Care Home: Richmond Lodge

What the care home does well Prospective people wishing to live at Richmond Lodge are assessed prior to admission so that the management and staff team are able to meet the individual`s needs. Overall people living at Richmond Lodge are happy and continue to like living there. Visitors to the home are made to feel welcome and people are supported to maintain friendships and relationships. People at Richmond Lodge are supported to pursue hobbies and interests and are given the opportunity to participate in a range of activities, both `in house` and within the local community. People are also given the opportunity to participate in the routines of the home. Staff have a good rapport with people who live at Richmond Lodge and several members of staff have worked at the home for some considerable time, providing stability and continuity of care to the people who live there. What has improved since the last inspection? Care planning and risk assessment processes have improved so as to ensure there is a plan of care in place which is detailed and records clearly the person`s care needs, guidance for staff as to how these are to be met and highlights risk areas that require on-going monitoring. Records also showed that where the care needs of individual people had changed, the plan of care was reviewed and updated to reflect the new information. Where appropriate there was evidence to show that appropriate healthcare professionals had been contacted for advice and intervention at the earliest opportunity so as to ensure people`s health and welfare. Medication practices and procedures in the home are much improved so as to ensure people`s health and wellbeing. All staff have received SOVA (Safeguarding of Vulnerable Adults) training. What the care home could do better: Improvements are required to ensure that staff receive training that covers the needs of older people and those conditions associated with the needs of people who have a mental disorder. In addition all staff must receive up to date training on how to deal with challenging behaviour. This will ensure that staff have the skills and competence to provide good care to people at Richmond Lodge. Staff who work at the home must receive regular formal staff supervision. Where improvements to the home environment are highlighted as requiring replacement, these must be undertaken in a timely manner. This refers specifically to the stair and landing carpets and the ventilation system on the first floor. Key inspection report Care homes for adults (18-65 years) Name: Address: Richmond Lodge 11-15 Richmond Avenue South Benfleet Essex SS7 5HE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Love     Date: 0 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Richmond Lodge 11-15 Richmond Avenue South Benfleet Essex SS7 5HE 01268566178 01268566178 shcrichmondlodge@estuary.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Estuary Housing Association Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Excluding any person who is liable to be detained under the provision of the Mental Health Act 1983. Date of last inspection Brief description of the care home Richmond Lodge is a care home providing nursing care for 12 residents with mental health needs. The weekly cost of care at this home is £989.87. The home is situated in South Benfleet and is very close to local shops, amenities and transport. The premises consist of 12 single bedrooms and one has ensuite facilities. There is a large bright lounge with a variety of comfortable chairs and sofas. There is a kitchen and dining room. The conservatory is used as the smoking room. The premises are surrounded by a large well-kept garden that is secure. There is parking to the front of the premises. 12 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 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: one star adequate 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 an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 7.5 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. In addition a pharmacist inspector examined medication practices and procedures. We did not ask the organisation to complete an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving as they had already submitted this prior to the inspection in September 2009. Information within the AQAA was used in the key inspection report of September 2009. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises Care Homes for Adults (18-65 years) Page 5 of 31 was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. The manager was not present at the home on the day of the site visit. Members of the staff team on duty including 2 qualified members of staff assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the qualified member of staff at the end of the inspection. The opportunity for discussion and/or clarification was given. At the time of the last key inspection to the service in September 2009 we issued an Immediate Requirement Notice in relation to concerns about the homes poor medication practices and procedures. A letter was forwarded to the registered provider and manager detailing our concerns and the actions to be taken to address the identified shortfalls and deficits. A prompt response was received from the Director of Supported Housing and Care for the organisation, detailing the actions undertaken to address the shortfalls. We asked for a specialist pharmacist inspector to undertake a random inspection to the home to check compliance with the Immediate Requirement Notice. This was undertaken on 6th November 2009 and compliance was achieved to meet the regulatory requirements as detailed within the key inspection report of September 2009. Care Homes for Adults (18-65 years) Page 6 of 31 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 on page 4. Care Homes for Adults (18-65 years) Page 7 of 31 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 31 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 31 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 considering moving into Richmond Lodge can be confident that they will be assessed and the home can meet their needs. Evidence: The organisation have a robust referral and pre admission assessment process in place. In addition to their own pre