Inspection on 15/05/06 for Birch Court Nursing & Residential Home

This inspection was carried out on 15th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Birch Court Nursing &... 06/06/07

Birch Court Nursing &... 19/12/05

Birch Court Nursing &... 25/05/05

Birch Court Nursing &... 14/12/04

Birch Court Nursing &... 22/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Riverbank Nursing Home Egerton Street Howley Warrington Cheshire WA1 2DF Lead Inspector Anthony Cliffe Key Unannounced Inspection 15th May 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Riverbank Nursing Home Address Egerton Street Howley Warrington Cheshire WA1 2DF 01925 573772 01925 240158 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Care Home 150 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (90), Physical disability (2), Terminally ill (3), Terminally ill over 65 years of age (3) Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users must not exceed 150 to include:* Up to 90 service users in the category OP (Old age, not falling within any other category) (Firth, Church and Bridge House) * Up to 2 service users in the category PD (Physical disability) in receipt of nursing care may be accommodated in Bridge House * Up to 30 service users in the category DE(E) (Dementia over the age of 65 years) in receipt of nursing care may be accommodated in Victoria House * Up to 30 service users in the category DE(E) (Dementia over the age of 65 years) in receipt of personal care may be accommodated in Beech House * One named service user under the age of 65 years may be accommodated in Bridge House until 24th October 2011 * One named service user under the age of 65 years accommodated in Victoria House until 23rd September 2008 Date of last inspection 19th December 2005 Brief Description of the Service: Riverbank provides nursing and personal care for a maximum of 150 residents across five units. These units are run and managed as separate houses each with their own staff team and unit manager, with a service manager overseeing the whole site. Personal care is provided for up to 30 older people with dementia in Beech House. Nursing care for up to 30 older people with dementia is provided in Victoria House. Nursing care for up to 30 older people is provided in each of the units Church, Firth and Bridge House. A main building houses central administration, kitchen, laundry and staff facilities. The home was opened in 1989 and is located in the Howley area of Warrington, close to shops, pubs, restaurants and a church and within easy reach of other town centre amenities. All bedrooms are single and are on the ground floor. There are no en-suite facilities. The home has extensive gardens that are well maintained and are accessible for service users. There is a range of fees for residents £433 a week is charged for personal care and £590 for nursing care. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Four regulatory inspectors and a pharmacy inspector undertook this unannounced site visit. The Key inspection was triggered by two adult protection referrals, which were referred under the local authority adult protection procedures. The Commission for Social Care Inspection (CSCI) met with representatives of BUPA Care Homes Limited in March 2006 where the company made a commitment to work on an improvement agenda at Riverbank. The site visit took place over 9 hours. Feedback was given to the manager. Records were inspected and staff practice was observed. Discussion took place with residents, visitors and staff. A tour of the premises was undertaken. Information was collected from a pre inspection questionnaire and people who returned questionnaires sent out by the CSCI. One requirement remained outstanding from the last site visit on 19th December 2005. There are still improvements to be made on Victoria House One resident questionnaire was returned as part of the data collection for the key inspection. The resident commented that the choice of food is limited and had not been asked about food preferences. Staff on the whole were helpful and satisfactory standards of care received but improvements in listening and acting upon concerns could be made. Staff response times to calls for assistance could be improved as staff informed the resident they were busy, but provided the help needed. The resident said that he did not join in all activities as ‘they were for women’. Four Relatives/Visitors cards were returned. These recorded that there was an overall satisfaction with the standards of care; sufficient staff were on duty and they knew how to make a complaint. One questionnaire recorded ‘ although private visits can be arranged in private bedrooms it would be nice if there was a special visitors room should the need arise’. What the service does well: Riverbank provides a range of services for residents with differing needs. Prospective residents have a full assessment prior to admission and written information is provided for them. Care plans are well documented on the units. Social activities are provided for residents and an improved social activities programme has been developed and implemented since the last visit. Residents’ monies are stored securely and where appointeeship is in place residents monies are appropriately managed. Riverbank provides a generally good environment with all residents having single, ground floor bedrooms. All were cleaned to a good standard. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 6 The health and safety of staff and residents is provided for. What has improved since the last inspection? What they could do better: Ensure policies and procedures for managing medicines are adhered to so instances of bad practice are eliminated that place residents’ at risk of not receiving their medicines safely. Improve the maintenance and security of the building so residents’ safety is not placed at risk. Ensure residents’ care plans include consistent information obtained about them and they reflect residents’ needs. Provide the activity co-ordinators with training on communicating with residents, managing challenging behaviour the promotion of equality and diversity when considering suitable activities for residents and ensure they promote the activities programme developed at Riverbank so residents can participate in them. Ensure meal choices are offered to residents in a format that they can understand and menus include the choices of pureed meals. Ensure the complaints procedure is displayed prominently in all areas of Riverbank. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 7 Improve the maintenance and décor on Bridge, Church and Victoria Hose. Improve the numbers of staff with an NVQ level 2 and update the training matrix to accurately reflect current staff training and qualifications. Confirm that actions identified as a result of quality assurance audits are completed. Supernumerary hours for house managers should be increased so they can contribute towards the quality assurance system at Riverbank. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 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 Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives. Residents’ needs are assessed prior to moving in but records need to consistently record information obtained about them. EVIDENCE: Several residents who had recently moved into Riverbank were case tracked. Resident’ case tracked had either a pre admission assessment by staff from Riverbank or a full needs assessment carried out by social worker prior to moving in. One resident had been visited in hospital by the manager of the house in which she was accommodated and the manager had also contacted the care home where the lady had lived previously for further information. Some inconsistencies in record keeping were noted. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 10 On Beech House two residents did not have a photograph on their personal records. On Victoria House the medical details of a resident were recorded on a continence assessment but not on the pre admission assessment. Information about the resident’s life history had been provided by a family member on moving into Riverbank but not recorded in a life biography or a pen picture of the resident. See recommendation 1. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is assessed as poor. This judgement has been made using available evidence including a visit to the service. Care plans do not always address residents’ needs. Medicine management and administration is unsafe and residents are at risk of not receiving their prescribed medicines. Residents are treated with dignity and respect. EVIDENCE: Several care plans showed that a wide range of assessment documents were completed; with a care plan to address residents’ needs. From looking at care plans, observing staff working practices and talking with residents, staff and visitors the health needs of residents were generally met. There were several examples of good practice regarding the care of residents and recording of personal, social and health care. On Firth House a resident case tracked had a pre-admission assessment by a social worker. The house manager had visited her in hospital and also contacted the care home where the lady had lived previously for further information. On Bridge House three places used to accommodate terminally ill residents had a high level of support provided by a local hospice and the Primary Care Trust (PCT) ‘end of life’ service. On Church House staff were looking forward to the delivery of a second standaid hoist. At present residents have to wait to use the stand-aid and a second will provide the necessary equipment for staff to assist residents. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 12 A care plan had been completed within the first few days of admission had been reviewed in April and in May. All of the assessments had been completed to a good standard. A bedrail risk assessment had been signed by a relative. There was evidence of a visit by his General Practitioner to review medicines. Blood pressure and weight had been recorded monthly. The care plan was very well presented and easy to follow and all sections were up to date. A resident was identified as having difficulty in sleeping in bed and could present a risk to himself and others. Staff had managed to get him to sleep in bed and had arranged a review of his care as his future accommodation needs, needed to be confirmed as the manager identified this as a contributory factor to the resident being unsettled at night. Some information in residents’ care plans was inconsistent. A resident’s care plan on Victoria House did not adequately address his needs. The plan did not give adequate information regarding managing his aggressive and challenging behaviour. Staff were instructed to ‘learn his non-verbal ways of expressing himself’. An accident report detailed an aggressive incident in January, however the care