Inspection on 08/03/07 for Four Rivers Nursing Home

This inspection was carried out on 8th March 2007.

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 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 16/08/07

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 Unannounced Inspection 8th March 2007 09:15 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.V325004.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.V325004.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 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.V325004.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 up to 5 service users between the ages of 60 and 65 years. New service 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 but no other detail to provide prospective service users with information about the services of the home. The care home rates have been set but service users have not received contracts/terms and conditions of occupancy. Fees for Four Rivers are: £725-750. Four Rivers Nursing Home DS0000068660.V325004.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 is used to make judgements about this service. This includes: records kept in the home, pre inspection information provided by the area manager on 7/3/07, medication records, discussion with people who use the service, discussions with the staff team, discussion with the deputy manager, tour of the premises, quality assurance process, registration reports, observation of care experienced by people using the service. Comments within the service user survey forms, GP comment forms, placing professionals survey and relative/visitor survey forms were taken into account. This is a new service and this fieldwork visit being the first since registration of the home October 2006. What the service does well: What has improved since the last inspection? What they could do better: The links between the style of home, its philosophy of care and its size, design and layout should be made quite clear in the home’s statement of purpose. The provider needs to make clear in its statement of purpose which clientele their home is aimed at e.g. for those people with dementia. The staff need to be aware of the content and philosophy of the statement of purpose so that it can be discussed in supervision and training. The provider needs to produce a service users guide and reflect in this the changes within the regulations (as from September 1st 2006) to include detail relating to the standard package of services provided, the terms and conditions which apply to key services and fee levels and payment arrangements. The Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 6 guide is also required to state whether the terms and conditions (including fees) would be different in circumstances where a service user’s care is funded, in whole or in part, by someone other than the service user. One service user said that they had not been provided with any written information but had been able to ask questions. The complaints process should be more visible within the home as well as the statement of purpose and service user guide. Care plans should be written in a way that reflects the wishes of each individual and their diverse needs e.g. dietary needs, activity/social/emotional support and spiritual and religious views. Omissions within the care plans suggests that staff meet needs in a reactive manner rather than understanding individuals diverse needs and proactively delivering the service. The quality of the care plan recording is such that people who are not familiar with its content would not be able to use it in an emergency. Treatment and care should take into account each person’s individual needs, wishes and preferences. Good written communication is essential, supported by evidencebased information, to allow staff and service users to reach informed decisions about their care. Care plans are a tool of professional practice and one that should help the care process and promote high quality health care. The service needs to improve record keeping for the management of medicines. The current practice and lack of adequate recording on medication records puts service users at risk. It is considered that health and personal care provision is satisfactory for some individuals requiring less intervention, but there have been frailer individuals who have required more attention than they have received. Staff stated they had received training in various topics, but lack of supervision documentation and planned future training dates does not indicate that management will ensure staff competence in these areas. This is essential to demonstrate that recruitment, induction, training and supervision all come together to achieve good outcomes for service users. The service has made attempts to address the lack of provision for social activity by recruiting a co-ordinator. Service users should have a choice in what leisure activities they pursue and whether to participate. Storage of equipment in open areas within corridors is a hazard and should be assessed to minimise risk of injury to service users, visitors etc. The report produced following the visits conducted under Regulation must be available for inspection purposes. The provider is aware of the management failures and has reportedly taken steps to ensure that individuals receive care to meet their specific needs. The responsible individual has verbally agreed to stop admission to the home until shortfalls have been fully addressed. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 7 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.V325004.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 Four Rivers Nursing Home DS0000068660.V325004.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): Key Standard 3 (6 not applicable). National Minimum Standards 1,2,4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective service users and their representatives do not have the full information needed to choose a home which will meet their needs Omissions in the records for the admission of new people to the service do not demonstrate that the process is personalised or that consideration has been given to the social aspect of care. Service users do not have contracts or terms and conditions so are unsure about the fees they will pay for care provided. EVIDENCE: The acting manager has undertaken pre-admission assessments. He stated that he reviews these to decide if the home can meet the prospective service user’s needs before the service makes the decision to accept the application for admission and offer a placement. As the service is new, he is aware of the Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 10 importance of not admitting any service user whose needs cannot be met by the current staff’s skills and abilities. Copies of the assessment summary and care plans of those carried out through care management arrangements are in place. The admission documents seen show the service takes into account the individual physical care