Care Home: Richmond Residential Care Home

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What the care home does well People told us their needs were met at the home and they had the care and support they required. They said “they look after me well”. People told us “staff are very much like family”, “staff are very kind”, and “staff talk to me properly”. We observed a good rapport between people in the home and staff with spontaneous affection shown. 14 out of 17 care staff, (approximately 80%), had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard required of 50% of care staff with the qualification. What has improved since the last inspection? Further changes and improvements had been made to the home, including the addition of 11 bedrooms, an additional lounge, a new kitchen and dining room, and new bathrooms. Four of the six requirements made at the previous inspection had been met, resulting in improvements to the information provided for people in the home, better care planning, and improved staff training. The menus had been extended and improved to provide a range of well balanced meals with choices at every meal time. The changes had been made in consultation with people in the home. What the care home could do better: Amend the Statement of Purpose to include correct information about the range of needs the home can cater for, and also to include the contact details for CQC. Also, provide each person with an individual contract that includes information about fees charged at the home. This will ensure that people have correct and up to date information about the home to help them to make a choice about living there. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that people`s rights are promoted and upheld. Include sufficient details in care plans of medicines prescribed ‘as required’ to ensure that staff are fully aware when and why the medicine should be given, and any alternatives to offer first. This will ensure that people are protected and have their medication as prescribed.Richmond Residential Care HomeDS0000020082.V378086.R01.S.doc Version 5.2 The environment of the home should consider the needs of people with dementia, in line with current research and good practice. The quality assurance system should be developed to include a wider range of surveys and an annual report with analysis of survey results and details of action taken to meet any issues raised. This will ensure that people know their views and ideas are taken into account in the running of the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Richmond Residential Care Home Recreation Road Shirebrook Mansfield Nottinghamshire NG20 8QE Lead Inspector Rose Moffatt Key Unannounced Inspection 13th October 2009 09:15 DS0000020082.V378086.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.2 Page 2 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 Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond Residential Care Home Address Recreation Road Shirebrook Mansfield Nottinghamshire NG20 8QE 01623 748474 F/P 01623 748474 richmond.house2@tesco.net 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) Richmond Residential Care Limited vacancy Care Home 36 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36) of places Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who may be accommodated is 36 2nd September 2008 2. Date of last inspection Brief Description of the Service: Richmond Care Home is in the village of Shirebrook, near to local shops, facilities and public transport. The home is in an older building that has a long history of care provision. There is an ongoing building programme to improve and extend the facilities at the home. There is an accessible courtyard garden. The home provides personal care for up to 36 older people, including people who have dementia. The fees at the home range from £365 to £400 per week. The fees do not include hairdressing, chiropody and personal toiletries. This information was supplied by the provider at the inspection visit on 13/10/2009. Information about the home, including inspection reports, is available in the entrance area of the home or from the acting manager. Richmond Residential Care Home DS0000020082.V378086.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 star. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place on 13th and 14th October 2009, over a total of 10 hours. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 8 completed responses. We sent out 10 surveys to the relatives or representatives of people living in the home and received 2 completed responses. We sent out 10 surveys to staff employed at the home and received 8 completed responses. There were 26 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The acting manager and the provider were available and helpful during the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 3 people were selected and the Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.2 Page 6 quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. What the service does well: People told us their needs were met at the home and they had the care and support they required. They said “they look after me well”. People told us “staff are very much like family”, “staff are very kind”, and “staff talk to me properly”. We observed a good rapport between people in the home and staff with spontaneous affection shown. 14 out of 17 care staff, (approximately 80 ), had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard required of 50 of care staff with the qualification. What has improved since the last inspection? What they could do better: Amend the Statement of Purpose to include correct information about the range of needs the home can cater for, and also to include the contact details for CQC. Also, provide each person with an individual contract that includes information about fees charged at the home. This will ensure that people have correct and up to date information about the home to help them to make a choice about living there. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. Include sufficient details in care plans of medicines prescribed ‘as required’ to ensure that staff are fully aware when and why the medicine should be given, and any alternatives to offer first. This will ensure that people are protected and have their medication as prescribed. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.2 Page 7 The environment of the home should consider the needs of people with dementia, in line with current research and good practice. The quality assurance system should be developed to include a wider range of surveys and an annual report with analysis of survey results and details of action taken to meet any issues raised. This will ensure that people know their views and ideas are taken into account in the running of the home. 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. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 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 Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People did not have full and correct information about the home to help them make a decision about living there. People’s needs appeared generally well met at the home, although care documentation was not always available to support this. EVIDENCE: The annual quality assurance assessment (AQAA) completed by the acting manager told us they provided a range of information to people who were interested in coming to live in the home. They encouraged the person, and / or their relatives, to visit prior to admission, and the person was admitted on a trial basis. They planned to improve by developing an information pack to send out to prospective residents and their families, and by developing a web site Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 10 for the home. The AQAA gave us statistical information about people living in the home. In January 2009 the registration of the home was changed to increase the number of people accommodated from 25 to 36. The Statement of Purpose was updated to take account of this; however, there was incorrect information about the range of needs that could be met at the home. The Statement of Purpose and Service User Guide were available in other formats if required, such as large print or Braille. The Service User Guide had been reviewed and updated and was available to all people in the home and their representatives. We found that people had a copy of the terms and conditions of living in the home, (a contract), but this did not specify the room the person was to occupy, and did not include the required information about the fees payable. People told us they had received enough information about the home. They said their needs, or those of their relative, were met at the home. They said “they look after me well”. We looked at the care records for 3 people in the home. 1 had a pre-admission assessment carried out by the home, though this was not dated or signed, and an assessment of their needs by social services. 1 person was admitted as an emergency and so did not have a pre-admission assessment, but did have an assessment on admission and an assessment of their needs by social services. For the third person, the assessments by the home and social services could not be found. The assessment of people in the home did not include consideration of their capacity to make decisions about their lives, care and treatment. Staff had not received training about the Mental Capacity Act 2005 and the implications of this for people living in the home. Standard 6 did not apply to this service as there were no people receiving intermediate care. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was generally a person centred approach to care so that people were provided with care and support that met their needs in the way they expected and preferred. EVIDENCE: The AQAA completed by the acting manager told us they produced comprehensive person centred care plans and risk assessments using a computer package. They said that care plans were created with the involvement of the person and their families and that people were consulted about their choices in everyday lives and routines. They planned to improve by having additional care and support staff at busy times of the day. Also, by continuing to develop menus to generally improve the diet intake of people in the home. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 12 We looked at the care plans of 3 people in the home. Each person had a comprehensive care plan with details of their personal preferences in daily activities and routines. The care plans had good details of the action required by staff to meet the person’s needs. Although people told us they were aware of their care plans, or those of their relative, care plans were not signed to show their involvement and agreement. The care plans were reviewed and updated monthly using the computer system. The care plans included reminders to staff about maintaining the person’s privacy and dignity. The person’s preferred name was noted. We observed a good rapport between people in the home and staff with spontaneous affection shown. Most people told us that staff always listened to them and acted on what they said. People said “staff are very much like family”, “staff are very kind”, and “staff talk to me properly”. The care plans included relevant risk assessments with details of the action to be taken to minimise the risk. The risk assessments were reviewed and updated monthly alongside the care plans. The daily records had been changed from the traditional style of staff writing at the end of each shift about any changes or concerns in the person’s condition and needs, to a pre-printed evaluation form. This form had a list of prompts for staff about aspects of the person’s daily life, such as their mood / demeanour, and diet, with tick boxes to indicate if this was normal for that person or different from normal. The forms were the same for each person in the home and did not relate to their individual care plans. There was space for staff to write any comments about concerns or changes in the person’s needs or general condition. We found that concerns noted were not always commented on by the next staff shift and so it was not clear from the daily record forms what action had been taken. We saw separate records of the input of the GP, District Nurse and other healthcare professionals. We found that people were promptly referred to the GP and there were sufficient details of treatment prescribed or action taken. People told us they always had the medical