Inspection on 18/05/09 for Rider House Nursing Home

This inspection was carried out on 18th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rider House Nursing Home 09/11/09

Rider House Nursing Home 19/05/08

Rider House Nursing Home 30/11/07

Rider House Nursing Home 14/11/06

Rider House Nursing Home 12/01/06

Rider House Nursing Home 11/07/05

Rider House Nursing Home 04/01/05

Rider House Nursing Home 06/07/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Key inspection report Care homes for older people Name: Address: Rider House Nursing Home Stapenhill Road Burton On Trent Staffordshire DE15 9AE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Davis     Date: 1 8 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Rider House Nursing Home Stapenhill Road Burton On Trent Staffordshire DE15 9AE 01283512973 01283511749 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rider House Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability terminally ill Additional conditions: 3 PD - 18 to 65 years 38 PD - Minimum age 60 years on admission 4 TI - Minimum age 60 years Date of last inspection Brief description of the care home Rider House is a 38-bedded care home (with nursing care) and is situated on the Stapenhill Road, approximately one mile from the centre of Burton upon Trent. Rider House is part of the Elder Homes Group, the registered manager is Roslyn FoxRoberts. The home is registered with us to meet the needs of adults with a physical disability and those with a terminal illness. The home also has two intermediate care beds, which are facilitated by the Primary Care Trust (PCT) and the Social Care and Health Directorate. This means people can reside at Rider House on a short-term basis with an intensive internal and external support programme with a view to them returning to their own home within a reasonable period of time. Information about the fees for this service are included within the Service User Guide, they vary from £500 Care Homes for Older People Page 4 of 37 Over 65 38 0 38 4 Brief description of the care home £545 per week. This was correct at the time of the inspection but people may wish to enquire directly to obtain up to date information. The environment is fit for purpose and in the process of modernisation and refurbishment. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over 1 day and was unannounced, this means the people who use the service and the staff did not know we were coming. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. We rate outcomes for people and these are described as excellent, good, adequate or poor based on findings of the inspection. This process considers the homes capacity to meet regulatory requirements, national minimum standards of practice and focuses on aspects of service provision that may need further development. Before visiting the home on this inspection, survey information was completed and returned to us by health care professionals, people who use the service and the staff. The service also has to complete an annual quality assurance assessment to tell us how they meet the needs of the people who use, or may use the service. This focuses Care Homes for Older People Page 6 of 37 on what they do well, how they evidence this and any areas in need of improvement. We looked around the home to make sure that it is warm, clean and comfortable. We looked to see whether people who use the service are being protected and the arrangements the service has for listening to what people think about Rider House. Information is gathered from speaking to and observing people who live at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of the people using the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We completed a Short Observational Framework Inspection (SOFI) on this inspection. During our pre planning we had information that told us people may not be receiving enough stimulation in the home. We were also aware the staffing levels may not meet peoples needs. SOFI is designed to give us an opportunity to record our observations during the inspection of care homes where people have dementia or severe learning disabilities. It can enable us to look closely at practice issues and observations; it is used illustratively alongside other evidence. SOFI offers first hand experience of sitting alongside people who use the service for a couple of hours in a communal space within the care home. It gives an insight into their general well being during this time, and also into the staff interaction with the people who use the service. Observations were made of interaction between staff and people who use the service around non-personal care tasks, at lunchtime and during the Short Observational Framework Inspection (SOFI.) Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? The requirements made at the last inspection have been complied with, this means the outcomes for people who use the service have improved within these areas. They were as follows Information regarding intermediate care beds should be expanded upon to ensure people who use the service have a clear understanding of the process and cost implications. This is now available but the two rooms should be identified as they have changed since the last inspection. The home must ensure the care plans are further developed for all people who use the service. They should link to the needs assessment, risk assessments, and be agreed with individual person, and/or their representative. This is now in place and care plans are well written. The home must ensure that in all instances the welfare of people using the service is promoted by robust risk assessments. This is so, the risks associated with delivering support are agreed and recorded. These are now evident. Modernisation and decoration of the home is required to provide more suitable and Care Homes for Older People Page 8 of 37 attractive surroundings. This is ongoing. We noted that some areas of the home had been redecorated and some bedrooms have been refurbished. Staff must receive appropriate supervision to ensure they are appropriately supported. Supervision records were seen in files inspected. The home must develop a contingency plan in the event of a fire or major incident; this must include a named place of safety. We were told this was in place but could not be