Care Home: Riccall House

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What the care home does well People live in a comfortable home and are cared for by staff who are competent, caring and professional. People have a pleasant dining experience with homemade food and a choice of drinks. The home provides a range of activities for people to participate in. One comment was "the home is excellent and it is always clean and fresh". Another comment was "the staff are wonderful and they always treat me well". What has improved since the last inspection? Everyone in the home has access to a call bell when needed. The laundry area is more secure which keeps the area safer for people people with dementia. Staff are more aware of fire safety and ensure that doors are not propped open by unauthorised means. The record keeping regarding controlled drugs has improved, with a special register now in place to record when medication is administered. The manager is more familiar with the policys and procedures regarding safeguarding. This helps protect people from harm. The Quality Assurance system now includes a range of medication, care plan and health and safety audits. What the care home could do better: The hot water system could be more effective, this would make it easier for people to have a wash. The risk assessments could be clearer so staff know what the risk is, this then helps to formulate a care plan. The training records could be better maintained. This would help to confirm which staff have received mandatory training and which staff need to be updated. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Riccall House Riccall House 78 Main Street, Riccall York YO19 6QD The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Bell     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Riccall House 78 Main Street Riccall York YO19 6QD 01757248586 01757249497 riccallhouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Diane Moughan Type of registration: Number of places registered: Mrs Gillian Mary Conroy,Mr John Anthony Conroy care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1 named service user under the age of 65. This condition will cease when the named service user reaches 65 or leaves the home. Service Users to include up to 18 (OP) and up to 18 (DE(E)) up to a maximum of 18 Service Users Date of last inspection Brief description of the care home Riccall House is registered to provide personal and social care and accommodation for 18 older people who may have additional dementia care needs relating to their age. The home is located on the main street in the village of Riccall, four miles from the market town of Selby and eight miles from the City of York. The village is on a main bus route to both of these locations. The home consists of a two storey Georgian building with a newer, purpose built ground floor extension. Twelve of the fifteen Care Homes for Older People Page 4 of 25 Over 65 18 18 0 0 Brief description of the care home bedrooms are for single accommodation. None of these have en-suite facilities. One of the three double rooms has an en-suite facility. The home has no passenger lift but has a stair lift. The fees vary per week depending on the indiviuals requirements, these are reviewed annually. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated,it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on Monday 8th December 2008. The visit lasted from 9:30 until 14:00. The purpose of the visit was to make sure that the home was operating and being Care Homes for Older People Page 6 of 25 managed in the best interests of people living there. Information has been used from different sources for this report. These sources include- Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. This is information which details what has happened during the past 12 months. 5 Surveys from people using the service, and three health care professional survey. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. The Annual Service Review from 2007. Details of complaints and allegations raised by people connected to the service. Progress of the previous recommendations made at the last site visit. At the site visit one inspector spent 4.5 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. The weekly fee levels are 425 pounds per person, this was correct at 8th December 2008. Additional charges are made for hairdressing and chiropody. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are effectively assessed prior to admission, which helps to ensure individual needs can be met. Evidence: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. All the surveys completed by people living there report that people are given enough information Care Homes for Older People Page 11 of 25 Evidence: about the service and what it provides. This means they can make an informed choice about whether to move there or not. The manager of the home often visits a person with a senior carer from the home, this is beneficial as the person has already met two members of staff and this helps them adjust to their new environment. The manager is very aware of the client group and how their needs can be met, but also how they will engage and interact with other people in the home. Information is also obtained from health care professionals and carers, a life history is also completed after the pre-admission stage. This helps staff to clearly understand what the persons daily routine is, their likes and dislikes and thier hobbies and interests. The manager is keen to ensure people are treated as indiviudals and all aspects of their care and needs are understood prior to admission. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met in a dignified manner. Evidence: People receive a good standard of care. One person said the staff are great, another person said its lovely here, the staff are really caring. People had visited the hairdresser, had their nails manicured and attention was paid to cleanliness of each individual. Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as at risk had a care plan in place describing how that risk was to be managed. It was evident that the risk assessments had information in that should have been put in the care plan. This area should identify the risk then be followed up in the care plan. The three plans had detailed information in Care Homes for Older People Page 13 of 25 Evidence: the risk assessment which was then repeated elsewhere. The manager needs to ensure that key risk assessments for moving and handling, falls, prevention of pressure sores and nutrition are completed to identify the risk, rather than been completed once the risk is evident. All three care plans had been regularly reviewed and evaluated and gave a good picture of how to care for each person. The home is aware of how to report accidents and injuries, through Regulation 37 notifications to The Commission. The home have a good relationship with the community health care professionals. One survey said the home offers excellent supportive care, another stated staff have the right skills and knowledge to meet peoples needs. The Doctors surgery is opposite the home and District Nurses visit when needed. This was apparent at the site visit. The medication system was inspected. Staff have received training in administering medication and a blister pack system was in use. Regular stock balances are taken and auditing of the system is in place. Three charts inspected confirmed that staff know how to administer and sign for medication. There is a system in place to dispose of medication and staff have a controlled drugs register for recording this type of medication. Medication is kept secure and the home have the facility to store medication in the fridge when needed. Staff do need to ensure they record medication in a consistent manner. For example tablets which are given only when needed (pain killers). The home offer homely remedies to staff, which includes paracetamol. A stock balance of this should be recorded to ensure all medication can be accounted for. Privacy and dignity in the home was observed and discussed. People are able to have a phone in their room and personal possessions. This was evident at the visit. Staff speak to people in a pleasant and caring way and ensure people are respected and treated in a dignified manner. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy dining in pleasant surrounding with appealing food. Evidence: The home encourages social activities by offering; quizzes, games afternoon; dominoes; shopping trips; regular church services; evening entertainment; selection of Christmas celebrations and seasonal events. An organiser is available on a regular basis, and records of the activities are available. At the site visit a morning quiz was talking place in the lounge, the Christmas decorations were been put up and music was available. Staff take some people into the village to the local shops or pub, and the grounds are available to spend time in. The homes daily routine is dependant on the needs of the people using the service. Visitors are welcomed at any time and many compliments had been received in the comment book on display in the entrance area. The lunchtime meal was observed. The dining area has tables which can seat up to four people per table. These are laid with crockery and cutlery and suitable drinking vessels depending on the persons choice. The food is homemade and the portion sizes Care Homes for Older People Page 15 of 25 Evidence: are good with the food looking appetising and appealing. People were observed interacting positively with staff and assistance was given in a dignified manner. Some staff have completed food hygiene training and staff know peoples likes and dislikes regarding food and drink. A previous visit from the environmental health officer showed they were satisfied with the kitchens hygiene and provision for food and drink. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their concerns listened to and acted upon, with staff been alert to signs of abuse. Evidence: The home have a complaints procedure in place which people and their visitors are aware of. There are currently no complaints or safeguarding issues ongoing. The complaints procedure is discussed at the admission stage and a copy of this is displayed in the home. Staff spoken to were aware of the safeguarding procedures in place. Some staff have completed abuse awareness training,and staff knew about the different types of abuse and the action to take if an abusive situation occurs.The home have a policy in place and staff are encouraged to use the Whistle Blowing policy. People said they felt safe in the home, with staff having protection of vulnerable adults checks prior to starting work. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and clean environment. Evidence: People live in a clean and well maintained, homely and welcoming environment. There are enough communal areas for people to spend time in and access to the grounds is available. All areas inspected were clean and fresh smelling. Staff have completed infection control training and are aware of the need to wear protective clothing. The laundry area is secure and the washing and ironing system is effective, with people observed wearing clean clothes. Some clothes are dried via the tumble drier and this is due to be replaced. People have access to call bells and moving and handling equipment is available. All surveys returned commented positively on the cleanliness of the home. One bathroom downstairs did not have hand towels for people to use, this would be beneficial and prevent cross-contamination from the use of one material towel for everyone. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are competent, well trained and recruited and in sufficient numbers to meet individual needs. Evidence: The home have eighteen older people who may have dementia. There is generally a senior carer and two care staff along with the manager to care for this client group. Staff have completed dementia training and have the skills and competencies to meet peoples needs. During the visit staff responded quickly to give assistance to people. Twelve out of 24 care staff have completed an NVQ Level 2 or 3 in care and this was evident when speaking with care staff. This helps to ensure people are getting consistently good care. Surveys from health care professionals confirmed that people receive the personal and medical care they need. Staff complete a two part induction training, this is rolled out to new staff but other staff who have worked in the home for some time are also working their way through this. This is equivalent to Skills for Care and covers orientation, care practises and health and safety. The home have a robust recruitment procedure in place. Two written references are obtained, along with a police check and protection of vulnerable adults check. Three staff files were inspected. References were available, though on one occasion some verbal information had been obtained in addition to the written references, though this Care Homes for Older People Page 19 of 25 Evidence: was not documented anywhere. The police checks were in place but were stored in another location. These checks help to protect people from harm. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people using the service. Evidence: The manager is registered with The Commission and has almost completed an NVQ Level 4 in Care and Management. She is an experienced manager with many years experience working with older people. The atmosphere in the home is calm and relaxing and visitors feel they can approach the manager and staff if they have any concerns.The annual quality assurance assessment was completed well, though more attention to equality and diversity is needed. The home have a quality assurance system in place which includes client and visitor questionnaires and a range of audits which relate to health and safety, the environment care practises and medication. An overall annual development plan which encompasses the different audits would be useful. The home has regular resident/relatives meetings where issues regarding daily routines are discussed. Care Homes for Older People Page 21 of 25 Evidence: People can keep personal money in the home. This may be used for chiropody, hairdressing, clothes or toiletries.Well-maintained records are kept of all transactions and invoices are available which confirm the money coming in and going out. Health and safety was discussed and a selection of policies were inspected. A fire risk assessment is in place and staff had a good understanding of the action needed in the event of a fire. The fire alarm was tested during the site visit and staff took appropriate action. Staff receive fire, moving and handling, infection control and food hygiene training. Specific training is also given relating to older peoples conditions. Individual staff confirmed that a range of training takes place, though the training records were not up to date and some certificates were kept at the Head Office. The electrical wiring certificate and gas safety checks are in place. The electrical wiring had some outstanding recommendations from 2006, the provider gave verbal information to confirm these had all been completed. This helps to keep people safe in their environment. Water temperatures are tested on a monthly basis. These do not exceed 43 degrees centigrade. It was evident in room 15 that the hot water tap at the sink was extremely slow running, it took over four minutes to increase the flow. This makes it problematic for people trying to have a wash. This was also evident in the bathroom next to this room (sink area). This should be reviewed. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 17 Training records for staff must be kept up to date. This will help the manager understand which staff have completed mandatory training and which staff need updating. 08/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The risk assessments could be clearer and more specific.This would help formulate the care plan so staff can be aware of the persons needs. Homely remedies which are administered should be recorded with details of the current stock balance. Stained sheets on peoples beds should be replaced. The upstairs bathroom should have hand towels for people to use when they have washed their hands. The hot water system could be improved in room 15 and the bathroom next to this. 2 3 4 5 9 26 26 38 Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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