needs of a service user. Records read demonstrated that information is not particularly personalised with little consideration of an individual’s social history. An admission assessment for a service user on the dementia unit was incomplete with important mental test score assessments (clinical cognitive assessments) left blank. There was no assessment of orientation in time, long term and short term memory and no indication of the personal daily routine of the individual. The statement of purpose gives an account of the service provided but does not provide specific information on how to make a complaint in the home. It states the home will be able to support service users with complex nursing needs such as PEG feeds and wound management. Staff employed have not yet received this training to enable them to do so. The service does not have a service user guide. Prospective service users or their families have insufficient information on which to make a considered choice of home. Service user comments state that they had been able to visit the home prior to admission and all questions had been answered. Out of 7 service user comment cards returned to the CSCI, all stated that they had not received a contract. The home could not provide examples of written statements of terms and conditions or any contracts for examination. Relatives survey results commented that they rely on verbal information to be informed of what is included in the fee, liability, and overall care. Records provided after the inspection show that staff have received initial training to equip them with the necessary skills and ability to care for residents who are admitted. Four Rivers Nursing Home DS0000068660.V325004.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): Key Standards 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all service users’ social care needs and mental health assessments are set out in their individual plans of care which does not ensure that all care needs have been addressed and will be fully met. The service understands the need to comply with safe medication systems but staff practice and lack of medication audits does not ensure that the home’s procedures are complied with and that service users health matters are always safely addressed. EVIDENCE: Records show that staff have received training in the use of the care plan format used in the home. The service users do have care plans which are poorly developed. They are written by qualified staff and not all those seen included the date when service user contribution or active involvement was Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 12 sought. There were omissions for dates of one service user for when the plans were produced. Review dates are planned to monitor changing circumstances but with no record of them having taken place on time or at all. Records do not demonstrate that service users are involved in reviews in any meaningful way or encouraged to communicate their needs. There is no record that feedback from reviews is shared with service users and actions are agreed. Admission assessments were briefly completed, as were nutritional, wound, pressure area, social and emotional support problems. Information recorded does not direct staff to provide correct care or to gauge whether appropriate care has been provided. E.g. staff noted on 1/1/07 that a service user on the dementia unit had a swollen area on her right hip. The first instance a care plan was dated to have commenced for this problem was 27.1.07 when the skin’s condition was noted to be black and with necrosis. The tissue viability nurse was asked to review on 14/2/07. The date the daily record recorded that a pressure relieving mattress was put in place was 9/2/07. The nutritional status of this person was poor and subsequently lost weight. Staff referred for dietetic advice and planned to record her weight weekly which was not recorded as having been carried out. Service users had been put at risk from lack of pressure relieving equipment but pressure mattresses have now been provided. The responsible individual had reported that district nurses have been asked for their input into wound care management. The statement of purpose states that the service will be able to offer care to people with complex needs such as strokes, multiple sclerosis and those requiring specific end of life care. However, as staff do not currently have the expertise to provide for people with needs associated with these conditions e.g. use of syringe drivers, management of PEG feeds, people awaiting placement with these needs are not being admitted. Care staff spoken with stated that they had received dementia care training. Medication records on two units are not up to date with gaps in recording. A service user whom the nurse stated had refused her medication that morning on 8/3/07, had signed as administering it on the medication administration chart and the tablets were still in a pot in the drugs trolley. The current practice and lack of accurate recording puts service users at risk. Receipt of additional medication had not always been recorded. Hand transcribed medication had not been signed by two staff for safety and accuracy. No clear system for checking compliance with the administration, safekeeping and disposal of medicines is in operation. Care staff stated they had received training for medication awareness. Medication and health care practice does not meet with the Nursing and Midwifery Council guidelines or the Royal Pharmaceutical Society Guidelines for care homes. There is evidence that staff in the home do not put training attended into practice or consistently treat service users in a way, which respects their dignity. For example, staff stated they had received dementia awareness Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 13 training, however, a service user was left in a wheelchair by the nurses station when she wanted to be taken to the lounge. A member of staff was heard to state to a carer “take her to the lounge” without any reference to the person’s name. Another service user became disorientated after she was left to wander up the corridor after asking staff if she could go to the toilet. A service user comment card received responded to the question ‘Do you always receive the care and support you need?’ as “when agency staff are on without regular full time staff the standard of care drops as they do not understand the personal needs of each individual”. Another responded “Sometimes I have to bite the bullet and wait”. Two relative comment cards stated that the staff are helpful and welcoming and nothing has been too much trouble for them”. Four Rivers Nursing Home DS0000068660.V325004.