Care Home: Richmond House

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What the care home does well Richmond provides a pleasant, homely atmosphere for people living there. There are only five places offered so people receive a personal service from staff who appear to know their needs well. Staff seem professional and competent. There is significant focus on ensuring people develop skills, and are enabled to have choice in how they live their lives. What has improved since the last inspection? A number of Statutory Requirements were issued at the last inspection and these have now been complied with. We saw evidence to confirm that the staff training program has improved. We tested the fire alarm and noted that it worked well with all self closing doors shutting securely. We were also informed that the Hard Wiring in the building had received the five year tests. The risk of legionella is suitably managed. What the care home could do better: It is recommended that where possible records relating to any given individual are kept on a file belonging solely to that person. For example accident records to be kept on the persons file rather than in a communal file. The Data Protection Act and Freedom of Information Act apply. We considered that the storage of medication was secure in that two locked metal cabinets and one locked wooden cabinet are used, all of them housed in a locked room. No Controlled Drugs were stored at this time. We do however draw your attention to safe storage of medication guidance which requires medication to be stored in a locked metal cabinet which is in turn permanently fixed to the wall. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Richmond House 31 Richmond Street Heamoor Penzance Cornwall TR18 3ET     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: Michael Dennis     Date: 1 4 0 7 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 28 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Richmond House 31 Richmond Street Heamoor Penzance Cornwall TR18 3ET 01736331005 01736331005 H5m006flecknor@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Mencap Society care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 5 Richmond provides care for up to 5 adults with learning disabilities. The home is situated in Heamoor, Nr Penzance. The registered provider is Mencap, which operates several care homes and domiciliary care agencies in Cornwall. Mr David Flecknor is the registered manager. All people who live at the home have their own bedrooms and there are suitable shared facilities. People who use the service have the opportunity to participate in suitable day activities. The building is not suitable for wheelchair users. A copy of the inspection report is available in the dining room. Further copies may be obtained from the Care Quality Commission. The fees charged at this home vary and are calculated according to the individual needs of those who live at the home. There are some additional charges e.g. for hairdressing, newspapers etc. Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 28 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which was unannounced. It took place on 14th July 2009 and lasted for approximately four hours. The registered manager was on holiday at the time. The deputy manager was present throughout the inspection and was competent in managing the home in the managers absence and had access to all documentation. The purpose of the inspection was to ensure that residents needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the residents there. Care Homes for Adults (18-65 years) Page 6 of 28 The inspection included meeting with one of the residents currently living at Richmond. We inspected the premises, Policies and procedures, employment records and other records required by legislation. The principle method of inspection was case tracking. This involved discussion with the deputy manager and examination of records relating to residents care. This provides a useful impression of how the home is working for residents overall. Three service users were case tracked in detail at this inspection. On the day of inspection 5 residents were living in the home. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have been issued with a tenancy agreement and a copy of Mencaps terms and conditions of residency at the time of admission. People who use the service subsequently receive suitable information regarding their rights and responsibilities. The pre admission assessment procedure is good, and enables the registered persons to ascertain they can meet the needs of prospective residents, before admission is arranged. Evidence: Copies of tenancy agreements, and an individualised copy of terms and conditions of residency, are contained on the files that were case tracked. Copies of social services contracts of care were also available. New residents are able to visit the home prior to moving in. This allows them to make an informed choice about coming to live at the home and also allows staff to gather further information as to the persons care needs. Suitable documentation regarding the assessment process was available for inspection. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Each potential resident is provided with information, presented in a form that can be understood, to enable the person to make an informed choice about moving to the home. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. All people who use the service have a care plan and these are regularly reviewed. Care plans ensure staff have suitable information to provide care. People who use the service are encouraged to make decisions about their lives with suitable assistance as required. The registered persons approach to handling residents monies is good, so people living in the home can be assured their finances are maintained appropriately where staff are involved in this area of their lives. The registered persons have a suitable approach to risk, so people who use the service can be assured they will be supported to take risks as part of an independent lifestyle. Evidence: There is a copy of a care plan in each residents file. Care plans are accessible to staff and are regularly reviewed. People who use the service are encouraged to make decisions regarding their lives; for example regarding small decisions such as what to eat to larger decisions such as how to spend their time. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Suitable risk assessments are in place to assess any risks or actions to promote independence. Some people who use the service are able to go out on their own and use public transport etc. Staff look after some monies on behalf of people who use the service, for which suitable records, including a risk assessment, are maintained. At a previous inspection it was noted that a person regularly went out on a bicycle. The safety and competence of this person was brought into question. Risk assessments are now in place and this person has achieved a cycle efficiency certificate. The registered provider has a satisfactory policy regarding diversity and equality. There are currently no people who use the service from ethnic minorities. The home would be more than happy to accommodate people from other cultures. The local population is predominantly Cornish, and from White-UK background. Women who use the service have equal opportunity compared with their male counterparts. Issues regarding sexuality seem to be suitably addressed. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 who use the service can participate in a suitable range of activities, and are able to mix with the wider community. People who use service are encouraged to maintain relationships with friends and relatives. People who use the service have their rights respected, and are enabled to take a suitable amount of responsibility in their daily lives. Suitable arrangements are in place so people who use the service enjoy a healthy and varied diet. Evidence: We were only able to talk briefly with one resident. During this conversation and through observation of the interaction between the person and staff, it was evident that the person was able to exercise a high level of choice in preparing for his planned daily activity. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: People who use the service attend a range of day activities including attending work placements, educational courses and leisure facilities. Activities are also arranged in the evenings and at weekends. The home has a car for service user use. People who use the service visit friends and relatives regularly, and they are encouraged to maintain contact via the telephone or post. Visiting arrangements are flexible. People who use the service can get up and go to bed when they wish, although some may need reminding to get up on the days they attend activities. Staff were observed to be respectful in the manner they worked with people living in the home, and the resident we spoke to said they had no complaints regarding staff conduct. Locks are fitted to bedroom doors so people living in the home can lock their doors if they wish. People living in the home are involved in household tasks for example doing laundry, cleaning tasks, shopping and cooking. People living in the home are involved in the preparation of food with appropriate staff support. Discussion with the Deputy Manager, observation, discussion with a resident and inspection of records evidenced the above comments. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Personal care is delivered to a good standard, and there are suitable links with medical professionals. The management of medication is generally to a good standard so people who use the service can be assured their medication is suitably looked after. Evidence: People who use the service said they received suitable care and support from staff. Any personal care needs are documented in care plans. The Deputy Manager demonstrated a clear understanding of the residents needs regarding the assistance people who use the service required. Care plans document appropriate links with the GP, dentists, opticians, chiropodists and other professionals. Medication is stored securely, and dispensed appropriately. The management of the system and records kept are to a good standard. Staff have received suitable external training regarding medication. Whilst medication is stored securely, the cabinets used should all be of metal construction and securely fitted to the wall within the locked medical room. Care Homes for Adults (18-65 years) Page 16 of 28 Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Residents are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. Evidence: Residents were encouraged to speak to us if they wished so that they could make their views known or raise any concerns. The complaints procedure is on display and all residents are aware of the process to raise any issues of concerns. In addition residents attend a residents meeting which allows the opportunity to express any concerns or ideas for improving the service. The people spoken with expressed satisfaction with the care and services provided to them at the home. The home has received no complaints in the last year. The home has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Service users are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. The majority of staff have attended the Multi Disciplinary Adult Protection course and have a copy of this policy. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) Page 19 of 28 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Richmond provides a clean, well maintained and homely environment for the people who live there. Evidence: The building was inspected. The home offers a pleasant and homely environment for the people who live there. The home is a Victorian end of terrace property. There is a small front garden with a table and chairs where people can sit. There is a small yard at the back of the building, but no garden. Bedrooms and communal areas are of a satisfactory size to meet the needs of people living there. There are suitable toilet and bathroom facilities on both floors. All bedrooms and communal rooms are well decorated, individual and homely. The home was clean and hygienic on the day of the inspection. Suitable cleaning routines are in place. There is no cleaner employed as people living in the home complete the cleaning with staff support. The fire alarms were activated during the day are were seen to work correctly. All fire doors closed appropriately, as they should being automatically linked to the alarm system. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Care Homes for Adults (18-65 years) Page 21 of 28 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staffing levels appear satisfactory so people who use the service can be assured they will get suitable levels of staff support. Recruitment records are good. Suitable recruitment procedures and records help to ensure people who use the service know they are in safe hands. Equal opportunities issues regarding recruitment and work practices seem appropriate. Evidence: Rotas indicate the registered persons provide suitable staffing to meet the needs of people who use the service. On the days of the inspection there was one member of staff on duty first thing in the morning, and two staff on duty in the afternoon and evening from 1500 hrs. One member of staff sleeps in through the night. The staff cover is regularly increased as necessary to facilitate events, activities and care needs. Staff files were inspected. The registered persons obtain suitable information regarding the recruitment of staff. This includes two references and evidence confirming the persons identity. Staff also have a Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check prior to commencing work. A staff induction system is in place for new staff. This involves staff working shadow Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: shifts with managers and more experienced staff. Mencap has a comprehensive induction and foundation course programme, which all new staff have to complete. There is also a brief in house induction checklist so new staff can be inducted regarding the homes routines. Mencap has a suitable training programme. This includes fire training, first aid, food hygiene, manual handling, and infection control. Staff training files were inspected and it is considered that staff receive relevant on going training. Mencap has a suitable approach to ensuring staff have the opportunity to obtain a National Vocational Qualification in care. According to the deputy manager 100 of staff have now achieved either a NVQ 2 or 3. The manager and deputy manager have attended training on the Mental Capacity Act and the Deprivation of Liberty Safeguards which they have in turn cascaded to other staff. Evidence was presented to indicate that staff are appropriately supervised and receive annual appraisals. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 well managed by a suitably skilled, experienced and knowledgeable manager. There is a good quality assurance system in place to enable people who use the service and other stakeholders to be consulted about their views. The management of health and safety issues has improved. Evidence: Mr David Flecknor appears to be suitably experienced, knowledgeable and skilled to manage the home. Staff and people who use the service were positive about his leadership and the changes made to the home. MENCAP has a suitable approach to quality assurance. Surveys are completed annually regarding stakeholder views and these were positive. Monthly monitoring takes place to ensure the home complies with Mencaps standards. A continuous improvement plan is in place, and a service development plan has been developed. The manager also arranges regular staff meetings and regular residents meetings. There is evidence of a staff supervision system in place. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The registered provider has a suitable health and safety policy. There are satisfactory records regarding portable electrical appliance testing, servicing of gas appliances, and preventative measures regarding legionella. Accident records are maintained to a satisfactory standard. It is recommended that these are kept on the persons file to whom they relate rather than in a combined file. Health and safety risk assessments are satisfactory. Checks by external contractors on the fire prevention system and fire extinguishers appear to be carried out satisfactorily. There is satisfactory insurance in place. General policies and procedures appear satisfactory and records required by legislation are in place. Care Homes for Adults (18-65 years) Page 25 of 28 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 Adults (18-65 years) Page 26 of 28 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 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 2 20 41 Medicines should be stored in locked metal cabinets which are securely fixed to the wall. Records pertaining to an individual, should where possible be stored on that persons file, for example accident records. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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