Inspection on 19/12/05 for Birch Court Nursing & Residential Home

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 &... 15/05/06

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 Unannounced Inspection 19th December 2005 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.V269864.R01.S.doc Version 5.0 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.V269864.R01.S.doc Version 5.0 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) BUPA Care Homes Limited Mrs Angela Zuraw 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.V269864.R01.S.doc Version 5.0 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 3 service users in the category TI/TI(E) (Terminal illness over the age of 50 years) may be accommodated in 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 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and shall comply with any guidance which may be issued through the Commission for Social Care Inspection 2. 3. Date of last inspection Brief Description of the Service: Riverbank provides nursing and personal care for a maximum of 150 service users 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 and deputy 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. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 5 All bedrooms are single and are on the ground floor. There are no ensuite facilities. The home has extensive gardens that are well maintained and are accessible for service users. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Due to the large number of registered beds three regulatory inspectors and a regulation manager undertook this unannounced inspection. The full inspection was triggered by a recent visit on 6th December 2005 to address a complaint about Victoria House. Together with and a number of matters that were referred under the local authority adult protection procedure. The complaint was substantiated. The registered manager has been providing managerial cover at another BUPA care home. The inspection took place over nine hours. Feedback was given to the deputy manager. Records were inspected and staff practice was observed. Discussion took place with residents, relatives and staff. One requirement remained outstanding from the last inspection visit. Concern was raised about the standard of medicine management and recording. This was identified at the previous inspection visit in June 2005. A pharmacy inspector will inspect these issues in the near future. What the service does well: What has improved since the last inspection? Where residents moved units written evidence to demonstrated that this was done in the best interests of each resident. The provision of basic toiletries, paper towels and toilet rolls had improved. Female residents were seen wearing stockings or tights. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 7 A number of bedrooms had been decorated. The areas needing repair and redecoration had been addressed and carpets replaced. What they could do better: The statement of purpose needs to reflect the current management structure at Riverbank. Each assessment of prospective residents needs to be completed in full by a competent and experienced person. Care plans need to improve to demonstrate that the health and welfare of residents can be provided for. Residents’ dignity and respect must improve to demonstrate that their rights and choices as individuals are respected and promoted. This includes improving signage in the home and the choice of food. The provision and recording of activities needs to improve to ensure residents have opportunities to participate in activities appropriate to their needs. Activities coordinators should to be incorporated into staff training programme. Staff need to be given training on moving and handling and challenging behaviour to ensure the safety of residents. The standard of health, safety and hygiene needs to improve to ensure residents’ safety is promoted, including the monitoring of water temperatures. The quiet room on Victoria House should not be used as a storage area and appropriate facilities must be provided for recreation and activities. The staffing levels, including mental health nurses and care staff who have received training relating to the care of people with dementia, needs to be reviewed on Victoria House. Staff should not be moved around from one house to another when staff are not familiar with the residents. Incidents of aggression between residents needs to be considered for referral under the adult protection procedure. Management and monitoring of the management and administration of records and practice needs to improve to demonstrate that Riverbank is managed in the best interests of residents’ health and welfare. This includes the management of complaints and training records Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 8 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.V269864.R01.S.doc Version 5.0 Page 9 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.V269864.R01.S.doc Version 5.0 Page 10 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): 1and 3 The Statement of Purpose needs revising. Residents are assessed appropriately prior to moving into Riverbank, apart from Victoria House where an experienced mental health practitioner must assess residents. People being discharged from hospital appear to have a planned admission process. EVIDENCE: The statement of purpose still contains names of the previous Operations Manager and Home manager. Not all pages of the certificate of registration were displayed in the entrance area of the home. Beech House Prior to moving into Beech House, the unit manager assesses potential residents and assessment documentation is obtained from the referring social worker in order to ensure the unit can meet the individual need. The unit will take emergency admissions and appropriate assessment documents are obtained in this instance. On admission to Beech House a detailed assessment is carried out, including a life map and life biography. This is good practice, although the unit manager should ensure that important information is included here. One resident who had recently been widowed after 50 years of marriage did not have her late husband’s name, or any other information about him, recorded. