Care Home: Richmond Park

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well The manager makes sure that people have a full assessment of their health and social care needs before they are admitted to the home. People are able to visit the home to have a look round and meet the staff and other residents, before they move into Richmond Park. The service has produced a guide to the home and the facilities available at Richmond Park. All of these things help to ensure that people live in a home that is suitable and able to meet their needs and expectations. We found that people living at the home have clear and detailed care plans of their health and social care needs. The care plans have been developed with the resident and their family, where appropriate. They provide staff with clear information and guidance to help them meet the individual needs and expectations of each resident. Some of the comments we received from people living at the home included; `The staff in the home are very good and can`t do enough for you.` ` I am looked after well and my room is kept clean. I have been able to personalise my room with my own belongings.` `I have no complaints, the staff are very good. The food is OK but could be better at times. The cook does come round and ask from time to time about people`s views on the food. We can have what we like to eat and there is always plenty, we can have seconds if we ask.` `The staff are very good at answering my bell, day and night, if I call them. There are things to do if you want to join in, but I like my own company and don`t often get involved.` We spoke to some of the staff and received comments from them via surveys. They told us; ` The home is very welcoming and homely place. Families comment on the fact it is like home from home for their parents.` `All the staff work as a team which reflects on the well being of all the residents. Every new resident seems to settle in the home. They meet lots of new friends and are made to feel welcome.` `We work well as a team. All the clients care needs are met. Within the home we have good communication with staff and clients. Confidentiality is kept at all times. The manager`s door is always open and she listens to any concerns which may occur.` `It is a pleasure to come to work at Richmond Park, as we all get on and work well together as a team. It feels like you are part of a family we treat everyone as we would want to be treated ourselves.` One of the visitors we spoke to said; `I have no complaints, they are always nice and my mother in law is always clean and tidy. We can visit when we like and we are always made very welcome, we can help ourselves to drinks and are offered refreshments when we visit. The home is always clean and fresh, whatever time of day we visit.` We found that staff are recruited safely and are well supported in their work by the supervisors and the manager at the home. Many of the staff have worked at the home for a number of years. This staff stability helps to ensure that people living at the home receive consistent and reliable support from people they know well and trust. What has improved since the last inspection? Since our last visit to Richmond Park a new manager has been appointed. She has been at the home for a year and has started to make her application to register with the Care Quality Commission. She should ensure that there are no further delays in submitting this application. The manager has developed a more structured activities programme and an activities coordinator is employed at the home. The home is also working in partnership with Age Concern on the enriched opportunities programme and there are 4 volunteers who visit the home with the team coordinator. Work has been done to improve menus and healthier snacks have been introduced. "Taster Days" have been held to help people choose what they want to see on the daily menus. The manager has implemented some good practices to help people with dementia find their way around the home and access the facilities. There are clear signs with pictures and colour co-ordinated facilities to help people understand and again access the facilities. What the care home could do better: Care plans and daily notes show that some people are prescribed creams and ointments. Consistent recording of this type of medication is not maintained. They are not recorded on medication administration record sheets and their application is not always recorded in individual daily notes by staff. This was discussed with the manager during our visit as it is an area the needs attention. All medications administered, must be clearly recorded and managed safely and we have asked the manager to address this matter quickly. The home is usually staffed during the day by six members of staff but there are times, particularly early morning, meal times and bed times when staff are stretched. During the night the staffing levels are greatly reduced. There are a significant number of residents that need care and support during the night, sometimes needing two staff to help them. This means that people may not always get the care and support they need, when they need it. We received comments about staffing levels from both staff and residents at the home. They included: `I think there should be more staff because at times if they are busy with a resident that leaves no one for any other that needs them.` (Resident)`I sometimes have to wait for staff to attend to me. Staff always come to help when requested but sometimes take a while because they are busy with someone else.` (Resident) `Service users are not being given the time if they just want a chat with you. You feel like you are against the clock.` (Staff) `Due to extra residents on respite we are sometimes understaffed. Extra staff would enable more quality time with residents.