admission assessment documentation, additional information is sought from the prospective persons placing authority and/or previous hospital placement. The prospective person prior to any admission being formally agreed, is given an opportunity to visit Richmond Lodge and to spend time there, to meet existing people who live at the home, support staff and to have a look around. Current people, who live at Richmond Lodge, have lived there for some considerable time. We were advised by the qualified member of staff on duty that no new people have been admitted to Richmond Lodge since the last key inspection in September 2009. At the time of this site visit there were 9 people living at Richmond Lodge and 3 Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: vacancies. Care Homes for Adults (18-65 years) Page 11 of 31 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. The care needs of individual people are clearly recorded detailing their specific needs and how these are to be met by the home. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. As part of the inspection process we looked at 4 peoples care files (2 in full and 2 in relation to specific healthcare needs). Each plan of care was observed to have a section on background information. This provided useful information relating to the persons social family history and their psychiatric history. In addition to this there was a section within the care file which provided a brief summary relating to the persons self care and personal hygiene needs, domestic skills, budgeting skills, physical health, mental wellbeing, communication and specific areas of risk. Records showed that since the last key inspection to the service in September 2009, positive steps have been taken by the manager and other members of the senior team Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: to address previous identified shortfalls relating to care planning and risk assessing. Records showed that since the last key inspection, all residents care plans have been reviewed, updated and rewritten. The care needs of individual people are now more clearly recorded and provide a good level of detail of the actions and interventions required by care staff to ensure that aspects of their health, personal, emotional and social care needs are met. Each care plan was seen to be written in plain language and was easy to understand. There was evidence to show that care plans are more person centred however care must be taken to ensure there is more evidence of residents and/or their representatives involvement in the process and evidence that their personal preferences and wishes have been included. At the last inspection to the service we looked at the care file for one person who has diabetes (insulin dependent). At that time records showed there was little evidence to indicate that the staff team were proactively dealing with the persons variable blood sugar levels at the earliest opportunity to ensure their health and welfare. At this inspection it was evident that their care plan had been updated to reflect their current care needs in relation to their diabetes. This clearly recorded the variable range that the persons blood sugar levels could reach, their daily blood glucose monitoring had been increased with the information being forwarded to a specialist healthcare professional each week and changes to their medication regime had been made. Records showed there are concerns with the persons dietary intake as they are prone to refuse to eat on occasions and will buy high sugar content items to eat at other times, which can have a dramatic effect on their blood sugar levels. For example their daily care records on one day made reference to them being sleepy and unsteady on their feet and having been found with food items on them. No care plan or risk assessment was devised in relation to their dietary needs and it was unclear as to when their diabetic diet sheet had been written. When discussed with the qualified person in charge they said that advice was being sought from the Diabetic Nurse Service. While we acknowledge this is being addressed for the future, no rationale could be provided as to why a plan of care relating to their dietary needs was not already in place. We requested to see the persons weight record and noted only two entries. The qualified person stated that measures are now in place to undertake this more frequently. At the time of the last inspection another persons care plan made reference to their psychiatric history and mental wellbeing and the effects this has on their activities of daily living. As detailed previously, whilst actions and guidelines were in place as to how best to support the person during periods of crises, there was no evidence as to the steps to be taken should their aggression and/or poor mental health deteriorate and/or escalate to a level that was unacceptable or not manageable. Although staff Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: spoken with at the time advised that de-escalation methods are used, specific information relating to this was not recorded within the support plan. At this inspection there was evidence to show their care plan had been updated and information now included the steps to be taken by support staff to proactively manage this to ensure their safety and wellbeing. Strategies included offering reassurance to the resident and enabling them to discuss their feelings. On the day of the site visit the resident was observed during the day to verbally exhibit hostility and suspicions to staff, however there was little evidence of reassurance given to the resident. Their plan of care also made reference to them on occasions refusing their medication. Information recorded was noted to be detailed however further information is required to include at what point a healthcare professional will be contacted should their refusal of medication be for a prolonged period. Care must also be taken to ensure that information recorded is accurate. For example the care plan for one person made reference to them having a specific obsession. The care plan was detailed and recorded guidance for staff to deal with this effectively. However information detailed within their care plan evaluation and information recorded