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 11 Bridge House The Junior Sister in charge was spoken to in the absence of the Unit Manager. Five records were looked at including care plans and progress records. Three relatives of residents were spoken with. Twenty residents were living in Bridge House. The sister in charge advised that three systems are in operation in the unit to accommodate residents; 13 Primary Care Trust (PCT) contracted beds, 14 Social Services funded beds and 3 Continuing Healthcare beds for terminally ill residents. Consultant cover is provided weekly or more often if needed for the residents in the health beds, whilst the resident’s own GP covers for the social services funded residents and those that are terminally ill. The PCT Funded Nursing Care Team or Discharge Liaison nurses prior to moving in to the unit assess the majority of residents. Although the minority of residents are assessed by the Unit Manager or Junior Sister before moving into Bridge House, the Sister in charge stated that people tend to be appropriately placed following full discussions regarding whether people’s needs can be met, provision of specialist equipment etc. At the time of the visit, the Discharge Liaison Sister telephoned and spoke to the sister in charge regarding a person’s needs prior to moving into Bridge House. Church House 30 residents live in Church house. Six of them have lived at Riverbank for over five years. The most recent resident had been admitted from her home on 15th December due to the illness of her main carer. A full needs assessment was received from her social worker prior to admission being arranged. One resident was transferred from Beech House on 25th November following a stroke. One resident was transferred from Victoria House on 8th December following reassessment by her social worker. The unit manager said that she was satisfied that both of these residents had been moved to Church House appropriately due to a change in their needs. Firth House On Firth House appropriate assessment documents had been obtained prior to residents moving in, and these had been used to formulate a plan of care. One resident was in respite care on the unit, and appropriate needs assessments were in place. Potential residents are welcome to visit the unit prior to making a decision to move in and the unit manager is happy to chat with visitors and their relatives, answering any questions they may have. Victoria House A resident who moved into Victoria House had a pre admission assessment completed by a staff nurse who was not a mental health practitioner. There was little detail of the resident’s mental health needs. Copies of the assessment from the NHS were present in the care plan and detailed the resident had complex mental health needs and was subject to the enhanced Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 12 Care Programme Approach (CPA). A copy of the CPA care plan was present with a care plan and assessment from the local authority. See requirements 1 and 2. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 13 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 and 10 Not all residents have the relevant care plans according to their assessed needs. On Bridge and Victoria house residents’ health and welfare needs are not being met. The quality of care plans needs to improve to demonstrate that residents’ needs can be met in these houses. Care Plans on Beech House, Church House and Firth House are in good order, individual and appropriately detailed. Care Plans are reviewed regularly and updated as necessary. Staff show a good working knowledge of the care needs of individuals but this needs to improve on Victoria house to protect the safety and welfare of residents. Privacy and dignity regarding the care of residents needs to improve on Beech, Firth and Victoria House and the reception area of the home. EVIDENCE: Beech House Care Plans on Beech House are in good order, individualised and appropriately detailed. Care Plans are reviewed regularly and updated as necessary. Staff show a good working knowledge of the care needs of individuals. All residents on Beech House have appropriate Care Plans in place. These are individual and describe how all aspects of care are to be managed. The Care Plans are regularly reviewed. Risk assessments are up to date and give good information, these also include health issues. Residents are referred to medical and other professional services appropriately ensuring their health needs are met. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 14 Documentation regarding the Care Programme Approach is on individual’s files and the unit manager had a good knowledge of her role in this process. Staff address residents politely and respectfully, and interact socially with them. Staff are discreet and respectful when helping residents with personal care, explaining to residents what is happening using signs where appropriate and maintaining eye contact. Residents are well kempt and a discreet toileting programme is in operation. Bridge House Three nursing assessments were looked at. One was partially completed, one was fully completed at different times by two nurses and only one was fully completed by the same nurse. A lady admitted from home on 29th November 2005 with a history of falls had a pressure ulcer on the spinal curve. Although a photograph was taken of this on admission, her nursing assessment was partially completed and there was no wound care plan. The sister in charge said that this was improving and another photograph needed to be taken to demonstrate healing. Another resident admitted with bilateral leg ulcers in 2003 was reviewed monthly by District Nurses. The care plan stated twice weekly dressings and photograph regular. The sister stated that the dressings were changed more frequently than twice weekly. The photographs were not in her care records but found in a separate drawer in the office. The last photograph was taken on 24th March 2005. The care plan of a lady stated that she was unable to communicate. The sister in charge however, said that she was able to communicate. As this lady was sleeping it could not be evidenced. Fluid balance charts commenced on 21st October 2005 were not fully completed, days were omitted and amounts were not totalled. The sister in charge said this chart was still being kept but was not needed now. It was suggested that a decision be made either to keep the chart and ensure full completion or to discontinue the chart. A positional change chart was also commenced for 2 hourly turns. This was also not fully completed. The sister in charge said that the lady was now sitting in the lounge and had since gained weight. This was not evidenced as the sister in charge said staff were unable to weigh this lady, as she was very stiff. Risk assessments are not always completed for each resident. A care plan audit has been undertaken by the Home Manager and the Deputy Manager and has identified many problems with care plans, assessments and risk assessments. Church House A sample of six care plans was looked at. These had all been completed to a good standard. New care plans had been written for the residents transferred Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 15 from other units. A full care plan was in place for the resident admitted on 15th December. The unit manager said that no residents on Church House had a pressure sore. One resident living in Church House had been admitted with a number of serious pressure sores and these were now all healed. The unit manager confirmed that appropriate pressure relieving mattresses and chair pads are always available to meet the needs of residents. Professional advice, including tissue viability, is available through the GP liaison service. The unit manager can refer residents directly to the speech and language team and to a dietician. A dietician was visiting on the morning of the inspection to give advice regarding a PEG feed. Physiotherapy had been arranged for one resident through her GP. Nutritional supplements are provided, and a list of the requirements of each resident was attached to the drinks trolley. Two frail residents were being cared for in bed. Some residents just get up for the morning, including breakfast and lunch; others are assisted to have a rest on their bed in the afternoon and get up again later. Firth House Care Plans on Firth House are in good order, individualised and