care and support they needed. Each person had a spiral bound file with all their basic details in case they had to be admitted to hospital. The file could then be taken with them to ensure hospital staff had all the correct information about the person’s needs, medication, next of kin, and so on. Some documents in the care records were kept ‘loose leaf’ in a wallet style file with labelled sections. This did not ensure a well organised system as, inevitably, documents were often in the wrong sections of the file. Medication was securely stored and was administered by senior care assistants who had received appropriate training. We saw satisfactory records of the Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 13 receipt, administration and disposal of medicines. We found that where medicines were prescribed to be given ‘as required’ the care plans did not have sufficient information about why and when the medicine should be given, and if any alternatives should be offered first. We found that there was no date of opening noted on a container of eye drops, (to ensure they were used within 28 days of opening as directed). Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the 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 were offered a range of activities, a varied and well balanced menu, and flexible routines so that the lifestyle in the home met their needs and expectations. EVIDENCE: The AQAA gave us details of the range of activities offered, including a weekly church service, trips out, gentle exercise, games, arts and crafts. The AQAA said the menus had recently been reviewed in consultation with people in the home and in line with current good practice guidance to give better balanced choices. New items had been included to give people the opportunity to try different meals. The home planned to improve by encouraging people to take part in more activities and further improvements to the menus. The care records we looked at included records of activities, such as the weekly church service, a regular gentle exercise session run by a volunteer, games, and trips to local shops. Individual preferences regarding daily routines Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 15 and activities were included in care plans. Activities were organised by the care assistants as there was no activities coordinator employed at the home. Most people told us there were usually activities at the home that they could take part in. We observed people watching television, chatting with staff, and playing games during the inspection visit. People told us they could get up and go to bed when they wanted to and could follow their preferred routines during the day. We observed that people moved freely around the ground floor of the home. There were several different lounges to provide quieter or more active atmospheres. People were encouraged to bring in their own possessions to personalise their bedrooms. People could have a key for their bedroom door, though the acting manager said that few people chose to do this. Visitors told us that they could visit at any reasonable time and were always made welcome. Most people told us they usually enjoyed the meals provided at the home. One person commented “wonderful catering”. The menus were varied and included choices at each meal. We observed that people were offered hot and cold drinks and snacks during the day. At lunchtime, we observed that people were asked for their choice of meal when seated at the tables, and were served portions according to their preferences and needs. The dining room was bright and welcoming. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were appropriate systems in place and good staff awareness so that people were protected and their complaints were generally effectively dealt with. EVIDENCE: The AQAA told us that the complaints procedure was displayed in the home and that each person had a copy in their bedroom. People who attended residents and relatives meetings in the home were asked if they had any complaints and also asked if they understood the complaints procedure. The AQAA showed that there were policies in place regarding complaints and safeguarding vulnerable adults, and that these policies had been reviewed in 2009. The AQAA showed that no complaints had been received by the home and no safeguarding referrals made in the previous 12 months. We had not received any complaints about the home and were not aware of any referrals regarding safeguarding vulnerable adults. People told us that they knew how to make a complaint. They said they would go to the staff with any concerns and were confident that appropriate action would be taken. Relatives spoken with said they preferred to go directly to the Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 17 acting manager or senior staff to sort things out, rather than make a formal written complaint. We saw that a complaints book was kept in the main entrance area for people to write in if they wished, although there were no entries since before the previous inspection. The acting manager said there were no recorded complaints because no formal complaints had been made. We found that a less formal complaint had been made recently and although the acting manager was able to give a verbal update on the action taken, there was no written record of this or of the outcome. There was a compliments book kept in the main entrance area with many cards and positive comments. We found that the safeguarding vulnerable adults policy in place had not been updated to refer to CQC. There was no copy available of the local authority multi-agency guidance for safeguarding vulnerable adults and the home’s policy did not refer to this. Staff training records showed that all staff had received training about safeguarding vulnerable adults. Staff were aware of what might constitute abuse and the correct procedures to follow if abuse was alleged or suspected. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the 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 was clean, well maintained and suitably equipped so that people lived in a safe, pleasant environment. EVIDENCE: The AQAA gave details of the many internal and external improvements made to the home in the previous 12 months, and their plans for further improvements in the next 12 months. The home had been extended to provide 11 new bedrooms. The AQAA said that people in the home, relatives and visitors made positive comments about the environment of the home. