CARE HOMES FOR OLDER PEOPLE
Richmondwood 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL Lead Inspector
Gill Kennedy Unannounced 28 July 2005 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 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 D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Richmondwood Address 19 Richmond Wood Avenue, Bournemouth, Dorset, BH8 9DL Telephone number Fax number Email 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 OP - 22 registration, with number of places Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26 January 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 accomodates 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 D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. Mrs Moore, the manager, was available throughout the inspection to provide information and answer questions. Also present during part of the inspection were the general manager, Mr Thomas, and the proprietor of the home Mr Glazer. In the afternoon Mrs Susan Dengal who is employed as compliance officer by a company owned by Mr Thomas was also present. All were helpful and co-operative. The files of four residents were read during this inspection. Three residents were seen privately to discuss their views about life in the home and the services provided. A selection of residents’ rooms were seen plus the communal areas. The time taken on this inspection was 6.5 hours and 10 standards were assessed and two standards (26 and 29) were partially assessed. CSCI comment cards were left at the home for residents to ascertain their views about the services provided. At the time of writing this report seven replies had been received. The terms resident and service user used in this report are interchangeable. What the service does well:
Mrs Moore took up her post as manager in February this year and her application to become the registered manager with CSCI is currently being processed. It was apparent from observing and talking with Mrs Moore as well as speaking to residents and looking at documentation that she has made a positive start in developing her role in the home. Care plans seen were comprehensive with clear guidance for staff on how residents’ needs were to be met. The home has robust systems in place to make sure that vulnerable residents are protected and the manager works closely with statutory agencies to safeguard residents. There are sufficient care staff employed in the home to ensure residents needs are met. Residents spoken to during the inspection were generally positive about the staff finding them ‘jolly good’, ‘awfully nice’ and ‘very patient’.
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Whilst the manager talks directly to residents to highlight what action she has taken in response to issues raised at residents meetings, it would be beneficial if minutes of the meeting were circulated in a format accessible to residents. The home is not able to show that water is delivered from all baths at a safe temperature and this could place residents at risk. Mr Thomas, the general manager, said this issue would be addressed as a matter of priority. The home should also be able to demonstrate that water is stored at a safe temperature, if necessary by undertaking Legionella testing. Radiators are not covered nor do they all have low temperature surfaces, although the proprietor states that radiators are kept at a set temperature to prevent risks to service users. However, risk assessments refer to the room and not the capabilities of each resident and these could be improved by highlighting individual needs and abilities, particularly when back up mobile heaters are supplied in bedrooms.
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 7 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 D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 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 standard(s) 1,2,3 Information provided to prospective residents enables them to make an informed choice and they are formally assured their needs will be met. Systems are in place that ensure service users are issued with a clear contract of the terms and conditions of the home. EVIDENCE: Prospective service users are provided with a Service Users Guide as well as the home’s colourful brochure. There is also a comprehensive folder available in the hall. This can be accessed by all residents and includes a copy of the last inspection report and the results of quality surveys completed by the home. The files of new residents seen during this inspection demonstrated that they had received an assessment prior to admission. Mrs Moore had written to them confirming that their needs could be met and copies of these letters were on file. Evidence was seen that residents are issued with a contract that confirms the room to be occupied and the services to be provided.
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 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 standard(s) 7 There are comprehensive care plans that set out service users needs and provide clear guidance for staff. EVIDENCE: The manager explained that she had done a lot to improve care plan documentation, which was thorough and gave detailed information for staff to enable service users needs to be met. A short resume is also provided for staff, so they are able to see at a glance key issues that need to be borne in mind when delivering care. There was evidence on file that service users had been involved in care plans and they or their relatives had been asked to sign assessments and care plans, although some residents when spoken to were vague about their involvement in care planning and said their memories were poor. Standard 9 medication was not assessed so the requirement and recommendations made on the last inspection will be carried forward. Christine Main, CSCI pharmacist, will inspect this standard and advise the home accordingly.
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12 Whilst the home is able to meet the expectations of most service users in their daily lives some work is still required in relation to food choice. EVIDENCE: Two recommendations had been made on the last inspection regarding this standard. One related to the time breakfast was served which was too early to suit some residents. The residents spoken to confirmed that they had breakfast when it suited them. The manager said the chef had details of the times residents liked their breakfast although evidence of this was not seen. The second recommendation related to initiating residents meetings and using these to ensure service users preferences were taken into consideration. The new manager has started to have residents meetings and a copy of the minutes of the meeting held on 12th July 2005 was supplied to the Commission. This meeting concentrated on residents’ feelings about the quality of the meals supplied and the manager confirmed in the meeting that action would be taken to meet residents’ requests. Feedback on how this has been progressed is given to residents verbally. It was suggested that the minutes and any actions taken should be made available in writing to the
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 12 residents, as some residents spoken to still expressed some dissatisfaction with the food supplied. The home’s own survey indicated that the majority of residents found the social activities on offer good to fair. There was evidence that a range of activities are organised by the home. Residents take part in activities as they wish and it was noted that some people had chosen to go to their rooms to read or listen to the radio. When residents move into the home, where practical, they are able to bring in their pets. Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18 Robust systems are in place to ensure vulnerable residents are protected. EVIDENCE: There have been two occasions since the last inspection when the manager has had to deal with suspected cases of adult abuse. In both instances Mrs Moore acted speedily and appropriately to protect residents. She worked closely with Social Services and the Commission. In only one instance were the concerns justified and the member of staff was suspended and ultimately dismissed. Mrs Moore also fulfilled her responsibilities by ensuring this person was placed on the Protection of Vulnerable Adults Register. All four residents who completed comment cards said they felt safe in the home. Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 14 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 standard(s) 25 The heating and water systems could place residents at risk. EVIDENCE: There are no pre-set valves on baths in the home to regulate the temperature of the water delivered. Mrs Moore was keeping a record of bath temperatures five of which were in excess of 56oC and could constitute a danger to residents. The general manager, Mr Thomas, had been made aware of the manager’s concerns and he confirmed verbally that immediate action would be taken and this was followed up in writing to the Commission the following day. However, Mrs Moore advised that in practice all residents have supervised baths. One new resident commented that she was enjoying having ‘lovely baths’ and found the staff caring and attentive. Mr Thomas undertakes yearly risk assessments where radiator covers are not supplied and the proprietor Mr Glazer stated that the radiators are kept at a set temperature. The risk assessments relating to radiators were not adequate, as they did not refer to the particular residents and their individual capabilities.
