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Inspection on 30/11/07 for Rider House Nursing Home

Also see our care home review for Rider House Nursing Home for more information

This inspection was carried out on 30th November 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The nursing and care staff communicate well resulting in an enthused team who are able to provide good quality care. The services admission procedure provides people with the opportunity to visit the service before deciding to move to live there. Peoples` descriptions of the home were as follows: "I am happy here" "Communication is good." " Staff are superb." Relatives` and other professionals` comments included: "Patient centred approach." "Caring staff." "I have found them to be very pleasant and feel I can visit whenever I like." Health needs are closely monitored and access to other health professionals is arranged as required, emotional needs appear to be addressed with care and sensitivity. Discussion with staff and observation of practices revealed that staff had a positive attitude and respect for people who used the service. Staff talked to people in a sensitive and respectful way. One person reported, " I have been very impressed with the staff here." When we spoke to people living at Rider House they said that they liked the staff and found them to be very caring, we saw staff had good relationships with the people who use the service. The management of residents` monies is robust and safe.

What has improved since the last inspection?

This is the first inspection for this inspector therefore it is difficult to assess what has improved and no requirements were made at the last inspection. One questionnaire returned stated: "`I think the standard of care has improved " and another said, " The home has made real progress."

What the care home could do better:

When we looked at the way the service recruited staff we found that their procedure was not protecting people who use the service. We saw that 7 people did not have suitable Criminal Record and Protection of Vulnerable Adult checks, we found some staff did not have 2 references, proof of identification or fully completed application forms which covered gaps in employment history. The Statement of Purpose and Service User Guide need to give individuals an accurate account of the home and its services especially around intermediate care and the fees payable. The home may also wish to offer a more "user friendly" version. 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 was no evidence to confirm people who use the service had involvement with their own plan of care. The home 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. We found that the staff had been provided with some training but records were difficult to find, the home has been asked to audit the staff files to ensure there is an appropriate skill mix and staff have been suitably trained. Medication administration is sound but risk assessments need to be developed for people who use the service who wish to self-administer. We concluded that the people who use the service require further stimulation and activities, this may need to be on a one to one basis for some individuals Two of the comments made were: " Not as many activities as we might wish." "Very limited, odd game of dominoes." The registered person has not met their legal obligation of recording the Regulation 26 visits. Not completing these means the responsible individual is not able to evidence an opinion of, or show how they monitor the standard of care provided at Rider House.People who use the service know how to complain but the procedure is outdated and does not offer all the information necessary.