` (Staff) There are no staff at the home with a formal, current first aid certificate. Staff are provided with Emergency Aid training which provides basic training on a variety of health and safety subjects, including an awareness of first aid. We have asked the manager to review and address this situation. Toilets, shower rooms and bathrooms were generally clean. There was one area where unpleasant odours were detected and we discussed this with the manager. We suggested that waste bins with lids fitted should be provided in bathrooms to help reduce this problem. As a result of this inspection visit we have made two statutory requirements that the manager and provider must address and six good practice recommendations that should be given serious consideration. Key inspection report Care homes for older people Name: Address: Richmond Park High Street Workington Cumbria CA14 4ES     The quality rating for this care home is:   three star excellent 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: Diane Jinks     Date: 2 8 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 Older People 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Richmond Park High Street Workington Cumbria CA14 4ES 01900325030 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.cumbriacare.org.uk Cumbria Care care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 29 service users to include: up to 29 service users in the category of OP (older people not falling within any other category) up to 17 service users in the category of DE(E) (Dementia over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. . The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Date of last inspection Brief description of the care home Richmond Park is operated by Cumbria Care, an internal business unit of Cumbria County Council. It is managed on a day-to-day basis by Ms Linda Walker. The home is Care Homes for Older People Page 4 of 31 0 0 Over 65 17 29 Brief description of the care home situated close to the centre of Workington and all of its facilities and services. The home provides accommodation and care for up to 29 older people, 17 of who may have dementia. The accommodation is provided on two floors and the home is divided into three living units. The units consist of lounge and dining room areas, each with small kitchen. Residents rooms, toilets and a bathrooms are nearby. On the ground floor there is a large lounge that is used to provide daycare for people from the local community Monday - Friday. This room can be used residents during the evening and weekends for special events and social occasions. The home is equipped to assist people with a physical disability and has a passenger lift, handrails and grab rails as well as equipment in bathrooms and toilets. There are well-maintained gardens with seating and a small car park. The weekly fees depend on the assessed care needs of service users. Additional charges are payable for such things as newspapers, magazines, hairdressing and personal items. Further information is available from the manager at the home. Care Homes for Older People Page 5 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service takes into account all of the information we have received for the annual service reviews we have undertaken since the last key inspection. We sent surveys to some of the people that live and work at this home in order to obtain their views about Richmond Park. The inspection included a visit to the home. We looked at a variety of the records that the home is required to maintain. We looked around the home to assess the general environment and living accommodation provided to people that use this service. During our visit to the home we spoke to some of the people that live and work at Richmond Park, including the manager. The manager also completed an annual quality assurance assessment (AQAA) and returned this to us. The information recorded in the AQAA provides us with information about the service and helps us to check the information we gather during the visit to the home. Care Homes for Older People Page 6 of 31 What the care home does well: The manager makes sure that people have a full assessment of their health and social care needs before they are admitted to the home. People are able to visit the home to have a look round and meet the staff and other residents, before they move into Richmond Park. The service has produced a guide to the home and the facilities available at Richmond Park. All of these things help to ensure that people live in a home that is suitable and able to meet their needs and expectations. We found that people living at the home have clear and detailed care plans of their health and social care needs. The care plans have been developed with the resident and their family, where appropriate. They provide staff with clear information and guidance to help them meet the individual needs and expectations of each resident. Some of the comments we received from people living at the home included; The staff in the home are very good and cant do enough for you. I am looked after well and my room is kept clean. I have been able to personalise my room with my own belongings. I have no complaints, the staff are very good. The food is OK but could be better at times. The cook does come round and ask from time to time about peoples views on the food. We can have what we like to eat and there is always plenty, we can have seconds if we ask. The staff are very good at answering my bell, day and night, if I call them. There are things to do if you want to join in, but I like my own company and dont often get involved. We spoke to some of the staff and received comments from them via surveys. They told us; The home is very welcoming and homely place. Families comment on the fact it is like home from home for their parents. All the staff work as a team which reflects on the well being of all the residents. Every new resident