appropriately detailed. Care Plans are reviewed regularly and updated as necessary. Staff show a good working knowledge of the care needs of individuals. Care Plans are clear, up to date and individually detailed. Clear and detailed risk assessments are in place. Victoria House A resident who moved into Victoria House had a pre admission assessment completed by a staff nurse who was not a mental health practitioner. There was little detail of the resident’s mental health needs. Copies of the assessment from the NHS were present in the care plan and detailed the resident had complex mental health needs and was subject to the enhanced Care Programme Approach (CPA). A copy of the CPA care plan was present with a care plan and assessment from the local authority. All these documents identified that the resident was a high risk of falling due to standing unaided. The resident was identified as benefiting from wearing hip protectors to reduce the risk of injury and to be seated in a reclining chair. The NHS and local authority assessment of need identified the resident needed ‘a specialist reclining chair’ to meet her needs. The home had not completed a risk assessment for falls or moving and handling or the use of bed rails. There were no risk management plans completed. The resident was not wearing hip protectors to reduce the risk of her standing unaided. Only two hand written care plans were in place regarding the disguised use of medicines and eating and drinking. These had not been put into place and staff said the resident took medicines as required. The resident had fallen on several occasions and severe facial bruising was evident. Daily records on the day of her admission Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 16 detailed ‘at risk of falling needs a reclining chair’. The resident was noted as requiring ‘constant obs due to the risk of falling’. The resident had a fall and sustained severe facial bruising and haematoma to the head. Neurological observations were carried out but the resident was not sent to hospital despite sustaining a serious head injury. In the morning the resident was observed to be sat in a ‘bucket’ chair but later in the morning sat in an armchair that did not recline. Daily records for 11th December recorded ‘skin tear to left buttock found, ? cause pressure sore pressure mattress requested. The resident had been assessed by staff on Victoria unit as having a very high risk to developing pressure ulcers. This was also noted in the NHS assessment. A pressure relieving mattress had not been put in place. There was no care plan in place regarding a pressure ulcer or confirmation if the tissue viability nurse had been consulted. The nurse in charge in referring to the resident stated ‘see the lady in the bucket chair, she throws herself out. She was here on a trial basis and is now permanent. We were not really told she was that difficult. She needs a one to one she is a danger to herself’. A resident’s care plan examined on 6th December during a complaint visit had not been updated as stated by the nurse in charge. The problem being the resident could not maintain a safe environment. The complaint referred to items of furniture put in the bedroom by the resident, which were a danger to the resident’s safety. This information was not detailed in the care plan on 6th December. The unit manager stated on the 6th December that a strategy was in place to work with the resident in reducing the items of furniture in her bedroom taking account of ‘ritualistic behaviour and reducing the anxiety of the resident’. The care plans had not been revised to reflect this approach. Another resident was described as presenting challenging and aggressive behaviour. Incident forms recorded previous episodes of the resident hitting other residents. The nurse in charge said ‘he is an ex boxer. If you raise your hands to him he thinks it’s the Marques of Queensbury rules and thinks you are going to hit him’. This information was not referred to in the resident’s care plans nor was there a care plan, risk assessment or risk management plan regarding challenging and aggressive behaviour. A psychiatrist had reviewed the resident and medication reviewed with a positive outcome as the incidents of aggressive behaviour were reduced. Examples were seen of positive and negative practice regarding the dignity and choice given to residents. On Beech House mail is given to individual residents and staff assist them to read it as necessary. On Beech House large bibs were used for some residents at mealtimes to maintain their dignity. Some residents were upset with the thought of having to wear them, and some residents wearing the bibs were not able to object. Issues were noted regarding respect toward residents on Firth House. Staff walked into residents’ bedrooms without knocking, and without acknowledging the person in the room. Staff did not interact much with residents on a social level and did not take individual wishes into account regarding entertainment. One staff member put on loud Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 17 Christmas music on a compact disc without asking the residents in the lounge if that was okay. This music drowned out the television, which was showing a musical film. Following this incident a domestic staff member vacuumed the lounge, without warning, making residents jump, and drowning out the film. On Victoria House a resident who was being supervised on a one to one basis was locked in his bedroom by a staff member while the staff member took dishes from the lunchtime meal to the kitchen. The home has an administrator and a receptionist. The administration area is very open, and visitors waiting in this area are able to hear telephone conversations that are sometimes of a personal and confidential nature. A prospective resident was asked questions and including questions about personal possessions in the administration area. The questions asked to the prospective resident were of a personal nature and should have been discussed in privacy. A staff member came into the home to enquire about employment information and again the personal details discussed in front of those present. See requirements 3 and 4 and recommendations 1and 2. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 18 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 Activities are neither well structured nor well attended. Photographs are not taken of planned events. Visitors are welcomed to visit at flexible times. More effort on Bridge, Firth and Victoria Houses would ensure residents have information to exercise choice, control about their daily life, participate in activities and choose meals. EVIDENCE: Beech House Beech House has a good up-beat atmosphere, with staff interacting well with residents. One staff member in particular created a buoyant atmosphere, by singing and drawing residents into banter. An activity co-ordinator is employed 30 hours per week on Beech House. She organises individual and group activities, as well as trips and outings. A recent trip with the male residents to an RAF museum had gone well. The activity co-ordinator had received no training regarding her role or about working with people with dementia and said that she felt she could benefit from this. Residents on Beech House are able to read, knit, chat, listen to music and watch