Service address: Richmond House, Richmond Road, Farsley, Leeds, LS28 5STService Provider: Leeds City CouncilDate and time: Monday 13th October 2014, 11am to 1pmAuthorised representatives: Stuart Morrison, Sally Morgan, Pat Newdall

Care Homes - Richmond House Care Home

Enter & View Report

Acknowledgements Healthwatch Leeds would like to thank the residents, relatives, carers and staff at Richmond House who gave us a warm welcome and spent time talking to us about their experiences of living at the centre or having relatives/friends staying at the centre.

Thank you also to the manager of the home for helping us to arrange the visit, showing us around on the day and providing relevant information about the centre that had been requested by Healthwatch Leeds.

Table of Contents

Page

1: Contents

2-3: What is Enter & View? / Introduction & background

4: Purpose of visit

4-5: Method

5: Summary of findings

5-8: Results of visit

9: Recommendations

9: Service provider response

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What is Enter and View?Part of the Healthwatch Leeds work programme is to carry out Enter and View visits. Local Healthwatch representatives carry out these visits to health and social care services to find out how they are being run and make recommendations where there are areas for improvement. The Health and Social Care Act allows local Healthwatch authorised representatives to observe service delivery and talk to service users, their families and carers on premises such as hospitals, residential homes, GP practices, dental surgeries, optometrists and pharmacies. Enter and View visits can happen if people tell us there is a problem with a service but, equally, they can occur when services have a good reputation – so we can learn about and share examples of what they do well from the perspective of people who use the service first hand.

Healthwatch Enter and Views are not intended to specifically identify safeguarding issues. However, if safeguarding concerns arise during a visit, they are reported in accordance with Healthwatch safeguarding policies. If at any time authorised representatives observe anything that they feel uncomfortable about, they need to inform their lead who will then in turn inform the service manager, ending the visit. In addition, if any member of staff wishes to raise a safeguarding issue about their employer they will be directed to the Care Quality Commission where they are protected by legislation if they raise a concern.

Introduction and BackgroundHealthwatch Leeds made a decision to undertake a programme of enter and view visits, to care homes in Leeds, during October and November in order to get the views of residents and relatives about the care that they receive.

These visits will be the first part of Healthwatch Leeds enter and view programme and aim to address some of the issues identified in the NICE quality standard 50 https://www.nice.org.uk/guidance/QS50/chapter/introduction

There were two pilot visits that took place in September and following these, it was

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agreed to carry out a further 10 visits to care homes across the city. The care homes to be visited were selected based upon a number of factors which included:

• Having a good geographical spread across the city• Looking at any information already held by Healthwatch Leeds, raising concerns about specific care homes• Ensuring visits did not conflict with other visits such as already planned CQC inspections and visits by the local authority• Considering any information already contained in CQC reports

Following each visit a report will be produced and this will form part of the final report of the full programme of visits.

Richmond House is a 20 bed community rehabilitation and respite centre in Farsley. There are 17 short term (usually 6 weeks) rehabilitation beds and 3 respite beds. Residents at Richmond House need to be referred by a Social Worker.The centre is purpose built and covers two floors, which includes a dining area, conservatory, lounge area as well as numerous equipped bathrooms.All bedrooms are single occupancy and the upstairs bedrooms are en-suite.

At the time of our visit 15 beds were occupied although 3 admissions arrived/were expected on the day of our visit.

Leeds City Council own the centre and the NHS pay for the beds. The Local Authority cater for social and personal care whilst NHS staff provide the rehabilitation service.The home employs a total of 28 staff in addition to NHS Nursing staff that are based upstairs.

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Purpose of the visit • To find out what daily life is like for the residents at the centre. • Observe the day to day functioning of the centre.• To engage with residents and relatives and carers to get views about:

• Day to day care and staff attitudes• Food and catering• Access to activities for residents at the centre and in the community

• Identify examples of good working practice.• Highlight any issues or concerns that were raised• Capture the experience of residents and relatives and highlight any ideas they

may have for change.