seems to settle in the home. They meet lots of new friends and are made to feel welcome. We work well as a team. All the clients care needs are met. Within the home we have good communication with staff and clients. Confidentiality is kept at all times. The managers door is always open and she listens to any concerns which may occur. It is a pleasure to come to work at Richmond Park, as we all get on and work well together as a team. It feels like you are part of a family we treat everyone as we would want to be treated ourselves. One of the visitors we spoke to said; I have no complaints, they are always nice and my mother in law is always clean and tidy. We can visit when we like and we are Care Homes for Older People Page 7 of 31 always made very welcome, we can help ourselves to drinks and are offered refreshments when we visit. The home is always clean and fresh, whatever time of day we visit. We found that staff are recruited safely and are well supported in their work by the supervisors and the manager at the home. Many of the staff have worked at the home for a number of years. This staff stability helps to ensure that people living at the home receive consistent and reliable support from people they know well and trust. What has improved since the last inspection? What they could do better: Care plans and daily notes show that some people are prescribed creams and ointments. Consistent recording of this type of medication is not maintained. They are not recorded on medication administration record sheets and their application is not always recorded in individual daily notes by staff. This was discussed with the manager during our visit as it is an area the needs attention. All medications administered, must be clearly recorded and managed safely and we have asked the manager to address this matter quickly. The home is usually staffed during the day by six members of staff but there are times, particularly early morning, meal times and bed times when staff are stretched. During the night the staffing levels are greatly reduced. There are a significant number of residents that need care and support during the night, sometimes needing two staff to help them. This means that people may not always get the care and support they need, when they need it. We received comments about staffing levels from both staff and residents at the home. They included: I think there should be more staff because at times if they are busy with a resident that leaves no one for any other that needs them. (Resident) Care Homes for Older People Page 8 of 31 I sometimes have to wait for staff to attend to me. Staff always come to help when requested but sometimes take a while because they are busy with someone else. (Resident) Service users are not being given the time if they just want a chat with you. You feel like you are against the clock. (Staff) Due to extra residents on respite we are sometimes understaffed. Extra staff would enable more quality time with residents. (Staff) There are no staff at the home with a formal, current first aid certificate. Staff are provided with Emergency Aid training which provides basic training on a variety of health and safety subjects, including an awareness of first aid. We have asked the manager to review and address this situation. Toilets, shower rooms and bathrooms were generally clean. There was one area where unpleasant odours were detected and we discussed this with the manager. We suggested that waste bins with lids fitted should be provided in bathrooms to help reduce this problem. As a result of this inspection visit we have made two statutory requirements that the manager and provider must address and six good practice recommendations that should be given serious consideration. 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. 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 Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of using this service have their health and social care needs assessed prior to moving into Richmond Park. This helps to ensure that the home will be suitable and able to meet their needs appropriately. Evidence: The home has a comprehensive admissions process. All prospective service users are invited to visit the home and where possible come in for respite care before making a decision about moving into Richmond Park. The home has produced a statement of purpose and service user guide. These documents help provide people with information about Richmond Park and the services it can offer. Some of the people that live at Richmond Park told us that they received enough information about the home to help them make their decision to move there. Some of Care Homes for Older People Page 11 of 31 Evidence: the people had prior experience of the service by visiting the home for day care or from using the respite services. The manager told us that a pre admissions meeting takes place with all prospective service users and relatives to formally meet with staff and familiarise themselves with the home. We saw that people have their health and social care needs assessed before they are offered a place at Richmond Park. The manager also obtains copies of any assessments that have been carried out by social workers or health care professionals. This information helps to ensure that Richmond Park will suitable and able to meet the needs of prospective residents. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service receive care and support based on their individual needs and expectations and takes into account their rights, choices and independence. Evidence: During our visit to Richmond Park we looked at a sample of some of the records kept regarding peoples care and support needs. We also spoke to some of the staff and residents at the home and directly observed some of the working practices. We found that care records are up to date and clearly reflect the care and support that people need and want from the service. Some of the people that use this service told us that staff are usually available when they need them. Sometimes they have to wait for a short time because they are busy, but they did say that staff always come to them when called. One resident told us, the staff in the home are very good and cant do enough for you. Personal information about each individual living at the home is carefully recorded and stored safely. Care plans are developed with each individual person and clearly reflect Care Homes for Older People Page 13 of 31 Evidence: the needs, wishes and expectations of people using this service. Wherever possible, people are supported to maintain their independence and are involved with the development of their own plan of care and support. Staff have a good knowledge of the care plans and each individual service user has a member of staff designated as their linkworker. This helps to ensure that care and support is provided in a consistent way. The manager told us that care plans are regularly discussed with staff to help ensure they understand individual needs of residents. Staff told us that they always have enough information to help them support the people that use this service and that the way in which information is passed on and shared within the home always works well. One member of staff said, The home keeps us well informed about concerns and issues regarding our service users. We all work well as a team and the service users needs are always met and everyone is treated with respect and dignity. Care plans contain information about personal preferences and choice. Elements of nutritional and risk assessments are included and where issues or concerns have been identified, the manager has ensured that appropriate advice and support has been sought, involving health care professionals where needed. Some of the other care records we looked at confirmed that people have access to medical professionals when they need them. Additionally, some of the people we spoke to at the home told us that the staff get the doctor or district nurses when requested. There are policies and procedures in place regarding the administration of medication. Staff are required to read the medication policies and procedures and to sign to say that they have done so and understand them. They are provided with training to help them administer medication safely. The manager has also started to undertake competency checks with staff as a further safety measure. We looked at a sample of the medication records kept at the home. Individual medication needs corresponded with those written in care plans. There is a photograph of the person attached to their medication records to help with identification and reduce the risk of medication errors occurring. Protocols for the use of when required medication are starting to be introduced and we saw examples of these in the medication records. This information should help staff to understand when and why this type of medication should be used and the importance of recording the effects. Some people do not need some of their when required medication as often as Care Homes for Older People Page 14 of 31 Evidence: anticipated and the home started to gain a stock of these medicines. The manager has written to the medicines managers at the doctors surgery and included copies of medication records to help demonstrate that some medicines are not used so frequently. This will help to make sure that people receive the medicines they need and that medicines do not go out of date. Care plans and daily notes show that some people are prescribed creams and ointments. Consistent recording of this type of medication is not maintained. They are not recorded on medication administration record sheets and their application is not always recorded in individual daily notes by staff. This was discussed with the manager during our visit as it is an area the needs attention. All medications administered, must be clearly recorded and managed safely. There are suitable arrangements in place at the home for the secure storage of drugs which are liable to misuse - controlled drugs. There are suitable recording methods in place, which keeps account of the medication in stock and the medication administered. We did a small check on this type of medication and found it was all accounted for. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are able to participate in a variety of social, religious and leisure activities, if they choose. This helps to ensure they can enjoy a stimulating lifestyle and maintain contact with friends, family and the local community. Evidence: The manager told us that there is an activities programme within the home that is suitable for everyone who wishes to take part. We saw some of the activities on offer at the home. The programme includes baking, games, bingo, dominoes, arts and crafts, fortnightly church services, trips out, parties and live entertainment in the home, including regular visits from a pet dog. Some of the people that live at Richmond Park told us that there are opportunities for leisure and social activities if they want to take part. Most of the people we spoke to like to keep themselves to themselves. They told us that they like to spend a lot of their time in their own rooms, watching or listening to their own television and radio. Many people also said they have their own newspapers or magazines delivered to the home. One resident told us, I have my own newspaper delivered to the home, I enjoy watching sport on my TV and I am able to have a few cans of beer if I choose. Care Homes for Older People Page 16 of 31 Evidence: Some of the staff at the home felt that there are times when the home is understaffed. They felt that, extra staff would enable more quality time with residents. One person thought that the