Care Home: Richmond Northampton Care Centre

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What the care home does well What has improved since the last inspection? This is the first inspection of the home. CARE HOMES FOR OLDER PEOPLE Richmond Northampton Care Centre Bridge Meadow Way Grange Park Northampton NN4 5AB Lead Inspector Katrina Derbyshire Unannounced Inspection 30th April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond Northampton Care Centre Address Bridge Meadow Way Grange Park Northampton NN4 5AB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01604 432 600 Richmond Care Villages Holdings Limited Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30) of places Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection First Inspection of the service Brief Description of the Service: Richmond Care Centre is located within the Grange Park area of Northampton, approximately 4 miles from the town centre. It is easily accessible by road being close to junction 15 of the M1. Richmond Care Centre is a Care home with nursing that aims to provide services to people who are 65 years of age and over. The care home is within the Richmond Northampton village. Richmond Northampton is a purpose built complex offering a range of services including serviced apartments and village apartments. The location of the home is within the Village centre and shares facilities with other services provided by the Richmond Northampton retirement village. The cost of staying at the home is between £850.00 and £995.00 per week, dependant on the assessed needs of the person and their room choice. Additional charges are made for, newspapers, hairdressing, specialist therapies, chiropody, escort duties and goods and services used in the communal areas of the village at published rates. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection was carried out on 30th April 2008. This was the first inspection of the home. The home had been registered with the Commission for Social Care Inspection since November 2007. At the time of this inspection the level of provision by the home was limited and consideration, must be given on the amount of information available to assess the standards against in view of this. The home had 23 vacancies resulting in occupancy of below 25 , in turn the level of staffing ratio to each person was high. Therefore it must be taken into consideration, that the findings following this inspection are not based on a fully operational home and the effect and or differences that full occupancy may have, on the outcomes for people living at the home. In addition it was not possible to assess all key standards. Information from the agency, through written evidence in the form of an Annual Quality Assurance Assessment has also been used to assess the outcomes within each standard. During the visit the communal areas of the home were seen alongside eight of the individual rooms. Time was spent with many of the people who live at the home in their rooms and the sitting and dining areas. The care of three people was looked at in detail. Evidence used and judgements made within the main body of the report include information from this visit, feedback from people who live at the home and the management’s submission of documentation. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The records kept about medication on receipt of medicines into the home needs to improve. Balances must be maintained so that audits can be undertaken, to check that people have been receiving their medication when they should. The care records maintained about people who live in the home need to improve. Each person has an individual folder that contains paperwork about how they should be supported. Many of the documents had gaps in the information, for example for one person there was no entry within their activity profile or life story document. It is important for these documents to be Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 7 completed in full and reviewed at least monthly so staff have comprehensive guidance to follow to ensure consistency in care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. We have made this judgement using a range of evidence including a visit to this service. Pre admission information on the home ensures people have all the information that they need. The standard of pre admission assessment at this home is good ensuring the staff have sufficient information to know if they will be able to meet the individual needs of the person. EVIDENCE: The statement of purpose was seen to be displayed in the home. The document provided information on the staffing, accommodation and services available at the home. All people using the service indicated that they felt they had been given enough information, before they decided to move into the home. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 10 Assessment documentation was in place for people that had moved into the home recently. This showed that the social, psychological and physical needs of the person had been looked at to ensure staff would know if they had the skills and experience to meet their needs. Management through discussion confirmed that an assessment of someone’s needs was always undertaken prior to their admission. Intermediate care is not provided at the home. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. We have made this judgement using a range of evidence including a visit to this service. Good access to medical support ensures peoples healthcare needs are met. However inconsistencies in care planning could place people at risk of not receiving the care that they need. EVIDENCE: Registered nurses provide assistance with dressings and other nursing support. Care records showed that everyone was registered with a General Practitioner. Records seen within the care files examined showed documents from health care practitioners, for example a dietician to demonstrate that access was gained when a person required it. People through discussion with them at this inspection indicated that they felt they received the medical support that they needed. There was evidence of nutritional screening prior to or after admission on each file tracked on this inspection, catering staff confirmed that they were Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 12 informed if a person needed a diabetic/specialist diet. Other records seen showed that people had access to dental, chiropody and community health services. Registered nurses administered medication in the home. Medication stocks were examined alongside the records relating to this area. The medication administration records did not show current balances for everyone, they did however contain initials of staff when medication had been given. Staff and information submitted by the service confirmed that training had been undertaken in safe administration. The stock maintained in the home was sufficient to provide for the current 28-day administering period. Controlled Drugs were administered by two appropriately trained staff and recorded in a Controlled Drugs Register. There is a need to ensure that balances are maintained so that an effective audit can be undertaken and a requirement has been made for this to be carried out. Care plans were seen to be of a mixed standard. One persons care plan had not been reviewed monthly, another person recently admitted to the home had a plan in place for pressure care but the guidance within it was not clear. Another persons plan contained no evidence to suggest that they had been involved in the planning of this document. Staff when questioned were able to describe the needs of the people living at the home, although some had a greater understanding than others. People living at the home felt that their privacy was maintained. Everyone spoken with said that staff knocked on their doors before entering and that they used their preferred term of address. Staff informed the inspector that as part of their induction they had received training which made clear that at all times the privacy and dignity of the people at the home must be maintained when providing personal care. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to continue personal relationships with opportunities to see relatives in private however resticted opportunities and participation in social activities and social contact does not meet peoples individual prefrences and needs. EVIDENCE: Policies examined and activities advertised suggested that there were no fixed rules or regulations on how people occupied their day. The individual interests for most people were recorded in their personal files and the village was soon to employ a person in the role of activities coordinator. People spoken with confirmed that activities available included film nights, a book club, quizzes, outings, beauty therapy, entertainment and music and movement. The home had a mini bus to assist in outings. The home has Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 14 shared use of an area, which provides a separate beauty/treatment room and hairdressing room. Price lists for treatments were displayed. Within the shop catalogues had been developed containing local services, including price lists. People could order flowers for example or celebration cakes from the village restaurant. It was noted that most activities at the time of this visit were undertaken within the village, not within the care home and as the number of people increase within the home this may need to be reviewed. People living at the home, relatives and staff confirmed that the home has an open visiting policy. People are able to choose whom they see and do not see and are able to receive visitors in private. Daily menus are in place and detail that there are options available for the lunchtime menu and evening meal. In addition as an alternative a selection of salads or omelettes are always available. A wine list is also available for people to choose from at mealtimes. It was observed that people were given sufficient time to eat their meal in an unhurried manner, and staff offered assistance when necessary. People were served their meals by a dedicated staff team whose roles did not include providing personal care. This was carried out discreetly, sensitively and individually; tables contained the necessary condiments to enable people to independently flavour their food and were dressed with fresh flowers, tablecloths and napkins. People could choose to eat in the homes designated dining room or alternatively eat in the village restaurant. Snacks and beverages are available at all times and offered regularly. Special therapeutic, religious or cultural diets are provided when required or requested. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place for receiving, investigating and responding to complaints are good so people are assured that their concerns will be listened to and acted upon. EVIDENCE: The complaints procedure policy of the home on examination showed that it was clear in its guidance to management and staff and included timescales that the complainant should be responded to if they had raised a concern. One written complaint had been received by the service. Documents relating to this were examined and showed that management had instigated an investigation into all the issues raised. Management had then responded to the complainant in writing, within the timescales and had changed practice in some areas to improve the standard of service. Everyone spoken to confirmed that they knew of their rights to complain and would feel comfortable in doing so. Records supplied by the home to the Commission for Social Care Inspection show that staff had undertaken training in the safeguarding of vulnerable adults. On interviewing staff they demonstrated a sufficient level of knowledge on the types of abuse including physical and psychological. In addition the home had in place a copy of the local guidance. The management and staff in Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 16 place at the time of this visit did demonstrate through discussion an understanding of the need to refer any allegation or suspected abuse. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The location, surroundings, décor, furnishings and level of cleanliness of this home is very good so people have a pleasant enviornment in which to live. EVIDENCE: The home is purpose built and to a high standard. It is located within the main building of the village. The grounds are attractive and well maintained and are accessible to people and their families. Records were seen to show the home met all fire and environmental health requirements. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 18 Individual rooms were seen, all rooms contained items, which assisted in the personalising of the rooms; room sizes were not measured on this inspection. All rooms have television and telephones. The décor and furnishings and fittings were of a high standard, domestic and well maintained and the home was seen to be clean and tidy throughout. There are bathrooms and shower facilities; each bathroom has assisted bathing facilities. In addition all rooms had en-suite facilities. Toilets are easily accessible to people and are located close to the lounge, sitting and dining areas. Furnishings are of a high standard. The home was clean and free from offensive odours at the time of inspection. Policies were in place regarding infection control and staff were seen to be using protective clothing. The home had a laundry area, with the walls and floor easily cleanable. Industrial washing machines and dryers are available. The disposal of clinical waste was through a contractual agreement and the inspector saw that this was disposed of correctly. Hand washing facilities were sited in the areas where infected material/clinical waste was being handled. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The initial training arrangements for staff have been sufficient for staff to be able to demonstrate a clear understanding of their role. EVIDENCE: Recruitment practices had changed within the home two days prior to the inspection. The systems that had been followed were not sufficient prior to this in all cases. However management were now directly overseeing this to improve in this area and the person previously responsible for carrying it out, was no longer undertaking this role. The induction and training of staff was recorded in the individual records of all employees. Staff through interviewing confirmed that they had undertaken a variety of courses these included health and safety, moving and handling and national vocational qualifications in care. Registered nurses, care assistants, catering and housekeeping staff are employed at the home . The rotas supplied by the home show that there are sufficient numbers of staff on duty throughout the day and night to meet the Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 20 needs of the residents at this time. People living at the home confirmed that staff were available to help and assist them when they need help. Staff were questioned on the individual needs of some of the people who live at the home, through this they demonstrated a good level of understanding of the needs of the person. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and safety systems are sufficent to reduce the risks associated with this area for the people living at the home. EVIDENCE: At the time of this inspection there was no registered manager in post. There was a Registered Nurse in post, who had submitted an application for registration with the Commission for Social Care Inspection. People living at the home and staff all advised that they found her in the short time that she had held her position to be knowledgeable and helpful. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 22 No monies were being held on behalf of anyone living at the home at the time of this visit. The home had not yet implemented its full quality assurance programme as the number of people living at the home had been limited. However monthly audits had been taking place. Health and safety policies were noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Approved contractors had undertaken servicing of equipment. Maintenance staff carried out the regular checks relating to water temperature checks for example and recorded the temperature on charts. Random water temperature checks were carried out at this visit; all were to the required level. Stocks of aprons and gloves were noted to be available for staff to use, in relation to infection control. No staff at this visit were seen to use these items inappropriately, their use was only seen to be made in the area where they were needed, for example at the lunchtime meal to reduce the risk of cross infection. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 30/06/08 2. OP9 13(2) A care plan containing sufficient information that is clear must be in place for each assessed need, to ensure people receive the care and support that they require. Medication systems must be 31/05/08 changed to allow for medication audits to be carried out to identify any shortage of stock, invalid entries being made on to records and checking people have actually received their medication. Then action taken must be recorded and reported by staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP19 Good Practice Recommendations An increase in the amount of activities available within the actual care home should be available. Consideration should be given to securing the entrance to DS0000071261.V363789.R01.S.doc Version 5.2 Page 25 Richmond Northampton Care Centre the care from the apartment area to improve security. Richmond Northampton Care Centre DS0000071261.V363789.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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