Inspection on 16/08/07 for Four Rivers Nursing Home

This inspection was carried out on 16th August 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

Four Rivers Nursing Home 08/03/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Four Rivers Nursing Home Bromfield Road Ludlow Shropshire SY8 1DU Lead Inspector Pat Scott Key Announced Inspection 16th August 2007 10:00 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 Four Rivers Nursing Home DS0000068660.V348937.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. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Rivers Nursing Home Address Bromfield Road Ludlow Shropshire SY8 1DU 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) 01584 813500 01584 813501 chris.musaka@shropshire-cc.gov.uk Shropshire County Council vacant post Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (30) of places Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The dementia unit must have a secure and service user friendly garden within two months of registration – 25th December 2006. The home may accommodate upto 5 service users between the ages of 60 and 65 years. 8th March 2007 Date of last inspection Brief Description of the Service: Four Rivers is a care home with nursing situated on the outskirts of Ludlow. It is managed by Shropshire County Council and offers single accommodation with en-suite facilities. It has good transport links to the town and local amenities. The home is set in newly established secure grounds that are accessible to service users and car parking facilities are provided for visitors. Four Rivers has a statement of purpose and service user guide which provides people with information about the services of the home. The fees for Four Rivers are: £743.13-768.75. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, a random pharmacy inspection conducted 5th July 2007, discussion with people who use the service, discussions with the staff team, discussion with the new manager and the responsible individual, tour of the premises, previous inspection report, quality assurance processes, observation of care experienced by people using the service. The Pharmacist Inspector made requirements and recommendations however since the timescale for compliance with these requirements had not been reached medication was not looked at in detail during the Key Inspection and there will be another random pharmacy inspection to follow up these concerns. During the inspection, significant time was spent in the lounge on the dementia unit watching how care staff looked after a small group of service users and also how these people spent their time. The care of these people was looked at in depth when comparisons with the observations were made with the homes records and the knowledge of the care staff. What the service does well: What has improved since the last inspection? The service information content and availability has improved. The service has identified where the quality of this can improve further i.e. to make the statement of purpose more reader friendly. Assessment records for new admissions are more organised. Through service audits gaps are identified and action plans provided to address shortfalls in documentation. Staff supervision arrangements are in place and being recorded. Care plan organisation has improved. The management have identified where bed rail risk assessments could be better so that the conclusions reached to use them are clearly documented. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 6 The provision of leisure pursuits for elderly service users has improved. Service users are consulted about their choice and preference for activities and those engaged in are recorded within individual care plans. The complaints process is more visible. The service has identified that the use of a comments/constructive criticism log would be beneficial. This will help to identify any trends in failure of the service. Management systems in place are more consistently used to safeguard service users, such as risk assessments, quality assurance surveys, audits and care plan reviews. There has been an improved approach to service user consultation and taking into account their views. 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. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3. National Minimum Standard 1,2, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with the information needed for them to decide whether the home will meet their needs. Admission of new people to the service has improved and demonstrates that consideration has been given to the social aspect of care. Service users are more assured that staff have taken their individual needs into consideration when planning care. EVIDENCE: The care provided for four service users was examined in detail. Two people had been admitted in July 2007 and two had been in the home for a few months. All spoke of the admission process and of the questions they had been Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 9 asked by senior staff. Records of the admission assessments have improved compared with those seen at the inspection in March 2007. The service users guide and the statement of purpose are in the foyer and each service user’s bedroom. Signed contracts are in place in service users’ personal files with a copy in their room. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care needs and risk assessments are set out in service users’ individual plans of care which direct staff to deliver dignified care. Service users are assured that most problems have been addressed and will be attended to. The management understands the need to comply with safe medication systems but staff practice does not ensure that the home’s procedures are complied with and that service users health matters are always safely addressed. EVIDENCE: Four care plans were examined and recording within them has improved. They are more organised, easier to follow and clinical interventions are more professionally written. Photos were in place on all four care files. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 11 However, two manual handling assessments read had omissions in their completion with regards to weight, height, overall score and signatures of the assessor nurse. This would not provide clear directions for safe practice for staff in hoisting service users. Staff are aware of this problem. There are some gaps in information but staff spoken with are able to think in a person centred way and are able to give a verbal update, even if the care plans do not reflect this. Bed rail risk assessments are in place but, as identified by the new manager and the acting manager, these could be more informative to demonstrate how the conclusion to use rails has been reached. This is particularly relevant where thick pressure mattresses are used and the rails are an integral part of the whole bed. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. The random pharmacy inspection of 5th July 2007 identified short falls with medication practice. Medication systems do not always follow good practice or safe practice guidelines and have needed remedial action. The practice identified and lack of adequate recording potentially puts people who use the service at risk. The management are now conducting medication audits to ensure compliance with the safe administration, safekeeping and disposal of all drugs and qualified staff will be made clear of what is required in their professional performance through the supervision process. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 12 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): Key Standards 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities have improved and generally meet residents’ expectations through assessment, consultation and choice. Residents receive a healthy diet according to their assessed requirement and preference. EVIDENCE: During the hour long observation on the unit for service users with dementia, an inspector focussed on three residents and observed activities and staff interactions. The care plans of two of these residents were later reviewed. Staff were aware of individual needs and preferences and organised activities to suit. For example one man whose care plan states is an artist was seen to be painting a picture with staff support. One resident was looking at a newspaper and a member of staff later went and sat with him to discuss articles of interest. Staff responded promptly to individual requests and made changes to the environment to support people to be as independent as Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 13 possible. During the observation some people spent periods of time sleeping and it was stated by the nurse on duty that this is part of a regular pattern of activity and the care plans support this identifying regular sleeping patterns. Residents enjoyed sharing stories of holidays and visits from family members with staff. Daily routines are well recorded in care plans and one section relating to the history of the resident was detailed and had provided information to staff to use to discuss with the resident. Records of daily activities confirmed this happened. Four residents had had their hair done by a visiting hairdresser. Other activities listed in the care plan included having nails painted, visits from friends and family, listening to music and sitting in the garden. One resident said that she had enjoyed her ice cream in the garden the other day. Multidenomination services are held regularly. Other activities available include; ‘knit and natter’, a summer fair, clothing sale. There are some service users accommodated who are not in the ‘older’ age group. One spoke of there being little to interest him and spends his time in his room by choice, and stated ‘but the days are very long’. The service should give consideration to providing lifestyle opportunities for younger adults. Service users spoken with during lunchtime were complimentary about the provision of meals. Menus are laminated and displayed on the dining tables. The catering manager issues meal choice lists which service users can tick their choice if able to do so. Service users were seen to be assisted with their choice by care staff. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Adult protection training is provided for staff so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users spoken to said that they would go to the staff in charge if they had a problem. They felt that staff are very understanding and try to sort out problems straight away. All expressed confidence that issues would be dealt with through the staff. Concerns spoken about by a person contacting the CSCI prior to the inspection stated their issues had not been promptly dealt with nor a satisfactory outcome reached. These comments had not been reported on in the complaints file and the service stated they are devising another way of recording non-formal complaints/issues and how the home deal with them. The management have identified this as a gap in the service and intend to introduce a comments/suggestions book. The home has received a number of complimentary cards/letters since opening. Staff have received adult protection training. Policies and procedures are available in the staff room. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables service users to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: Areas seen around the home are clean and rooms personalised according to taste. Call bell systems are working and are within reach of service users. Equipment such as hoists are still stored in the corridor recesses but have now been risk assessed for safe management. Service users spoken with said they were happy with their rooms. Results of the service user survey rated hospitality at the home as excellent and good. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 16 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): Key Standards 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. The competency of qualified staff for dealing with medication is lacking so that service users may not be given their medication as prescribed by their doctor. The recruitment steps ensure the service secures suitable staff and that service users are in safe hands. EVIDENCE: Qualified staff have now been trained in the management of syringe drivers for symptom control, PEG feeds and male catheterisation. Training files are maintained for individual staff. 54 of care staff have an NVQ qualification with 35 working towards one. Staff stated they are well trained and gave examples of courses they had attended. Staff know who to speak to if they have any concerns and all feel that they are listened to. There were three staff on duty on the unit for people with dementia. In addition a nurse was assigned to the unit. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 17 Staff files examined demonstrate that the recruitment procedure is followed in practice and there is accurate recording at all stages of the process. There is still some use of agency staff but this doesn’t adversely affect the quality of the individual care and support that people receive. The service is currently conducting recruitment checks on potential new employees. The home will then have a full complement of staff. Service users commented that staff are ‘warm and attentive’. A visitor commented that ‘staff are very good, polite and caring’. The random pharmacy inspection July 2007 questioned the competency of certain nursing staff in medication practice and compliance with procedures of the service and of their own professional body, the Nursing and Midwifery Council. This puts service users at risk of harm. A qualified staff member stated she had been provided with a days training through an external provider. The management are reviewing this area of service through audit and staff supervision. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 18 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): Key Standards 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has implemented quality assurance systems and audits so that service users are more assured that the service is closely monitoring its own practice and that the overall conduct of the home is being better managed. EVIDENCE: The management is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. For example audits for infection control, nursing care documentation and medication have been conducted in June and July 2007. As reported in outcome sections for health and personal care and staffing, the medication Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 19 audit is in place but could be improved to be more robust to eradicate poor practice. Records for the management of health and safety are maintained. Fire records showed that tests and drills had taken place. Supervision has commenced with a record of those undertaken and a separate document on staff files detailing areas discussed. Staff spoken with confirmed supervision is now in place. Quality assurance processes are now in place. Service user meetings are to be held 3 monthly during which the results of any surveys will be fed back. Customer feedback sheets are contained within the statement of purpose and service user guide folder in each bedroom. A relatives and visitor survey has been conducted. A service user survey has also taken place. The management is in the process of collating results to inform an overall picture of the views of people who are involved in the home. Staff stated that they have the opportunity to air their views through meetings. A care staff spoken to said ‘The acting manager has been very supportive and gradually things have improved’. Reports under Regulation 26 reviewing the conduct of the service take into account the views of staff and service users. A new manager is in post who will be applying for registration in due course. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 21 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. 1 Standard OP9 Regulation 13(2) Requirement The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Medication must only be administered to the person it has been prescribed, dispensed and labelled for to ensure that medication is given safely and correctly. Timescale for action 10/09/07 2 OP9 13(2) 10/09/07 3 OP9 13(2) Where people have been 10/09/07 prescribed, when required medication there must be written information in place to ensure that the circumstances when such medication should be administered are clear to all staff. This will ensure that medication is appropriately administered and residents are not receiving medication unnecessarily. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 22 4 OP9 13(2) Staff who administer medication must be trained and competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. All medication must be stored securely so that only authorised persons has access to it. (Requirements 1-6 made following random inspection 5/7/07.) 10/09/07 5 OP9 13(2) 10/09/07 6 OP9 13(2) 10/09/07 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 OP9 Good Practice Recommendations The medication audit used in the home should be expanded to be inclusive of all shortfalls identified at the random pharmacy inspection of 5th July 2007 and be conducted at a frequency to eradicate poor practice. The Controlled Drugs cabinet is fixed to the wall in order to comply with the Misuse of Drugs (Safe Custody) Regulations 1973. Where medication is administered with food and consent is not possible because of lacking capacity records must be made of the multidisciplinary team agreement that the way in which medicines are administered is in the best interests of that particular person and that the procedure DS0000068660.V348937.R01.S.doc Version 5.2 Page 23 2 OP9 3 OP9 Four Rivers Nursing Home will not effect the viability of the medication. Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Four Rivers Nursing Home DS0000068660.V348937.R01.S.doc Version 5.2 Page 25 - 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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