Method of the visitThis was an announced Enter and View visit.

The visit was undertaken by a team of three authorised Enter and View representatives, including one Healthwatch staff member and two volunteers and lasted approximately 2 hours.

Before the visit the centre was sent a visit plan sheet outlining the purpose of the visit, who would be attending and requesting further information. A poster giving details of the visit and Healthwatch contact information was also sent for the centre to display prior to the visit.

The visit was informal and involved a combination of observation and talking to residents, carers and relatives to gather information and views, with questions around care and help, food and activities. During the course of the visit the team spoke to 12 residents and 2 relatives/carers and logged all findings on the questionnaire sheets.A large proportion of the visit was observational, involving the authorised representatives walking around the public/communal areas and observing the surroundings to gain an understanding of how the home works and get a feel of the general environment. Observation sheets were used to record this information.The Enter and View team also spoke at length with the Manager, who provided detailed 4

information about the centre, the activities and menus, as requested, and answered any queries that were raised. Further information was also given out about Healthwatch Leeds to residents and carers and relatives and the home was given leaflets about Healthwatch Leeds to display in the entrance.

Summary of findingsAt the time of our visit, the evidence is that the centre was operating to a very good standard of care with regard to daily life and care of residents

• The residents we spoke with appeared content and happy and we saw no evidence of lack of care.

• We saw evidence of staff interacting with residents in a positive, kind and caring manner.

• Residents told us that they were happy with the food.• We saw evidence that the residents had access to some activities in the home,

one of which was taking place on the day.• The residents and relatives that we spoke with appeared on the whole to be

content with the range of activities on offer.

Our visit identified no material issues nor any points that could be classified as a cause for concern. The points arising from the visit as reported below are cited, as a general overview of the findings on the day of the visit.

Results of VisitAccommodation and Environment Richmond House has two main communal areas, a lounge with a television and a conservatory with a music system. There is also a good sized dining area adjoining the lounge.

The accommodation and environment in these areas was of a good standard. They were clean, warm and had welcoming décor. The conservatory and dining areas in particular had lots of natural light.

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The bathrooms and bedrooms were also clean, tidy, well-maintained and fully equipped. There were no unpleasant odours in any areas of the centre that we visited.The furniture appeared well maintained and we witnessed a thorough cleaning of chairs etc in the lounge during lunch time.The seating in the lounge is arranged in one long line facing the television and another set of seats along the same side as the television. This is due to the size of the lounge and also for access arrangements for the residents as due to the nature of the residents a high number will require frames or wheelchair access during their stay.

ActivitiesThere are activities every day apart from weekends. These activities are led by staff members (there is no specific events co-ordinator employed) and feedback from residents was that the activities were enjoyable. On the day of our visit we observed a lively game of dominos in the Dining Area and spoke with those playing who were very enthusiastic about the game and the centre in general.

Activities such as the gentle exercise group are carried out with the Occupational Therapists as part of the rehabilitation of residents.

There is a large screen television in the lounge area. On our visit sub-titles weren’t being used but we were assured that for the majority of time they are. There is a loop system in place, however, we are not sure if the residents are aware of this facility.There was a large choice of reading material and music in the lounge area and flat screen televisions were present in bedrooms. The centre also provides a regular haircut and nail service for residents.

There is an outside courtyard area that can be used and residents can be taken out of the centre with relatives.

Healthwatch suggestions: 1. The television in the lounge area is in a position that is out of sight of some residents due to the way the seating is arranged. Is there a possibility of another television in the lounge area?

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2. If audio books (and the loop system) are available, are residents/relatives/staff made aware? Residents with sight/hearing problems should be made aware of the alternative facilities if not already.

