Inspection on 29/02/08 for Richmondwood

This inspection was carried out on 29th February 2008.

CSCI found this care home to be providing an Adequate service.

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 23/07/07

Richmondwood 02/11/06

Richmondwood 28/04/06

Richmondwood 24/11/05

Richmondwood 28/07/05

Richmondwood 26/01/05

Richmondwood 17/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Richmondwood 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL Lead Inspector Marjorie Richards Key Unannounced Inspection 29th February 2008 09:15 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.V357557.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmondwood Address 19 Richmond Park Avenue Bournemouth Dorset BH8 9DL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 511179 01202 511179 holly.glazer@hotmail.co.uk and beverley.radford@hotmail.co.uk www.richmondwoodresthome.co.uk Mr John Andrew Glazer Post vacant at present Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd July 2007 Brief Description of the Service: Richmondwood is a care home providing personal care and accommodation for up to twenty-two older people. The registered provider is Mr John Glazer. The registered manager’s post is vacant at the present time. Richmondwood is situated in a tree-lined avenue in a quiet residential area, within walking distance of the shops at Charminster. The main shopping centre of Bournemouth is less than two miles away. There is a car parking area to the front of the home and further car parking is available for visitors on the roadside. Bus stops are available from the nearby Charminster Road. Richmondwood is a large, detached property set in attractive and wellmaintained grounds, which are accessible to residents. Accommodation is arranged over two floors, with a passenger lift available to aid access between the floors. There are twenty-two single bedrooms and nineteen have en suite facilities, including baths in some rooms. The home has a large communal lounge with adjoining dining room. There are sufficient bathrooms, including assisted baths, and toilets to meet the needs of residents. Twenty-four hour care is provided. Laundering of personal clothing is carried out on the premises. All meals are prepared and cooked within the home. A choice of menu is offered and a variety of alternatives are always available to suit individual taste and preference at mealtimes. Special diets can be catered for. A range of social activities is offered to provide stimulation and interest for residents and each month there is an inter-denominational communion service held in the home. Current fees, as confirmed at the time of the inspection, are £363 - £500 per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. For further information on fee levels and fair contracts you are advised to refer to the Office of Fair Trading website: www.oft.gov.uk. We have published ‘A fair contract with older people? A special study of people’s experiences when finding a care home’ and this can be accessed on our website www.csci.org.uk Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over 11 hours on the 29th February 2008 and was carried out by two Inspectors. The main purpose of this unannounced inspection was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. On the day of inspection, fourteen residents were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the daily routine during the inspection, as well as talking with residents and the staff on duty. Discussion also took place with Mr Glazer, the registered provider and the two acting managers now jointly in post. For the purposes of this report, people who live at Richmondwood are referred to as residents as this is the term generally used within the care home. The Inspectors were made to feel very welcome in the home throughout the inspection. What the service does well: Richmondwood has an informative Statement of Purpose and Service Users Guide available, which combined with a thorough admissions procedure, allows prospective residents to make informed decisions about admission to the home. Richmondwood has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. The home will consider taking small pets and this can be discussed with the acting managers if admission is being considered. Every resident has a care plan in place. These show that health care needs are well met, with evidence of good support from community health professionals The staff treat residents with respect and provide encouragement for them to pursue their own lifestyles, wherever possible, and to make choices about their daily lives. Activities are available every day for those who wish to participate. Residents are supported to maintain contact with family and friends, enabling Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 6 people living in the home to continue to enjoy relationships that are meaningful to them. Residents say that their visitors are made welcome. The staff provide encouragement for residents to pursue their own lifestyles, wherever possible, and to make choices about their daily lives. Residents confirm that their individual preferences and routines are respected. Residents are able to choose where in the home to take their meals. All residents spoken with were very positive about the quality of the meals provided. Residents commented: We are very fortunate to have such a good cook. The food is very good. We have a good choice. The food is wonderful. People who live at Richmondwood feel confident that they can raise any issues or concerns and these will be taken seriously and responded to. They are also protected from potential abuse. The home has a well trained team of staff to ensure that residents are well cared for. Quality Assurance questionnaires are sent out annually to residents, staff, relatives and other visitors to the home to obtain their views and ensure that the home is run in their best interests. Feedback from the most recent survey is available in the Information File in the entrance hall. Small amounts