television through the day. Activities are posted on a board, but this is not very accessible to residents. Bridge House The activities co-ordinator works in Bridge House for 15 hours per week 3 hours Monday – Friday. She also works in Victoria House for 15 hours per week Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 19 in the afternoons. There were no observed activities that morning however and the co-ordinator was on Victoria House. The sister in charge was unaware how many hours the co-ordinator worked but said she worked more in Victoria House. The rota for the previous week included going into the rooms, painting, music, ballgame, nail care, singing, board games and a DVD is shown on Fridays. An annual barge trip was not attended by any of the residents from Bridge House. Bingo is played weekly in Church House but residents from Bridge House do not attend. A champagne and strawberries afternoon in June and a recent Christmas party took place but no photographs were taken. Church House Residents spoken with said that they had enjoyed the Christmas party held the previous day and thought that the entertainer was very good. Staff had visited on their rest day to help with the party. People were seen visiting the resident hairdresser. One resident said she had been here 18 months but had never seen the matron; she thought the unit manager was ‘very nice’. One resident said that she had no difficulty in communication with overseas staff but another said that she couldn’t always understand them. One resident said that at first she found it ‘a bit embarrassing’ to have personal care provided by a ‘lad’, but she had got used to it, and two residents agreed that the male staff were very good and they appreciated having a joke with them. Residents spoken with said that all staff were very kind. A resident was upsetting others in the lounge by making rude and insulting remarks. The unit manager said that she had received three complaints from visitors about this. She had discussed the problem with the home manager. Sometimes this resident is asked to go to her bedroom. A new resident felt that she was being ‘picked on’ by this person. There is no choice of lounges available. Firth House Firth House is a quiet unit whose residents have high dependency needs. On Firth House the activity co-ordinator is employed for 15 hours per week and spends time reading to residents, playing dominos and chatting. Again there were no displays of information regarding activities. Most residents in Firth House are in bed and staff state that this is due to tissue viability issues, and they try to get people up as much as possible. One relative stated that his wife does spend time in the communal lounge when activities are going on, but then returns to her bed. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 20 Victoria House On the day of the visit Victoria House was described as ‘chaotic’ by the two qualified staff and a care assistant. The activities organiser was on Victoria House and did not provide an activities programme due to the high level of expressed emotion in the unit. The activities coordinator said ‘I work 30 hours a week Monday to Friday 10.00am to 4.00pm but only 15 hours a week on Victoria. I do a small activities programme. I have bought a tea set and I have tea with a group of ladies most days. It promotes social interaction and I offer the ladies a choice of a drink and let them choose if they take milk and sugar. I encourage them to pour the milk and take sugar from the bowl and the help themselves. We also do beauty and reminiscence therapy. We go out a lot. We went to Wales on a barge recently. We celebrated Halloween and Christmas. Margaret the nurse in charge is marvellous and helps out with activities, as does some of the staff. Family are very supportive and usually attend functions. Today I have been like a carer, as one of the staff has had to go to hospital. The only thing wee need is more facilities. On this unit residents only have their bedroom for privacy. For activities we have the quiet room, which is totally unsuitable, or the main lounge. Three activities coordinators and no separate facilities we could do a lot more’. Details were available of a number of planned activities over the Christmas period. Meals Beech House Menus are presented on a 4 weekly rota. Residents are asked to choose what they want to eat the day before. Staff on Beech House say that this procedure can sometimes cause difficulty as residents change their minds once food arrives. Alternatives are available, although choices are not displayed and there is a reliance on staff spending individual time with residents and talking through the various choices. Staff on Beech House complained that the process of choosing meals took up a lot of time. Bridge House A visitor on Bridge House said that the menus were on a 4 week rolling programme. He marks his wife’s likes on the menu. He said, “ my wife is nursed in bed and enjoys her meals”. The mother of one resident said that her son had pureed food and apart from breakfast was fed by the family. From the minutes of the residents, relatives and staff meetings on Church House 18th May 2005 food questionnaires were to be redistributed. Some families expressed an inconsistency in food. Three catering staff prepares meals and the chef was to address this. Church House Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 21 Meals are chosen for the next day on a form that is returned to the kitchen. There is a set main meal each day but a list of other alternatives that the kitchen can provide was also available. Seven residents required a pureed diet, and no choices were recorded for these residents. Seven other residents were not having the main meal and omelettes had been ordered for all of these residents. It was therefore questionable whether they had been offered a choice. The unit manager said that catering staff provide a very good service for residents. A cooked breakfast is available every day. On Sundays the main meal is served at lunch-time, but on other days it is at 5pm. Residents spoken with said they are ‘very well fed’. Firth House On Firth House many residents have swallowing difficulties and are on pureed diets. Staff said that they ask relatives to give information on individual likes and dislikes where appropriate. The chef said that he was in the process of updating his menu, based on feedback from residents and their families. He stated that the individual units need only to contact him to arrange alternative meals if the day’s choice was not to an individual likes. The chef also provides special diets as necessary. The chef is looking into how information about food choices is conveyed to residents, he had received feedback from one resident saying that provision of a cooked breakfast would be appreciated, and he was concerned that this individual was not aware that a cooked breakfast was offered daily. See requirement 5 and recommendations 3 and 4. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 22 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 The complaints procedure needs to be more freely available in the houses so relatives are aware of it. Response to complainants needs to include the outcome. For example whether a complaint is upheld or not. On Victoria House residents are not adequately protected from abuse. Managers at the home need to monitor and report all physical incidents and confrontation between residents. These should be reported under the adult protection procedures when necessary to improve the residents’ protection. Staff awareness and training of how to manage challenging and aggressive behaviour needs to improve to ensure residents are protected from abuse. EVIDENCE: The procedure on how to make a complaint is displayed in the reception area and includes details of CSCI. The response to a complaint by a resident regarding her nails cutting into her skin, complaining of a sore bottom and also being thirsty was resolved satisfactorily but not described in the response as upheld. Other examples of complaints made were agreed with in the response to the complainant, but not specified whether the complaint was upheld. Bridge House Whilst residents’ views were not asked, three relatives of different residents were spoken with. One relative said of her cousin “ Her hair’s beautiful, she always looks well, the staff seem caring”. The husband of one resident said he was happy with her care and that “staff are more caring than where she lived before. The laundry service is better Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 23 here, the meals are alright”. He felt his complaints were sorted out at the home. He visited every day The mother of one resident said she was happy with the care in the home and knew how to complain if necessary. Victoria House Two relatives on Victoria House complained directly to the inspector about a number of issues regarding the care of their relative. They expressed concern that over a six month period their relative had a number of unexplained bruises, cuts and a black eye. The relatives said the staff had cooperated with them during the complaint and allowed them to see their relative’s records. One serious incident was not recorded in the accident/incident records. The relatives said ‘There are too many unexplained bruises and gashes. Apart from that there are no other problems’. The relatives were advised to use the BUPA care homes complaints procedure. They said they would have followed the complaints procedure but ’it was not mentioned’. On Victoria House a number of residents were identified as presenting with challenging and aggressive behaviour. One of the qualified staff said that residents punched out at other residents and staff and ‘some residents are still actively psychotic’. There are two levels of residents on Victoria unit. Those who are physically frail and have dementia and those who are acutely ill and present challenging behaviour’. Two care staff interviewed talked about how they dealt with challenging behaviour. A care assistant from Poland said ‘I do not know what some residents are saying at times. One resident says get out of my bedroom. He likes to walk in garden he is a quiet man. He can be aggressive. I have had training on adult abuse but not had training on aggression. I am calm, I use this. I will not stay if I am uneasy. We are told leave him to calm down’. Another care assistant said ‘we don’t stop for 12 hours constantly stopping residents falling or from hitting one another. I recently had training on the causes of dementia. This does not tell you how to handle residents. A lot are resistive to help. We are told to leave residents and not to use restraint. We usually intervene after an incident. It’s not clear’. A qualified staff member asked ‘can we have a conservatory area; we need a quiet place for residents. The mixture of residents is so different on here. If we had a quiet room we could split the dependency of residents up’. When asked about the policy on the use of physical intervention the staff member replied ‘maybe two staff have had training on challenging behaviour since you were last here in June. If residents are resistive or aggressive they are told to leave them to calm down. I’ll agree that staff maybe hesitant or not sure if they should hold someone’s hands to stop themselves being hit. We constantly have to do this. Yes I suppose staff should be clear on what they can do to protect residents and themselves’. CSCI needed to advise the deputy manager to refer three incidents to the local authority under the adult protection procedures prior to the inspection visit. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 24 See requirement 6 and recommendations 5 and 6. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 25 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, 21 26 The communal and bedroom areas of the houses were free from odours and satisfactorily decorated but some improvement in the décor of residents’ bedrooms could be made. Health and safety and hygiene standards in Beech and Victoria House must improve to maintain the safety of residents. The signage of bedrooms, bathrooms and toilets of Victoria house could improve to enable residents who are cognitively impaired to recognise these facilities and aid independence. Additional private/quiet facilities in the houses are needed to offer residents and families’ alternative places to receive visitors or relax. EVIDENCE: Beech House On Beech House most residents use the communal lounge, which is pleasantly decorated, safe, comfortable and homely. The lounge/dining area is used for activities, meals and entertainment as well as social interaction. All bedrooms are single and residents can to personalise these as they wish. All bedrooms have ‘memory boxes’ set up outside and residents are able to display photographs and mementos in these. This is good practice as it is a discreet way of helping residents orientate themselves and for them to share their life history with other residents and staff. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 26 The bathroom on Beech House was in a poor state of repair. The flooring was stained, with rust around the base of the toilet. The toilet seat was broken and the bath panel worn and broken. It is required that this bathroom is attended to. In addition, the hot water temperatures remain low despite this being raised in a previous inspection. Since the last inspection bedroom 15 has been fully decorated. Church House A new carpet has been fitted in the lounge and new flooring in the dining area and outside the kitchenette. There are new chairs in the lounge. This has greatly improved the environment. Corridors have been painted but the new paint has been knocked and scratched in places by trolleys and wheelchairs. There is a pleasant garden that is accessible from the lounge. This has been developed during 2005. One of the care staff has been particularly involved in improving the garden and others have also brought in plants. The unit manager said that she was awaiting the delivery of new commodes, and had received some new pillows and bedding. Most bedrooms have new bedside cabinets, which have a locking drawer. Some bedrooms are in need of redecoration. Bedrooms 8,11,14,20,27,35 have been partially decorated The house was clean and tidy with no unpleasant odours. Bridge House The broken toilet seat in Room 32 has been replaced since the last inspection. There has not been any further decoration to Bridge House since the last inspection. The unit was free from odours Firth House Since the last inspection corridors A side and B-side and bedroom 20 has been fully decorated. Firth