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): Key Standards 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are provided with some social activity and can keep in contact with family and friends. Social, cultural and recreational activities may not meet resident’s expectations because of lack of assessment, consultation and choice. Service users receive a varied diet according to their choice on the day but lack of nutritional care plans suggests not always according to assessed need. EVIDENCE: Records do not show active consultation regarding their choice of daily activity. Service users on the dementia unit seemed compliant with the routine of the home. For example service users on this unit were seen sitting in front of a television programme but not watching it. Activities are not provided on a planned basis. There is no record of service users having been asked for their preference. Minimal consideration is given in care plans to supporting service users faith needs or social preferences. One care file seen has a life history in place and the records showed that staff had taken time to talk to this person about this. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 15 The provider reported that service has recruited an activity co-ordinator due to start in April 2007. The hairdresser was visiting and has a separate facility to dress service users’ hair. The salon was being used to store other items other than hairdressing equipment. It was not decorated in a way that would enhance this room and provide more of a social occasion for service users using it. The seat at the wash basin is not appropriate, as service users cannot transfer into it. A relative comment card stated, “the hairdresser comes in, but no other activities are provided”. Two other comment cards stated activities are “never” provided. There was little evidence of service users having personalised their rooms but it is reported that people can bring in their own personal items. A service user survey card stated, “Hooks in the bedroom for personal pictures would be lovely. Some pictures and a large faced clock in the lounge would make this a bit more homely” Menus are available and forms seen showed that service users are asked what they like or dislike on the day. Food is cooked by catering staff who stated they had received training. Service users were seen to be offered drinks at the morning tea/coffee round. A service user sitting on her own in the lounge/dining room area had a carton of drink supplement by her. This had not been opened and the straw was still attached in its plastic wrapper to the side of it. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 16 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): Key Standards 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not have access to a complaints procedure and lack of detail regarding this does not assure people that their complaint would be appropriately dealt with. Shortfalls within other outcome areas demonstrate that service users are not fully protected from abuse. EVIDENCE: The service’s complaints procedure was not visible within the home or, as comment cards stated, known by service users or others associated with the service. People are not provided with clear information in the statement of purpose and so do not know who to complain to, how to complain or what can be expected to happen if a complaint is made. Recent concerns for two service users re lack of equipment to promote tissue viability, omissions re wound care and poor pressure relief at the home should have been considered as a complaint. Advise has been given to the responsible individual to regard the two people whose care had been inadequate as vulnerable adults and to refer through the safeguarding adults process. Care staff stated that they had received safeguarding adults training at induction. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 17 The services aims, objectives and documentation do not refer to the rights of service users as a key principle of the placement. Service users may not be aware of their rights and are not actively supported to make independent choices or decisions in their daily living as seen within the care plans. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 18 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): Key Standards 19,26. 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 well-maintained and comfortable environment. EVIDENCE: The service does not clearly link its design of the environment to any philosophy of care within the statement of purpose. All bedrooms are single rooms and all have en-suite facilities. There was little evidence of personalising their rooms, but it is reported that people can bring their own furniture and belongings. Assistance with fittings, hooks, etc needs to be requested formally and the service needs to ensure that people know of this. Service user comments cards state that they are comfortable and the home is clean, warm and well lit. There were no odours in any part of the home. The Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 19 CSCI had been informed of concerns at the home regarding inadequate staff handwash facilities. Facilities have now been improved. Hygiene equipment is available but pedal operated waste bins do not work properly. The allocated storage area on the ground floor for 2 hoists, 2 wheelchairs and sit on weighing scales is not enclosed and immediately adjacent the main corridor. This poses some potential risks to service users which need to be managed appropriate to the needs of the client group. A soiled laundry bag was left in a bathroom and not in the designated colour coded laundry skips. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 20 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. There are no effective systems as yet for monitoring and supervising staff in order to develop individual and collective training and development plans which would promote good practice and improved outcomes for people using the service. EVIDENCE: Staff stated that initial training had been provided. Records provided after the inspection show that induction and mandatory training has been provided. The acting manager said that specific training to meet assessed needs of prospective service users is now improving. The training matrix does not show the qualification or role of the individual staff members and further training needs have not yet been identified through supervision or appraisal processes. The service uses a high level of agency staff. Service users commented that the care staff are very caring and helpful but that the quality of the support is unpredictable and inconsistent, particularly when agency staff are on duty. Staff reported that supervision has not taken place. Staff need to be able to fully record assessments, plans, evaluate and monitor the outcomes of care for service users. Supervision is an important element, which brings together all these practices and ensures that, after training, staff are competent to do their job and that competency is maintained. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 21 A staff member did comment that staff were attending NVQ programmes and training opportunities had improved. She felt staff were more motivated now and are looking forward to new management and was optimistic that care would improve. The service does not keep recruitment files on site. Files were viewed at Shropshire County Council offices on 19.3.07. Discussion with the Human Resources Manager identified that an audit undertaken by Shropshire County Council had identified gaps within the records and steps had been taken to resolve this. In general all of the files seen were very well organised. However, lack of recruitment information held on site at the home, does not allow any potential manager to have access to information about staff experience and skills. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management and leadership of the home is lacking which does not benefit service user care. Record keeping in the home is of poor quality so that service user’s rights and best interests are not safeguarded. EVIDENCE: There is no registered manager for the home. Interim arrangements are in place and active attempts being made to appoint a new person in the management role. The home contracts with the Primary Care Trust to enable it to manage the care home. The service does not have a named person to provide professional nurse advice for the organisation on older people’s mental Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 23 health and general nursing issues. In particular, to provide mentorship for the future home manager. This is imperative in order to support management and staff to develop this new service. There has been a failure to evidence through management systems that elements of staff training have been put into practice and staff lack leadership. Service users interests are not safeguarded as evidenced by poor record keeping. This has lead in some circumstances to putting service users at risk, for example by poor recording of medication, wound care, pressure area care and nutrition. Quality assurance monitoring has not been implemented as a core management tool. Policies and procedures are easily accessible in the staff room. The lack of a service user guide for the home makes it difficult for the staff and service users to be familiar with the aims and objectives of the provider. Service users have the opportunity to manage their own money if they wish, and facilities are provided to help keep it safe. Where the home manages money on service users’ behalf a system is in place to record transactions and accounts for spending. The responsible individual is reported by the deputy manager to visit the home but could not produce a report of the visit as required under Regulation 26. Lack of resources and poor management mean that service users have not been adequately protected or safe in this home. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 24 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 1 1 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 1 3 Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4(1) Requirement Timescale for action 08/05/07 2 OP1 5 (1)(2)(3) and 5A. The registered provider shall compile in relation to the care home a written statement of purpose. This document must be updated, written in plain English and made available in a format suitable for intended service users. It must contain improved detail setting out the aims, objectives, philosophy of care and terms and conditions of the home. You are required to do this because service users should have the opportunity to exercise choice. This can only be achieved if full information is provided. The registered provider shall 08/05/07 supply a written guide to the care home. It must include a summary of the statement of purpose, terms and conditions for service users, contract, summary of the complaints procedure. The registered person shall include the fee level in the terms and conditions where a service user’s care is funded in whole or in part by someone other than a service user. You must do this DS0000068660.V325004.R01.S.doc Version 5.2 Four Rivers Nursing Home Page 26 because service users should have full information about the home, which they can refer to, and prospective service users and their families can take away with them. 3 OP16 22 The registered provider shall establish a complaint procedure specific for the home. You must comply with this because service users/relatives/supporters/visitin g professionals should have access to a formal procedure. They need to be able to air their views about anything which happens in the home that they are dissatisfied, with in terms of treatment and care given by staff or the facilities which are provided. The registered provider shall ensure that persons working at the care home are appropriately supervised. You must demonstrate that you ensure staff competency and that competency is maintained. 08/05/07 4 OP36 18(2) 08/07/07 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 2 Refer to Standard OP3 OP7 Good Practice Recommendations The recording of entries within admission assessments should improve and be completed in full demonstrating consultation with all parties concerned. The recording of entries within care plans should improve demonstrating discussion between all members of the DS0000068660.V325004.R01.S.doc Version 5.2 Page 27 Four Rivers Nursing Home 3 4 OP9 OP12 5 OP12 6 7 8 OP22 OP24 OP29 9 OP37 inter-professional team and the service user. The recording of entries within medication records should improve to ensure that practice complies with policies and procedures and guidance. The registered provider should demonstrate consultation with service users about a programme of activities and arrange for these to take place according to ability and choice. The routines of daily living and activities should be provided that are flexible and varied to suit service users expectations, preferences and capacities. The service should make the hair salon more user friendly so that service users in wheelchairs can access the sink. The room should not be used for storage of other items and equipment. The registered provider should ensure that the hazard posed by open storage for aids and equipment is assessed and the risk to service users, visitors and staff minimised. The registered provider should ensure that people know that requests to furnish and personalise their rooms need to be made formally. There is an agreement to keep staff recruitment files at the personnel office in County Hall. The provider should maintain copies of relevant documents such as criminal record check outcomes, references, skills and experiences of staff within the home. The manager needs to have access to this information so that she/he can deploy staff appropriately to care for service users. The report of the visits conducted under Regulation 26 should be available within the home. Four Rivers Nursing Home DS0000068660.V325004.R01.S.doc Version 5.2 Page 28 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.V325004.R01.S.doc Version 5.2 Page 29 - 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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