plan review stated that no aggressive incidents had taken place. Appropriate details regarding use of pressure pads to monitor the resident getting up at night were recorded. A resident’s care plan did not reflect management problems due to anxiety and pain that were affecting his well being. A resident who was a diet-controlled diabetic had her blood sugar tested on 10th May and was 11.1 mmol/l. Her care plan prescribes monthly blood sugar testing, which is the usual practice for residents who are dietcontrolled diabetic, however it would be good practice to review a newly admitted resident’s blood sugar more often, particularly when, as with this resident, the reading was rather high. A married couple were accommodated and provided with a bedroom to share and bedroom for a sitting room. The records for one of the residents were informative about how the resident’s care needs were to be supported. The key worker diary in place provided evidence of bathing, hair washing and a visit by chiropodist. The care files contained full details of all past medical and mental health history. There was a well considered care plan regarding managing anxiety. The individual care plans were very well written and organised. Eating and drinking preferences were recorded; there was a nutritional assessment and weights recorded. There was a pressure ulcer assessment completed, and risk assessments about mobility, safer handling and falls. Information on washing and personal hygiene needs was fully written. Records of doctor’s visits were informative; District nursing notes were in place to inform staff about residents’ needs. Riverbank has written policies and procedures for managing medicines. Some units carry out these procedures and manage their medicines to a reasonable standard. However the visit also showed many instances of bad practice that are of serious concern. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 13 There is a system to keep the legally required records of medicines arriving into Riverbank, given to or refused by residents and medicines discarded as waste. Most of the records are made on printed sheets provided by the supplying pharmacy. Throughout Riverbank some records were made to a good standard but there were some that were not satisfactory. These included not recording the dose given, where the doctor had prescribed a medicine in a variable dose according to the residents’ needs. There were a few unexplained gaps in the records of receiving and giving medicines and records of the use of creams were ticked rather than initialling the box provided. Medicines are taken to the residents in a trolley at prearranged times during the day. On Church House the nurse left the trolley open and unattended whilst she took medicines to residents having breakfast at the other side of the dining room so residents could have had unsupervised access to it. Some residents had gone to see the hairdresser before having their medicines. These had been put into medicine pots labelled with bits of paper awaiting their return. This practice is unacceptable. On Firth House it was not clear if some residents had been given their antibiotics properly as the records showed more doses given than were supplied. All five units have dedicated rooms for medicine storage with cupboards and trolleys, separate refrigerators, facilities for controlled drugs and oxygen. The residents’ medicines were on the whole stored tidily so that they were easy to find. On Church and Firth House there were two bottles of testing sticks for blood and urine that had date expired some months ago. These, if used, may give false readings. On Firth House a member of care staff asked for the keys to the pad store that were on the same bunch as the medicine keys. It was clear that there was a practice of sharing the keys for such things and that the drug keys were sometimes handed to staff who would not be allowed access to the medicines. On Victoria House there was a bottle of medicine in the trolley that should be refrigerated. On further examination there were no records of the resident having any since it was supplied yet the bottle was only half-full, a discrepancy of approximately thirty medicine spoonfuls. Other medicines were then counted and checked. There were fewer tablets available than would be expected. It was agreed that the service manager would investigate the discrepancies and inform the police. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 14 Controlled Drugs. Each house has a cupboard for storing controlled drugs that meets the Safe Storage Regulations of the Misuse of Drugs Act 1973 and a controlled drug record book to keep the required separate account of controlled drugs. On the houses where residents need controlled drugs they were managed satisfactorily. Waste medicines. Riverbank had a waste disposal contract that provides containers for unwanted medicines from the units providing nursing care. Waste medicines belonging to residents receiving personal care only are returned to the dispensing pharmacy. The Commission has been advised that where residents receiving personal care are living in a home registered to also provide nursing care their waste medicines are classed as industrial waste and require a waste disposal contractor. See requirement 1 and recommendation 1. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices in their lifestyle but choice and inclusion in social activities needs to improve so residents in Victoria House have control over their lives. Residents have a choice of meals in pleasing surroundings but how residents are supported to choose meals and the choice of pureed meals needs to improve so residents can make decisions about their preferences. EVIDENCE: Since the last site visit a detailed activities programme has been devised that covers a four-week programme and includes a core of activities and on which house the activities are taking place. Activities do not exclusively take place on one of the houses and residents are able to participate in activities taking place in other houses. At 9:45, on Church House twenty-two residents were having breakfast in the dining room. Most were seated at the dining tables and others were seated in armchairs and were being assisted by staff. On Firth House one resident is a smoker. There is no separate area for residents who smoke and during the visit the resident was smoking in the centre of the lounge. This may not be acceptable to other residents and is an issue that needs to be addressed by the provider. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 16 A small number of residents are able to join in social activities and were enjoying a game of dominoes. A member of staff was assisting one resident reading a newspaper. On Bridge House a social afternoon was taking place in the lounge. Most of the residents taking part were from Beech House; only one was from Bridge House. The activities co-ordinator on Victoria and Bridge House works 15 hours per week on each unit. She has worked at Riverbank for four years and not had any training on dealing with challenging behaviour or providing activities. She produced a weekly schedule of activities and placed this on a small notice board in the corridor. The activities board in the lounge of Victoria is a large whiteboard and displays a programme of activities, which are not undertaken and written in a language difficult for residents to understand. This whiteboard has remained unchanged whilst the activities coordinator has worked at Riverbank. The programme states passive exercise and reality orientation. The activities co-ordinator was advised to use this board to display activities for each day and use the four-week activity programme devised. The activity which took place on Victoria consisted of four female residents having a cup of tea at the table and having their nails painted. No activity was offered to the male residents. During the visit the new manager commenced a book to record individual activities to be transferred to individual files. The television and radio were both very loud on Victoria House. A male resident who walked around the unit was offered a cup of tea but not invited to join in activities. Another resident who could not communicate was cared for physically but staff did not interact with her or invite her to join in the organised activity. Staff talked about their responsibilities for promoting residents’ health and welfare. A staff member who worked with physically dependent residents said ‘ I am responsible for filling in my key worker diary, fluid balance and food waste records. We can manage people by using these as we monitor fluid out if a resident has a catheter bag. We record if a resident had a bath or uses the toilet. Even though residents are physically dependent there is a lot going on here. The activities coordinator is over there playing dominoes with four residents. Staff can join in if they are not busy. Two staff are helping the residents to play. We also sit and read newspapers with residents’. Meals on Victoria House are chosen almost a week in advance. Residents were unable to remember their choices. Likes and dislikes are recorded in a file. Food is plentiful. Breakfast was being served at the commencement of the visit. Some breakfasts had been served to people in their rooms. Tea and biscuits were served at 10.50am. Two staff members were observed assisting residents to eat and their practice was inappropriate. One staff member stood to assist a resident who was sitting and another member of staff perched on the arm of an adjacent armchair to assist another resident. This poor practice was fed back to the service manager. The choice of meals was discussed with a member of staff responsible for asking residents about meal choices. She said Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 17 that food was plentiful to accommodate last minute choices. The menu is not displayed in a central place for residents to see and be reminded of the choice of menu available. On Firth House twenty-seven residents were accommodated. Twenty-three residents have a soft diet and one resident is fed through a tube in the stomach. Fourteen residents had a pureed diet. Four of the residents’ choice of lunch had been missed of the record of choice but meals were provided. The main menu did not record what the choice of pureed meal was. The menu for the day of the site visit recorded the choice as home made soup and sandwiches, jacket potato with fillings of beans, cheese or tuna mayonnaise. The manager said the pureed choice would be ‘mashed potatoes, vegetables with fish or meat but we won’t know until it arrives’. Staff on Firth House were asked how residents choose meals. A staff member said ‘ we choose meals for residents who cannot talk. You get to know what they like. That gentleman likes curry and that lady prefers fish. Families tell us what residents like or you get to know