House was clean, hygienic and pleasantly decorated. The unit had 4 baths, although only 2 of these were used. Staff complained that the drinks trolley was in a poor state of repair and had not been replaced despite the issue being raised with management. One relative complained about the commode in his wife’s bedroom, as she did not use this. He said he had been told that it was policy to have a commode there. This issue was addressed with the unit manager who agreed to remove the commode and replace it with a comfy chair. The relative also commented that space in bedrooms was minimal and had been reduced further as the 3 drawer bedside cabinets had been replace with single drawer ones. Victoria House The quiet room designated for residents was being used as a store room and was full of boxes, black bags, gifts for Christmas and dried flowers. A small table and chairs was provided with a bench seat on one wall. The room is decorated in a dark maroon colour with no natural light. There was a low Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 27 wattage bulb providing light. The nurse in charge commented that staff had been using the quiet room for breaks. Residents can use the quiet room however; the stored items were a hazard to residents’ safety. A resident who was walking around the corridor said ‘its very noisy and I don’t want to be with the others. They shout all the time, I keep away. I have walked round three times but there is no quiet place to sit. If I sit in there they shout at me. I’m only here to help but they won’t let me help them’. In bathroom 37 a cot bumper was left on the floor. This was stained brown and smelt of vomit. The shower bracket in this bathroom was broken. The main corridors, lounge and office had not been cleaned and there were shards of paper everywhere. A fire exit was partially obstructed by a number of boxes containing incontinence products. Two of these were open an in use. These were later removed. Better signage of bedrooms, toilets and bathrooms would help residents to recognise these facilities. Three staff members work in the central laundry every day between 8am and 4pm. There are three large washing machines and two large driers. Laundry staff said that another drier would be very useful but there is no space. They said that various different shift patterns had been tried but the present arrangements worked well. A truck collects the laundry from each house every morning. Washing from each house is done separately. All laundry can usually be completed by 4pm. Clean laundry is placed in residents’ bedrooms and care staff are responsible for putting it in drawers and wardrobes. Items of clothing that cannot be identified are kept in a separate area and relatives and/or staff can look for any missing items. The kitchen facilities are good. Food is plentiful and stored appropriately. Good systems are in place for ensuring high standards of hygiene and preventing cross infection. Health and safety issues are addressed appropriately with temperatures being recorded, risk assessments completed and COSHH requirements being met. See requirements 7 to 9 and recommendations 7 and 8. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 28 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 Staffing numbers and skill mix were satisfactory apart from Victoria House were the health and welfare of residents is at risk because staff are not sufficiently trained to do their jobs. Staffing levels and training are inadequate to care for the number of residents on Victoria House who present with challenging behaviour. Care assistants are regularly moved to different units. Training records need to be comprehensive and accessible to senior staff members. All staff should receive mandatory training in manual handling. EVIDENCE: Staffing Bridge House Shifts are either 6 hours or 12 hours. A full time staff member works 42 hours per week. Nurses provide cover for each others shifts when on annual leave. Staffing rotas showed satisfactory staffing levels. Current staffing levels were 2 nurses and 4 care assistants. A female care assistant had been transferred to Beech House to provide more female carers. A male care assistant from Beech House was transferred to Bridge House but then quickly transferred to Victoria House. The sister in charge said “the care assistants are moved about a lot and get fed up with it”. The sister in charge was also providing site cover for problems on the other four units, including staffing levels and clinical issues. She said that nursing staff covered the site manager role approximately once a fortnight. Staff tend to cover shifts for sickness and annual leave with agency staff used as a last resort. The care assistants are allocated certain residents and act as their key worker, but provide cover for each other when absent. Each carry individual notepads and transfer their notes into the key worker diaries. These diaries were not looked at on this occasion. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 29 Church House Church House has had a considerable staff turnover during 2005. Vacancies exist for both nursing and care staff. There were two full time nurses on days and two on nights. Staff working additional hours cover most shifts, but there is some reliance on agency staff. The unit manager was mentoring one adaptation student. She had only been in post for a few weeks but is gaining in confidence. Victoria House Due to the poor communication about staff taking leave and the ill health of a resident staffing on Victoria House was insufficient. A staff member had been given the day off and this had not been communicated to the nurse in charge so the morning shift was a staff short. A resident became ill and a staff member had to escort the resident to hospital. No arrangements were made to cover the shortfall in staff until mid morning when a staff member was allocated from another unit. When asked about the needs of a resident the staff member replied ‘I don’t know the residents I am not from this unit’. A resident was assessed as needing on one to one supervision funded by the PCT. This was not happening. The resident was later locked in his bedroom by a staff member who said he took this decision, as he needed to take the resident’s lunchtime dishes to the kitchen. Relatives expressed concern about the staffing levels on the unit. A complaint was recorded about insufficient staff numbers in the lounge area. Relatives who expressed their concern during the visit and said ‘we are concerned that the previous manager and original staff have left. We have told the manager there is not enough staff. We have been here for half an hour and there are no staff in the lounge. In the past I have had to stop fights. Staff must be around but we don’t see them. It is not a problem, whether the staff are English or not. It is the English staff that is the problem. They put drinks into residents’ hands when they are half asleep and leave them. They don’t prompt them. If you came here sometimes you would have the shock of your life. We visit everyday. We think staff are rough handling residents or are not trained. Are staff dedicated? Do they understand the illness of my mum?. Staff don’t have the time’. One care assistant said ‘ staff were more stable over the last few months’. Another care assistant said ‘ I have worked in