CateringThe menu on offer at the home provided a good range of dishes and if residents don’t like something on the menu or have special dietary requirements then the kitchen will provide for individuals. They will also cater for those that are unable to eat too much and offer items such as scrambled eggs etc.Our observation of the meal service was positive and the residents appeared to be enjoying their meals. The residents that we spoke with all said that there was a good choice of food and they can get assistance with eating if necessary. Although meal times were fixed, residents told us that there was no issue if they needed to eat later (following a hospital appointment for example).We observed that fruit was available between mealtimes and we were told that drinks are available although there was little evidence of drinks on our visit.

Care and HelpFrom our observations and speaking with residents we are pleased with the quality of care provided at Richmond House. The residents were extremely satisfied with the services provided and all those spoken with had full confidence in the staff engaged in providing their care.

Staff were kind, caring and polite and all residents and relatives that we spoke to felt very well cared for and looked after. It was pleasing to note that the centre would not accept residents after 8pm – this recognises the impact this has on residents/patients when being discharged/admitted late at night and highlights a good level of thought for the residents’ well-being.Residents were assessed quickly and smoothly on admission.

We observed residents being helped into the dining area, and not being rushed. Personal hygiene and privacy/dignity appeared to be met and the residents we spoke with were happy with this aspect – “having a bath in the evening is absolutely wonderful”!

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Residents personal choice is met as they told us that they were addressed how they wished and could go to bed at a time of their choosing. There are good accident/incident recording procedures and follow-ups.From our observations we also felt that the centre’s Multi-Disciplinary Team worked well together.

Healthwatch suggestions:1. The visit team noted that there was only one type of chair available in the cummunal

areas, despite the range of mobility requirements. The home has responded to this concern later in the report.

2. More hand gels or reminders for people to use them. We didn’t witness residents/staff using hand gels before lunch.

Staff attitudesThe attitude of staff at the home was praised by everyone that we spoke to on the day. Staff (from cleaners to the Manager) were observed to be kind, considerate and caring and took time out to talk to residents.

Residents spoke highly of staff and we observed the interaction between staff and residents during the domino’s activity and there was lots of laughter. The staff seemed happy in their work and this was reflected in their behaviour towards residents.

Carers and RelativesThe relatives that we spoke with were appreciative of the care received by their relative. It was their first experience of coming into this environment and they were not sure what to expect but are happy with the way things are going.They did raise a concern about not being notified that there was a recent infectious incident at the centre (which Healthwatch was notified of at the beginning of our visit). The Manager told Healthwatch that it wouldn’t be possible to contact all relatives when an infectious incident occurs and that a sign was put on the entrance door during the duration of the outbreak to inform visitors.

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Healthwatch suggestions:1. That a primary contact is identified when a resident is registered and informed by

phone/email when there is an infectious incident.

RecommendationsThis report highlights the good practice that we observed and reflects the appreciation that residents and relatives felt about the care and support provided. Based upon the key findings we do not have any major recommendations to make to the centre as it was operating in a professional and caring manner. We have made a number of suggestions and have given the centre the right to respond to these.

Service Provider responseSuggestions to Activities1. Additional television in the lounge area – due to the layout of the building we have

identified that an additional television is not possible. The area is small and if two televisions are present and on different channels then it would become noisy and confusing.

2. Signs have been placed informing of the loop system for clients and visitors. Manager to source information on availability of audio books.

Suggestions to Care and help1. Research has shown that a sofa is not suitable for rehabilitation due to restrictions to

getting up with no arms to assist. Rising chairs are not used for individual clients due to rehabilitation purposes if a client does not have a rising chair at home then this can have an impact on the physiotherapy work carried out at Richmond House.

2. There are hand gel dispensers situated throughout the home. One in the main entrance, one on reception and one outside the main lift with notices. All staff carry personal hand gel and use discreetly and accordingly.

Suggestions Carers and Relatives1. The Manager has added to the infection control procedure to contact clients Next Of

Kin of any identified outbreak.

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Healthwatch Leeds,Ground Floor, Unit 8 Gemini Park Sheepscar Way,Leeds LS7 3JBTelephone: 0113 898 0035Textphone: 0113 237 4512Email: info@healthwatchleeds.co.uk www.healthwatchleeds.co.uk