Inspection on 06/06/07 for Birch Court Nursing & Residential Home

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Birch Court Nursing &... 15/05/06

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

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

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

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

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Riverbank Nursing Home Egerton Street Howley Warrington Cheshire WA1 2DF Lead Inspector Anthony Cliffe Unannounced Inspection 09:00 6 and 7th June 2007 th 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.V333970.R01.S.doc Version 5.2 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.V333970.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverbank Nursing Home Address Egerton Street Howley Warrington Cheshire WA1 2DF 01925 573772 01925 240158 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.com BUPA Care Homes (CFHCare) Limited Ms Jacqueline Mary Boylan 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) Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category may be accommodated in Firth, Church and Bridge House: Code OP (maximum number of places: 90). Old age, not falling within any other category aged 55 years and above may be accommodated in Bridge House: Code OP (maximum number of places: 15). Physical disability in receipt of nursing care may be accommodated in Bridge House (maximum number of places: 2). Dementia over 65 years of age in receipt of nursing care may be accommodated in Victoria House: Code DE(E) (maximum number of places: 30). Dementia over 65 years of age in receipt of personal care may be accommodated in Beech House: Code DE(E) (maximum number of places: 30). The maximum number of service users who can be accommodated is: 150. Date of last inspection 21st December 2006 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. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 5 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 DS0000005164.V333970.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 6th and 7th June 2007 and lasted eight and a half hours. Three Regulatory Inspectors carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents and staff were also spoken with and they gave their views about the service. What the service does well: What has improved since the last inspection? Policies and procedures for managing medicines were adhered to and instances of bad practice had been reduced. The introduction of QUEST had helped information in residents’ personal plans to include more consistent information obtained about them and they generally reflected residents’ needs. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 7 Meal choices were offered to residents and their choices recorded. The complaints procedure was displayed prominently in all areas of Riverbank. The maintenance and décor on Bridge, Church and Victoria House had been improved. The deputy manager is supernumerary and able to support the house managers. House managers have the opportunity to develop their management potential. 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. The summary of this inspection report can be made available in other formats on request. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives so they can make a choice about where they live. Residents’ needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: Riverbank accommodates mainly people from the Warrington area and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 10 Residents or their relatives were provided with a copy of the service users’ guide and statement of purpose on request and copies of this and the most recent inspection report were available in each unit. Service user guides were available in bedrooms but not all bedrooms. This contained details of the facilities and services provided to residents. Information could be provided in different formats on request to head office. Survey’s returned from residents prior to the site visit confirmed that they had received information on Riverbank that helped them or their relative to choose to live there. Seven of the seven residents’ surveys returned prior to the site visit said information had been received about Riverbank before a decision about moving in was made. Three personal plans were examined of residents who moved into Riverbank. The residents had met with the manager or registered nurse to discuss their care prior to moving in. Information was gathered and this was recorded. This included information on their physical and mental health. Copies of these documents were on two residents’ plans. The other used the format provided by the intermediate care team, which purchased beds in one of the units at Riverbank. Copies of social workers assessments and care plans were on file with information from the Primary Care Trust and local councils that placed the residents at Riverbank. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 6, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal plans do not always reflect residents’ needs so they will not be informed about the care provided to them. Residents are not always treated with respect and so their dignity not upheld. EVIDENCE: Eight residents’ personal plans were looked at. The personal plan format used had changed to one developed by BUPA care services and was called QUEST. Staff were very complimentary about the Quest format and said it challenged them to think differently when completing it and that it gave them direction in what additional documents needed to be completed. For example a range of risk assessments and risk monitoring documents. Staff were able to make judgements on the needs of residents’ physical and mental health by using a set of descriptions about care needs. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 12 If residents’ needs were given a certain score then staff had to complete the additional risk assessments or risk monitoring forms. Staff confirmed they had three hours training on using the format. They said there were some gaps in the documents so support managing health care needs and this had been fed back to the manager. Some staff were unaware that there were new wound management documents in place and were either using the previous wound management charts or none at all. QUEST identified were residents were independent of need and looked at lifestyle choices. Support plane were completed where necessary for each area of lifestyle choice. All residents had their care plans changed over to the QUEST format other than those cared for in intermediate care beds. There were good examples of personal plans in place that monitored residents’ health. Personal plans were individualised to each resident. The plans related to medical and mental health conditions and gave guidance to staff. A resident had very badly bruised arms. Her personal plan was looked at. The QUEST assessment identified that she bruised and marked easily. Her personal plan was very thorough. The moving and handling plan was reviewed monthly. A bedrail risk assessment and risk of developing pressure ulcers were in place and reviewed monthly. Her records noted she had a recent visit from a General Practitioner. Another resident’s personal plan showed consultation with her relatives. Two residents were identified with pressure ulcers. Photographs had been taken of the wounds and shared with the relatives. Progress of the healing of these was recorded in the daily notes but no wound management charts or personal plans was in place. Staff were unclear if the QUEST format had a wound chart. One of the residents had been admitted into an intermediate care bed and no documentation from BUPA care services to supplement the care records from the intermediate care team had been completed. The resident had fallen but no falls risk assessments were completed. On one of the dementia care units the QUEST format had very detailed personal lifestyle support plans in place and these were generally reviewed monthly. They identified several aspects of the behaviour of a resident, which highlighted difficult behaviours that affected the resident and other residents’ behaviour towards her. The resident was noted as being aggressive at times and there were concerns about the resident’s sleep pattern. Reviews of her care did not focus on all of the concerns and how they were managed or if staff were looking at the underlying causes of the poor sleep pattern. The reviews recorded the resident had difficulty in communicating. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 13 A sample of medicine administration records were examined on Beech, Firth and Victoria houses. There were no errors noted on Firth and Victoria Houses. On Beech House there were some minor errors in the recording of administration, which were attributed to the unit manager being disturbed during the administration of medicines. In discussion the unit manager and senior carer said they found it difficult not to be disturbed by General Practitioners or district nurses that visited during the medicine round because they demanded the attention of who was in charge when only the manager or senior care was in charge. This was added to by the amount of time it took to complete the medicine round in the morning. They said that they were going to discuss with the manager the idea of reducing the morning medicine round by having once a day items moved to later in the day and not administering medicines during meal times which were busy and caused distractions. These would reduce the incidents of making errors. Prior to the site visit three relatives returned surveys. One relative said her experience of staff was that they treated residents as individuals and understood them. Two relatives contacted said that some of the care practices were poor. A relative said that her father in law never had his mouth washed following meals and she visited to find him with food around his mouth from the previous meal. Another relative said that on one unit the residents were referred to as the ‘ressies’ by staff. A staff member described some residents that needed assistance from staff as ‘the feeders’ and another staff member was heard to compliment residents by saying ‘good girl’. Some poor practices were seen but mainly there were positive interactions and good practice from staff. The examples of poor practice seen were fed back to the manager and deputy. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited staff interaction in some units reduces residents’ choices about their lifestyle so they have no control over their lives. EVIDENCE: Riverbank employs three activities coordinators that work on the five units. Details of the activities available were displayed on the units. Residents’ surveys returned prior to the site visit said that activities were usually or sometimes arranged and available to them. QUEST personal plans contained social lifestyle personal plans and details of residents’ family histories. A resident’s survey returned prior to the site visit recorded ‘rarely do the activities cater for my needs. Occasional musical performers visit’. Others said they enjoyed the activities but could not or did not want to join in. The activities organisers were seen on the units and activities varied form unit to unit. On Victoria House the activities organiser took a resident out to the local park for a walk at her request. She said she worked three mornings and two afternoons on Victoria House. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 15 There were details of activities on the residents’ notice board. A weekly exercise programme was due to commence 6th June 2007. This was a weekly session of oriental Pekeen exercise. The activities organiser asked residents what they wanted to do. One resident in particular wanted to listen to music and others agreed. An old time music hall CD was put on and residents, staff and the activities organiser all sang along to this. On Beech House the activities organiser said she worked full time. In the afternoon she had arranged to take a group of residents to another unit for a coffee afternoon and quiz. Staff spoke very positively of the activities organiser on Beech House and said she was very enthusiastic and energetic. On Church House the unit manager and staff said that they have some input from the activities organiser each day but could do with more. A resident said that people are asleep because “There are not much activities to keep us awake”. There was a quite relaxed atmosphere but daily living arrangements seemed routine. Residents sat in three ‘groups’ in the lounge and care staff did not get involved in any social activities. Details of the activities available on Bridge were limited. Staff on Firth House said, ‘not many residents can do anything on here’. Breakfast on Victoria House was seen