Inspection on 25/05/05 for Birch Court Nursing & Residential Home

This inspection was carried out on 25th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 &... 19/12/05

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 WA1 2DF Lead Inspector John Mills Unannounced Inspection 25 May and 13th June 2005 th 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 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 F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Riverbank Address Egerton Street Howley Warrington WA1 2DF 01925 573772 01925 240158 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sue McLean/BUPA Care Homes Limited Angela Zuraw (proposed) Care home with nursing 150 Category(ies) of Dementia - over 65 years of age (60) registration, with number Old age, not falling within any other category of places (90) Physical disability (2) Terminally ill (3) Terminally ill over 65 years of age (3) Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. The total number of service users must not exceed 150. 3. No more than 90 service users in the category of OP (Firth, Church & Bridge House) be in receipt of nursing care. 4. No more than 3 service users in category TI/TI(E) (Terminal illness over the age of 50 years) may be accommodated in Bridge House. 5. No more than 2 service users in category of PD (Physical disability) in receipt of nursing care only may be accommodated in Bridge House. 6. No more than 30 service users in the category of DE(E) (Dementia over the age of 65 years) in receipt of nursing care may be accommodated in Victoria House. 7. No more than 30 servcie users category of DE(E) (Dementia over the age of 65 years) in receipt of personal care may be accommodated in Beech House. 8. Two named service users under the age of 65 years may be accommodated in Bridge House. Date of last inspection 14 December 2005 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. 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. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by three inspectors over two days. Victoria House and Bridge House were inspected on 25th May 2005. A number of concerns, relating to staffing on Victoria House, were raised with the service manager and an immediate requirement was also made in relation to the disposal of clinical waste. The second visit took place on 13th June 2005. The other three units were inspected and the arrangements that had been put in place to address the concerns raised on the first day were reviewed. Time was spent in conversation with the service manager. A tour of the residential units was conducted. On each of the five units, the inspectors spoke with residents, staff members of all grades, and visitors whenever possible. Care plans, staff rotas and a sample of other records were inspected on each unit. What the service does well: What has improved since the last inspection? The provision of social activities for residents has been increased. Some improvements have been made to the environment including new carpets on Church House, Firth House and Bridge House, and redecoration of the corridors on Firth House. A new garden has been developed for Beech House. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 6 What they could do better: 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 F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1, 3 and 4. Standard 6 is not applicable. Information about the home is provided for residents and their relatives. Prospective residents are assessed prior to admission to ensure that their needs can be met. Residents are sometimes moved from one unit to another, and when this happens the home should be able to demonstrate that the move has taken place in the best interests of the resident concerned, and following consultation. EVIDENCE: On Church House information folders for residents were seen in all bedrooms. There was evidence of pre-admission assessments by social workers employed by Warrington Borough Council in the residents’ care plans. Pre-admission assessments carried out by the home’s staff were not always signed or dated. The unit manager said that she usually goes out to assess prospective residents but the home manager or deputy manager may also do this. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 9 A number of residents had been transferred from Victoria House to Church House. The care plan relating to one of these residents was looked at. It showed no reason why the resident had been moved, but seemed to show that she was quite settled in Victoria House. The care plan contained no record of the decision being taken to move this person and contained no evidence of consultation with the resident or her family, although the unit manager said that she knew that the family had been consulted. The unit manager said that she was asked to go and meet the person prior to the transfer but was not consulted as to whether she agreed to the transfer. A reassessment had been carried out by a social worker. See recommendation. On Victoria House a new resident was being admitted. Pre-admission assessment details were available. The person’s relatives had visited and she had a sister who was resident at Riverbank. The pre-admission assessment for another resident was not signed or dated. On Beech House the newest resident had been admitted on 26th May 2005. A full pre-admission assessment was in her care plan. On Bridge House, service user guides, providing useful information for new residents, were in the bedrooms. There were 25 residents living at Bridge House and another was in hospital. Two residents were in the terminal illness category. Most of the residents are admitted to Bridge House initially for a short stay. The unit manager does not routinely carry out a pre-admission visit but does so if the individual has complex needs or there is any doubt whether their needs can be met in full at the home. A full assessment of each person is received from health professionals before admission is arranged. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8 and 10. Each resident has a care plan. The standard of care plans varied between the five units from being very good to being poor. In some parts of the home the health and personal care needs of residents were met in full, however this was not upheld throughout the whole service. Most of the residents spoken with considered that their privacy and dignity was upheld, however this was not demonstrated in all parts of the home. EVIDENCE: Church House had 30 residents. A sample of care plans was inspected. Care plans contained a good range of assessments including falls risk assessment, bedrails risk assessment (signed by a relative), nutritional risk assessment and assessment for pressure relieving mattress. These had been reviewed monthly. Care plans also recorded monthly weights, referrals to health professionals including dietician and optician and copies of any accident reports relating to that person. The care plans were generally well written and kept up to date, and showed that residents’ health needs were being met. This was confirmed by observation from the inspectors. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 11 Beech House had 27 residents. The care plan relating to a recently admitted resident was inspected. Problems that had been identified at the residential home where she had previously resided, for example non-compliance with medication, had not been included in the care plan. Whilst the care plans examined had been completed in full, the entries in them were very general and generic and were not specific to individual residents. It appeared that the staff involved in compiling care plans would benefit from training in this regard. See recommendation. A problem with the supply of basic toiletries for residents was raised by staff. This was discussed with the home manager who said that toiletries were available but a practice of ‘hoarding’ stocks on the units had been identified and addressed. Several of the ladies had no tights or stockings on. See requirement. On Bridge House a sample of four care plans was inspected. These had generally been completed to a good standard and were kept up to date, however the care plan relating to a resident who required regular dressings to an ulcerated area contained no description of the wound and no wound management plan. No camera was available to record wound care progress. The record of multi disciplinary interventions for a short stay service user who is due to return home was seen. The inspectors spoke to staff and residents and confirmed that their health needs were being met in full. On Firth House the care plans inspected had been very well written and maintained. A number of residents had been transferred from Victoria House to Firth House when they become physically frail. Ten residents were in the lounge. A member of care staff said that five residents stayed in bed, and the other 15 get up for a short while only. The unit manager said that some people get up for a short time in the morning but due to their frailty are returned to bed after lunch. A resident and her husband, who visits every day, were spoken with. He was very positive about Firth House and said that he is always made welcome. This resident’s care plan was seen, and was written and maintained to a good standard. The inspectors were told that there was some shortage of disposable wipes and paper towels. The care being provided to residents on Victoria House caused some concern to the inspectors. One resident was presenting with challenging behaviour which posed a risk to the other residents. Residents were constantly encouraged to return to their seats in the lounge and not offered any other form of diversion. An incident of inappropriate moving and handling was witnessed. A carer was observed to put her leg behind a service user’s knee in order to get her to sit Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 12 down. Another resident was in a chair in her bedroom at the end of a corridor. She was distressed and noisy. She could not see out of the window and had no TV, radio or other stimulation. The nursing assessment for one resident described him as ‘a well kempt gentleman’. When an inspector spoke to him at 2.50pm he had food all over his t-shirt, cardigan, hands, trousers and old food stains on his slippers. He had a dressing on his shin; staff on duty were unaware why this was there. Another gentleman was also seen to have food stains on him. This indicated poor standards of basic care in this unit. The ‘quiet room’ was being used by a staff member having lunch. See requirement. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12 Social opportunities are provided for residents. EVIDENCE: Beech House has its own activities organiser for 30 hours per week and it was evident that residents were deriving great benefit from her input. On Victoria House there was no evidence of any ‘therapeutic interventions’ taking place even though an activities board was displayed. Two residents had gone with the activities organiser to join in activities on another unit. Firth House has social activities on a Tuesday and Thursday and residents may also join in events taking place on other units. The inspectors were informed that the quantity of food supplied had been reduced. This was discussed with the home manager who said that issues of excessive wastage and unauthorised consumption by staff had been identified and addressed. On Bridge House three residents were spoken with in the lounge all said that the food was ‘very nice’. They were also very happy with the way in which staff provided care for them. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 14 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 standard(s) Not inspected on this occasion. EVIDENCE: Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19 and 26. Overall the environment was found to be clean and well maintained, but a number of shortfalls were identified which need to be addressed. EVIDENCE: Church House had a new carpet in the corridors which had improved the appearance but was causing a problem with trolleys veering to one side. This information was passed on to the home manager who agreed to look into the issue. There was a malodour noted upon arrival in the unit. See requirement. Hot water temperature was hand tested and appeared satisfactory, but paper towels were not provided in every bathroom and toilet. See requirement. The hoists were last serviced in May 2004 Bedrooms visited all showed some degree of personalisation. Some lumpy pillows were noted. See recommendation. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 16 The corridors in Beech House are badly marked in places and need a coat of paint. See requirement There was an odour in the corridor near to the entrance. See requirement Bathwater temperature was recorded daily in one of the bathrooms. Temperatures recorded over the last few weeks were 37 or 38 degrees, which is rather cool. The unit manager confirmed that bath water is rather tepid. See recommendation. The unit has a very pleasant new garden. Staff members expressed concerns regarding shortages of toilet rolls/paper towels. See requirement. Bridge House presented a good physical environment with the exception of a broken toilet seat in room 32. The corridors in Firth House had been improved by re-decoration, re-carpeting and new lighting. There were new armchairs and dining chairs in the lounge. The carpet outside the kitchen area is badly stained. See requirement. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 On three of the five units, staffing was satisfactory. Beech House had some recorded shortage of staff. Victoria House was very short of regular staff and in particular staff with mental health training. EVIDENCE: The duty rota for Church House showed that there were usually three nurses and three care assistants on duty in the morning, two nurses and three care assistants in the afternoon/evening and one nurse and two carers at night. The unit manager did not have any rota’d supernumerary time for management tasks. A member of domestic staff was on duty between 9am and 7pm. The unit manager considered that a change-round of staff earlier in the year had caused disruption to the unit, which was commented on by relatives, but the new team had now settled. The staff rota for Victoria House showed two nurses and four care staff in a morning, one nurse and four care staff in the afternoon. The unit had only three nurses employed on days and they are one registered general nurse and two second level psychiatric nurses. The unit manager has left. The other nurses were provided by Nurses Agencies. There was one registered mental nurse employed on night duty. At the time of the inspection the rota showed only there were only three regular care staff working on days, with two others marked as ‘absent’ and one Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 18 off sick. The inspectors were told that Polish staff were employed and that their command of English varied in competence. See requirement. Following concerns raised by the inspectors on May 25th, the deputy home manager was deployed to manage Victoria House until a new unit manager could be appointed. On Beech House a senior care assistant was carrying out domestic duties due to a shortage of domestic staff. This resulted in the number of care staff being depleted. The unit manager said that, following recent changes, staff were concerned at the prospect of being moved to other parts of the home. Rotas showed that five staff were on duty in a morning, four in the afternoon and three at night, however staff sickness had resulted in some shortfall in these numbers on occasions. The unit manager considered that staff morale had slipped a little. See requirement. Firth House rota showed that there were usually two registered nurses on duty between 8am and 8pm and one at night. A total of six staff are provided in the morning, five in the afternoon/evening and three at night. These levels are maintained with some usage of Agency staff. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 Not inspected on this occasion. EVIDENCE: The home has a new manager. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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. 4. 5. 6. 7. Standard OP8 OP10 OP19 OP19 OP26 OP27 OP27 Regulation 12 12 23 23 16 18 18 Requirement The personal care needs of residents must be met in full. Basic toiletries and adequate supplies of paper towels, toilet rolls etc must be provided. The carpet outside the kitchen on Firth House needs to be replaced. The corridors on Beech House need to be painted. The home must be kept free from offensive odours. Suitably qualified staff must be provided to meet the needs of residents. Staff must be provided in sufficient numbers to meet the needs of residents. Timescale for action 13/6/05 13/6/05 30/11/05 30/11/05 13/6/05 13/6/05 13/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP4 Good Practice Recommendations Residents should not be moved from one unit to another unless it can be demonstrated that it is in their best interests. F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 22 Riverbank Nursing Home 2. 3. 4. OP7 OP19 OP19 Senior care staff responsible for writing care plans should receive training to enable them to write the plans to a good standard. Hot water should be supplied at a comfortable temperature for bathing. Lumpy pillows should be replaced. Riverbank Nursing Home F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 F51 F01 S5164 Riverbank V228463 250505 Stage 4.doc Version 1.30 Page 24 - 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. 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