them. The information should be in their care plan but I don’t always get the time to read them. If a resident’s family gives me information I ask the nurse to record it we only complete carer diaries so don’t always read the care plan. I can’t honestly say I know what all the residents like or dislike if I don’t read their care plans. At lunchtime we can give the soft diets what’s on the menu and the puree is what the chef sends up. We don’t know what the puree is as it’s not on the menu and can’t offer people choice’. On Beech House the staff used a ‘patients food order sheet ‘ to record residents’ choices of meals. Staff confirmed this is completed with residents. A four-week menu was available. The manager said two residents could not use words to communicate so staff chose on their behalf. The two residents are not asked about their choice of meal and the unit does not use symbols or pictures to aid residents to choose meals. The records of the two residents recorded their dietary preferences and the manager said ‘even though one of the residents cannot talk he uses facial expressions or pushes the food away to tell us what he likes. No we haven’t recorded this is how he chooses meals’. On Bridge House a menu and alternatives menu was available and residents had chosen from this. The manager confirmed that seven of the residents had a pureed diet and the choice of menu was not included on the main menu. In the afternoon on bridge House two of the activities coordinators had a sherry and tea afternoon when residents were invited from other houses. Residents were encouraged to socialise and serve themselves. The relatives of a terminally ill Resident on Bridge House was very pleased with the care he is receiving and said it ‘couldn’t be better’. She said ‘I feel supported by the staff and have a good rapport with the junior sister. I can make a drink in the kitchen on the unit and visit any time. I am kept well informed’. The husband of a long-term resident visited every day and is involved with her care. He said ‘I assist her with her meals. I choose from the menu for her each day and this is recorded in her care plan. Any small complaints I had were dealt with satisfactorily on the unit’. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 18 On Beech House relatives spoke about the standards of care. A relative said her mother is well cared for and staff members gain her co-operation. Food is of a good standard and there is always a happy and welcoming environment on the unit. The two daughters of a resident said ‘the food is good as was the entertainment on VE day. We have a good relationship with staff and staff with residents. There is good level of communication by staff to the family. The hairdresser attends weekly’. Suggestions from the daughters included the introduction of gentle chair based exercises. The manager explained that she has already made attempts to arrange this. Daughters visiting said staff are always courteous and respectful and that there is always a ‘happy banter’ on Beech House. The family take all laundry home as some clothing has been spoiled in the wash. An expensive woollen suit was completely spoiled. No compensation has yet been offered. They were advised to speak to the manager about this. See recommendations 2 and 3. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 19 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Complaints are acted on appropriately but the complaints procedure needs to be prominently displayed so residents and visitors can see it. An informed staff group and manager who take appropriate action to protect them protect residents from abuse. EVIDENCE: The complaints procedure was displayed in all the houses except for Bridge House. The complaints procedure is displayed in the main reception area of the home but is not in a position where it is likely to be noticed by visitors. The pre inspection questionnaire gave details on a number of complaints made to the manager. A complaints file is kept in the manager’s office and was examined. A total of 26 complaints had been recorded over the last year, eight since the last visit. The complaints file was well maintained and contained an index and summary. A complaint received on March 30th and the service manager had investigated one on April 9th. Records showed that the issues raised had been fully investigated and remedial action taken as required. The complainant had been responded to in writing within the specified timescale. Since the last visit the manager had made several referrals under the adult protection procedure to the local authority and investigated the conduct of a staff member at the request of the local authority. The manager took appropriate action to protect residents that resulted in disciplinary action being taken against a staff member. Two of the House managers have commenced training on ‘vulnerable adults and dementia’. This is a two-part course focusing on adult abuse and protecting vulnerable adults. One of the managers confirmed this training would be cascaded to all staff. A copy of the local Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 20 authority adult protection procedure was available for reference. Care staff were observed moving and handling residents. They were observed to use the portable hoist and protective equipment. Staff explained the procedures they were doing with residents. See recommendation 4. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is assessed as adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a generally well-maintained home, which is clean and hygienic but maintenance, the decor and storage needs to improve in some areas so residents’ safety is maintained and access to personal space is not restricted. EVIDENCE: Since the last site visit a new shower has been fitted in Bridge House. A smoke room has been added to Bridge House and decoration of Victoria House corridors and lounge completed. The rear entrance corridor has been decorated. On Church House the environment was clean tidy and well maintained and no unpleasant odours were detected. Some areas of the corridor were badly marked and scraped. On Firth House the environment was clean, tidy and well maintained, with no unpleasant odours. A variety of pictures of the history of Warrington were displayed in the corridors. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 22 On Bridge House Clean the environment was tidy with no unpleasant odours. Three maintenance issues were noticed: a large stain on the lounge carpet, a bathroom door coming off its hinges and drawer in the medicine room had been broken for a long time. On Beech House the environment was clean and tidy. On Victoria House a diffuser is needed to the fluorescent light in bathroom 18. Toilet 22 had a missing tap top to the sink. Toilet 32 has two metal clips protruding from the wall; they are sharp and present a risk. The quiet room was being used for storage of activity materials so not being used as a quiet room. Sluice rooms were left unlocked and cleaning fluids left in them on open shelving. A resident’s bedroom smelled strongly of urine. It was found during the site visit that he had been inappropriately urinating in a small chest of drawers in his room and these are spoiled and needed disposing of. The patio doors were left open when he was not in the room, to air it. The keys to the patio door lock were left in place and needed to be removed to keep him safe. A plug socket in the resident’s bedroom was cracked and needed replacing. A total of three bedrooms were seen on this unit, the two other rooms were fresh and clean and personalised. There was a small storage/linen cupboard, which had old and discarded clothing on the floor, and this needed to be removed. See requirement 2 and recommendation 5. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are adequate to meet residents’ needs. Training to NVQ level 2 is needed to promote quality care. Staff recruitment ensures residents are protected. EVIDENCE: On Church House between 2 pm and 8 am there is only one nurse on duty. The unit manager said that the care needs of residents could be met, but it was very difficult to complete other responsibilities such as staff supervision and mentorship and quality auditing. Three staff have recently achieved NVQ. Firth House was fully staffed and had an additional member of staff on some shifts due to low occupancy on Bridge House. Bridge House were assisting other houses with staff due to low occupancy. On Bridge House no staffing problems were identified. The junior sister considered that additional training will be needed for rehabilitation of residents as care staff are accustomed to meeting all the needs of residents rather than promoting independence. On Victoria House staffing has improved with the recruitment of a manager who is a registered mental nurse. She had recently started and was keen to instigate new practices and improve the care delivery on the House. She kept a list of things she needed to address and was tackling them as she could. Whilst the site visit took place she instigated an accident tracking book and activity book, so that she could track what activities the residents were getting Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 24 involved in. The manager on nights had transferred to days. He is also an experienced mental health nurse. Staffing at the site visit was as follows. Unit manager 8am to 2pm. Staff nurse 8am to 8pm. 4 carers 8am to 8pm and 1 carer working 8am to 2pm. Information provided in the training matrix records fourteen staff with an NVQ level 2 or above and four staff undertaking an NVQ level 2. The pre inspection questionnaire records a total of twenty two out of seventy four care staff employed hold an NVQ level 2 or above qualification. Five staff files were looked at. All contained appropriate identification documentation and completed Criminal Record Bureau disclosures. All files had two written references, including appropriate interpretation of references for Polish staff. One staff file contained records of disciplinary action and this was appropriate. There was evidence of qualifications on staff files. The service manager had completed a training matrix for the staff team. This recorded individual and dates for updating. It also indicates who is a qualified trainer. The matrix needs to be dated as several copies are stored which show different information. The training matrix confirmed staff had received mandatory training. Staff were interviewed about training and development. A staff member said ‘ I have just completed my NQ 2 in care. It took me six months. It has helped me understand the English care system. In Poland I am a qualified social worker. I want to register with the General Social Care Council and work as a social worker. The manager has helped and supported me she got me the number and encouraged me to contact them. We have had some problems at Riverbank