Inspection on 28/04/06 for Richmondwood

This inspection was carried out on 28th April 2006.

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 23/07/07

Richmondwood 02/11/06

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 Carole Payne Unannounced Inspection 28th April 2006 10:00 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.V292591.R01.S.doc Version 5.1 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.V292591.R01.S.doc Version 5.1 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 Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/11/05 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 home is managed on a day-to-day basis by Baseline, a management company. 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.V292591.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 28th April 2006 and took a total of 11.45 hours, including time spent in planning the visit. The inspectors, Carole Payne and Christine Main were made to feel welcome in the home during the visit. The new manager, Georgina Smee and the compliance manager, Sue Dengel were available throughout the inspection. This was a statutory inspection and was carried out to ensure that the twenty residents who were living at Richmondwood were safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. The premises were inspected and records examined. Time was spent in discussion with people living at the home, the management team and staff members on duty. Ten residents were spoken with during the visit, both individually and as part of a group. The daily routine in the home was observed during the inspection. What the service does well: People who move into Richmondwood are provided with clear information about the service, enabling them to make an informed choice about where they would like to live. When a person moves into the home a thorough assessment of needs is carried out. A letter to the prospective resident confirming that the home is able to meet their needs supports this. Service users’ health, personal and social care needs are supported by detailed plans of individual care. The majority of residents’ general health needs are satisfactorily met. People say that they enjoy living at Richmondwood. They say that they are treated with care and respect. The lifestyle of people living in the home offers varied individual and shared social and religious opportunities, which reflect people’s interests and preferences. People living in the home are also 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. A resident said that ‘It is ‘home form home’ cooking.’ Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 6 Residents spoken to say that they feel able to raise any issues of concern. ‘I have no complaints, if I had I would say so.’ Generally people live in a safe and well-maintained environment. Where issues are identified these are risk assessed and programmes put in place to minimise the presenting risks. Personal rooms visited were attractively furnished, with matching fabrics and décor. All included necessary furnishings and personal items and possessions, which made them feel like ‘home.’ There is a continuing programme of renewal and refurbishment in the home. The number of staff working adequately meets the needs of people living in the home. ‘they always pop in to check I am OK.’ During the visit the new manager demonstrated effective management skills in the organisation of the daily routine in the home and a good rapport was observed between residents and staff members. A detailed system for listening to and seeking the views of people involved in the life of the service ensures that the home is run in the best interests of the residents. What has improved since the last inspection? Storage of Controlled Drugs has improved and one resident looked after her own medication. Residents are treated with courtesy, dignity and respect. The home’s menu is reviewed and the views of people living in the home are sought and listened to. The provider has confirmed that pre-set valves of a type unaffected by changes in water pressure, that have fail safe devices, have been fitted to all residents’ baths since the last inspection. From records sampled wash hand basins used by residents have been subject to risk assessments. The risk assessments reflect residents’ needs and capabilities. The home has complied with a requirement issued at the last inspection to demonstrate that water is stored safely to prevent the risk of Legionella. As required within the last inspection report issued to the home the registered person has ensured that access to the property is properly secured and the safety of the residents is prioritised. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 7 Full records of accident investigations and outcomes are now kept and periodic audits take place to identify possible patterns of accident e.g. time, place, person, activity. According to the outcomes, appropriate action to prevent the risk of reoccurrence is taken. Further work has been undertaken to implement a thorough system of quality assurance systems in the home in order to demonstrate that the home is meeting its aims and objectives and statement of purpose. The action plan produced from this reflects the aims and outcomes for service users. What they could do better: The home is taking steps to ensure that care plans are reviewed at least monthly and that details of reviews are recorded. The new manager is supervising this. Water jugs must be made available in individual rooms to ensure that all service users, and in particular those spending time in their rooms, and at risk of dehydration, have regular access to fluids, additional to the fluids provided by the home regularly throughout the day. A number of errors in relation to the safe handling of medicines potentially compromise the home’s capacity to protect the people living in the home. Concerns about some medicines not being given correctly were serious and put residents at risk so an immediate requirement was made to ensure that medicines are given as prescribed. The home’s complaints log should include all details of the course of complaints investigations, including outcomes. Where radiators do not have low temperature surfaces, progress has been made to ensure that each are guarded. The timescale for full compliance with this requirement has been extended. Wash hand basins, which have been assessed as presenting a risk of scalding to residents, must be fitted with a thermostatic control valve. All staff starting work in the home must have two written references. They must also be up to date in all areas of mandatory training, including where appropriate ‘Skills for Care’ or equivalent induction; moving and handling, adult protection, infection control, health and safety and food hygiene. 