of money are held on behalf of some residents. These are well managed and held securely. Good practice ensures that the health and safety of residents is suitably safeguarded in the home. What has improved since the last inspection? Some aspects of care planning have been improved and these are now agreed and signed by the resident or their representative. Since the last inspection there have also been a number of improvements in the administration of medicines, to help ensure the safety of residents. Work is now approaching completion to eradicate the serious damp problem in the ceiling/wall areas in one area of the home, which had affected the plasterwork. Some bedrooms have been redecorated and new carpets, furniture and fittings have been purchased, making these rooms much more comfortable and attractive. Risk assessments are now in place with regard to the additional heaters in some bedrooms. The potentially unstable wardrobes have been made secure. A detailed staff training programme, including induction training for new staff, is now in place. More care is being taken to ensure potentially harmful cleaning products are not left accessible to vulnerable residents. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 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.V357557.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Standard 6 is not applicable at Richmondwood Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Richmondwood. Information provided about Richmondwood and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. EVIDENCE: The Statement of Purpose and Service User Guide contain a wide range of information about the home and its facilities. The Service User Guide has been updated since the last inspection and gives a good indication of what a resident can expect from the home and includes details of the complaints procedure. A copy is provided in every residents bedroom. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 10 The Statement of Purpose and Service Users Guide are also included in an Information File placed in the entrance hall at Richmondwood, where a copy of the current inspection report can also be viewed. This file also includes further details, e.g., about the services visiting the home, such as hairdressing, chiropody, dentists and opticians, sample menus, the opening hours for the Tuck Shop and information about where residents and visitors may help themselves to refreshments within the home. All of the information is provided in an easy to read style and in large print. A copy of the Office of Fair Trading Fair Terms for Care report is also available. The home will consider taking small pets and this can be discussed with the acting managers if admission is being considered. Prospective residents are always assessed, prior to making a decision as to whether the home is able to meet their needs. A comprehensive form has been developed for this purpose. Two pre-admission assessments were examined and these showed clear information in place for prospective residents prior to moving to Richmondwood. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs can be met. A copy of this letter is retained on file. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Richmondwood. Residents are treated with respect and the home ensures they have access to a range of health services, such as General Practitioners, District Nurses and chiropodists etc, to ensure their needs are met. Some shortfalls in care planning and medication documentation are being addressed, to help ensure the care provided is safe and meeting the resident’s individual needs. EVIDENCE: The home has a clear admission procedure in place. Care planning documentation is comprehensive. It includes questions about how the resident likes to be addressed, their wishes regarding the gender of staff caring for them, also religion, ethnicity and language. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 12 The care documentation for three residents was examined. This contains a great deal of information to help enable staff to provide the care required by each resident, including their individual wishes and preferences. However, not all of the relevant information has been transferred into a care plan. This makes it more difficult and time consuming for staff needing to read everything in the file, in order to have all of the information they require to meet the care needs of residents. For instance, a pre-admission assessment refers to a serious health problem but there is no care plan to say how this is to be monitored and managed. The assessments for two residents state that certain foods and fluids cannot be tolerated due to current medication. However, this information is not included in medication or nutritional care plans. A mental health assessment states that a resident is “cheerful” and “smiling” and feels comfortable at Richmondwood. However, no mention is made of the resident’s significant past mental health history that is detailed elsewhere within the documentation and there is no care plan to assist staff in knowing how to prevent or manage any re-occurrence of mental health issues. In one of the care records we looked at, six comprehensive risk assessments had been completed, including the actions required to minimise these risks. However, these had not been carried forward into a care plan. Informative daily records are maintained and comprehensive reviews are taking place at least monthly, which clearly detail any changes in care needs that may have occurred. However, where changes have taken place, the care plan and risk assessments have not always been updated, which means that staff have to read all of the monthly reviews to obtain up-to-date information about care needs. We discussed the method of recording information with the acting-managers and the need to ensure that all of the relevant details are included in the care plans and that these are updated as necessary. They took detailed notes of what was said and confirmed that the relevant assessments and care plans would be immediately reviewed. Both acting-managers demonstrated a positive and proactive commitment to addressing all of the issues raised. There is now documentary evidence to demonstrate that residents and/or their representatives are able to contribute to the care planning and review process. Records evidence that residents have access to General Practitioners, District Nurses, chiropodists, opticians etc., as necessary. This was later confirmed in discussion with residents, managers and staff. Since the last inspection there have been a number of improvements in the administration of medicines, to help ensure the safety of residents. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 13 The home stores medicines and Controlled Drugs securely. There are clear photos of residents to help ensure medicines are given to the correct person and records of medicine allergies or “none known” are recorded on Medicine Administration Record (MAR) charts. The correct procedure for the administration and recording of Controlled Drugs is followed to safeguard residents. There is now a much improved audit trail for medicines. One resident self-medicates and appropriate records are kept, including a risk assessment that is regularly updated. However, this resident should have a lockable facility for storing medicines in their room. (We have since been informed that a lockable cabinet has been provided.) One person’s MAR chart was handwritten but not countersigned as checked by a second person to ensure the details were accurate. One resident is prescribed a medicine “when required” but there is insufficient information to guide staff as to the circumstances when this should be given. One medicine was inadequately labelled “as directed” and the GP should be requested to include full directions on the next prescription. A great deal of information about each medicine is recorded on the MAR charts, but not all care staff have access to these. The acting managers say they will now include this information in care plans. The home regularly carries out an audit of medicines and the acting managers will continue to monitor the administration of medicines to ensure they are given appropriately. Residents have their own single bedrooms, thereby offering an opportunity to be on their own if they wish, or allowing privacy for any visitors or personal care needs. We discussed with the acting-managers the need to store continence products more discretely in bedrooms, to protect each occupant’s privacy and dignity. (We have since been informed that this has been achieved.) Staff were seen to knock at bedroom doors, to offer personal care discreetly and to use residents’ preferred names. They interact with residents in a friendly, relaxed yet respectful manner. It was clear from observation and the time spent with residents that they feel comfortable and at ease with staff. Staff were seen throughout the inspection to be treating service users with courtesy and kindness. A resident commented, “The staff respect my privacy when I want to be on my own, but I know they are there if I need them.” Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Richmondwood. The daily routine of the home enables residents to retain control over their lives wherever possible. Residents enjoy a range of activities and are served with a choice of nutritious and appetising meals in the surroundings of their choice. EVIDENCE: The social, cultural and religious needs of people moving into the home are reflected in assessments and care plans. Residents, their relatives and staff have been invited to be involved in the preparation of basic information about each resident’s personal history, hobbies and interests etc. An informative summary, written as if by the resident, is provided discretely in each resident’s bedroom for the benefit of staff. It is hoped that information about social history, interests etc will be used to provide the focus for the provision of activities to ensure they meet the needs and wishes of residents. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 15 The activities programme is displayed in the lounge. A range of activities is available, including giant dominoes, quizzes, manicures, ball games, sing-alongs, artwork and bingo. On Saturday, the home provides a film show in the lounge in the “Saturday Home Cinema.” An activities organiser attends the home on two afternoons each week to provide a variety of group and individual activities for residents. The previous manager identified the need to organise outings for residents in her Annual Quality Assurance Assessment. She was also planning to develop more one-to-one activities with individual residents. The acting-managers say they intend to continue with these plans. Arrangements are made to assist individual residents in practicing their religious beliefs if they so wish, either by attending services or arranging for clergy to visit them at Richmondwood. A monthly inter-denominational Christian communion service is held within the home. Residents and staff confirm that visiting times at Richmondwood are unrestricted and visitors are made welcome. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Some residents are able to go out of the home alone or with their visitors or with staff. A telephone is always available to residents so they may make or receive calls from family and friends. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirm that staff respect their decisions, for example to spend most of their time in their bedrooms or to go to bed early or late. One resident decided to remain in bed for a day and this wish was supported and made possible by staff. Residents are able to bring their own possessions into the home to personalise their bedrooms. They are encouraged to make choices, e.g., about what to wear and what they prefer to eat or drink and they have the freedom to come and go as they please. Residents confirm that their individual preferences and routines are respected. Lunch on the day of inspection was breaded cod or smoked haddock, with chipped or mashed potatoes and peas, or salad. Baked apples with custard or icecream, fruit yogurt or cheese and biscuits followed this. A range of alternatives, such as jacket potatoes with a variety of toppings, fish, omelettes, soups, egg/baked beans/cheese on toast or ham/corned beef/tuna/cheese salads etc is available to suit individual taste and preference. For the evening meal, residents could choose from prawn cocktail, soup or sandwiches with assorted fillings and crisps. This was followed by fruit jelly with tinned pears, yogurt or icecream. Residents may choose where to eat their meals and during the inspection, residents were observed to be taking meals in the dining room, lounge and in their bedrooms. Special diets are catered for and discreet staff assistance is available for those who need help with their food. Good supplies of fresh, frozen, tinned and dry foods are available. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 16 Residents and their visitors may help themselves to tea and coffee at any time from a refreshment area adjacent to the lounge and dining room. The menu for the day is displayed a large print on each table in the dining room. Mealtimes are unhurried and residents clearly enjoyed their lunch on the day of inspection. The following comments were received from residents: We are very fortunate to have such a good cook. The food is very good. We have a good choice. The food is wonderful. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Richmondwood. The systems in place provide residents with the confidence that their complaints will be listened to and acted upon and they are protected from possible abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints policy is also available to visitors in the Information File in the entrance hall. Residents spoken with said they had no complaints, but would know how to voice any concerns if the need arose. The complaints record shows that no complaints have been received by the home since the last inspection. The home has an Adult Protection policy in place to protect residents from possible abuse. The policy and procedure has been reviewed and updated to follow guidance provided in the Department of Health No Secrets document. The contact details for the local Social Services offices are incorrect. The acting-managers took action to correct this information immediately. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 18 All staff, with the exception of new employees, have received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. Further training for the new staff has been arranged. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Richmondwood. A number of improvements have been made recently to help ensure the home provides comfortable accommodation for residents. However, further work is needed with regard to décor, furnishings, furniture, carpets and cleanliness to ensure a satisfactory standard is maintained. EVIDENCE: Accommodation is arranged over two floors at Richmondwood, with a passenger lift available to aid access between the floors. The majority of bedrooms have en suite facilities, including baths in some rooms. The lounge and adjoining dining room are situated on the ground floor and provide Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 20 comfortable communal space. There is also a small sitting area off the hallway. These communal areas are well used by residents. Richmondwood has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. Facilities are provided where residents and visitors can make themselves a drink of tea or coffee at any time. The home has attractive and colourful gardens to the front and rear of the property, which are accessible to residents. These include a terrace area with fishpond. Garden furniture is available. One resident commented, I love to go out in the garden when the better weather comes. It always looks very colourful and attractive. It lifts my spirits to spend time in the garden.” At the last inspection, it was apparent that the overall environmental standard was deteriorating. We discussed this with the manager and provider and asked them to implement a refurbishment plan. During this inspection we saw that a good start has been made in making the necessary improvements. For instance, we found that work is now approaching completion to eradicate the serious damp problem in the ceiling/wall areas in one area of the home, which had affected the plasterwork. Some bedrooms have been redecorated and new carpets, furniture and fittings have been purchased, making these rooms much more comfortable and attractive. Risk assessments are now in place with regard to the additional heaters in some bedrooms. The potentially unstable wardrobes in some bedrooms have been made secure. When we walked round the home we confirmed that further work is still needed in some rooms with regard to redecoration and worn furnishings and furniture. A number of carpets are also showing signs of wear. Many of the extractor fans in bathrooms, toilets and ensuite facilities are dusty and still not in working order. One bedroom did not have pillowcases on the pillow and V shaped pillow in use. Some of the towels in use are very thin, frayed or holed. We also found that many of the bathrooms and toilets did not have access to liquid soap and paper towels, to help minimise the risk of cross-infection when different people use these facilities. We discussed this with the provider and asked him to prioritise the remaining work in a refurbishment plan, to ensure all rooms receive attention as necessary. We also found that the less accessible areas in bedrooms were sometimes dusty and cobwebs were in evidence on a number of light shades. This was highlighted at the last inspection and is not intended as a criticism of the standard of work undertaken by cleaning staff, which was observed to be thorough during the inspection. The staffing roster shows that the home only allocates thirty hours per week for all cleaning tasks. The laundry is rather cluttered, with no access to soap and towel at the sink. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 21 Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Richmondwood. Staffing levels must be reviewed to ensure the care needs of residents can always be met. There have been improvements in recruitment practice but some shortfalls must be addressed to ensure residents are protected from the employment of unsuitable staff. Richmondwood provides a range of staff training, but National Vocational Qualification training must be improved, to help ensure residents are in safe hands at all times. EVIDENCE: The home has a weekly staffing roster, which is clearly laid out with the full names of staff, their status, their shifts and any subsequent changes. This shows that, although one or other of the acting-managers is supporting staff in the provision of “hands-on” care, there are times during the afternoon/evening when only two care staff are on duty. We discussed this with the actingmanagers and provider, asking them to review the staffing arrangements as some residents require the assistance of two staff for transfers and personal care. This means that when this is happening, there are no other care staff available to help the remaining residents, which has the potential to place them at risk. During this discussion the provider stated that the home is not Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 23 fully occupied at present and the number of staff on duty is adequate in dealing with care needs at present. Residents are generally very complimentary about staff, although some feel staffing levels are insufficient or that staff are sometimes too busy to assist them when needed. Residents commented: We have very good staff here on the whole. They are usually very helpful. The staff are very good but also very busy. It is difficult to get their attention sometimes. I get on alright with the staff. We understand each other. They come if I need them. I feel there could be more staff on duty. We are supposed to play Bingo in the afternoon, but sometimes the staff are too busy. There are simply not enough staff on duty. The home has not achieved the target of at least 50 trained members of care staff with National Vocational Qualification (NVQ) level 2, to ensure residents at Richmondwood are in safe hands. We were informed that at present, only two members of staff have attained NVQ level 2 and five more are now studying for NVQ level 2. An equal opportunities policy is in place at Richmondwood. Three staff files were examined and these demonstrated that a more thorough recruitment procedure with all of the required documentation is now in place prior to the commencement of employment, to help ensure the protection of residents. Some small improvements are still needed. For instance, a full employment history must include more precise dates, not just years, e.g. 2003– 2005; interview notes should be dated. The home sometimes uses Agency staff on shifts to cover staff absence or vacant posts. We found that no employment information was held about these staff and the home had not satisfied itself with regard to training and their suitability to meet residents’ needs. Since this was raised at the inspection the provider has contacted the agency and profiles are now in place in the home for all agency staff. All new staff receive induction training, which includes a four-day introduction to Richmondwood. This is followed by a twelve-week induction, which is based on the Skills for Care Common Induction Standards. An induction file was examined and found to contain all relevant parts completed and signed off appropriately by the previous manager. The home has a training matrix and this demonstrates that nearly all staff have received a wide range of training opportunities, including mandatory training such as moving and handling and protection of vulnerable adults. Further training is being arranged for any staff that have missed a session. At the last inspection, the manager identified five residents with dementia and the home has now provided appropriate training to ensure that staff can meet these needs. During discussion, we identified further training that would be Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 24 beneficial to staff in caring for the present group of residents, e.g., nutrition, stroke, anxiety and depression. Copies of all training certificates are retained to evidence that staff receive a minimum of three paid days training per year. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Richmondwood. There is currently no registered manager at Richmondwood. However, the interim management arrangements in place and the home’s quality assurance systems help to ensure that the residents live in a home where the service is safe and standards are improving. EVIDENCE: The registered manager has recently left her post at Richmondwood and the provider has subsequently appointed two acting-managers. It is planned that they will share the management role over the seven days of each week, whilst Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 26 also providing some hands-on care to residents. Both have experience of working with older people and have attained the National Vocational Qualification (NVQ) level 4 in care. It is intended that both acting managers will also attain the Registered Managers Award to ensure they have the management skills necessary to run the home. An application to register them with the Commission must be made as soon as possible. Since the last inspection, a clerical assistant has been appointed to provide support to the management team. This will release more time to spend in dealing with management tasks, including the regular internal auditing of systems and any updating of policies and procedures etc. Quality Assurance questionnaires are sent out twice a year to residents, staff, relatives and other visitors to the home to obtain their views. Feedback to the specific questions from the October/November 2007 survey is available in the action plan, which can be viewed in the Information File in the entrance hall. Miss Smee confirms that, in order to protect residents it is the policy of the home, where possible, not to have any involvement in their personal finances. Therefore, all residents who are unable or not wishing to handle their own affairs, have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment each month. However, small amounts of money are held for some residents. Detailed records are kept and monies are held securely. Records were checked at random and the amounts held found to be correct. Information about advocacy services is available to residents within the home and policies are in place precluding staff acceptance of gifts or involvement in residents wills. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as gas appliances, call bell system, hoists etc are regularly serviced and maintained. When the lift was serviced in November 2007, further recommendations were made and the provider says these matters are in hand. Measures are in place to help ensure the safety of residents. For instance, the home has completed a programme to fit radiator covers to ensure the protection of residents from contact with very hot surfaces. The hot water temperatures were tested and found to be close to the recommended temperature is 43C, to prevent any risk of scalding. We found there was no restrictor fitted on one first floor bedroom window, but when we informed the acting-managers, this received immediate attention. It may be helpful in assisting residents when climbing the stairs to consider the installation of a broom-handle stair rail on the main staircase. This is already in place over part of the stairway, but not on the main section. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 27 Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is arranged. A new fire panel will be fitted in April 2008. Routine checks are carried out at appropriate intervals and staff confirm this. Staff fire training is taking place and fire drills are arranged so that staff are fully aware of the action to take in the event of a fire. A Fire Risk Assessment is in place, which was reviewed on 27 February 2008 to ensure it is kept fully up to date. The majority of staff have received first aid, health and safety and moving and handling training to help ensure the safety of all in the home. Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2) Requirement The registered person must ensure that when reviews take place, the care plan and any risk assessments are updated, as necessary. Timescale for action 30/04/08 2. OP8 15(1) 3. OP9 13(2) 4. OP19 23(2)(d) 16(2)(c) Previous timescale of 30/09/07 not fully met. The registered person must 30/04/08 ensure that all relevant information is contained in the care plan. The registered person must 30/04/08 ensure that care plans include relevant information about residents’ medication, including the purpose of their medicines and any special requirements. The registered person must 30/04/08 ensure that all parts of the home are kept reasonably decorated. The registered persons must also ensure that all bedrooms are provided with adequate furniture, furnishings and carpets and equipment. Worn items must be repaired or replaced. This includes ensuring that extractor fans in en-suite DS0000003977.V357557.R02.S.doc Version 5.2 Page 30 Richmondwood facilities are fully operational. Previous timescale of 30/09/07 not fully met. An action plan (with timescales) showing how this requirement will be met must be forwarded to the Commission by 30/04/08 The registered persons must ensure that all parts of the care home are kept clean. 5. OP26 23(2)(d) 30/04/08 6. OP27 18 7. OP28 18(1)(a) Previous timescale of 30/09/07 not met. The registered person must 01/04/08 ensure that sufficient staff are employed to meet the needs of residents. A review of staffing levels must take place and the results of this review and any action plan must be forwarded to the Commission. The registered persons must 30/09/08 ensure that 50 of care staff have gained a nationally recognised qualification in care, e.g., National Vocational Qualification level 2. Previous timescale of 30/09/07 not met. The registered person must not employ staff to work with residents until satisfactory recruitment checks have been fully completed and all necessary documentation has been received. This includes obtaining sufficient information in relation to Agency staff, ensuring that suitable employment checks have been carried out and that staff have the knowledge and ability to meet the needs of residents at Richmondwood. The registered person shall DS0000003977.V357557.R02.S.doc 8. OP29 19(1) 30/04/08 9. OP31 8&9 30/04/08 Page 31 Richmondwood Version 5.2 ensure that the home is managed by a person or persons who are fit to be in charge and able to discharge their responsibilities fully. An application to register the newly appointed manager(s) with the Commission must be made as soon as possible. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that the home should follow guidance from the Royal Pharmaceutical Society: When staff hand-write the details of prescribed medicines on to the medicine chart a second competent person should countersign to confirm that all the details are correct. If the dose on the label is “as directed” the doctor should be asked to include full directions on the prescription. If the dose on the label is “when necessary” the care plan should contain full information for staff as to the circumstances when this should be given. It is recommended that a review of washing powder/fabric softener be carried out to ensure there is no “residue” left on towels etc. It is recommended that the fire risk assessment be updated annually or more frequently if changes are necessary, to ensure it is kept fully up to date. 2 3. OP26 OP38 Richmondwood DS0000003977.V357557.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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