but the manager works hard and gives help to everyone. She knows I want to do better. Jackie has been appointed at the service manager. This is good as you can talk to her and this gives the continuity of care to the patients’. A manager said ‘I have put forward care staff, senior care staff and the activities coordinator for dementia care training as they have been asking me and the seniors. The staff are a settled team no changes have been made. It would upset a happy unit if staff changes were made. I asked Jackie not to touch my staff. We recently had a day’s seminar from Dr Stokes the mental health advisor from BUPA. It was on the ‘person centred approach’. He talked about how we can develop our view of dementia. It was about dealing with the person not the behaviours or symptoms and looking at and acknowledging feelings, dealing with that not because the person has dementia but because you are dealing with a whole person. We need the carers to understand dementia. We need this to be ongoing so it’s not just a one off. I am currently on a course on adult protection and dealing with vulnerable adults. I can then pass this down to other staff’. See recommendation 6. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The manager is suitably competent and experienced but she is not registered with the Commission for Social Care Inspection. Quality assurance systems need to improve. EVIDENCE: Since the last site visit a new service manager had been appointed. This was the promotion of the deputy manager appointed in April 2006. She had been the deputy manager for over two years and had acted up to the manager’s position during this period. The manager confirmed she has obtained an application pack to register as manager and is in the process of obtaining all the relevant information as part of the Commission for Social Care Inspection’s revised registration process. She confirmed that the deputy manager’s post had been advertised and four candidates were to be interviewed on 16th May. Staff have welcomed the appointment of Ms J Boylan as manager. Staff interviewed said ’ Jackie’s appointment is positive, she is very good, approachable and someone you can talk to. She is here every shift and knows Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 26 the problems we have had. Staff are more confident and have said they are happy with her appointment’. A care assistant said ‘Jackie has been made the manager, that’s brilliant. She is really helpful and we are happy she is the matron. A few weeks ago one of the young girls was having personal problems. I asked her to talk to Jackie and she has helped her. We have a very large and experienced staff team of different ages and Jackie can talk to anyone and sort out problems’. Staff spoken with felt very positive about the new manager. They found her to be approachable and fair. A senior member of staff was very happy with the new service manager and described her as a ‘person who gives and receives respect’. Staff morale was clearly much improved and there was a more open and relaxed atmosphere throughout Riverbank. A ‘Care Home Relative Satisfaction Survey’ had been completed in 2005. This was generally positive, but did raise some issues for which an action plan had been developed. Improvements suggested included: increase the range of activities offered, improving laundry services, improving general maintenance and improving the quality and upkeep of the garden areas. The service manager audits care plans on a monthly basis. Problems were identified with care plans and an action plan developed to address the shortfalls. There was no evidence to suggest that the service manager followed up on the action plans to ensure they were completed. Medication audits were regularly completed, these include developing an action plan to address the shortfalls identified, but again there is no evidence that these were followed up. The service manager completed pressure sore statistics monthly. This is sent to the BUPA quality assurance team. If the home has more than 5 of residents with pressure ulcers, the service manager is asked to forward an action plan regarding monitoring and reducing incidence. Riverbank had an 8 incidence of pressure areas. However the majority of these were residents who had been admitted with sores. As recommended at the previous site visit the ‘Quality and Development Self Audit’ had been updated for each house. The self audit relates to each standard of the National Minimum Standards for Older People (NMS) and provides an assessment of how Riverbank meets these standards. An example on this was on Firth House were under standard 14.1 of the self audit it was identified that photographs were not on residents’ files. An action plan was in place to address the shortfalls but had not been updated to reflect the corrective action taken. On Victoria House the accident records are completed and sent to the administrator for signing before being returned to be stored on individual files. Accident records are recorded with a reference number to comply with the Data Protection Act. A house manager said of quality assurance within Riverbank ‘ There were some staff changes in January when about 50 of my existing staff team were changed. I have spoken to Jackie about staff changes and she agrees we will not make too many changes in future. Jackie’s appointment is good, I am happy with this. She visits the units’ Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 