being served. It was a choice of a cooked breakfast of eggs, sausages, tomatoes and black pudding well as cereals. Tables were set with table clothes, cutlery and condiments. There were jugs of fruit juice and glasses on the tables for residents to help themselves. Where residents were being assisted to eat staff sat at the same height as them and reminded then to eat or assisted them. Residents were not rushed when helped. The unit manager said staff were assisting residents to choose their meals daily but this proved difficult, as some residents did not remember what they had chosen and when they saw their friends meal usually wanted that. He said that they chose for residents that could not and most days the kitchen provided equal portions of the menu choices and staff would then show the residents the choices and allow them to choose one. A resident said, “I don’t mind living here for some time but not for good. I like to go out and walk around and also go shopping to Sainsbury’s for fancy cakes. I like fish and chips that, we get occasionally but not all the time. I can always have something else if I don’t like the meal I chose”. On Church House most residents had breakfast in the lounge. Staff were chatting with residents and there was some laughter. Staff spoke pleasantly and respectfully to residents. At lunchtime the choice of main meal was lasagne or bolognaise. Residents were able to choose what they wanted or carers choose for the others. There were a lot of eggs on the menu and a male carer said he had been told that there would be new menus from 15th June 2007. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 16 All residents looked nicely dressed and their clothes were in good condition but unit manager said that the laundry service is ‘not much better’. Laundry staff brought clean clothes to the unit and put them in residents’ bedrooms then the care staff put them away in drawers and wardrobe. Often the wrong clothes are brought also carers put the clothes away without checking. On Beech House lunch was seen being served. Tables were set with condiments, cutlery and flowers. Residents helped themselves to drinks available on the table. Staff were available to assist and remind residents to eat their meals. The manager had the daily menu sheets that they used to record meal choice. On Firth house mealtimes were seen during an observation of resident interaction with one another and staff. Pureed meals were presented in portions but there seemed a high number of residents with a pureed diet. A relative questionnaire returned prior to the site visit raised concern about how staff assisted residents to eat their meals on Firth House so an observation of practice was decided. The relative recorded ‘Mum has swallowing difficulties and is fed by teaspoon by the family. Other residents with similar difficulties are fed by a tablespoon loaded inappropriately and residents given little time to swallow. Staff stand to feed them and limited interaction takes place. I am always anxious that in my absence, mum is also fed like this. I have raised the issues and been assured she is not’. During the site visit a new method on gathering the experiences of residents was used on Firth House. A small group of residents who could no longer used words or communicate their needs were watched for a period of two hours. Information on how they related to one another, staff, pets and their environment were recorded. This included staff interaction and practice. The findings of the observation were that there were poor interactions from staff to residents. Examples of these were; A nurse walking past the back of a resident sat in his chair. The nurse got hold of the chair and pulled it backwards so that it was in line with the other chairs. This momentarily startled the resident. A drink was placed on a table in front of him but no words were spoken. A member of staff later tried to put the cup into the resident’s hand. He would not hold it and looked at the staff member. The member of staff started to walk away then turned back and wiped his mouth but didn’t speak to him. Two members of staff stood near the resident discussing whether they should change his t-shirt as it was stained, but they decided to do it later. Another passing member of staff wiped his mouth with a tissue but didn’t speak to him. A member of staff started to give a resident her lunch but did not speak to her except to say her name. After a few attempts the carer said to another carer ‘she’s not swallowing this’. She took the meal away and returned with a beaker of tea, which the person drank. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 17 Another resident appeared to be sleeping. She still appeared to be asleep when a carer started to put food into her mouth. It was five minutes before the carer spoke to her. She was not given a drink after her lunch. Later she was given a drink from a spoon. Later on two carers started to put a sling underneath her. They didn’t speak to her. Another carer came with the hoist and said “you’re going to have a nice rest now”. As she was put onto the hoist one of the carers said, “up we go”. These were the only words spoken. The practices on Firth House were discussed with the manager and deputy at the feedback session. The manager said she was genuinely concerned as a staff had ‘personal best’ training, which covered how to uphold individuals’ dignity and how to communicate with residents. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are acted on to demonstrate they are taken seriously. An informed staff group and manager protect residents from abuse. EVIDENCE: There were several recorded complaints since the last site visit. The local council also provided details of complaints made to them about Riverbank. The complaints file was looked at and contained copies of complaints and letters sent to family members following the investigation of complaints. The letters acknowledged that complaints were valid and apologies offered. Most complaints were about the laundering of clothing or clothing going missing. The manager said she would replace items of missing or ruined clothing. The main concern was that large amounts of clothing was not being returned to the right resident and the home being without appropriate ironing facilities for a year. The manager said this had been due to repairs not being completed despite requests to her manager. Comments received from residents and relatives were that they knew how to make a complaint or who to complain to. A relative had completed a survey raising several concerns about the care of a relative and said the concerns had not been discussed with the staff or manager. Another relative said she had raised concerns and the manager had looked into them and following a meeting with staff there had been improvement. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 19 The manager had made several referrals to the local council under the protection of vulnerable adults. Riverbank cooperated with the local council and suspended staff. The local council asked the registered manager to investigate some of the concerns raised and also looked into them with the local council. The local council were satisfied that the registered manager had completed full investigations and no further action was taken. Examples of decisions following the completion of investigations were that staff members was supervised for a period of three months following an investigation. Two staff members was dismissed and referred to Protection of Vulnerable Adults Register. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and well maintained environment, which is equipped to meet their needs. EVIDENCE: The home is set in its own grounds and each of the residential units has its own enclosed garden. The grounds were well maintained and pleasant areas had been provided for residents to sit and walk in. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 21 On Victoria House some bedrooms were looked at. The majority of bedrooms have vinyl non-permeable flooring in them. The floor in bedroom some were marked with use. The manager said she would replace flooring as her budget allowed but some were a priority. The smoking room in the lounge had been changed to the staff office. The staff office was being changed to a themed quiet room using a mid 20th century theme. The small residents’ quiet room was being considered as the smoking room due to the few residents on the unit that smoked. Staff said since they used the former smoking room as the office they were able to have more direct observation and contact with residents. The charge nurse said that staff were able to intervene more quickly when potential altercations were seen and this had helped the environment to be calmer. Memory boxes had been put up outside residents’ bedrooms to help them recognise their bedroom. Some bedroom doors had been fitted with doorknockers to make the look more like a front door. The manager said this helped some resident recognise their bedroom door as much as the memory box. Memory boxes contained photographs of the resident from their life. For example if they had completed national service, or a picture of their family, relatives or pets. The décor on Bridge House looked shabby and worn and in need of up dating and painting. A new office had been created and the old office was to be used as smoke room. A relatives’ survey returned prior to the site visit said the décor on Bridge House was in need on improvement. A new assisted bath had been fitted. On Firth House the décor was adequately maintained. Some residents were smoking in the main lounge, some people were coughing. There was no attempt to move them nearer to a window or door. Later an extractor fan was put on which helped clear the air. On Church House corridors had been re-decorated and the appearance was better. The carpet was clean and in good condition. In the lounge there was only a choice of large armchairs or very low ‘curtain’ type chairs. A resident of slight stature was sat in a large armchair was slumped over; a carer commented that they need more ‘bucket chairs’. The garden area was well maintained. Staff members helped out with weeding and brought plants in. There was no evidence of residents being involved or sitting in the garden but most could see the garden from lounge or their bedroom. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 22 The manager said that she was discussing how smoking arrangements were to be finalised, as there were very few residents that smoked across the five houses. To provide separate smoking facilities in the houses that didn’t have them would cost several thousand pounds. She said she would discuss this with her facilities manager. She confirmed a major refurbishment of Riverbank had been postponed. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures that residents are protected. The induction and training programme provides a skilled workforce that protects residents’ welfare. EVIDENCE: Staffing levels were appropriate and the manager confirmed that staffing numbers were determined by the dependency of residents and could change. Each unit had an appropriate mix of qualified and unqualified staff. The unit manager on each unit was experienced in the care of the residents for that unit. The pre inspection questionnaire returned prior to the site visit recorded that seventeen of the seventy-seven care staff employed had an NVQ level 2 qualification and eleven were completing one. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 24 Four staff had commenced employment and had been supervised through an induction programme, which included training on the protection of vulnerable adults. The records of these staff were examined. All contained appropriate identification documentation and completed POVA First and Criminal Record Bureau disclosures. All files had two written references. But two staff had references from the deputy manager at Riverbank who they had previously worked with at another BUPA care home. There were no employers’ references and the ones form the deputy manager were confirmed as accepted as such. Files contained copies of the induction programme. The personal identification numbers of registered nurses were checked with the Nursing and Midwifery Council. Staff completed the induction programme supervised by the manager, deputy or a registered nurse dependent upon the grade of staff. Induction programmes ran each month and included familiarisation with policies and procedures. Staff received a handbook which contained the companies adult abuse policy and the General Social Care Council code of practice during induction. Staff had a post induction supervision session or appraisal. Staff files contained evidence that staff had undertaken statutory training. Training calendars were on each unit and recorded