the unit for a few months. I have settled in, it’s very hard, very dependent. We don’s stop for 12 hours stopping residents falling or hitting one another. It’s very rewarding. I have brilliant conversations with residents. One resident lets me stay with him because I respect his rights. If he says leave I sit outside his room when on one to one. The main problem is staffing. If you get five experienced staff working together you have a good day. If you don’t it’s hard. Your rarely get five experienced staff working together. The main problem is consistency. The Polish staff are very good but they cannot understand the residents and vice versa. One staff member is frightened of the residents and goes to pieces. She really is scared. Agency staff doesn’t know the residents so you give them easy jobs like putting clothes away. We have a new manager who I haven’t seen Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 30 much of. He is busy sorting out care plans. There are more important problems to sort out like staffing but the management are on his back if things don’t get done. I suppose it’s about priorities. If we had more staff we could do a lot more. We don’t have sufficient staff. At quarter past eight this morning we had two carers and two qualified staff, it was chaotic. It’s only after 6pm you can sit down and spend time with residents, otherwise you are busy. I think the staff team are very dedicated but we need more of them’. A qualified staff member identified staff understanding of English as a problem and said ‘maybe English lessons would be useful’. Another qualified staff said ‘we need experienced staff. Some of the residents here would be challenging to an NHS facility. There needs to be more RMN’s employed but that’s difficult. We need a consultant on a more regular basis to review people who present with challenging behaviour. We spend a lot of time intervening to protect residents. Those who are unpredictable are the most challenging’. Records of seven new members of staff were looked at. The home’s receptionist maintains these records in good order. All files contained an application form, a medical declaration, and record of interview. A POVA first check, and a Criminal Records Bureau disclosure had either been received or had been applied for. A PIN check had been carried out for a nurse. Two files contained only one reference, and others did not all have an employer’s reference. Most of the recently recruited staff did not have any previous experience of similar work. 49 staff left Riverbank during 2005. These included nine bank carers/nurses, nine nurses, 17 carers, and 11 domestic/laundry staff, three others. Training Riverbank has six care staff with NVQ level 3, and 16 with NVQ level 2. Seven staff were working towards NVQ level 2 and two staff were waiting to start level 3. The deputy manager has recently completed NVQ level 4 in management. On Bridge House the sister in charge was unaware of any planned training but said that management would put names forward. She said that she completed a 3-month Macmillan Community Nurse Course in December 2004 and that the unit manager had trained in the end of life pathway. She was unsure as to any training undertaken by the other nursing staff. Minutes of the Heads of Department meeting 13th December record that “it appears that a number of staff have not had manual handling training in the last 12 months, some of these are long standing staff and a lot of new rules have been introduced within the last 12 months”. Central training records detailed staff attending training courses. The information given was that each unit had its own training record. A training matrix provided was confusing as it did not alphabetically or chronologically record what training staff had undertaken or when training was due. Since June 2005, twenty three staff had fire training. Six staff had adult Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 31 abuse awareness training in November 2005. Four staff had a two day course on dementia care in August and October 2005. Each month a day’s induction course had taken place. Two staff completed training on ‘seasonal immunisation programme’. Manual handling training was recorded as taking place in July 2005. A record of training is kept on each house and there are also central records, however there was no definitive way to establish what training each staff member had received and when. At a Heads of Department meeting held on 13th December, it was identified that some staff had not attended a moving and handling update during 2005. New staff receive a one day induction training, which includes moving and handling, fire safety and adult protection. Staff on Church House had attended ‘eat safe and drink well’ training provided by Warrington Hospital and the unit manager said that this was very helpful. See requirement 11 and recommendations 9 and 10. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 32 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 The lack of consistent management of Riverbank has resulted in a lack of leadership and guidance. Residents do not receive consistent quality care. The management priorities on Victoria House are not clear. This results in some practices that do not promote and safeguard the health and safety of people living there. The quality assurance system in use at Riverbank is not adequate. Residents’ monies are dealt with safely. Regular maintenance of the building and equipment provided to meet residents’ needs maintains their safety. EVIDENCE: The registered manager was not present as she was acting as manager at another BUPA care home. The deputy manager was acting as manager of Riverbank and was unable to fulfil her role of coordinating the house managers and advising on clinical matters. A manager who is inexperienced in managing a dementia care unit has been appointed as manager on Victoria House. A number of problems were identified during this visit. These included staffing, management of staff and the dependency levels and challenging behaviour of a number of residents. Staff are unclear about the role of Victoria House. One Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 33 example is the resident locked in his bedroom and not being given one to one supervision as needed. Another resident was not wearing appropriate equipment to protect her safety or given a reclining chair. Risk assessments and risk management plans had not been completed to promote the health and welfare of the resident. Despite some training in dealing with aggressive behaviour, staff are unclear about the use of physical intervention to protect both themselves and residents. As part of the quality assurance system the unit manager on Church House provides a monthly pressure sore audit to the home manager. All accident reports are sent to the home manager. The unit manager reviews all medicines monthly and contacts GP’s to discuss any changes to prescriptions. Results of a relative satisfaction survey were published in March 2005. 56 questionnaires were despatched with 32 returned. This represents a response rate of 57 . Overall 25 of relatives rated the quality of care received as excellent, 54 rated the care as very good and 21 quite good. The overall results were better than the previous year with 79 rating the quality of care as excellent/very good compared to 72 in 2004. The survey showed the most improvement from 2004 in the amount of information relatives are given. 