 12(1) 30/09/07 3. OP9 13(2) The correct medications must be administered at the time that they are prescribed, ensuring that people living in the home are protected by the home’s procedures for the safe administration of medicines. The home must record details of any medicine sensitivity or ‘none known’ on or with the MAR chart to protect residents from receiving medicines they are allergic to. 31/08/07 4. OP10 12(4)(a) 5. OP18 13(6) 6. OP19 23(2)(b) 23(2)(d) 23(2)(p) The registered person must ensure that all staff that give medicines have training in the administration of medicines (see “Professional Advice: Training care workers to safely administer medicines in care homes” at www.csci.org.uk) so that correct procedures for the administration and recording of medicines and Controlled Drugs are followed to safeguard residents. The registered persons must 30/09/07 ensure that suitable arrangements are made to ensure that the privacy and dignity of residents is always respected. The registered persons must 30/09/07 ensure that residents are safeguarded from all possible forms of abuse. The Adult Protection policy and procedure must be updated and amended where necessary and staff must receive training, to ensure a proper response to any suspicion or allegation of abuse The registered persons must 30/09/07 ensure that all parts of the care home are kept in a good state of repair. DS0000003977.V343594.R01.S.doc Version 5.2 Page 32 Richmondwood Adequate arrangements must be in place to keep the home reasonably decorated. Areas where damp is penetrating must be identified and appropriate action taken to rectify the situation. The heating system must be fully 30/09/07 operational and adjustable, to meet the requirements of residents. Where additional heating is provided, risk assessments must be in place to ensure the safety of residents. The extractor fans in en-suite facilities must also be fully operational. 31/03/08 The registered persons must ensure that all bedrooms are provided with adequate furniture, furnishings and carpets. Worn items must be repaired or replaced. Wardrobes must be made secure so they cannot tip forward onto residents. This must be done by 30/09/07 The registered persons must ensure that all parts of the care home are kept clean. The registered persons must ensure that 50 of care staff has gained a nationally recognised qualification in care, e.g., National Vocational Qualification level 2. The registered persons must not employ staff to work with residents until satisfactory recruitment checks have been fully completed. This requirement did not meet the deadline of 24/07/07 The registered persons must DS0000003977.V343594.R01.S.doc 7. OP19 23(2)(p) 8. OP24 16(2)(c) 9. OP26 10. OP28 23(2)(d) 18(1)(a) 30/09/07 31/03/08 11. OP29 19(1 31/03/08 12. OP30 Richmondwood 18(1) 31/03/08 Page 33 Version 5.2 13. OP31 10(1) and 12 14. OP38 13(4)(a) and (c) ensure that all staff are provided with the knowledge and skills necessary to carry out their work. This includes induction and mandatory training, also specialist training such as dementia care. The registered provider and the manager shall carry on and manage the care home with sufficient care, competence and skill. They must ensure that robust procedures are in place for the protection of residents. The registered persons must take steps to identify any unnecessary risks to residents and, as far as possible, see they are eliminated. Cleaning products must not be left unattended whilst in use or left accessible in the laundry. 30/09/07 30/09/07 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 2 Refer to Standard OP7 OP16 Good Practice Recommendations It is recommended that the care plan policy be updated, to ensure it corresponds with the way care plans are currently laid out. It is recommended that the complaints log should include all details of the course of complaints investigations, including outcomes and any actions taken as a result. Repeated It is recommended that water jugs be made available in individual rooms to ensure that all residents, especially those spending time in their rooms, have regular access to fluids. This should be in addition to the fluids provided regularly throughout the day. It is recommended that the registered persons talk with residents and review the staffing arrangements, to ensure DS0000003977.V343594.R01.S.doc Version 5.2 Page 34 3 OP24 4 OP27 Richmondwood 5 6 OP33 OP38 sufficient staff are on duty at all times, to meet the needs of residents. It is recommended that the registered persons include comments made by residents, relatives and staff when reviewing Quality Assurance questionnaires. It is recommended that the fire risk assessment be updated annually or more frequently if changes are necessary, to ensure it is kept fully up to date. Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 35 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 © 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 Richmondwood DS0000003977.V343594.R01.S.doc Version 5.2 Page 36 - 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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