found on the day of inspection. We will ask the manager to produce this on her return. Some staff told us there are no improvements. They said they felt really positive 12 months ago (recorded in the last report) when Elder Care Homes had just purchased Rider Homes, but now they are demoralized and have not noticed any recent improvements. What they could do better: The home is providing care, nursing and accommodation for a large number of highly dependent people. All persons accommodated have individual and often complex needs and aspirations which require appropriate levels of clinical and staff support, and supervision. The service must seriously review and consider the number of care staff on duty on each floor for the health, well being and safety of everyone living at the home. We have issued a requirement for staffing levels to be appropriate to the needs of the people living at Rider House. This is to promote and maintain the health and welfare of people living in the home. We found there are not enough activities for people who live at the home. The home does not employ an activities coordinator. Given the dependency of people who live at the home the hours available are insufficient. The number of care staff available to care for people at the home is inadequate and affecting outcomes for people who use the service. It also means care staff have little time to engage with people living at the home. Staff told us: Id like to sit and have a chat with the residents but we just dont stop. We try so hard but its sometimes impossible we dont have time. A visiting professional recorded on a questionnaire, Better staffing is always helpful. The home needs to establish a planned programme of activity to improve the quality of life for people, including trips out of the home. The home needs policies and procedures on Depravation of Liberty. This means staff have clear information to establish whether the home needs to make an application to request a depravation of liberty from the appropriate professionals. Information within the home should be tailored to meet the needs of the people who Care Homes for Older People Page 9 of 37 live there. We recommend the home promotes pictorial and easy read literature. The service needs to consider how to improve morale and ensure all people involved with Rider House feel confident to raise issues. Relatives and staff have used the phrase with regard to the company, It is like hitting your head against a brick wall. And We do not feel listened to. Communication and liaison with people who use the service should be documented to evidence people have a say into their homes environment and anticipated change. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to live at the home have an assessment of their needs, giving assurance the staff are aware of these, and can meet them. Intermediate care is provided effectively. Evidence: From the information made available to us in the AQAA it was possible to establish how many people were funded through Local Authorities and how many through the Primary Care Trust ( PCT). It was also possible to establish how many persons were self funding. The homes AQAA stated there had been 25 deaths in 12 months, though these were not collated in any way, for example whether persons were admitted for palliative care, whether the deaths occurred at the home or in hospital. We have fed back to the manager previously and fed back to the area manager on this occasion that more information within the AQAA would demonstrate a positive approach to management of information. Care Homes for Older People Page 12 of 37 Evidence: People who use the service are suitably assessed and offered the necessary information regarding Rider House, this also includes information on intermediate care beds as required, however these are not identified and we recommend they should be recorded within the Service User Guide. The Statement Of Purpose and a Service User Guide have been reviewed since the last inspection and contain the required information, this means people have access to everything they may need to know. It is recommended that people using the service are informed that the Statement of Purpose and Service User Guide could be made available in a format appropriate to the people who use the service, their individual capacity and language. The home may also wish to consider an audio or pictorial version. People living in the home are assessed by the manager or a senior member of staff from the home prior to moving in, this helps to ensure peoples individual needs can be met. Paperwork available and discussion with the staff told us that a full assessment before admission to the home is taken seriously and fully considered. Areas such as health care needs and social needs are discussed along with the individuals ability to live with the current group of people living at the home. We saw that everyone we requested files for had an assessment of their needs before agreement was reached for them to come and live at the home. This gives people reassurance the home can meet their needs. We were told that people were encouraged to visit the home before making a decision to live there and indeed a family visited on the day we undertook the inspection for a look around. Questionnaires revealed: Patients with intermediate care have always fed back good reports to the team. Patients are made to feel welcome. Rider House is not registered to admit people with a learning disability, one persons records we case tracked evidenced this area of need. It was clear there were also a number of nursing needs for this person but the home must be clear on the primary care need, and in what capacity the person is admitted. Not doing so is a breach of their registration. The home must also be confident the staff have the training to meet the needs of all people admitted to the home. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive personalised care and support to meet their needs. However, these are not always met in a timely manner. Evidence: All people living at Rider House have an assessment of their needs from which a plan of care is developed. We found plans of care and care records have improved. Care plans fully identify all the persons care needs and these are clearly reviewed. Other professional support is requested when needed, one nurse said, we are not afraid to ask and seek other professional support. Visiting professionals who completed questionnaires reported: Home visits are arranged where possible. Excellent with palliative care patients. Good team work. Care Homes for Older People Page 14 of 37 Evidence: Staff seek advice and support where appropriate Patients have regular meetings with the staff team. There are care risk assessments in place for potential poor nutrition, pressure sores, falls, and the use of bed rails and we found these risk assessments are regularly reviewed. We were able to see that people are seen by other health professionals such as doctors, dentists, chiropodists, opticians and community psychiatric nurse (CPN) when clinically indicated. We require that the arrangements for bathing people must be reviewed to ensure that people are bathed regularly and to promote their health and wellbeing. There was insufficient evidence to demonstrate this had been met. One person said I am not allowed more than one bath a week because of time; I know the staff would bath me if they could. The home still does not have a key worker system (a recommendation made at the last key inspection) which should enable staff to establish special relationships and work on a one to one basis. We heard from a number of staff who told us they really liked working at the home but found the work very pressured and they felt they often did not have sufficient time to spend with each person. From observation and discussion we noted the routines are primarily task orientated. We observed a nurse administering medication in the dining room at lunchtime and saw she was following appropriate procedures in handling and recording what she gave to people. She kept the medication secure at all times. We have made two recommendations because as and when ( PRN) medication records are only completed when the person is asked and has the medicine. A record of all requests and refusals should be in place. Some medication records refer to take one or two as required, but it does not offer guidelines of when it is one or when it is two. This needs to be in place to ensure consistency from staff administering these medications. We saw the lunchtime meal being served. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person Care Homes for Older People Page 15 of 37 Evidence: at their pace, making them feel comfortable and unhurried. Staff were unable to wear aprons as none were in stock. As a result of the Short Observation Framework Inspection (SOFI) the subsequent evidence is available. This part of the inspection was carried in the lounge located on the ground floor between 13:50 and 15:20 We continually observed 4 people during this time, although one person went for a shower at 14:35. Staff came in to complete tasks such as bringing in cups of tea or to sit with people and chat. Hot drinks were given out in cups but there were no saucers. A care assistant also came in to carry out nail care and manicures to some of the people sitting in the lounge. A second care assistant joined her. Staff were polite and respectful and people who use the service did get appropriate interaction or responses. One person who uses the service was asleep during all of the observational period. One member of staff did make an attempt to speak with them on one occasion but they did not wake. Another person was helped to go to the toilet by a member of staff. This was carried out discreetly and in a dignified manner with some assistance being given. The person was then encouraged to maintain independence and walk with the aid of a Zimmer frame. The carer who took the person for a shower asked him would you like a bath or a shower? and would you like a shower now or later? When the care assistant transported the person she did so using the correct moving and handling techniques and also promoting independence. The same staff member gave out drinks and made statements to suggest that she was aware of individual preferences I need to put sugar in that for you dont I? and I have made it milky just how you like it. The staff chatted naturally to the people in a friendly manner. The following comments were heard, From a person using the service to a staff member that young nurse who showered Care Homes for Older People Page 16 of 37 Evidence: me this morning was very good. Also from a person who uses the service to a staff member whilst she was completing the daily care plan with them What is that in aid of? and she replied Its your personal care plan which I have to complete, she then went on to show it to them. The room was supervised by staff for almost all of the time with only very short intervals of about three minutes when there was no staff present. It was confirmed by staff that staffing levels were exceptional on the day of the inspection and more often than not there would be two or three less. It must also be noted that the SOFI was done when there was a staff shift change so again more staff were present. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sometimes people living at this home have limited opportunities to take part in activities. People are encouraged to maintain contact with their friends and families and visitors are welcomed. Evidence: The home does not have an activities coordinator and staff provide the activities. Due to time constraints this proves difficult and there was no structured activity programme for the day, nor evidence of what activities should be provided. The Regulation 26 visit completed in March 2009 by the area manager for Elder Homes states; The home does not currently have an activities coordinator. Staff do make best efforts to ensure service users have activities but recording of these is sporadic at best. The staff confirmed there are few activities as there is little time. We observed nine out of ten people were asleep in the upstairs lounge. The staff team said It is because they are bored. When the staff engaged with they all woke and were happy to participate with the staff team, I only wish we had more time, it is so Care Homes for Older People Page 18 of 37 Evidence: lovely when we play the yes and no game, have quizzes and discussions or reminisce. Look how responsive they are. People who live at the home are able to have visitors at any reasonable time in