50 of care staff should be qualified at NVQ level 2 and qualifications gained by the extended date of 2006. More secure means of holding personal monies will ensure that no money can fall out of loose open envelopes and support the safeguarding of residents’ financial interests. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 8 All hazardous substances must be safely and securely stored in the home to protect people from harm. 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.V292591.R01.S.doc Version 5.1 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.V292591.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People who move into the home are provided with clear information about the service, enabling them to make an informed choice about where they would like to live. A thorough assessment is supported by written confirmation to the prospective resident that the home is able to meet their needs. EVIDENCE: One resident who had enjoyed a respite stay in the home had copies of the statement of purpose and service user’s guide in their room. The resident said that they had found the information useful, particularly as some of the key details are presented in clear print and give information about the daily life of the home; which for a person who moves into the home occasionally, provides a useful resource. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 11 Clear pre-admission assessment information had been recorded for two people who had moved into the home since the last inspection. This included information from external healthcare professionals and reference to the involvement of service users and, or, their relatives. The manager said that she always endeavours to visit people, prior to making a decision as to whether the home is able to meet their needs. A copy of a letter confirming that the home was suitable for meeting a service user’s needs was retained on the individual file and one resident also had a copy of the letter with them. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users’ health, personal and social care needs are supported by detailed plans of individual care, but are not currently reviewed sufficiently to ensure that needs are met. Most of the residents’ general health needs are satisfactorily met. However, a number of errors in relation to the safe handling of medicines potentially compromise the home’s capacity to protect the people living in the home. The home has procedures for managing residents’ medication but they are not always followed and this puts residents at risk of not having their medicines as prescribed. People living at Richmondwood say that they are treated with care and respect for their privacy and dignity. EVIDENCE: Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 13 Care plans for three residents case tracked informed how care was to be delivered to meet residents’ personal, social and healthcare needs. Detailed assessments, including general and specific risks were recorded. Corresponding care plans had been produced outlining how the risks were to be minimised. Discussions with the residents reflected the care required which was outlined in the plans. Where possible the plans had been signed by an appropriate person, either the resident themselves, or, if this was not possible, by a relative or representative. Detailed daily records supported the plans. Plans seen had not been reviewed monthly. In the sampled plans two to three months had passed without review and the details of the reviews were not recorded. The new manager confirmed that monthly reviews would take place, or more frequently according to changing needs, as the format for recording was changing and new records will adequately support the provision of reviews. This will be assessed during the next inspection. Two residents described how they receive regular support from domiciliary healthcare services. Records seen included comprehensive details of multidisciplinary contacts and assessments of well being. Initial assessments included details of skin and manual handling risk assessments, as well as medical histories. For example for a service user at risk of falls, accident records had been audited and the person had been referred to the falls clinic, to support the home in minimising the risk of future falls. Well being is also promoted in the daily life of the home, with people describing how they retain independence in day-to-day activities and participate in the home’s exercise sessions, which are part of the social opportunities made available in the home. It was noted in one resident’s records that they were at risk of dehydration and required encouragement with fluids. This resident spends most of the day in their own room. Regular hot and cold drinks were served during the day, but there were no water jugs in individual rooms so that residents could help themselves or have a regular glass of juice. The manager undertook to organise for water jugs to be placed, where appropriate, in individual rooms. Medicines that staff give were stored in a locked trolley or cupboards. The trolley was not secured to the wall when not in use and it must be. One resident looked after her own medicines safely. A sample of residents’ medicines in stock was checked to see if the quantity left agreed with the records indicating that they were given correctly. For most of those checked the Medicine Administration Record (MAR) charts were signed to record when medicines were given and the number of tablets left agreed with the records indicating that they were given as prescribed. Problems were found with three medicines. For one the dose given was not recorded on 3 occasions, but from the number left the wrong dose was given Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 14 twice. Staff had not recorded applying one cream, or the reason for this. For another medicine there were six more capsules left than expected, indicating that some doses were not given as prescribed although staff had signed for giving them. This had been picked up in the home’s own checks on medication but nothing had been done about it. The manager must take action to address any medication errors (including doses