home could improve, if the budget was more generous for more staff and outings for clients. Another person said, Service users are not being given the time if they just want a chat with you. You feel like you are against the clock! We spoke to some people who were visiting the home. They told us that they are able to visit their relatives and friends whenever they choose. People told us that they are always offered refreshments when they visit the home and that they are always made welcome at Richmond Park and that the staff are very helpful and friendly. There is a four weekly menu in place at the home and this provides a wide variety of choice for every meal time. The menus show that people are offered a varied diet with at least two choices at each meal. The people we spoke to told us that if there is something they dont like then they are able to choose something else. People said that they are able to get up and go to bed when they please and we saw that breakfast was being served at various times over the morning. Some people were having breakfast in their rooms or in one of the dining areas, as they preferred. Each unit has a kitchenette where toast, cereals, snacks and drinks can be prepared. A cooked breakfast is available if people request it. People had a tea or a coffee when they wanted one and staff asked or reminded others about drinks throughout the day. The manager and the cooks at the home have been doing a review of the menus to check that they meet the preferences of the people that live at Richmond Park. The home also provides some day care services and the menus are being adapted to help ensure that people who come for daycare on a specific day dont get the same meal each week. We observed the service of the lunchtime meal in one of the dining areas. We noted that staff were sensitive to the needs of residents, giving people a choice of meal and explaining what was available. Where necessary alternatives were offered and people were also offered extra portions if they wanted them. Meals were nicely presented and looked appetising. People were given a choice of cutlery to help them manage to be more independent with their meals. Some people needed extra support, encouragement and time to eat their meals. Staff supported people with kindness and sensitivity. We observed that people were offered a choice of hot or cold drinks with their meal. People were helped back to their easy Care Homes for Older People Page 17 of 31 Evidence: chairs after the meal and the lunch time news was put on the TV for those that wished to watch. There was no rushing and staff were helpful and patient. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are able to raise concerns if they wish. There are policies and procedures in place to help them do this and to help protect them from the risks of harm and abuse. Evidence: The manager told us that all staff within the home know how to manage a complaint, and are aware of the new complaints procedure. There are policies and procedures in place to support the safeguarding of vulnerable adults. All of these documents are covered in staff induction training and are refreshed frequently during staff supervision sessions and staff meetings. Staff participating in the inspection of this service are aware of their responsibilities and aware of who to speak to if they have any concerns. They told us that they are provided with training to help them deal with any concerns, complaints or allegations they might receive. This type of training helps to ensure people using this service are protected from harm and that if they do raise a concern, staff know what to do to ensure it is dealt with properly. The complaint process is displayed within the home. The people we spoke to knew about the complaint process and who to speak to if they were not happy. No one we spoke to had needed to make a complaint about anything. We, the Care Quality Commission, have not received any complaints about the home, nor has the manager. Care Homes for Older People Page 19 of 31 Evidence: Earlier in the year the manager told us about an incident that was reported to the social worker for further investigation. The manager acted appropriately to ensure that all of the people living at Richmond Park were safe and protected as far as possible from the risk of harm or abuse. There are robust processes in place regarding the recruitment of care staff. These help to ensure that people using this service are protected from the risks of harm or abuse and that only suitable staff are appointed to work with vulnerable adults. Care Homes for Older People 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, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally maintained to a good standard and people living at Richmond Park are provided with a warm, safe and comfortable environment to live in. Evidence: The manager told us that there is an annual planned maintenance programme in place at the home. This helps to ensure that the standard of the environment at home is well maintained. The organisations estate manager also has oversight of improvements and maintenance at the home. The home employs domestic staff on each unit, Monday to Friday. They follow planned cleaning schedules to help ensure the building is kept clean, odour free and hygienic. We spoke to some of the people that live at Richmond Park. They told us that the home is usually clean and fresh. One visitor told us, the home is always clean and fresh, whatever time of day we visit. A resident said, my room is kept clean and I am able to personalise it with my own belongings. We did receive comments about the lack of domestic staff at the weekends. Comments included; I think there should be a cleaner everyday to make sure the toilets and rooms are kept clean. As part of our visit to the home we looked around all areas of Richmond Park. We found that