the day. We observed several visitors arriving and leaving during this visit. To help us accumulate evidence we circulated surveys to gain peoples views about the home and we also spoke to some people on the telephone. There were a range of views, some people were positive about their experiences, others had some concerns and a few have raised complaints about unsatisfactory standards. We did not inspect the kitchen on this visit; the service has a recent five star rating from Environmental Health. The main meal was either hamburger or sausage with vegetables, gravy and potatoes. The pudding was rice pudding or ice cream. Pureed meals were served to those who required a soft diet and it was pleasing to note all foods were pureed separately. Everyone seen had a glass of water with lunch, when we asked about choice of juice or a cup of tea we were told I have seen a mixture of drinks in the past squash, beer. The meals are served in the dining room and the delivery of the mid-day meal was observed. Meals are served individually to the people who use the service and choice is offered. However, no one was asked which vegetables they would like and gravy were not served separately and poured over everyones dinner. The occasion was relaxed and pleasurable. Two people told us that the food was always nice and hot. One person told us menus were repetitive. We asked the chef to consider more visual and pictorial information which may prove useful and benefit people who use the service who may find it difficult to express themselves verbally. We have asked the home to consider a pictorial menu next to the written one on the chalkboard, thus offering further support to enable people to know the menu for the day. The chef said there were plans in place for this. People who use the service said that hot teas are now rare, usually it is sandwiches or salad but occasionally, more recently, they have been offered soup. Four days a week the kitchen staff finish at 14:30 or 15:00 and care staff have to deliver the tea. The service must consider hygiene issues and the lack of hot teas now provided due to the new staff rota. Care Homes for Older People Page 19 of 37 Evidence: Care Homes for Older People Page 20 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and have access to the complaints procedure, although not all people feel listened to. There are adult safeguarding policies and procedures in place that promoted the protection of people from harm but these need to be developed to comply with new legislation. Evidence: People can access the complaints procedure because it is displayed in the foyer and describes the procedure for people should they have any concerns. It is clearly written, easy to understand and explains what the procedure is and how long the process will take. All records need to be changed to reflect the new Care Quality Commission (CQC came into being April 1st 2009), rather than the Commission for Social Care Inspection (CSCI). We are aware of a number of concerns and complaints and there is a record of six complaints since the last inspection, this tallied with the information provided in the AQAA. Complaints seem to have been dealt with but in some instances an outcome is not recorded. Recording needs to be improved upon. Care Homes for Older People Page 21 of 37 Evidence: One complaint received by us in September 2008 covered staffing issues and included the following information Staff morale is very low the staff are becoming very tired and tearful. They told us when people are got up they are left sitting in wheelchairs for a long time before they are transferred to a lounge chair. They confirmed concerns have been raised with the management, but they do not appear to be listening. This was reaffirmed by another complaint we have received. On the day of inspection we spoke with people who use the service, staff and visitors, there was a clear message from all sources that staffing levels are not meeting peoples needs. People say they have to wait regularly to go to the toilet, sometimes for half an hour and relatives have raised this prior to the inspection with the Care Quality Commission formally CSCI. Another person said his relative had had to have a word about lack of staff members the previous day. Another relative spoken with said that breakfast had merged into lunch as sometimes people are not up and dressed until 11:00. This was verified by staff and people who use the service. One person said I am not allowed more than one bath a week as there isnt the time. Staff are clearly saying they have little time, some people are not up until 10:45 and lunch is at 12:30, staff say they are still making beds at 3pm. The staff are aware of protection of vulnerable adults (POVA) and safeguarding. There have been two safeguarding referrals since the previous inspection one is concluded, one is ongoing. We are confident the home knows how to manage these procedures. The home needs to ensure staff are made aware of The Mental Capacity Act deprivation of liberty safeguards. They must be aware of their responsibilities and ensure there are no other less restrictive ways of keeping people safe and well if liberty is deprived. Decisions must always be in the persons best interests and assessments and questions must be satisfactorily answered. We have asked the home to follow this through and ensure records are in place in one instance. We have made a requirement that the home drafts appropriate policies and procedures, we were told on the day of inspection these were near completion. Care Homes for Older People Page 22 of 37 Evidence: Care Homes for Older People Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The changes to the decor and furnishings create a pleasant environment for people to live in. However any disturbance and disruption to people living at the home should be suitably managed. Evidence that people have had a choice in the style of home is not apparent. Evidence: Rider House is clean, warm and safe, there was no mal odour noted during our visit. Door guards have been fitted to bedroom doors where people wished their door to remain open. The home has a variety of aids and adaptations which are suitable for dependent people, there is a staff call bell system throughout the home. We checked with staff and they felt there was enough equipment