within recent review documentation for a healthcare professional did not tally and it was unclear as to which information was correct. We discussed this with the qualified member of staff but they were unable to confirm which record was correct or the rationale for conflicting information. Where it is noted that people have specific allergies e.g. penicillin, specific information detailing the reaction and symptoms if given inadvertently should be recorded within the support plan. Daily evaluation records were observed to be completed each day and after every shift. In general terms information recorded was seen to be informative, detailing how people spend their time. However additional information is required to evidence staff interventions and/or specific support provided to individual people. For example one persons daily care records recorded them as being very volatile and verbally abusive towards staff. No information was recorded providing specific information as to the specific nature of their actions or support staffs interventions and the outcome. We spoke with 2 qualified staff and 3 support members of staff during the site visit. All were able to demonstrate a good understanding and awareness of individual peoples care needs. We spoke with four residents during the site visit. Three out four people spoken with said that support staff were kind and met their care needs. One resident stated that staff were not always kind or understanding and that they did not enjoy on some occasions living at Richmond Lodge. Care Homes for Adults (18-65 years) Page 14 of 31 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 can be sure that their social care needs and dietary needs will be met. Evidence: The social care needs of people remain the same since the last key inspection to the service in September 2009. There is no plan of care detailing individuals social care needs however there is sufficient evidence within their daily care records and following discussion with residents, to confirm that people living at Richmond Lodge are actively encouraged and supported to pursue opportunities to take part in activities and to engage in hobbies and interests according to their personal preferences and wishes. This refers specifically to adult education classes (Healthy Living Group and Art), accessing the local community and pursuing hobbies and individual interests e.g. reading, watching sport on television, gardening, making clothes, arts and crafts, undertaking personal shopping, keep fit, day trips locally or abroad e.g. France or Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Belgium. A notice board in the small sitting room displays information about activities available and/or upcoming local events. There was evidence to show that people who live at Richmond Lodge are actively encouraged and supported to participate within the routines of the home. In the dining area there is a list of tasks assigned to each person for the week e.g. laying the table, clearing the table etc. People continue to be happy with this arrangement and believe this to be a fair system. In addition people are also supported to complete their own personal laundry, to tidy and clean their bedroom and to assist with the weekly food shop. It was evident that people have the opportunity to undertake these tasks and can opt out if they so choose. There is an open visiting policy whereby people at Richmond Lodge can receive visitors at any reasonable time. People spoken with confirmed they continue to be supported and enabled to maintain friendships and family contacts. We were advised by support staff that the homes menu is planned one week in advance by residents and support staff. On inspection of the menu book/diary this showed that people receive a varied diet and the menu is flexible to take into account peoples wishes and individual choices. People spoken with confirmed the menu is flexible and that staff know their personal food likes and dislikes. The quality and quantity of meals provided to people on the day of the site visit was observed to be appropriate. Two residents spoken with confirmed they like the meals provided at the home. Care Homes for Adults (18-65 years) Page 16 of 31 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. People can be sure they will have their healthcare needs met and current medication practices and procedures within the home will promote positive outcomes for people. Evidence: The majority of people who live at Richmond Lodge continue to manage their own personal care where appropriate. Where assistance is required, support staff are available to provide help. Of those care files case tracked, records showed that service users have access to a range of healthcare professionals and services as and when required. These include GP, Community Psychiatric Nurse, Social Worker, Chiropody, Phlebotomist, Optician and Dietician. There was evidence to show there is an audit trail detailing healthcare interventions provided and outcomes. Where possible and appropriate, people are encouraged to make their own arrangements for healthcare while others are supported by members of the staff team. We looked at the practice and procedures for the safe storage, handling and use of medicines. Most medicines are stored securely for the protection of residents but we Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: found the door to the medicine storage room on the first floor to be unlocked during a tour of the building in the morning. The fridge used to store medicines within this room was also open and so medication stored there was accessible. This was resolved during our inspection so we have not made a requirement for secure storage on this occasion. All other areas where medicines are stored were secure. The temperatures of the areas where medicines are stored are monitored and recorded regularly to ensure the quality of medicines given to people, but we saw that the temperature of the fridge used to store medicines had been recorded outside the recommended range without any action taken to investigate the performance of the fridge or the quality of medicines stored there. We expect this to be managed by the home rather than make a requirement on this occasion. We looked at the records made when medicines