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 19 People told us they were satisfied with their bedrooms and they liked the communal areas. People in the newest lounge said they liked it as it was bright and comfortable. There were several lounges of different sizes so that people had a choice of areas to use. The lounges were comfortably furnished. The bedrooms seen were well personalised with people’s own belongings. There was a large courtyard garden that could be accessed from the main lounge or from the dining room. People told us they enjoyed using the courtyard and eating meals outside in good weather. Some consideration had been made for the needs of people with dementia in the design and layout of the home, such as providing several small lounges, and having an accessible outdoor area where people could walk safely. There were no suitable signs on toilets and bathrooms. The acting manager said these had been provided, but had been removed from the doors by people in the home. The laundry was small with 1 washing machine and 1 dryer, both suitable for use in a care home. Clothes had been left to soak in a plastic container in the laundry. This was not good practice in line with current infection control guidance from the Department of Health. There was an area next to the laundry used for ironing. This area was dimly lit. The provider told us there were plans to extend and improve the laundry. People told us that the home was always fresh and clean. One person said there was “excellent cleanliness – housekeeping”. We found the home was mostly clean and free from offensive odours, except for one bedroom. Most of the staff had received training about infection control. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory recruitment procedures, staff training and staffing levels so that people were protected and their needs were met by competent staff. EVIDENCE: The AQAA told us they have a pro-active approach to staffing the home, recruiting new staff ready for the planned increase in places in the home, and providing more staff when required to meet specific needs. They had improved by promoting a senior care assistant to be a second assistant manager and by increasing the training provided for all staff. They planned to improve by further developing the staff training programme, and by employing additional ancillary staff. The AQAA showed that staff turnover in the home was very low with no use of agency or temporary staff. The staff rotas we saw showed that there were usually 4 care assistants on the morning and afternoon shifts and 3 at night. We found that most shifts had been fully staffed in the previous 2 months. People told us there were usually staff available when needed. Staff told us that staffing levels were usually sufficient to meet people’s needs. They said staffing could be improved by Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 21 having a laundry assistant and an activities coordinator. They said they were usually busy and would like more time to sit and talk with people. We looked at the records of 3 members of staff. Each had the required documents in place, such as a Criminal Records Bureau (CRB) disclosure and 2 written references. 2 did not have a full employment history and there was no written explanation of the gaps. New staff had an induction programme that met Skills For Care standards. Training records showed that staff were up to date with required training, such as manual handling, fire safety, and safeguarding vulnerable adults. Most staff had received training about caring for people with dementia. Staff had not received training about the Mental Capacity Act 2005. 14 out of 17 care staff, (approximately 80 ), had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard required of 50 of care staff with the qualification. People told us that the staff listened to them and acted on what they said. They said “all staff are wonderful”, and, “staff are very kind”. Staff told us they had relevant and useful training to help them to understand and meet people’s needs. They said the staff “work well together as a team”, “staff are always on some type of course to benefit both the service users and ourselves”, and “Richmond is a lovely place to work”. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the 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 was well managed so that people received a consistent service that met their needs. EVIDENCE: The AQAA told us the ethos in the home was of openness and transparency so that people in the home, their relatives, visitors and staff able to speak freely to any of the management team. They had improved in the last 12 months by updating and streamlining systems and procedures. They planned to improve by more staff training, developing the web site, and producing a newsletter. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 23 The acting manager had been in post since August 2008. She was suitably qualified and experienced to manage the home. She had started the application process for registration with CQC. People told us they liked the acting manager and they were confident she would take appropriate action about any concerns raised. Staff told us “we have a very approachable manager”, and, “any problems, I know I get full support from the manager”. The acting manager was supported by 2 assistant managers. The providers also took an active part in running the home and supporting the acting manager. The acting manager did not have specific help with administration tasks. The acting manager had completed the AQAA. The AQAA contained clear, relevant information supported by a range of evidence. They gave details of changes and improvements made, and of how they planned to make further improvements. The data section was fully completed. The acting manager had sent notifications to CQC of deaths and other events as required and kept copies of all notifications sent. We found one incident had not been notified to us when the police were called to an intruder on the home’s premises. The quality assurance system included