Inspection on 19/05/08 for Rider House Nursing Home

This inspection was carried out on 19th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rider House Nursing Home 09/11/09

Rider House Nursing Home 18/05/09

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rider House Nursing Home Stapenhill Road Burton On Trent Staffordshire DE15 9AE Lead Inspector Rachel Davis Key Unannounced Inspection 19th May 2008 09:30 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 Rider House Nursing Home DS0000022364.V364143.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. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rider House Nursing Home Address Stapenhill Road Burton On Trent Staffordshire DE15 9AE 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) 01283 512973 01283 511749 Rider House Limited Roslyn Ann Fox-Roberts Care Home 38 Category(ies) of Physical disability (38), Physical disability over registration, with number 65 years of age (38), Terminally ill (4) of places Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 38 PD - Minimum age 60 years on admission 4 TI - Minimum age 60 years 3 PD - 18 to 65 years Date of last inspection 2nd September 2002 Brief Description of the Service: 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 has recently been sold and is now part of the Elder Homes Group; the registered manager Roslyn Fox-Roberts remains the same. Rider House Nursing Home is registered with the Commission for Social Care Inspection 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 - £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 home has two floors and thirty- six single occupancy bedrooms, the 1 remaining bedroom is a shared room. The environment is fit for purpose but in need of modernisation and refurbishment. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means people who use this service experience adequate outcomes. This unannounced inspection took place over seven hours. It was carried out by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. This was a ‘key inspection’ and therefore all the core standards were assessed, this is the second key inspection this financial year, the last one was in November 2007. Since we undertook the first key inspection we have also completed two random inspections, one in December 2007 and one in February 2008. These were carried out to ensure Rider House were taking proper steps to recruit people because we found staff working without a Protection of Vulnerable Adults first check. This check is necessary to ensure staff are suitable to work with vulnerable people. During the random inspection in December we concluded the manager had requested these checks for all the staff where necessary. On the second random inspection we checked the home was meeting the requirements made in November 2007. We had asked them to complete an improvement plan and found the home has worked hard in achieving these requirements and were working in a positive and proactive way. This means the outcomes for people who use the service are improving. During this inspection we looked at the experiences of a sample group of people who use the service, including the assessment process for requiring the service and their experiences when receiving the service. We considered if the information given to us confirmed people were having the service they required, if they had a plan that showed the care they needed, and whether Rider House was making sure people were safe. We revisited the Annual Quality Assurance Assessment, which the home completed in September 2007, this is required by law on an annual basis from each registered service provider, and in this document they give their own assessment of how they are meeting outcomes for people who use their Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 6 service. Some statistical information is also provided. We sent questionnaires to a number of people who use the service to find out directly from them how the service is being managed, if they are satisfied with the standard of the care being received, and if the staff understand their needs and have the training and support required to meet them. Three people who use the service returned survey forms to us with their views, four staff also returned questionnaires to inform us on how they feel they are supported, trained and managed. During the visit we met and spoke to a number of people living in the home, three visitors and seven members of staff. Observations were made of staff and resident interaction around non-personal care tasks, lunchtime activity and the administration of people’s medicine was also seen. We looked round the home to check the standard of the accommodation and some of the people living in the home showed us their bedrooms. Our inspection reports can be obtained directly from the provider or are available on our website at www.csci.org.uk. What the service does well: Any person considering moving into Rider House is given assurance that the home can meet their needs, they are assessed prior to moving in and are encouraged where possible to visit the home before making any decisions. If the Local Authority refers a prospective user the manager obtains an assessment from the social worker and in all cases a member of the homes management team assesses the person themselves. Overall people who use the service and who were involved with the inspection process are happy with the care they receive at Rider House and consider the staff to be helpful and supportive. They used words like “kind”, “helpful.” “patient” and “caring.” People who use the service felt staff responded to them appropriately, respected their privacy and dignity and understood their needs. Questionnaires confirmed the staff listen and act on what people who use the service say, people receive the medical support needed, and staff are available as necessary. One person who uses the service said: “I would recommend it here, it’s home from home.” Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 7 Another person said: “ Staff are very nice to me.” When we looked at the way the service recruited staff we found that their procedure is now protecting people who use the service. People who use the service can be confident that all staff have had the necessary checks to make sure that they are fit to do the job. What has improved since the last inspection? What they could do better: Although care plans and risk assessments are developed for the people who use the service there is room for improvement. Plans of care should be person centred and give a picture of the individual, looking at their abilities as well as their needs. There is still no evidence to confirm people who use the service have involvement with their own plan of care. Rider House still needs to complete an evaluation of their annual quality assurance. It must also be made available to the people who use the service and this needs to include information around the quality of nursing. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 8 Although some redecoration has taken place since the last key inspection this home is in need of updating throughout with many areas now looking worn and tired. This is especially pertinent to communal areas, toilets and bathrooms. The programme of redecoration and refurbishment should be implemented quickly in order to improve the appearance and comfort of the environment for the people who live there. Rider House need to consider providing training in relation to the Mental Capacity Act, paying particular emphasis on client care choices, presently only the manager has received this training. 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. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 9 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 Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 10 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): 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have a needs assessment carried out before they are admitted to the home. This means people who use the service can be confident the home has the necessary skills to meet their needs. More written information is required to ensure people can make a fully informed choice about Rider House. EVIDENCE: The service has developed their Statement Of Purpose and Service User Guide, which set out the aims and objectives of the home, and include information about the service. They have been reviewed and now include the fees payable and information about the two intermediate care beds. The home should identify these rooms and also add information pertinent to costings for the intermediate care beds, which are decided by the Primary Care Trust and not Rider House. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 11 The home should be as open and transparent as possible, an example of this would be to also include the fact that door guards are not provided by the home and would need to be purchased by the individual. Offering such information then enables prospective users the opportunity of making an informed choice as to whether or not to use this service. Although confirmed by the manager that the people who use the service receive a Service User Guide there was no evidence to verify this and this should be considered. 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. The home may wish to consider an audio or pictorial version. The care records were checked and contained the needs assessment as required, pre admission documentation is sound and offers appropriate opportunities for the manager to assess whether Rider House can meet the needs of the prospective user. It was evident the manager has assessed the needs of the resident prior to admission and a subsequent care plan had been developed, this affords staff the information necessary to provide appropriate care. Although the home meets the needs of the people who use the service they should consider ways in evidencing equality and diversity and how they support people with complex needs. It is strongly recommended that the home should operate a key worker and/or named worker system to help individuals feel comfortable in their new surroundings, and enable them to ask any questions about life in the home. It will also encourage and help staff to develop a person centred approach to care. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Each individual has a plan of care but they are not person centred. Staff have a positive attitude to their work and the principles of respect, dignity and privacy are put into practice. EVIDENCE: We looked at three plans of care and spoke to people who use the service and staff members. The delivery of personal care is flexible, consistent and reliable. When discussed one person said: “I like the place very well” another person said; “They’re brilliant, they always knock on my door, answer the buzzer and check that Im alright.” People who use the service said staff respect privacy and dignity and are sensitive to changing needs. Staff were seen and heard speaking to individuals in a respectful manner. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 13 All people who use the service have a named nurse but not a key worker. The key worker system enables closer resident staff relationships where likes, dislikes and needs are shared and should also be recorded, this system is strongly recommended. The care plans still need to evidence a person centred approach and contain clear information about the individual’s wishes, choices and decisions as their health deteriorates. There is a need to expand on individuals information with reference to an individual’s particular needs regarding gender (including gender identity), age, sexual orientation, race, religion or belief or disability, or address any needs identified in a person centred way. Nursing and care staff work to a consistent standard and constantly monitor pain, distress and other symptoms to ensure individuals receive the care they need. We discussed the recordings of fluid intake and pressure care and we were advised that most of this information is delivered verbally at handover. Presently no one person takes ownership of monitoring, for example fluid intake, it is recorded but not totalled. There is not a specific management plan for pressure care and the nurse on duty confirmed body maps would prove useful. The home needs to ensure their recording becomes more robust in these specific areas of care. Records examined evidenced that people who use the service have access to healthcare and remedial services. The home has support from palliative care specialists and use end of life tools such as the Liverpool Care Pathway for the dying patient. Risk assessments were evident but on occasion there lack in clarity on how to manage the risk, an example of this would be pressure care. Rider House also needs to ensure there are assessments for people who use the service when they are enjoying community activities. These assessments need to include the views of people who use the service or their representatives to support individuals taking reasonable risk. People who use the service have the aids and equipment they need and these are well maintained to support them and staff in daily living. An example of improvement since the last inspection was the purchase of three profile beds, mattresses are presently in need of upgrading and this is also being addressed. Staff have access to training in health care matters and are encouraged and given time to attend seminars on specialist areas of work. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity. One member of staff said recent training had “ given her the confidence to deliver specialist care.” Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 14 The medication procedure was examined and discussions were held with the nurse in charge. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. The controlled drugs book and a random sample of drugs were checked and no errors were noted. Medication is stored in a locked area however only some of the oxygen is safely stored; three cylinders were not attached to the wall as required and needs addressing. The majority of medication records are fully completed but we did notice some gaps in the records, and this must be addressed. Regular management checks should be expanded upon and recorded to monitor staff compliance. There was no evidence to show people who use the service are given the support they need to manage their medication if they so wish and are able to, following a satisfactory risk assessment. We saw a medication form that confirms medication must be handed over to the home, this was discussed with the manager and the form will be removed. Rider House needs to ensure where people who use the service choose to self medicate, and are able, they are given this opportunity and accommodated. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service have opportunities for community and family contact . Daily life is geared around meeting the preferences, abilities and needs of the people who live in the home. EVIDENCE: People who use the service have the opportunity to develop and maintain important personal and family relationships. Visitors were observed during the visit and are able to come and go at anytime of the day. Families and friends are encouraged to become actively involved in the life of the home such as helping with activities or trips out if they so choose. Visitors comments included: “ I can call anytime.” “ I feel the home communicate well with us when needed.” “ I can pop in and speak to the nurse on duty, they are always helpful.” People who use the service confirmed they are involved in meaningful daytime activities, these are of their own choice and according to their individual Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 16 interests, diverse needs and capabilities. It is an area all staff are mindful of and appreciate there is always room fro improvement one staff member recorded: “ Sitting and talking to the residents and making time for them could be improved.” Questionnaires returned to us confirmed activities are provided. Rider House has started to record these activities however, their records are rather spasmodic and peoples care plans could contain more information around life histories and preferences in respect of activities. People who use the service can access and enjoy the opportunities available in their local community, on the day of the inspection two people were off to the National Arboretum, which proved very enjoyable. Another resident enjoys tending to plants in the greenhouse and specialist activities, for example talking books, are also provided. Several people who use the service told us that the quality of the food was good and questionnaires also confirmed this to be so. People also said there was a choice both at lunchtime and at tea. The food was well presented on the day of the inspection and lunch was seen to be relaxed with staff offering sensitive and dignified support where needed. The kitchen is well maintained, and meets the standards; records asked for at the last inspection regarding the food provided are now sufficient in detail to enable anyone inspecting them to determine whether the diet offered promotes choice. Discussions with the cook confirmed new 5 weekly menus have been introduced by Elder Care Homes but these have not been discussed with the people who use the service, this shortfall is being considered and the cook has requested a review of some of the meals recorded on the menus. Involving the people who use the service is paramount in Rider House showing their commitment to empowerment and person centred care. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service feel safe, secure and are confident their welfare and safety needs are promoted. EVIDENCE: We received one formal complaint about the home since the key inspection held in November 2007. The homes past proprietor investigated this and wrote subsequent reports, they were to a satisfactory standard, the matter has now been concluded. Rider House has received two complaints and these are recorded within the logbook. We advised the manager to ensure these logs offer date, investigation and outcome, during the inspection it was not possible to ascertain if an outcome had been reached. Rider House has also introduced an informal ‘niggles, comments and compliments’ book and it is available by the visitors signing in book. A visitor has entered one compliment; this open approach shows the home is happy to look at areas of improvement and good practice recommendations in a transparent way. The complaints procedure has been corrected and now offers robust information, questionnaires confirmed people who use the service knew how to Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 18 complain and when we talked to people they confirmed they would feel comfortable in approaching either the nurse in charge or the manager, should the need arise. The complaints procedure is available in the service user guide (all people who use the service have a copy of this in their bedroom) and by the homes’ notice board in the hall. When we talked to the nurses we realised they dealt with a number of comments, queries or informal complaints in the majority of instances. Rider House could therefore ensure pertinent information is recorded so they can then use this information as part of their quality assurance processes and also look to see if there are any patterns or trends. From the records available on the day of inspection it was clear all the staff are trained to recognise the signs and symptoms of adult abuse. The manager confirmed this training was part of Elder Homes mandatory programme and all staff are required to undertake refresher training on a yearly basis. One vulnerable adult referral has been made since the last inspection and this is being dealt with as required in a multi disciplinary way. As recommended during the last inspection the home has obtained a copy of the Safeguarding of Adults policy and protocol to ensure they are up to date with new procedures. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Refurbishment is needed but the home does provide a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: Rider House is clean and comfortable and has a homely feel however, communal areas, toilets and bathrooms, carpets, curtains and fittings are in need of upgrading. For example there are bare light bulbs in bathrooms, and some are without blinds or curtains, paintwork is chipped and some carpets are in need of replacement. Elder Care Homes has confirmed to the manager that a refurbishment programme is within their business plan. It is hoped the homes contract states Rider House will consult with the people who use the service and/or their family on all matters, it should also confirm the home is designed to be the service users home and they are actively Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 20 encouraged to be involved in all matters. We would strongly recommend involvement in this field from the people who live at Rider House. At the last key inspection the safety of the unguarded radiators and exposed pipework needed to be assessed for the risk they presented to the people who use the service. On speaking with the manager she confirmed all radiators are low surface temperature and risk assessments have been completed. We have seen that the exposed pipework has been boxed in where it presented a risk. Storage has been addressed and equipment has been moved from bathrooms and toilets, the manager confirmed storage is still an ongoing problem. Bedrooms are personalised and the people are happy with their private space, there is still little evidence to show if people have been offered a key to their bedroom. There was no evidence within care plans seen to show that a choice had been offered. The manager did confirm that everyone does now have a lockable drawer and suitable key in their room. The home has a designated laundry and this area is well organised, all clothing is individually returned to avoid misplacement. Laundry is being washed at the required temperature and dealt with correctly. We saw that red alginate bags are used and placed on a sluice cycle where people are incontinent to ensure infection control standards are met. Infection control measures are in place, examples of this include: paper towels, liquid soap, hand sanitizer and personal protective clothing. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Recruitment procedures follow safe practice and support the need to protect vulnerable adults. EVIDENCE: Two staff files examined demonstrated that a thorough recruitment practice is now in place, this includes 2 written references, criminal records bureau checks, application forms that cover gaps in employment history and the required identification certificates and photograph. Male staff are also recruited to the home, which promotes equality and choice. Staff spoken to were very happy working at Rider House, they used words like “friendly”“ homely atmosphere” we’re a family here.” The staff group said they: “ We all work as a team. ” Another staff member wrote “I feel that we are friendly, approachable and open in our dealings with our residents.” People who use the service were also complimentary, “the staff are helpful,” “they are kind and thoughtful.” Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 22 Visitors felt that overall had “good relationships” with the staff and were kept “well informed.” The majority of people who use the service have complex needs and these are understood and well managed by the staff team. All of the staff spoken to and questionnaires reflected that staffing levels are satisfactory but if they ever ran short (in exceptional circumstances) it was very difficult to maintain the level of care. We spoke with the manager to ensure agency staff are used when regular staff are not available, there was evidence to confirm this to be so. One questionnaire stated; “ On day duty the girls are very busy and do their best to meet individual needs of clients and relatives. I feel sometimes we may fall short here as we have an increasing number of higher dependency residents. There is only one registered nurse on duty on late shift and one at night and on a busier shift we are spread thinly.” The home must be confident they can meet the needs of the people who use the service at all times, therefore staffing levels need to be under constant review. Discussions with staff and files seen identified staff supervision sessions are lacking. This needs to be addressed without delay to support the staff team Supervision sessions should be regular and helpful with a focus on improving outcomes for people using the service. Notes and action points should be taken of meetings and sessions with progress regularly reviewed. All staff receive relevant training that is focussed on delivering improved outcomes for the people who use the service. The home has put a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 23 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, 36 and 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home must continue to evidence that it is run in the best interests of the people who use the service EVIDENCE: The annual quality assurance assessment (AQAA) is a legal document that all services have to complete on a yearly basis. Because Rider House completed one in October last year we can only refer to the information given to us at that time. All sections of the AQAA were completed and the information gave us a reasonable picture of the situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 24 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. The manager is suitably qualified and understands person centred planning and thinking. However, there is little evidence of translating this theory into practice to make a difference to the staff team or outcomes for people who use the service. The manager trains and develops staff who are competent and knowledgeable to care for the people who use the service. The service focuses on the individual, takes account of equality and diversity issues, and generally works in partnership with families or close friends, as appropriate, and professionals. The home has a statement of purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. More work is needed in this area. Where the home is responsible for resident’s money it works to a safe system and maintains clear records. During our visit we observed monies being transacted in an appropriate way. Rider House has now recorded individual risk assessments in relation to fire evacuation for all the people who use the service. However, it needs to include an emergency contingency plan. The home needs to develop a plan for ultimate evacuation to a place of safety and consider the needs of the people who use the service and staffing levels. Due consideration is to be given to access alternative accommodation and emergency contact numbers. This plan should be reviewed regularly and updated to reflect any changes. Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 25 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 2 X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 26 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 5(1) (b) Requirement 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. 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. 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 delivering support are agreed and recorded. Modernisation and decoration of the home is required to provide more suitable and attractive surroundings Staff must receive appropriate supervision to ensure they are appropriately supported. The home must develop a DS0000022364.V364143.R01.S.doc Timescale for action 01/07/08 2 OP7 15(2)(c) 01/07/08 3 OP7 13(4) (b)(c) 01/07/08 4 OP19 23 (2) (b) (d) 18(2) 23(4)(c) 16/08/08 5 6 OP36 OP38 01/07/08 01/07/08 Page 27 Rider House Nursing Home Version 5.2 (iii) contingency plan in the event of a fire or major incident; this must include a named place of safety. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations 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. It is strongly recommended that a key worker system is introduced at Rider House to encourage and develop a more person centred approach to care. Plans of care should be developed to evidence a person centred approach. Equality and diversity information about people’s preferences should be included on care plan documentation and this will ensure that people are treated as individuals and in the way they prefer. A record of the maximum and minimum temperature of medication stored in the fridge should be recorded. This will ensure medications are always stored within the correct temperature range The home should consider ways to monitor competency around medication practices. This will assist in ensuring a safe service is continually promoted. The home should ensure that the programme of redecoration and refurbishment is stepped up in order to improve and update the environment. When the home is decorated and decisions are made, people who use the service should be consulted. This means they take an active role in decision making within their own home. Training on the Mental Capacity Act should be offered to a cross section of the staff team. 2 3 OP4 OP7 4 OP9 5 6 7 OP9 OP19 OP19 8 OP30 Rider House Nursing Home DS0000022364.V364143.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Rider House Nursing Home DS0000022364.V364143.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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