planned and completed training for wound care, personal best, food hygiene, infection control, QUEST training, fire moving and handling, health and safety and abuse awareness. Staff were spoken with care practice looked at. On Bridge House a staff member spoken to said they had been employed as a carer for one month but had not yet had an induction. The staff member was supervised and not moving or attending to any residents needs unless another staff member was assisting them. On Victoria House a carer spoken with said, ““I’ve worked here on regular mornings for the last year with the same resident who I do a one to one with. She can be quite challenging at times with her behaviour but she’s really nice and we get on well. I get a lot of support from the regular staff and feel part of the team. I have a good relationship with the other residents and can help with their care. We go out to town and to Sainsbury’s for a cup of tea and a cream cake, which she really enjoys. She also likes regular walks. She has told me all about her life and where she used to live and we talk about the ladies she used to live with. I think she misses living there and I know that the unit manager is trying to make sure she lives in the right place for her”. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 25 On Beech House a staff member said, “I’ve only recently transferred from another unit after I was appointed the senior carer. The manager on here is very supportive and they are a good team to work for. We have lot’s of ideas but sometimes we wonder who we should talk to them about as we want to put them into practice but the manager and I don’t feel we can make these decisions without consulting the manager and deputy. They are both very good and have asked us for our ideas and we see that as an important step in making changes. We want to have protected meal times so residents are not disturbed with tablets during them. It might be useful to look at how we do things but sometimes you don’t look at yourself so don’t see how you can improve. We were due to have a heads of department meeting and we were going to discuss our ideas. We have started to work alongside the care staff more so we can look at their practice. QUEST has made a big difference as when you write the support plan it makes you really thinks about what information you need to consider and it’s based around lifestyle choices which is a different way of looking at how we support residents”. On Church House the unit manager said that she had a full team of staff that she was very satisfied with. No agency staff were being used. The unit manager was doing additional training so that she could support the manager and deputy when required. She said she was enjoying it. A recently appointed care assistant spoken with said that had completed all their induction training and was now doing ‘personal best’ and would like to do an NVQ qualification. The housekeeper spoken with said she had worked at Riverbank for a year and completed all mandatory training including personal best. He said he liked to make time to speak to residents and would like to become a care assistant. He said, “The unit manager is excellent to work for we are a good team”. Another care assistant spoken with has completed an NVQ level 2 qualification and wanted like to do an NVQ level 3 qualification but was told there was no funding at present. He said there were frequent staff meetings and staff were able to say anything they want to. He said “everyone’s open-minded here”. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good quality assurance systems, financial procedures and maintenance of the building and equipment safeguards residents and ensure they are safe. EVIDENCE: The home manager has been in post for one year. She was a registered general nurse and had the registered manager award. She was previously the deputy manager for several years. A deputy manager or clinical services manager had been appointed and supported the manager. They were developing into a stronger management team, as these were there first management posts. A full time and part time administrators supported them. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 27 An area manager carries out visits required by regulation 26 of the Care Homes Regulations. The clinical services manager is responsible for audits that compliment the quality assurance system. Each month she completed a random sample of personal support plans and medicine administration records of individual residents across the site. Copies of these were on residents’ files. The audits identified errors in the writing and recording of both care plans and medicine administration records. This set out timescales for errors to be rectified and clearly identified who was responsible for ensuring errors were rectified. The clinical services manager clarified that if timescales were not met then a decision if disciplinary action should be taken would be considered. A part of the quality assurance system there were audits of accidents, pressure ulcers, equipment, water temperatures each time residents were bathed, maintenance and fire system each month. The regional manager then audits the care home each month using the original data gathered by the manager. To support the quality assurance system questionnaires were sent to relatives and a report collated from the information received. Meetings for relatives were held and minutes of these available. Unit managers did not have supernumerary hours but the clinical service manager was employed in a full time supernumerary capacity and available to support them. Staff had completed a ‘personal best’ initiative, to improve the quality of the service provided. The units hold their own staff meetings. Heads of department meetings were held monthly and include catering and housekeeping. Monies held on behalf of residents were kept safely and securely and records of administration confirmed residents’ monies were administered correctly. Information provided by the provider in a pre inspection questionnaire and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed. Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations 2. OP10 3. OP14 Riverbank Nursing Home DS0000005164.V333970.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V333970.R01.S.doc Version 5.2 Page 31 - 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. 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