27 everyday and knows what is going on. I feel there is more of a commitment as we have had too many changes of manager in the last eighteen months’. Two of the house managers identified that they could not complete a number of the quality assurance standards at Riverbank, as they did not have sufficient supernumerary time. A manager said ‘ as we are not at full occupancy consequently we have more staff on the unit and today we can do more as this is a busy unit. Finding time to do care plan audits, supervision and personal best is hard. I don’t have time to do all this. I am supposed to have six supernumerary hours a month, which is difficult as I work forty-two hours a week. We only have one trained nurse in the afternoon and are six hours a week short on qualified cover. If you have an admission in the afternoon having one trained staff on duty can be difficult’. Another manager said ‘ I have no supernumerary hours. I work between forty to sixty hours a week. I am struggling with supervision, appraisals and training. I try to keep on top of medicine and care plans audits’. No residents’ money is kept on the units. Residents are usually advised not to keep more than £5. Personal money can be given to the administrator for safekeeping and accessed for the resident by request. Money raised for the units by fundraising or donation is also given to the administrator for safekeeping. The administrator said that the majority of resident’s families deal with their finances and that Riverbank acts as appointees for a small number of residents. Four records were examined and showed appropriate receipts for purchases. Some resident’s finances are handled by Social Services, therefore the administrator makes requests for their personal allowances ranging between £100-£150 monthly. Four records were examined and again showed receipts for purchases and invoices and the account in which the residents’ monies are kept is their individual account, which pays interest. A care assistant spoken with said that she does personal shopping for two residents who do not have close relatives. She enjoys buying nice things for example toiletries for these ladies. She requests spending money from the home’s administrator and provides receipts for all purchases. A house manager said that she was not aware of which residents have any personal spending money in safekeeping at the home but thought it was very few. The pre inspection questionnaire confirmed that all the required maintenance services and health and safety checks had been completed as required. See recommendations 7 and 8. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 28 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? Yes Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 30 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 OP9 Regulation 13 Requirement The registered person must make arrangements for records of the audit trail of all medicines to be clear, complete and made by the staff accountable for the action at the time of the action. The registered person must make arrangements to ensure that staff follow safe procedures when giving residents their medicines including stopping the unsafe practice of potting up medicines in advance. The registered person must make arrangements for medicines to be stored securely and that audits are carried out at appropriate intervals to ensure that medicines audit trails do not have discrepancies. The registered person must make arrangements for safe handling of medicines to ensure medicines that have date expired or are no longer fit are removed promptly from use. The registered person must ensure that the Commission is informed of the outcome of the investigation into the apparently missing medicines. Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 31 Timescale for action 15/06/06 2. OP19 13(4), The registered person must 23(2)(c)(e ensure that all areas of )(m) Riverbank are maintained to a safe standard, including keeping storage rooms locked and access from residents’ bedrooms. The quiet room on Victoria House must not be used for storage. 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP12 Good Practice Recommendations Residents’ care plans should include consistent information obtained about them and reflect residents’ needs. The activity co-ordinators should receive training on communicating with residents, managing challenging behaviour and the promotion of equality and diversity when considering suitable activities for residents. The activities programme developed at Riverbank should be promoted for all residents to participate in. Meal choices should be offered to residents in a format that they can understand and menus should include the choices of pureed meals. The complaints procedure should be displayed prominently in all areas of Riverbank. The maintenance and décor on Bridge, Church and Victoria Hose should be improved The numbers of staff with an NVQ level 2 should be improved and the training matrix updated to accurately reflect current staff training and qualifications. The manager should confirm that actions identified as a result of quality assurance audits are completed. House managers should have sufficient supernumerary hours to contribute towards the quality assurance system at Riverbank. 3. 4. 5. 6. 7. 8. OP15 OP16 OP19 OP28 OP33 OP33 Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverbank Nursing Home DS0000005164.V292716.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!