CARE HOMES FOR OLDER PEOPLE
Richmondwood 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL Lead Inspector
Sally Wernick Unannounced Inspection 10:30a 24 November 2005
th 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.V260938.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 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 Mr John Andrew Glazer Mrs Susan Moore Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th July 2005 Brief Description of the Service: Richmondwood is a large family style home, which has been extended to provide optimum use of space for the benefit of those residing there. The property is set in attractive, well-maintained grounds, which are accessible. The home is located in a quiet tree lined avenue close to local shops. Richmondwood is registered to provide personal care for up to twenty-two older people and accommodates residents with low to medium care needs. There are twenty-two single bedrooms seventeen of which have en suite facilities. Nine rooms are on the ground floor and the remaining thirteen on the first floor. There is a passenger lift to the first floor. The communal space is on the ground floor and comprises a large lounge and dining area, it is well used both by residents and visitors. The service users rooms and communal accommodation are well maintained and the furnishings are domestic in style. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 10:30am on 15 November 2005. Unfortunately a power cut as a result of an industrial fire in Poole prevented the inspection from taking place. A second unannounced visit by two inspectors on 24 November enabled the inspection to be completed. It was conducted as part of the normal routine of inspecting twice during a twelve-month period. The registered manager Mrs Moore assisted in the inspection, as did Ms Susan Denger compliance officer from “Baseline”. Mr Glazer proprietor of the home was also on hand to assist. Methodology used included a tour of the premises, review of records and discussions with service users and staff. The Inspector also reviewed the contact sheet for Richmondwood and Regulation 37 reports submitted by the registered manager since the last inspection. Not all of the minimum standards were assessed on this visit. Please note where a National Minimum Standard was not assessed the score is shown as X. What the service does well:
Discussion with residents and examination of care plans evidenced that there are good links with community health providers. The home monitors the health and welfare of residents and ensures that doctors and community nurses are contacted when necessary. Friend and relatives are made welcome at Richmondwood and there are links with the local community. Daily routines are flexible and Information about activities, are available to all service users. Residents manage their own affairs and where needed external advocates are identified. Where possible residents are accommodated and pets are welcomed where appropriate. Meals are appetising and of good quantity and quality. The home is comfortable and set in attractive gardens. There is a clear complaints procedure and the home is generally clean, pleasant and hygienic. Staff, receive regular training and the registered manager is committed to good practice. Mrs Moore is described by staff and residents as easily approachable and there is confidence in her style of management, which sees action being taken where needed. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
An immediate requirement from the last inspection remains outstanding and has been repeated. A further requirement has been met, another is currently being actioned. The home is still not able to show that water delivered from all baths is at a safe temperature. Results are awaited from recent Legionella testing. Individual risk assessments have been undertaken for those radiators not guarded. However, this is insufficient to ensure the safety of all residents and there is now a requirement to eliminate the hazards that these are presenting. Similarly there is a requirement to assess all wash hand basins that are currently being used by residents as high water temperatures may be placing residents at risk of scalding. Access to the property is often left unsecured. Steps must be taken to ensure the safety of residents by taking appropriate action. Whilst there are few incidents of falls at Richmondwood there should be an audit of accidents, which demonstrates the action taken to minimise a reoccurrence. Staff, were spoken of at Richmondwood in positive terms by residents. Staff are, reminded however, of the need to treat residents in a courteous, respectful manner and to assist them to maintain their dignity at all times.
Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 7 Menus are varied and nutritional. In order to monitor and maintain good standards the menus should be reviewed at set intervals. It remains the case that 50 of care staff must have NVQ level 2 qualification by the extended date of 2006. Whilst residents and staff indicated that they are generally happy with the way the home is run, there is no formal way of demonstrating this. Further work must be undertaken on the homes quality assurance system so that it can be clearly demonstrated that resident and stakeholder consultation has taken place it has been responded to and the home is meeting its stated aims and objectives. 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. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 8 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.V260938.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this occasion EVIDENCE: Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8,10. Good support from community health professionals helps to ensure that the health needs of residents are well met. Residents are generally treated with respect and their privacy and dignity is promoted. EVIDENCE: Discussion with residents, examination of care plans and direct observation during the inspection demonstrated that a good level of care is provided. All of the care plans examined were clearly set out, detailing the health and personal care needs of each resident, the aims and objectives and the staff assistance necessary to ensure these are met. Records demonstrate that care plans are reviewed and reflect the changing needs of residents. They are well detailed and give a good picture of the care provided, including visits by community health professionals. Records demonstrate and residents confirm that they have access to GP’s, district nurses, dentists, opticians, chiropodists etc and attend for hospital appointments as necessary.
Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 11 Records are maintained of weight although it is suggested that these be recorded in individual case notes rather than be maintained in a general journal. The registered manager has agreed to implement this and documents will be reviewed during the next inspection. Risk assessments are in place and appropriate steps are taken to minimise any risks identified. A review of accidents and injuries reveals that these are not common occurrences. However the home does not yet provide sufficient evidence to demonstrate that there is a monitoring of such occurrences. A number of residents were consulted with and all but one who stated she was occasionally spoken to sharply confirmed that they were treated with kindness by staff at the home and their privacy was respected. The registered manager was described as very approachable and someone whom could be spoken to if there were any concerns. During the inspection the inspector did observe a resident being “ cajoled” to join the lunch table despite her clear reluctance to do so. Another resident was spoken to sharply. This is not good practice and staff, are reminded that residents must be treated with courtesy at all times and their wishes respected. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15 Residents are encouraged to maintain contact with family and friends and the wider community. Residents are assisted to exercise choice and control over their own lives. Meals are appetising and of good quality and quantity. EVIDENCE: All of the residents spoken to received visitors at the home and stated that all were made welcome. Times remained flexible and visits took place either in resident’s own rooms or communal areas. Visits were made from the local church and there are a number of social and leisure activities in place. A number of residents choose to go out with friends and family returning as and when they wish. Records evidenced that one, resident was supported by an advocate from an external agency and financial and individual autonomy was promoted and respected for all. There is good communication with friends and relatives and service users are able to personalise their rooms. There is a planned daily menu, which operates on a four-week basis. This is reviewed periodically although not at set intervals. Mrs Moore has recently
Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 13 implemented changes as a result of resident feedback and the quality of food has much improved. All residents spoken to expressed satisfaction with the food and some praised it highly. Most residents eat in the dining room although some prefer to receive meals in their bedrooms. In the view of the inspectors and to ensure quality and choice is maintained it would be considered good practice to review the menu periodically. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Complaints are managed properly and residents are confident that their concerns are listened to and acted on. EVIDENCE: Richmondwood has a formal complaints procedure in place, and residents spoken to felt that their complaints would be listened to and acted on. No complaints against the home have been received or investigated since the last inspection. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Failure to maintain the environment sufficiently well continues to compromise and undermine the safety and well being of residents. The heating and water systems could place residents at risk. The home is generally clean pleasant and hygienic. EVIDENCE: An immediate requirement following the last inspection in July to regulate bath temperatures by installing pre-set valves has not been implemented. As a result the home have been issued with a further immediate requirement notice and work is expected, to be undertaken within a matter of days. Mrs Moore the registered manager confirmed that the baths are not in use and in the main all residents have supervised baths in bathrooms with pre-set valves. She acknowledged however, the potential risk to residents and confirmed verbally that steps to remedy the situation would now be taken. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 16 The registered provider Mr Glazer stated that all radiators that are not covered are kept at a set temperature and do not represent a risk to residents. An examination of all radiators revealed that this is not the case and in some areas the temperature was found to be high. Again Mrs Moore acknowledged the potential risk of harm to residents and confirmed that MDF covers will be fitted as a matter of priority. Individual wash hand basins were also found to be of a high water temperature. It is recommended that individual risk assessments be undertaken for all residents and steps taken to achieve safe temperatures by taking appropriate measures. A recommendation and requirement following the last two inspections identified the need for a water heating check to ensure compliance with Legionella prevention. The registered manager confirmed that an assessment had taken place and that the results and report are expected on 8 December. It has been agreed that these will be forwarded to the Commission for Social Care for inspection. Until that time the requirement will be repeated. A tour of the premises revealed that the home is generally well maintained. One residents room was found to have a window, which did not close and a downstairs bathroom required maintenance to a tap. Steps were taken to address these and the registered manager gave reassurance that these would be completed as a matter of priority. Despite a notice to the effect and reminders from the registered manager to staff and visitors access to the property is often unsecured presenting a very real risk to residents who live there. Safety must be a priority and action taken to ensure that instructions and requirements are adhered to. This should be monitored on a daily basis. Laundry facilities were inspected on this occasion and there are policies and procedures in place for maintaining cleanliness and safe handling. The system for managing the laundry is to be reviewed by the registered manager as three residents spoken to state, that items had on occasion gone missing. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,30 The home has a qualified staff team and a commitment to training. However, the target of 50 staff with NVQ 2 qualification by 2005 has yet to be met. EVIDENCE: Records indicate that staff induction does take place and there is an analysis of training needs. The home has its own accredited training provider and there is mandatory training, which all staff members must complete. The registered manager also identifies training for specific members of staff according to identified need and there is a degree of flexibility to meet the changing needs of residents. Three of the nine care staff is, qualified at NVQ level 2. It remains the case that 50 of all care staff must be qualified to at least NVQ 2 by the extended date of 2006. Staff spoken to at the home felt that they received good levels of training, supervision and appraisal and were well supported by the registered manager. Where a training need was identified by a staff member access to training was facilitated. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 The quality assurance system in place does not yet fully reflect the views of residents, staff and stakeholders. Resident’s financial interests are safeguarded. EVIDENCE: The registered manager stated that a questionnaire had been devised to obtain the views of residents. This had been distributed in the early part of the year and a chart reflecting resident’s views was available. Questionnaires however, have not been extended to staff, families or other stakeholders and a sample was not available during the inspection. Residents meetings do provide an opportunity to gather the views of those living at the home. Not all residents attend however, and meetings take place only occasionally. A written plan was not available in response to the questionnaires distributed to residents. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 19 Resident’s at Richmondwood, do where possible manage their own finances. Those who are unable to do so have a relative or other representative to assist them. Where necessary the home pays for services such as chiropody and hairdressing and a record is maintained. The amount is then invoiced to resident’s relatives or representatives for payment at appropriate intervals. Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 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 3 17 x 18 x 1 x x x x x 1 3 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 x x x Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 21 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 Requirement Unnecessary risks to the health and safety of service users must be identified and as far as possible eliminated. To prevent scalding pre-set valves of a type unaffected by changes in water pressure that have fail safe devices must be fitted on all residents baths. (Repeated for the second time) Where radiators do not have low temperature surfaces steps must be taken to ensure that each are guarded. This is necessary to ensure that risks to residents are eliminated. All wash hand basins used by residents must be subject to risk assessments. These must reflect the needs and capabilities of residents and must be assessed at least six monthly. The home must be able to demonstrate that water is stored safely to prevent the risk of Legionella. The registered persons must ensure that access to the property is properly secured and the safety of the residents is prioritised.
DS0000003977.V260938.R01.S.doc Timescale for action 1 OP25 13 24/11/05 2 OP38OP25 13 24/02/06 3 OP25 13 24/02/06 4 OP25 13 15/12/05 5 OP25 13 15/12/05 Richmondwood Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Full records of accident investigation and outcome should be kept and periodic audit undertaken to identify possible patterns of accident e.g time, place, person, activity. The monitoring of service user’s weight should be achieved through keeping an individual record in each service user’s case notes. Residents must be treated with courtesy, dignity and respect at all times. Staff should be reminded of this through induction, regular supervision and observation of their practice. The menu should be reviewed at a minimum of three monthly intervals to ensure quality and choice for residents. This should be recorded and the record maintained. 50 of care staff must be qualified at NVQ level 2 and qualifications gained by the extended date of 2006. Further work must be undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meeting its aims and objectives and statement of purpose. The annual development plan should be based on a systematic cycle of planning, action and review and should clearly reflect aims and outcomes for service users. 1 OP8 2 OP10 3 4 OP15 OP28 5 OP33 Richmondwood DS0000003977.V260938.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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