the laundry was clean, tidy and well organised. There were facilities for Care Homes for Older People Page 21 of 31 Evidence: staff to wash their hands and protective equipment is also supplied to help reduce the risks of cross infection. Toilets, shower rooms and bathrooms were generally clean. There was one area where unpleasant odours were detected and we discussed this with the manager. We suggested that waste bins with lids fitted should be provided in bathrooms to help reduce this problem. Protective aprons and gloves are available in bathrooms and toilets for staff to use. We found that some bathrooms and toilets were not supplied with paper towels and this is another matter that the manager should address quickly. The home is divided into three units. Each one has a kitchenette area, dining area and a lounge. Some of the residents bedrooms are en-suite but there are plenty of toilet and bathroom facilities throughout the home. In some of the communal areas, emergency call bells had been tied off the floor. This would have made it difficult for people to summon help from staff if they had fallen on the floor. Outside of the home there is a small car park and private gardens with pleasant seating areas for residents to access in warm weather. The manager has implemented some good practices to help people with dementia find their way around the home and access the facilities. There are clear signs with pictures and colour co-ordinated facilities to help people understand and again access the facilities. There are grab rails in all the bathrooms and toilets and hand rails throughout the home. This type of equipment helps people to access facilities more easily and helps maintain and support their independence. Bathrooms are also equipped with handling equipment to help people access baths and showers with some assistance from staff. Care Homes for Older People 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 staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are supported by staff that are experienced and trained to a good standard. There may be times when insufficient staff are on duty and this means that people may not always receive the help and support they need, when they need it. Evidence: The manager told us that she tries to ensure that staffing levels are maintained to meet the individual needs of the people that live at Richmond Park. On our arrival at the home in the morning, there were few staff about. Most of them were helping people to get up and eat breakfast and two people were administering the medication. The home is usually staffed during the day by six members of staff but there are times, particularly early morning, meal times and bed times when staff are stretched. People told us that there are usually enough staff on duty to meet their needs and requirements but they added that there are times when they may have to wait a short while for staff to come and help them when needed. One relative told us, I think there should be more staff because at times if they are busy with a resident it leaves no one for any other resident that might need them. Most staff told us that there are usually enough staff on duty. One person said, all the staff work as a team which reflects on the well being of all the residents. Other members of staff told us, Due to extra residents on respite care we are sometimes understaffed and Units should be Care Homes for Older People Page 23 of 31 Evidence: manned by two members of staff, there should be extra hours to relieve the stress of trying to run a unit on your own if your second person is doing the medication rounds. During the night the staffing levels are greatly reduced. There are a significant number of residents that need care and support during the night, sometimes needing two staff to help them. This means that people may not always get the care and support they need, when they need it. We discussed this matter with the manager. She told us that there are times when she is able to bring in extra night staff. Staffing levels at night should be reviewed, taking into consideration the needs of the people using this service. Richmond Park has a robust staff selection and recruitment process. This helps to ensure that people using this service are protected from staff that may be unsuitable to work in care homes. We looked at a sample of staff recruitment records. We found that people are not employed at the home until the manager has received the results of all the checks required. Prospective staff must undergo criminal record bureau checks (CRB), safeguarding of vulnerable adults list checks (SOVA) and references are obtained from their previous employers. Prospective employees complete application forms and attend for interview with the manager as part of the recruitment process. There is a low turnover of staff at Richmond Park. This helps to ensure that people using this service receive a consistent and reliable service from people they know well and trust. We also looked at the training offered to staff that work at Richmond Park. 85 of the staff have gained a national vocational qualification (NVQ) in care at either level 2 or 3. Domestic staff have also undertaken NVQ training to help them do their job well. We saw evidence to confirm that staff undertake other training to help them with their work. Core subjects such as induction training, moving and handling, health and safety, medication, infection control and safeguarding adults have been undertaken by most of the staff. Some staff have also undertaken specialist training to help them understand and meet the needs of people who may have dementia, continence problems and people who may be in the final stages of their life. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interests of the people that live there. Evidence: The home is managed by an experienced and qualified manager. She has completed the Leadership and Management Award, (formerly the registered managers award) and is waiting to register for an NVQ 4 in management. The manager is not currently registered with us, the Care Quality Commission, but she tells us that her registration application is in process. The manager has worked hard to ensure that the home is run in an open and positive atmosphere. Staff, residents and visitors told us that they receive support from the manager and that, the managers door is always open and she listens to any concerns which may occur. Another person said, we are kept well informed about concerns and issues regarding our service users. We looked at the way in which services users finances are stored and managed by the Care Homes for Older People Page 25 of 31 Evidence: home. Where possible people manage their own finances or this is managed by one of their friends or relatives. There are procedures in place at the home to help ensure that residents finances and valuables are kept safe. Monies are stored separately but securely. There are records kept and where purchases are made on behalf of a resident, receipts are obtained. There are two signatures required in the finances book. The manager audits and checks this from time to time. There is a policy and procedure in place at the home to help ensure service user finances are handled and managed safely. The samples we looked at were accurate. The manager completed the annual quality assurance assessment when we asked for it. She included information about the home, particularly where improvements have been made and where she intends to make further improvements to the quality of the service. She told us that monthly health and safety audits are conducted at the home to help ensure the home is maintained safely. We saw that the manager ensures annual service checks are made to fire detection and fire fighting equipment as well as regular checks of the central heating system, handling equipment and the passenger lift. There are no staff at the home with a formal, current first aid certificate. Staff are provided with Emergency Aid training which provides basic training on a variety of health and safety subjects, including an awareness of first aid. Training records do not demonstrate that this training has been regularly undertaken to help ensure staff are aware of current procedures and good practice guidelines. Staff should receive this refresher training every 3 years and many staff are in need of updates. As well as staff training records, we looked at the way in which staff are supported and supervised in their work. Staff told us that they receive regular supervision and that team meetings take place. Records confirmed that staff are frequently and properly supervised and supported in their work to help ensure they follow their training and work within good practice guidelines as far as possible. We looked at the records kept with regard to accidents that have occurred at the home. We found that the manager generally ensures that accidents are recorded and that we, the Care Quality Commission are notified of significant events as required by law. However, accidents were not always recorded consistently and we discussed this with the manager during our visit to the home. We looked at the kitchen and food storage areas as part of our visit to the home. The Care Homes for Older People Page 26 of 31 Evidence: kitchen was clean and tidy and food storage areas and freezers have been cleared and re-organised. Food in the freezers was labelled and stored properly, but some of the food products in the fridges had not been dated and labelled. It is important to do this so that other staff coming on duty know when foodstuffs have been made or opened. All the cooks at the home have undertaken training in food hygeine, and the local food safety officer has awarded the home 5 stars (excellent) for food safety. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 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 9 13 All records for the administration of medication, including creams and ointment, must be accurately and consistently maintained. Accurate recording will help ensure that people using this service receive their medications as the doctor intended. 01/03/2010 2 38 13 Staff must be provided with suitable training in first aid. Unnecessary risks to the health and safety of people using this service must be eliminated as far as possible and staff must be provided with training suitable to the work they are to perform. 31/05/2010 Care Homes for Older People Page 29 of 31 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 22 Emergency call bells should be easily accessible in all areas of the home. This will help ensure that people using this service are able to summon assistance from staff in emergencies. Suitable waste bins should be provided for the disposal of continence products. This will help minimise the risk of unpleasant odours in communal areas. Staffing levels at night should be reviewed, taking into consideration the needs of the people using this service and the layout of the home. This will help to ensure that people using this service receive the care and support they need, when they need it. The provider should continue to support the manager with her application to register with CQC. There should be no further delays in submitting this application to register the manager. Food products should be stored, dated and labelled properly. It is important to do this so that other staff coming on duty know when foodstuffs have been made or opened. Where residents, staff or visitors to the home suffer an accident, proper records should be completed in line with current legislation. 2 26 3 27 4 31 5 38 6 38 Care Homes for Older People 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). 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