are ordered, received into the home, when they are disposed of and when they are given to people. These were in good order, provide a good audit trail of medicines in use and demonstrate that people receive their medicines as prescribed. We saw that one person was prescribed a medicine when required to control behaviour and the medication record form and protocol for its use stated that it would only be used where distraction was ineffective but we could not find, in the persons care plan, any reference to what sort of distraction techniques would be used. One person looks after and takes his own medication and we saw that this was securely stored and the container is now labeled with the contents. We also saw that appropriate risk assessment and risk management plans were in place for this. People are only given their medication by suitably trained staff and there is evidence of recent training provided. At our last inspection we made a requirement that, following such training, people are assessed that they are competent to undertake the task. We saw on this inspection that staff had been assessed as competent and so the requirement made about this on the last inspection has been met. Care Homes for Adults (18-65 years) Page 18 of 31 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. People who live at the home are able to express their concerns and are protected from abuse. Evidence: Information relating to how people can make a complaint or raise concerns was observed to be readily available at Richmond Lodge. On inspection of the homes complaints log, records showed that there have been no complaints raised at the service since October 2004. We asked if there were any records of compliments and were told by the qualified person on duty that there were none. People spoken with were confident about raising concerns and knew who to contact should the need arise. There are corporate safeguarding policies and procedures in place. There have been no safeguarding referrals since the last key inspection to the service. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the person in charge and/or manager. At the last inspection to the service, staff training records showed that not all staff had up to date SOVA (Safeguarding of Vulnerable Adults) training. Staff training records at this inspection showed that all staff have now received SOVA training. As advised at previous inspections to the home, there are people who live at Richmond Lodge who exhibit both verbal and physical aggression towards others on Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: occasions. At the last key inspection to the service we made a requirement that all staff should receive appropriate training to deal with peoples challenging behaviours by December 2009. On inspection of 11 members of staffs training records, there was no evidence to show that this training has been provided. Care Homes for Adults (18-65 years) Page 20 of 31 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. People live in a safe and homely environment which meets their needs. Evidence: A partial tour of the premises was undertaken by us throughout the day of the site visit. The home provides a physical environment that is appropriate to the specific needs of the people who live there. Some areas of the home environment continue to be maintained, decorated and furnished to a good standard and is both homely and comfortable while other areas of the home require redecoration and refurbishment. Furnishings and fittings were domestic in nature and were of a good quality and were in keeping with the environment. There is sufficient communal space and this refers specifically to one large lounge, a dining area within the confines of the homes large kitchen and one smaller lounge/dining area to the front of the property. On inspection of a random sample of peoples bedrooms, these were seen to be personalised and individualised, reflecting peoples personalities and interests. At the last inspection to the service we were advised by staff that the homes stair and landing carpet are to be replaced as they are dirty and heavily stained. At this inspection we noted these have not been replaced and are now emitting a stale odour. We were also advised by the qualified member of staff in charge of the shift that there have been no changes to the homes ventilation system and works remain Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: outstanding. Minor health and safety issues were highlighted whereby we observed the cupboard under the stairs to be left unlocked. A sign on the door details keep locked shut and on the floor were bottles of toilet cleaner and disinfectant. Maintenance tasks at the home are undertaken by external contractors. A random sample of maintenance records and certificates were examined in relation to fire drill records, emergency lighting, fire alarms, fire equipment, fire risk assessments and servicing of the homes gas and electrical installation. Fire records were initially oberved to be muddled as there are several records available with no logical sequence of dates to show these have been checked at regular intervals and records were not easily located and this took 3 members of staff some considerable time to find. The gas safety certificate was observed to remain in date however the electrical safety certificate dated October 2002 was out of date and there was no record to show this has been serviced since 2002. Care Homes for Adults (18-65 years) Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are in sufficient numbers to support the people who use the service. Evidence: Staffing levels at the home are 1 qualified member of staff and 1 member of support staff between 07.00 a.m. to 21.00 p.m., 1 support member of staff between 09.00 a.m. and 16.30 p.m. and 1 qualified member of staff and 1 member of support staff (waking night) between 20.30 p.m. and 07.00 a.m. each day. On inspection of 4 weeks staff rosters records showed that the above staffing levels have been maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. We were advised by the qualified person in charge of the shift in the afternoon that no new people have been employed at Richmond Lodge since the last key inspection. We looked at the staff files for 3 people and