to support the people living there. Toilets are situated throughout the home, are accessible, and have grab rails. There is only one bath in the home presently and this must be improved upon, we were told a new bath is arriving in the next two weeks. We noted in some of the new en suites there is exposed pipe work, this needs to be risk assessed to ensure it does not become too hot and put people at risk. During our visit we were advised hot water was only available in approximately 30 Care Homes for Older People Page 24 of 37 Evidence: of the home, we raised this with Elder Homes who have ensured an engineer was sent following the inspection. We were told they visited Rider House on May 22nd to rectify the problem. Infection control is well managed and all the required measures such as liquid soap, gloves and aprons and sanitizer are in place. Rider House care for vulnerable people, some of whom are admitted for end of life, palliative care or short stay intermediate care (when poorly) with a view to going home. Noise disruption for these people may be very difficult, as is moving bedrooms. We have asked the home to ensure that in future they can evidence that peoples best interests are fully considered during building work. Families are also consulted where appropriate. Care Homes for Older People Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not always met in a timely way. Evidence: Records were checked and staff are suitably recruited to make sure people who use the service are protected. We saw no evidence on file to show if a new member of staff had received an induction. We spoke with this person who confirmed a formal induction had not been done but she had worked alongside another member of staff. They also said they had not received manual handling training. This must be addressed. We are satisfied that overall the staff team have the skills necessary to meet the needs of the people living at Rider House. During the time we spent at Rider House we spoke to all the staff and observed some of them supporting people. We found there were very positive and engaging interactions between those people living at the home and the staff members. Staff comments in questionnaires and speaking with them are as follows: New company have streamlined the workforce sometimes difficult to cover shifts. Care Homes for Older People Page 26 of 37 Evidence: Most staff are disappointed with the senior management of the new group, sometimes it feels like we are hitting our heads against a brick wall. Staff questionnaires and comments also reveal: We offer exceptional care for all service users. We are supported by the team. Relatives told us; Staff are scared, they are worried about their jobs. Another person spoken with said: They will loose really good staff, some have gone already. Visitors were present during the inspection and were either in the communal lounges or with people in their own rooms for privacy. When touring the building we observed staff knocking on doors to bathrooms and bedrooms. This means they are respecting peoples dignity and privacy. We are clear there are not usually enough staff to support people who live at Rider House in a timely manner. The effect of this is that people have to wait longer for attention. As already reported, one person told us that there are times we are not offered breakfast until 11.30. Another person repeatedly told us there are not enough staff. A visitor said no one had been in the lounge on some days they visited for an hour and a half. They commented: There are not enough staff to adequately care for residents. We are advised by people who use the service their families and staff people who use the service are left unsupervised in the lounge areas, sometimes for over an hour. The home must consider the complexity of the needs of the people who use the service and ensure their health and welfare is considered at all times. The homes policies, procedures and guidance should be revisited to ensure they support and inform practice, it may also mean ensuring a member of staff being present in this areas at all times (i.e. when people who use the service are present.) Care Homes for Older People Page 27 of 37 Evidence: Care Homes for Older People Page 28 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to have appropriate arrangements in place to keep people safe, meet their needs and promote their health and wellbeing. Evidence: The manager was not available during this key inspection but we are aware from previous visits that she has the required qualifications and experience necessary to run the home. The annual quality assurance assessment (AQAA) is a legal document that all services have to complete on a yearly basis. As already mentioned in earlier sections of this report we received the homes Annual Quality Assurance Assessment report when requested. However the information was not sufficiently detailed to demonstrate the service was based on robust and continual self assessment. All sections of the AQAA were completed but the information gave us a minimal picture of the situation within the service. The evidence to support the comments Care Homes for Older People Page 29 of 37 Evidence: made is lacking, more supporting evidence would have been useful to illustrate what the service has done or how it is planning to improve. The AQAA only gave us limited detail about the areas where they still need to improve and the ways that they were planning to achieve this are only briefly explained, there was no reflection on previous requirements. For example under what we do well in outcome group personal care which covers service user plan, health care, medication, privacy and dignity and dying and death states : We strive to provide high quality individualised care. It does not tell us how, what there is in place to support the rationale or what impact this has, or how the two requirements made last year have been met. The home has appropriate arrangements in place for the safekeeping of peoples money. We checked the records and found receipts available for transactions; balances were also checked and accurate. As expected no member of staff is an agent for peoples money. The home has undergone some internal work since the last inspection, rooms have been upgraded and one bathroom has been removed as have some lavatories. From