86 rated this as excellent compared to 60 in 2004. The excellent/ good rating for the range of activities offered showed a decrease in 2005 of 17 . Laundry services also showed a decrease of 16 . The maintenance of the home was rated by 69 of relatives as excellent/ very good in 2005, a decrease of 17 from 2004. A quality and self – development self-audit process is completed by the Registered Manager and verified by the Quality and Development Manager. The file is muddled making it difficult to find recent evidence and contains record sheets from July 2003 which have been signed off in June 2005. Although there are standards numbered between 1 and 3 there are no explanation of these standards. Riverbank has a residents committee for residents to contribute to the running of the home. The minutes of the meeting were not informative. The minutes were seen of the Heads of Department meetings on 26th October 2005 and the staff meeting 26th April 2005. Although there is evidence of meetings, the minutes are very basic and not informative for a staff member who may not have been unable to attend. Management meeting were also not informative The home has published a customer satisfaction action plan dated June 2005, which aims to address 5 areas: - privacy & dignity, activities, laundry, maintenance of home, improve gardens around the site. Although dates are assigned to each action point, progress will be evaluated through the next audit. There is no indication of when this audit will be conducted. One example is the area of activities which actions a more structured activity programme with immediate effect by the co-ordinators. This was not evidenced and is Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 34 recorded as being evaluated through the next audit when concerns have been identified about the activities provided. Two thank you letters for the last twelve months were displayed in a folder in the entrance of the home. The deputy manager said that more had been received. The chef has attended a ‘Chef’s Best’ training course which is provided by the company. This has been a useful course and has generated many ideas for improving the food delivery at Riverbank, for example creating a herb garden. The Chef uses a quality assurance process to continually monitor and improve food delivery. He uses questionnaires and verbal feedback and these are used to improve and change menus. 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. Two 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. Two records were examined and again showed receipts for purchases and invoices. The maintenance man kept comprehensive records. Weekly fire alarm tests were evidenced. The last alarm service was recorded as 15th December 2005 and the last fire drill 9th September 2005. Emergency lighting is tested monthly and a monthly maintenance plan completed. Quarterly sterilisation of showerheads and hoses completed Oct 2005. Electrical inspection of food trolleys completed monthly. Monthly heating service record completed. Mobile and static hoists inspection logbook completed monthly. PAT inventory register completed. Monthly water service record completed. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 35 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 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 x x 2 X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 3 Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 36 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 2 3 Standard OP1 OP3 OP7 Regulation 4(1)(c) 14 14 and 15 Requirement The statement of purpose must be amended to reflect changes in the management structure. A competent and appropriately trained person must assess residents prior to admission. The registered person must ensure that records that identify residents’ needs and staff responsibilities in meeting their health and welfare are completed in full, kept under review, including appropriate care plans, risk assessments and risk management strategies to meet their needs. The registered person must ensure that residents are treated with dignity and respect at all times. The registered person must consult residents; their relatives or representatives about their social interests and about a programme of activities arranged by or on their behalf and provide activities in relation to recreation with records of the activities undertaken. DS0000005164.V269864.R01.S.doc Timescale for action 01/02/06 01/02/06 01/02/06 4 OP10 12(4)(a)) 01/02/06 5 OP12 16(2)(M)( N) 01/02/06 Riverbank Nursing Home Version 5.0 Page 37 6 OP18 7 8 9 10 OP19 OP19 OP19 OP27 11 12 OP30 OP31 The registered person must ensure staff are aware of the providers policy on the management of challenging behaviour and provide staff with suitable training to reflect the philosophy of care at Riverbank. 23(2)(b)(c Repairs and redecoration and ) cleaning must be carried out in the areas identified. 23(2)(L) The residents’ quiet room on Victoria House Must not be used as a storage area. 23(2)(H) Suitable space must be provided on Victoria House for the provision of social activities. 18 The registered person must review the staffing numbers on Victoria House to ensure the health and welfare needs of residents are met. 18(1)(i) The registered person must ensure that staff are trained in moving and handling. 12, The registered person must 13(6)(7) ensure that the care home is conducted to make proper provision for the health and welfare of residents including suitable management of Riverbank and Victoria House. 18(1)(i) 01/03/06 01/02/06 01/02/06 01/04/06 01/03/06 01/03/06 01/02/06 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 3 Refer to Standard OP7 OP10 OP12 Good Practice Recommendations Important personal information is included in an individual’s life biography. The use of bibs should be reviewed on Beech House. The activity co-ordinators should be included in the staff DS0000005164.V269864.R01.S.doc Version 5.0 Page 38 Riverbank Nursing Home 4 5 6 7 8 9 10 11 OP15 OP16 OP18 OP19 OP19 OP27 OP30 OP33 training programme. Food choices should be offered to residents in a format that they can understand The complaints procedure should be more widely publicised and responses to complainants should verify if a complaint is upheld or not. Incidents of aggression between residents should be monitored to see if they need to be reported under the local authority adult protection procedure. Signage of residents’ bedrooms, toilets and bathrooms on Victoria House should be improved. The hot water temperature in the bath on Beech House should be monitored more frequently as the water temperatures were too low. Staff should provide care to residents with whom they are familiar and not be moved around. The accessibility to training records should be improved with the recording of training that has taken place. The quality assurance system should be reviewed to provide more information on the standards used and feedback from staff meetings. Riverbank Nursing Home DS0000005164.V269864.R01.S.doc Version 5.0 Page 39 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.V269864.R01.S.doc Version 5.0 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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