these showed they had been transferred to Estuary Housing Association under TUPE arrangements in the past. The files were seen to be in good order but did not contain evidence of all documentation as required by regulation. There was no evidence of one persons health declaration, no evidence of a Criminal Record Bureau (CRB) check for any of the files examined, no recent photograph for one person and no evidence for 2 people of their NMC (Nursing and Midwifery Council) membership. The qualified member of staff confirmed that the Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: above records should have been held on the individual staff members file and would not be stored anywhere else. Records showed that since the last key inspection to the service, staff have received training relating to the Administration of Medication, SOVA, Diabetes Awareness and Health and Safety. Further training is required for those conditions associated with the needs of older people and people who have a mental disorder. On inspection of a random sample of 5 member of staffs supervision records, these showed that staff are not receiving regular formal supervision in line with the recommendations as detailed by the National Minimum Standards for Younger Adults. Care Homes for Adults (18-65 years) Page 24 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the home is well and provides some psoitive outcomes for people in the home. Evidence: On the day of the site visit the registered manager was not present and the inspection was undertaken with the 2 qualified members of staff on duty throughout the day. In general terms residents spoken with were complimentary about the management of the home and in all but one case, people stated they were happy living at Richmond Lodge. Evidence showed that on a day-to-day basis the home is generally well run and provides positive outcomes for the people who live at Richmond Lodge. It is positive that since the last key inspection to the service in August 2009 further improvements have been made to ensure positive outcomes for people and out of 20 statutory requirements recorded, 16 have now been met. The qualified member of staff advised that folders have been newly created in the office and there is further filing and organising to be completed so as to ensure that all records are easily accessible. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Improvements are still required in some areas and these relate to ensuring that all staff receive appropriate training to the work they perform, especially in relation to training around the needs of older people, mental disorder and challenging behaviour, ensuring all staff receive regular formal staff supervision and there is a quality assurance system in place to seek the views of people who live at Richmond Lodge, their representatives, support staff and other stakeholders about the quality of the service and facilities provided. The organisation have ways of monitoring the quality of the service provided at Richmond Lodge. These include monthly Regulation 26 visits however on the day of the site visit no evidence could be found to show these are being undertaken each month. Records of staff and resident meetings were available and these show that these are held regularly. There is a health and safety policy and procedure readily available and the management team and staff team of the home have access to a health and safety officer. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 36 18(2) Ensure that staff, receive regular supervision. So that staff feel valued and the management team of the home are able to discuss both good and poor care practices in a formalised way. Previous timescale of 11/9/08 and 15/10/09 not met. 01/04/2010 2 39 24 Ensure there is a quality 01/05/2010 assurance system in place to seek the views of people who live at Richmond Lodge, their representatives and other stakeholders regarding the quality of the services and facilities provided at the home. Previous timescale of 1/12/09 not met. Care Homes for Adults (18-65 years) Page 27 of 31 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 23 13 Ensure that all staff receive training relating to dealing with peoples challenging and/or inappropriate behaviours. So as to ensure peoples safety, health and wellbeing. For staff to feel confident and competent to deal with any issues. Previous timescale of 1/1/09 and 1/12/09 not met. 01/06/2010 2 24 23 Ensure that all areas of the home are kept clean. This refers specifically to the homes stair and landing carpets. So that people live in a home that is clean. 01/05/2010 3 34 19 Ensure that all records as required by regulation are avilable for inspection. To demonstrate robust recruitment procedures are 01/03/2010 Care Homes for Adults (18-65 years) Page 28 of 31 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 adopted at the home and procedures safeguard people who live at Richmond Lodge. 4 35 18 Ensure that staff receive 01/06/2010 appropriate training to the work they perform. This refers specifically to training for the needs of older people and people who have a mental disorder. This will ensure that staff have the competence, confidence and ability to meet peoples care needs. Previous timescale of 1/1/09 and 31/12/09 not met. 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 6 Where peoples dietary needs are cause for concern and require regular monitoring, ensure a weight record is maintained. Where the same information is recorded in several places within the persons care file, ensure the information is accurately recorded. Ensure that all of a persons care needs are clearly recorded within their support plan. Ensure that the homes electrical installation is serviced by the due date and a copy of the certificate to confirm it remains in good working order is readily available. Ensure that all COSHH (Control of Substances Hazardous to Page 29 of 31 2 6 3 4 6 24 5 24 Care Homes for Adults (18-65 years) 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 Health) are locked away so as to ensure peoples safety and wellbeing. 6 39 Ensure evidence of monthly Regulation 26 visits are avilable for inspection. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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