discussion with people who use the service, their family members and staff there has been no consultation about this. People have not been involved in colour choices, materials, chairs or changes to their rooms. One relative had recorded in the niggles book on 16.2.09: New chairs uncomfortable too upright, good for posture not for sleep. The manager has recorded on 17.2.09 spoke to relative but it does not offer any resolution. One person told us that a chair belonging to a person using the service could not remain in the lounge as it did not match. There is a lack of communication or choice from the management team in respect of the people who live there. We are aware that poorly people have had to listen to building work i.e. new en suites and walls being knocked down without being fully informed. The home also only has one bath which does not meet with national minimum standards. We have been told Care Homes for Older People Page 30 of 37 Evidence: approximately 30 of rooms do not have hot water and the one bath does not have regular hot water. Staff are carrying bowls from one room to another to deal with this. We have asked Elder Homes to address this as soon as possible. We looked at the last Regulation 26 visit, this is what providers have to complete on a monthly unannounced basis. The last one available to us was undertaken in March 2009. A report should be completed monthly to establish the quality of the service provided, the home could not provide a report for April. We will ask Rider House to provide us with an improvement plan to show how they are going to improve the outcomes for the people who live there. This is requested when we send out the final report. The organisation needs to develop supportive and effective management strategies to resolve the quality failures highlighted in this report and implement improvements, which will benefit people who live at the home. Care Homes for Older People Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 12 Regulation 12 (3) 30/06/2009 To make sure people are safeguarded you must ensure there are policies and procedures in place in regard to The Mental Capacity Act deprivation of liberty safeguards. This is to make sure staff know what course of action to take, understand the assessment processes and are clear of their legal responsibilities. 2 19 13 Regulation 13(4) (a) Exposed pipe work within the home must be assessed for the risk they present to the people who use the service and action taken to minimize the risk. This is to ensure people are protected from harm 30/06/2009 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 19 23 Regulation 23 (2) (j) Hot water must be available to all people who use the service. This means people receive personal care in an appropriate manner. 19/06/2009 4 27 18 Regulation 18(1) (a) To make sure peoples needs are fully met you must take action to ensure staffing levels are reviewed in conjunction with occupancy and dependency levels confirming that each persons needs are consistently being met throughout the day and night. This is to safeguard the health, well being and safety of people living at the home. 19/06/2009 5 28 18 Regulation 18(1)(c)(i) 30/06/2009 To make sure people are supported appropriately the staff team require training to meet peoples needs. This is to ensure everyone is safe. 6 33 24 Regulation 24 (1) (a) (b) 30/06/2009 The registered persons must implement effective quality monitoring systems, which demonstrate that positive Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It is recommended that information is made available to confirm that the Statement of Purpose and Service User Guide are available in a format appropriate to the people who use the service, individual capacity and language. We consider any decision making processes comply with codes of practice where liberty is compromised. This is to ensure decisions have been taken in peoples best interests. To guarantee you meet with the registration status the home should be very clear under what category people are being admitted into the home. Medication instruction on administration should be clear, where it says take one or two there should be a clear protocol as to what constitutes the decision making process i.e. when is it one and when are two necessary. This will ensure medication is administered consistently. The records of administration for the people who use the service need to be accurate to demonstrate that all medication is administered as prescribed. This is to ensure people are kept safe and records tally with actions. Provide a programme of activities that takes account of the individual needs and preferences of people at the home and includes individual stimulating activities. Consider the employment of an activity co-coordinator, so that time can be provided to people for social activities to improve their quality of life. Page 35 of 37 2 4 3 4 4 9 5 9 6 12 7 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 15 There should be daily menus produced in appropriate formats, such as large print or pictorial, suitable for people with dementia or sensory impairments to assist their understanding and help them make realistic choices. All records should be updated to reflect the change in name of the regulatory body from the Commission for Social Care Inspection (CSCI) to the Care Quality Commission (CQC). To provide sufficient and appropriate bath and showers at the home to give assurance that facilities are suitable for peoples needs. The organisation continues the maintenance, renewal and redecoration programme throughout the home, with clearly identified priorities and timescales to provide a pleasant and comfortable environment for people living there. That serious consideration be given to implementing a key worker and system and introducing allocated workers for each person with complex or immediate needs on a daily basis to ensure all their needs are effectively met. The content of the AQAA should be improved upon and offer evidence on how the service corroborate their statements. Prioritised action must be taken to ensure essential mandatory up to date training is provided for all staff commensurate with their role. 9 16 10 19 11 19 12 27 13 31 14 38 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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