annual surveys sent to the relatives or representatives of people in the home. Surveys were not given to people in the home or to staff or to others involved in their care, such as care managers or District Nurses. There was no report produced of the results of surveys or of the action taken to meet any issues raised. There were regular meetings for people in the home and their relatives, usually held monthly though the last one was in June 2009. The provider kept notes of the meetings in a diary, but the notes were not made available to people in the home / their representatives. People were able to express their views at the meetings and make suggestions for improvements. They were also asked if they had any concerns or complaints. The provider produced a report each month of a visit to the home, as required by regulation 26. The reports were up to date and showed that the provider had spoken with people in the home and staff to find out if they were satisfied with the care and service provided. The AQAA said that changes had been made as a result of listening to people’s views and ideas. These included changes to the menus, the introduction of gentle chair-based exercises, and the provision of large, wide screen televisions. We looked at the system for managing the personal money of people in the home. There were details of the systems in place in the Statement of Purpose and Service User Guide. The money was securely kept and there were satisfactory records with receipts for all transactions. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 24 The AQAA showed that the maintenance of systems and equipment was up to date. Although the AQAA said that written assessments on hazardous substances were in place, the acting manager said these were not yet available as she was waiting for information from their supplier of cleaning products. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 25 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 2 2 2 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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5(1) Requirement Each person in the home must have an individual written contract/ statement of terms and conditions that includes: • the total fee payable to the home • the arrangements for paying the fee • the arrangements for charging and paying for any services additional to those included in the fees. This will ensure that people have full and correct information about living in the home. There must be records of all complaints made about the home, including the action taken and the outcome. This will ensure that people are confident their concerns will be taken seriously and appropriate action taken. The previous timescale was 30/09/2008. This requirement has not been fully met. A time extension has been given. If this Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 27 Timescale for action 30/11/09 2 OP16 17(2) 30/11/09 3 OP18 37 extended timescale is not met, enforcement action will be taken. Notifications of all events as 30/11/09 specified in the regulations must be made to CQC. This will help to ensure that people are protected. The previous timescale was 30/09/2008. This requirement has not been fully met. A time extension has been given. If this extended timescale is not met, enforcement action will be taken 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 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should be amended to include correct information about the range of needs the home can provide for. This will ensure people have the right information when making a decision about living in the home. To ensure a robust system that protects people and ensures they have their medication as prescribed: • where medication is prescribed ‘as required’ there should be details in the person’s care plan of when and why the medication should be given, and of any alternatives to offer first • where there are handwritten instructions on medication administration records, there should be two signatures of staff who have checked the entry is correct • the date of opening of eye-drops should be noted to ensure they are disposed of after 28 days as instructed. An activities coordinator should be employed to further develop the range of activities provided and ensure that people are offered activities that meet their needs and DS0000020082.V378086.R01.S.doc Version 5.3 Page 28 2 OP9 3 OP12 Richmond Residential Care Home 4 OP16 5 OP18 6 7 OP19 OP27 8 OP29 9 OP33 10 OP33 11 OP38 preferences. The complaints book should not be left in the main entrance area as this may not encourage people to express their concerns and complaints. People may be reluctant to write about a complaint when they know that anyone can view the book. There should be a copy in the home of the local authority multi-agency policies and guidance about safeguarding vulnerable adults, and staff should be familiar with this. This will help to ensure a robust system that protects people in the home. The environment of the home should take into account the needs of people with dementia, in line with current research and good practice. The staff complement should include a laundry assistant so that care staff have more time to spend with people in the home, and an administrative assistant to ensure the manager’s time is used effectively and to improve organisation of records. There should be a written explanation of any gaps in the employment history of applicants for jobs at the home. This will ensure a more robust recruitment procedure and help to protect people. The quality assurance system should be developed to include a wider range of surveys and an annual report with analysis of survey results and details of action taken to meet any issues raised. This will ensure that people know their views and ideas are taken into account in the running of the home. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. There should be written assessments in place of all substances in use in the home that are hazardous to health. This will help to protect people in the home. Richmond Residential Care Home DS0000020082.V378086.R01.S.doc Version 5.3 Page 29 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@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. 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