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 15 It was also noted that mobile heaters are supplied in some residents’ rooms and these need to be referred to in individualised risk assessments. A selection of bedrooms were seen during the inspection and none had beds placed beside radiators. Mrs Moore confirmed that no beds were now placed beside radiators. It was recommended on the last inspection that a water heating check was obtained to ensure compliance with legionella prevention but this had not been done. Details were given on how this can be undertaken and Mr Thomas said he would follow this up. Standard 26 was not fully assessed but the home was found to be clean with no unpleasant odours. Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staff are employed in sufficient numbers to meet the needs of residents. EVIDENCE: Copies of staffing rosters were supplied to CSCI. The full names and designations of staff are on the roster and it is clearly recorded if shifts are altered due to sickness and so on. Extra care staff are available at key times and there are two waking night staff. There are also ancillary staff cooks and cleaners and the manager, Mrs Moore, is on duty or a senior care assistant. Three residents who completed comment cards said staff treated them well, one person said they did ‘sometimes’. One resident spoken to said the staff were ‘jolly good’ and had enough time to look after her. Another person commented that her bell was always answered quickly and she felt happy at the home – ‘I think I’ll settle here’. Standard 29 was not fully assessed, but the requirement made on the last inspection was being acted upon. It was noted that a CRB check had been obtained for the registered provider’s daughter who works at the home and other documentation in accordance with the care homes regulations was being sought by the new manager to be placed on this employee’s file. Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 Systems are in place to obtain feedback from residents, which can be used to shape the services provided. Ongoing work is still required to ensure that service users health and safety is fully protected. EVIDENCE: The home carried out a survey of residents in March 2005 and out of eighteen service users accommodated at that time sixteen replied. Whilst there are some areas where improvements can be made, the majority of respondents were positive about their overall impressions of the home. The manager has tried to address residents concerns about food by introducing more fresh produce and varying the menu. There were other issues where the majority of residents said the service was fair to poor and the home needs to be able to demonstrate what action has been taken to reflect residents concerns.
Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 18 On the day of the inspection workmen were in the home fitting door closures that will enable doors to remain open without compromising the fire regulations. This was in response to an immediate requirement that was made on the last inspection. Evidence was seen that appropriate fire training and checks are undertaken and the fire officer had visited the home on 6th July 2005. There are concerns about service users health and safety that relate to radiators and the delivery of water at safe temperatures. See Standard 25 for more details. Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x 1 x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 x x x x 2 Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 Requirement It is required that amendments are made to the written procedures concerned with the management and administration of medication to ensure that it accurately describes the actual practice and situation in the home. This requirement is carried forward as it will be assessed by the CSCI pharmacist. Unnessary 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. Where radiators are not guarded nor have low temperature surfaces, risk assessments must reflect the needs and capabilities or residents and must be assessed at least six monthly. The home must be able to demonstrate that water is stored safely to prvent the risk of Legionella.
D55 S3977 Richmondwood V229098 280705 Stage 4.doc Timescale for action 31.03.05 2. 25 13 Immediate 3. 25/38 13 31.09.05 4. 25 13 31.10.05 Richmondwood Version 1.30 Page 21 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 9 Good Practice Recommendations It is recommended that Service Users who manage their own medication are periodically reminded of the importance of securing their tablets in the lockable storage provided. It is recommended that systems are put in place to ensure that all creams and liquid suspensions are marked with the dates they are opened. It is recommended that risk assessments are undertaken to assess the risk to all service users of creams/steradent tablets that are kept openly in service users’ rooms where the occupants choose not to lock their doors. Minutes and any actions taken as a result of residents meetings should be supplied to residents in a format that is suitable for them. Work should continue on the file of the providers relative to ensure all the necessary documentation is received including two relevant references. Issues highlighted in residents quality control survey should be discussed in residents meetings, e.g. the homes response to complaints and comfort of residents rooms and thought given to how these can be improved. 2. 3. 9 9 4. 5. 6. 12 29 33 Richmondwood D55 S3977 Richmondwood V229098 280705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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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