not given) picked up through selfmonitoring. One resident had recently been given the wrong dose of medication on several occasions because staff incorrectly wrote the directions on the MAR chart, despite a second member of staff checking them. The dose on the medicine label was correct and this should have been copied on to the MAR chart. As mentioned at the last inspection when giving medication staff must carefully check the medicine label as well as the MAR chart and question any difference to ensure that medicines are given correctly. Failure to do this compromises the safe administration of medicines to people living in the home. Several medication errors have been reported to the Commission by the home since the last inspection, and a further error was reported before this inspection. There was no written confirmation of the dose of one temporary resident’s medicine and this issue was also mentioned in the last report. The medicines on the trolley were checked and it was found 4 eye drops for one resident that were opened on 8th March. These were still in use but should have been replaced with a new supply after 4 weeks to reduce the risk of infection. Four bottles of eye drops were stored at room temperature rather than in the fridge. The inspector explained the storage requirements and this was corrected straight away. Two new members of staff both said they had previous experience of handling and administering medication. The inspector was told that one had done two years nursing training and the other a safe handling of medicines course. There was no evidence in the home to confirm their training or assessment of competence. Throughout the visit residents were observed being treated with care and respect. Staff members knocked on people’s doors and used residents’ preferred names. Remarks from residents regarding staff included ‘they are so kind’. ‘I could not ask for better.’ One resident said that they receive help with personal care, and that the help is given with consideration for their privacy and dignity. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The lifestyle of people living in the home offers varied individual and shared social and religious opportunities, which reflect people’s interests and preferences. People living in the home 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. On the morning of the inspection visit a number of residents were taking part in communion. The manager described personal history photo albums that are currently being compiled with residents to share with them. An activities coordinator visits the home each day. Although she was absent on the day of the visit staff members sat with a group of five residents in the lounge, participating in a quiz, which was shared with companionship. One member of staff described offering to read a paper to Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 16 a male resident and another resident said that they very much enjoy going down to get the papers in the morning and reading them over a cup of tea in their room. Residents described the daily routine as being very flexible. One resident had had a good lie in; another said that they liked to get up early. The manager said that visitors were welcome to visit the home at any time. One resident said that their relative enjoys a cup of tea with them in their room. If a resident is poorly, it was clear that support is given to enable relatives to enjoy quality time with their family members. During the day the manager went to check on a resident who was poorly to ensure that they had everything that they needed. Residents spoken with describe how they are supported to make choices; for example about what they would like to do and when. ‘I do what I want, when I want to.’ One resident said that they had been offered a larger room, and also spoke of how she is able to carry out activities of daily living independently, with the enabling support of staff members. People living in the home praised the standard of food provided. ‘The food is good.’ ‘It is ‘home form home’ cooking.’ The cook, who has been working at the home for some years, also works sometimes as a carer. She outlined how her knowledge of the residents’ needs helps her to reflect dietary expectations in menus, and cater for specialist needs. The manager said that a residents’ meeting was planned for 11th May and that consultation regarding menus was on the agenda. Asking people what they think about the menu had also been included in a recent quality assurance exercise. During the visit people needing help with eating received sensitive support. At lunch time residents eating in the dining room said that they had thoroughly enjoyed the traditional Friday fish and chips. Tables had been attractively laid, and there was a warm and welcoming atmosphere. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 17 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home’s system for recording complaints does not currently fully support the home’s commitment to listen and respond to service users’ complaints. Currently every member of staff has not received appropriate adult protection training. The service has committed to ensuring that key aspects of mandatory training are completed in the next three months, promoting the protection of residents from abuse. EVIDENCE: The home has a complaints procedure, which is included in the service user’s guide. Residents spoken to say that they felt able to raise any issues of concern. ‘I have no complaints, if I had I would say so.’ The home has a complaints log, which details complaints received. There was no record of the outcome of a complaint received in January 2006 from a relative of a resident, within the log. The manager found details of a response within the relevant individual file. It was advised that the course of all complaints be recorded in the log, from receipt, through to investigation and conclusion; including details of responses within timescales, and other outside sources involved and informed, where applicable. The new manager confirmed that complaints would, in future, be appropriately recorded. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 18 Records of training seen reflect a need to train staff in all aspects of adult protection. The new manager spoke following the inspection visit regarding the action she would take if an allegation of abuse was made in the home. She was clear that she would contact an external body to seek advice, and was advised to read the local Dorset adult protection guidelines, with particular reference to steps to be taken in the case of such an incident. No known allegations of abuse have been made since the last inspection. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 19 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, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. People living at Richmondwood live in a generally safe and well-maintained environment. Where issues are identified these are risk assessed and programmes put in place to minimise the presenting risks; the fitting of valves to basin water outlets which present a risk of scalding and the completion of the programme to fit radiator covers to risk areas, will promote safety within the environment. Residents benefit from safe, comfortable bedrooms, with their possessions around them. The home is maintained to a good standard of cleanliness; the home intends to support this with infection control training for all staff. The manager highlights any issues requiring attention and a programme is proposed, for example in relation to the organisation of the laundry. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 20 EVIDENCE: Areas visited were clean and free from offensive odours. The only area of concern was the laundry, where the flooring is poor; the cupboard for the storage of hazardous substances is not adequately fixed and the room is generally untidy and disorganised. The manager had recognised this and planned to ensure that the room was cleaned and tidied. The maintenance person was on duty at the time of the visit and was helpful and supportive. The home has domestic staff on duty each day to ensure that all areas of the home are cleaned throughout the week. The home’s quality assurance action plan details a continuing programme of renewal in individual rooms. Personal rooms visited were attractively furnished, with matching fabrics and décor. All included necessary furnishings and personal items and possessions, which made them feel like ‘home.’ The provider has confirmed since the last inspection that water temperature control valves have been fitted to bath water outlets. The temperature of water from basin outlets had been risk assessed in personal records seen; taking into account the general and specific risk of the uncontrolled temperature. There was a warning sign above one of the basins in the en suite, highlighting the risk of the hot water. One risk assessment identified the risk as high and that a thermostatic valve needed to be fitted to protect the service user from scalding. The compliance officer said that this applied to a small number of outlets, which had all been formally risk assessed and recorded. The provider visited at the time of the visit and a timescale of two months from the date of the inspection was agreed with the compliance officer for the fitting of the valves. 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. The home has complied with a requirement issued at the last inspection regarding the testing for legionella. The home is now recording the running of shower outlets periodically as recommended from the testing to prevent the risk of water stagnating and presenting an infection risk. Staff require updating in infection control training as part of the home’s commitment to update all mandatory areas of practice. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The number of staff working adequately meets the needs of people living in the home. The home is making progress with producing new induction programmes, which reflect the new standards. Staff members feel that they receive a good introduction to the working life of the home. Both the induction and training in all aspects of mandatory training must be updated to ensure that staff have the skills to do their jobs and people living in the home are in safe hands at all times. People living in the home are generally supported by the home’s recruitment policies and practices. EVIDENCE: Rosters seen, the number of staff on duty at the time of the inspection and feedback from people living in the home, ‘they always pop in to check I am OK’ ensure that people’s needs are met by the number of staff on duty. The home’s compliance officer said that the management company are currently reviewing the home’s induction programme to meet the requisites of ‘Skills for Care’ and to correspond to the individual’s level of need for initial training in relation to the home and their previous level of care experience. A Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 22 senior member of care staff who had recently started work in the home and a new carer on their first day both said that they felt supported by the induction that they were receiving. Two members of staff aside from the manager have a National Vocational Qualification in Care. The manager confirmed that three members of staff are in the process of undertaking the qualification and that other staff have expressed an interest in starting the qualification. A total of fourteen care staff were working at the home at the time of the visit. Three recruitment files were seen. The detail within one file, the seeking of additional references and records of interview, demonstrated that the home is thorough in its search for the right applicants. One file did not contain proof of identity, POVAFirst or a photograph. The compliance officer advised that these had been obtained by head office and arranged for the details to be faxed through so that copies could be put on the file at the time of the visit. One file contained one written reference, rather than the required two. This member of staff had commenced employment on the day of the visit. The home has a programme of planned training. A current matrix devised by the new manager and list of attendees compiled by the previous manager and records in an individual file showed that there were shortfalls in the completion of mandatory training in the home. A requirement has been issued in this report and the timescale of three months for the updating of all staff was agreed with the compliance officer at the time of the visit. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a new manager, who is yet to be registered. During the visit she demonstrated effective management skills in the organisation of the daily routine in the home and a good rapport with residents and staff members. A detailed system for listening to and seeking the views of people involved in the life of the service ensures that the home is run in the best interests of the residents. More secure means of holding personal monies will ensure that no money can fall out of loose open envelopes and support the safeguarding of residents’ financial interests. Regulation 37 Notifications must be forwarded to the Commission for Social Care Inspection regarding all issues, which adversely affect people living in the home to ensure that record keeping systems fully safeguard residents’ rights. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 24 As all staff are not currently trained in all aspects of health and safety, the welfare of people living in the home is not fully promoted. EVIDENCE: The new manager demonstrated a good knowledge of the operation of the service and the needs of its residents. She liaised well with members of the staff team during the day. One member of staff commented that they found her to be ‘very supportive.’ The home has made progress with implementing a quality assurance process. The service has consulted people living in the home and other people outside the home, who are involved in the life of the service. The information received has been collated and an action plan has been written. The results of the survey have also been compared with the last one conducted and show improvements in all areas of the life of the home. The manager confirmed that neither the service, nor any of its representatives, act as appointees for any residents. Some residents’ monies are held for safekeeping and are securely stored. However, the actual money is retained in open envelopes and minor anomalies were found when amounts recorded were checked against monies held. The manager suggested that the money be held in zipped pockets, that all monies are checked so that there is a basis that can be accurately worked with. She confirmed that the minor discrepancies would be rectified. The home maintains records of the periodic servicing of equipment in the home. Routine checking of fire systems takes place. Training in some areas of health and safety requires updating. This is of particular reference to manual handling. Accident records showed that one resident had been left on the floor until night staff members that were able to use the hoist came on duty. The compliance manager recognised that dependency levels in the home were increasing and the needs for training supportive of these needs, more urgent. A timescale of three months was agreed with the compliance officer for the updating of staff in manual handling training and all other aspects of safe working practice. During the visit it was noted that a large bottle of disinfectant had been left out in the laundry. This was immediately placed in a cupboard. However, the cupboard was inadequate and the maintenance person was able to open and close it without a key. The manager discussed with the maintenance person the replacement of the cupboard and undertook to safely store any hazardous substances held in the interim. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 25 The home had recently experienced problems with the electrical systems in the home. A complaint had been raised about this. The Commission has received no copy of a Regulation 37 Notification, which, from the details of the complaint affected the welfare of service users. This problem has now been resolved. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 26 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x 3 1 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 2 x 2 1 Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 27 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 OP8 Regulation 12(1), 16 Requirement Water jugs must be made available in individual rooms to ensure that all service users, and in particular those spending time in their rooms, and at risk of dehydration, have regular access to fluids additional to the fluids provided by home regularly throughout the day. Timescale for action 31/05/06 2 OP9 13 The registered person shall make 28/04/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) Ensuring that medicines are given as prescribed and accurately recorded. b) Storing medicines at the correct temperature. If the temperature of the fridge used to store medicines is outside the recommended range action must be taken to address this. Procedures for this should Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 28 be added to the medication policy. A requirement to ensure that medicines are safely handled was issued in the last inspection report. (Timescale 14/03/06 not fully met.) On this occasion this was issued as an immediate requirement at the time of the inspection. 3 OP25 13 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. Progress has been made with meeting this requirement. (Previous timescale of 24 February 2006 not met.) 31/08/06 4 OP25 13 Wash hand basins, which have been assessed as presenting a risk of scalding to residents, must be fitted with a thermostatic control valve. All staff starting work in the home must have two written references. All staff members working in the home must be up to date in all areas of mandatory training, including where appropriate ‘Skills for Care’ or equivalent induction; safe administration of medicines, moving and handling, DS0000003977.V292591.R01.S.doc 15/06/06 5 OP29 19 31/05/06 6 OP30 18 31/08/06 Richmondwood Version 5.1 Page 29 adult protection, infection control, health and safety and food hygiene. 7 OP37 37 A Regulation 37 Notification 31/05/06 must be submitted regarding any incident, which adversely affects the welfare of service users living in the home. All hazardous substances must be securely stored. 31/05/06 8 OP38 13 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 a) Medication training should be reviewed and any problems with medicine administration and handling followed up in staff supervision. b) The home should have written confirmation of a new resident’s medication from an authoritative source. Repeated c) Eye drops should be discarded 4 weeks after opening to prevent infection. 2. 3. OP16 OP28 The complaints log should include all details of the course of complaints investigations, including outcomes. 50 of care staff should be qualified at NVQ level 2 and qualifications gained by the extended date of 2006. Richmondwood DS0000003977.V292591.R01.S.doc Version 5.1 Page 30 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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