CARE HOMES FOR OLDER PEOPLE Rider House Nursing Home Stapenhill Road Burton On Trent Staffordshire DE15 9AE Lead Inspector Rachel Davis Key Announced Inspection 30th November 2007 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.V352164.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.V352164.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.V352164.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 14th November 2006 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. It is owned by Rider House Ltd, the responsible individual is Steven Moxham, the manager is Roslyn Fox-Roberts. 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 has three 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. A variety of specialist equipment is available to assist the people who use the service. Information about the fees for this service were not available as needed, fees must be recorded in the Service User Guide but presently people will need to enquire directly to obtain this 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 some modernisation and refurbishment. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 5 Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection (3 days notice given) took place over eight and a half hours. It was carried out by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. This was a ‘key inspection’ and therefore all the core standards were assessed, this was the first inspection of this service for this inspector. During our visit we looked at how people were admitted to the service and the information they had to make a decision. We looked at the life people were able to lead and whether their health and personal care needs were being met. We also looked to see whether people who use the service were being protected and the arrangements the service had for listening to what people thought about Rider House Nursing Home. We read the Annual Quality Assurance Assessment, 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 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. Eight 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, two visitors and five members of staff. Observations were made of staff and resident interaction around non-personal care tasks, lunchtime, activities, and the medication administration was also seen. We looked round the home to see the standard of the accommodation and some of the people living in the home showed the inspector their bedrooms. We have not needed to visit the home since the last inspection held in November 2006. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? This is the first inspection for this inspector therefore it is difficult to assess what has improved and no requirements were made at the last inspection. One questionnaire returned stated: Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 8 “`I think the standard of care has improved ” and another said, “ The home has made real progress.” What they could do better: When we looked at the way the service recruited staff we found that their procedure was not protecting people who use the service. We saw that 7 people did not have suitable Criminal Record and Protection of Vulnerable Adult checks, we found some staff did not have 2 references, proof of identification or fully completed application forms which covered gaps in employment history. The Statement of Purpose and Service User Guide need to give individuals an accurate account of the home and its services especially around intermediate care and the fees payable. The home may also wish to offer a more “user friendly” version. 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 was no evidence to confirm people who use the service had involvement with their own plan of care. The home 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. We found that the staff had been provided with some training but records were difficult to find, the home has been asked to audit the staff files to ensure there is an appropriate skill mix and staff have been suitably trained. Medication administration is sound but risk assessments need to be developed for people who use the service who wish to self-administer. We concluded that the people who use the service require further stimulation and activities, this may need to be on a one to one basis for some individuals Two of the comments made were: “ Not as many activities as we might wish.” “Very limited, odd game of dominoes.” The registered person has not met their legal obligation of recording the Regulation 26 visits. Not completing these means the responsible individual is not able to evidence an opinion of, or show how they monitor the standard of care provided at Rider House. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 9 People who use the service know how to complain but the procedure is outdated and does not offer all the information necessary. 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.V352164.R01.S.doc Version 5.2 Page 10 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.V352164.R01.S.doc Version 5.2 Page 11 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, 4 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective people who use services have a needs assessment carried out before they are admitted to the home. More written information is needed to ensure that people who use the service and prospective residents can make an informed choice about the home. EVIDENCE: The service has developed a Statement Of Purpose and Service User Guide, these set out the aims and objectives of the home, and includes information about the service, they are now outdated and not necessarily a current reflection of the service, they need to be reviewed and include the fees payable and also contain information referring to the 3 intermediate care beds available at Rider House. There was evidence to verify that the Service User Guide was made available to all people who use the service. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 12 The content was discussed at length with the manager, some parts should be removed, for example the inspection report summary had been isolated from the main report and needs to remain intact. It was recommended that the documents are made available in a format appropriate to the people who use the service, their family, individual capacity and language. The care records of a recent admission were checked and contained the needs assessment as required, following discussion it was noted a couple of elements need to be added to the assessment to meet with the requirements. The manager 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. One person did state they were unclear of “ where the responsibility lies.” When asked in questionnaires: Did you get enough info regarding home before moving in? Seven said yes and 1 person said no. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 13 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 person has a plan of care but practice of involving people who use the service in the development and review of the plan is lacking, and plans should be developed in a person centred way. The principles of respect, dignity and privacy are practiced. EVIDENCE: The care record of two people who used the service were checked during this inspection. A plan of care for both had been developed and reviewed. There was no evidence to confirm whether the individual had been involved with the development of their care plans or the reviews. When we asked staff they said they were not, people who use the service must be involved in this process to confirm agreement and understanding. It is recommended that the information recorded is expanded to ensure that staff know exactly what support is required especially where people who use the service are not able to express themselves easily. Care plans could Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 14 become more person centred and contain more succinct information around areas of need such as personal care, recreation, nutrition, spiritual needs, sexuality, life skills, hobbies etc. The plans of care did include an assessment of risk for moving and handling and the information on how to manage this risk is then recorded on the plan of care and subsequent reviews. The plans included a nutritional risk assessment and a Waterlow assessment; information on how to “manage” these assessments was again recorded on the care plan. The service should consider the use of Plain English to ensure everyone has an understanding of a person’s condition. When people who use the service were assessed as ‘stuporous,’ it did not say what this meant. All people were well presented and dressed in a style of their choosing. From observation, it was evident, that staff have ensured that individuals are able to receive support to address personal care issues and personal hygiene. People who use the service are very happy and commented: “Most of the staff are kind and helpful and make themselves available when asked.” “If there is a concern about health or well being it is always taken seriously.” There was evidence to confirm that professional visits are offered and provided as is necessary, one visiting professional spoke to the Commission and stated, “ The staff have very good knowledge, use common sense and call us when appropriate.” The home has a medication trolley and the Monitored Dosage system (MDS) is used, the medication is administered from Blister packs. Medication is stored securely, and an examination of the system and Medication Administration Records revealed these had been accurately completed for administration purposes. Medication procedures were observed, generally they were safe, and meet with the regulations. However, requirements were made in relation to the following. All people who use the service who choose to self-administer medication must be assessed as competent to do so and a subsequent risk assessment needs to be completed. The home needs to include a signature sheet to offer an audit trail on the Medication Administration Records. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 15 A photograph of every person who uses the service must be available within the home, preferably on the care plan or on their Medication Administration Record. The home needs to develop a programme to assess and monitor the staffs’ competency in administering medication to the people who use the service. Oxygen must be appropriately stored and excess stock removed. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is flexible and attempts to provide a service with opportunities for interaction and events within the current staff and resources. Some activities and stimulation are in place but they need to be improved upon to further stimulate the people living at Ryder House. People are able to maintain good relationships with family and friends and receive visitors at any time. EVIDENCE: The home does not presently operate a key worker system, which would enable closer resident staff relationships where likes, dislikes and needs are shared and should also be recorded. Rider House does not employ an activities coordinator. Presently there were no individuals in residence from the ethnic minority groups or anyone with specific religious needs. People who use the service were asked: Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 17 Are there activities arranged that you can take part in? Two said always Three said usually Three said sometimes Comments made included: “`I think the standard of care has improved my ongoing concern is the lack of therapy and endless sitting.” “ Pairing them up with a talker would be good for my relative. “ Not as many activities as we might wish.” “Very limited, odd game of dominoes.” One staff questionnaire returned read “I feel we should offer more entertainment but we haven’t got the time or the staff.” There was no written evidence on notice boards or within the Service User Guide that an activities programme is in place, on the day of inspection no activities were noted but there was a church service held in the morning, we were advised these occur on a monthly basis. The manager has recorded under this section on the Annual Quality Assurance Assessment (this is a legal document that must be completed by the home for the Commission for Social Care Inspection) that “ I feel they have the balance right but are open to suggestions to improve our service.” On speaking with the people who use the service it appeared that the television and reading were the main sources of day-to-day stimulation. A number of staff confirmed that they did not have the time to sit with people on a one to one basis on many occasions, but when they did they were happy to do so. The manager reported that links with the community are forged and some service users had been into town the previous week. The home has an open door policy and people who use the service may come and go as they please. The Commission were advised that outside entertainers do visit the home on a monthly basis. Following discussions and observations there is a requirement to revisit the activities and stimulation provided, especially for those with more complex needs, this is to ensure a high quality of life for all the residents. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 18 The kitchen is well maintained, it was inspected and found to be clean and tidy, crockery and cutlery were of a suitable standard. All the required records were in place for temperatures, cleaning duties and food probing. Food supplies were plentiful and fresh fruit and vegetables were available. The home has one dining area off the entrance hall and adjoining the kitchen, lunch was relaxed and informal. Food was considered by the residents to be good: “Breakfast and lunch very good, tea variable.” “My relative likes the food, they eat well.” “ I am offered alternatives.” “Food is varied but palatable.” The Commission observed lunch being served and alternatives were seen, a record of what was on offer was written on the menu board. Some of the people who use the service and remain in their rooms were not sure of what was on offer, and this should be considered. Records of the food provided by the home should be in sufficient detail to enable anyone inspecting them to determine whether the diet offered promotes choice and these records would also be necessary following any outbreak or food poisoning, we felt these records should be more detailed to ensure clarity and exactness. The Commission were advised that the home has recently received a 5 star rating from the Environmental Health. A recommendation to confirm with Environmental Health if fly screens are necessary at the kitchen windows has been made following this inspection. Staff were seen assisting people who use the service at lunchtime in a discreet and sensitive manner. The home looks at providing aids to support people who use the service with eating for example plate guards and large handled cutlery. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 19 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 poor This judgement has been made using available evidence including a visit to this service. People who use the service are not adequately protected from abuse due to poor recruitment practices. The complaints procedure fails to give clear information about who to complain to. Some, but not all staff have received training in the recognition of abuse. EVIDENCE: The recruitment of staff to Rider House does not follow the requirements and therefore people who use the service are not protected from abuse in this area. Information referring to this shortfall is recorded under “ Staffing.” The Commission for Social Care Inspection has received one formal complaint about this service since the last inspection held in November 2006; the manager has dealt with it in an appropriate fashion. The complaints procedure is displayed on the notice board as you enter the home and is in the Service User Guide (all people who use the service have a copy of this in their bedroom). The procedure records that individuals can make a complaint at any time, and if not resolved can approach the Commission for Social Care Inspection. It did not include timescales and was not “user friendly.” The contact details for the Commission were not accurate and out of date, demonstrating the policy had Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 20 not been reviewed. The service must review the procedure to inform people that they are able to contact the Commission at any time, and the correct contact details and phone number are to be recorded. The home should consider making the complaints procedure available in other formats and consider how people with complex conditions are able to voice any of their concerns. The service was able to provide us with a copy of the records of their complaints but it was not up to date, the manager stated that this would be rectified. The manager is happy to promote the recording of complaints in a transparent manner but the home still needs to develop this approach. Comments, compliments, grumbles or concerns can also be recorded in the suggestions box sited in the porch. From the records available on the day of inspection it was unclear if all the staff are trained to recognise the signs and symptoms of adult abuse. This training is mandatory and a requirement has been made under ‘training’ for the manager to audit all training records and confirm with the Commission the state of play. No vulnerable adult referrals have been made since the last inspection, Discussion with staff revealed that people were not always fully aware of the safeguarding adults’ procedures and how to respond to an alert. Staff need to be supported to deal with suspicion of abuse, how to manage an alert and recording processes. The manager was not aware of the new safeguarding protocols and had out of date information. It is strongly recommended that the home is in receipt a copy of the Safeguarding of Adults policy to ensure they are aware of new procedures. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 21 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, 21, 24, 25 and 26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable, but the people who use the service are placed at risk in some areas. People who use the service are encouraged to personalise their bedrooms, redecoration is required in bathrooms and toilets. EVIDENCE: Rider House is clean and comfortable and has a homely feel, (except bathrooms and toilets) redecoration in needed in these areas. A tour of the environment was taken and confirmed the décor requires upgrading in these areas. The safety of the unguarded radiators and exposed pipework throughout the home needs to be assessed for the risk they present to the people who use the service, and any action taken to minimize the risk must be recorded. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 22 Storage must be seriously considered, hoists wheelchairs and zimmer frames are not to be stored in bathrooms, and storage under the stairs is a potential fire hazard. On two occasions we went into the treatment room which was unlocked and were able to access medication, this is unsafe and a real risk to the people who use the service. Bathrooms and toilets have bare light bulbs, there were not any curtains at the window, showerheads and glideabouts were not as clean as necessary. The floor in the shower room downstairs has lifted and paint was peeling from the walls, flooring wasn’t sealed to stop the ingress of liquid and thus minimise infection. In the bathroom and shower room hard bar soap was evident, as were toiletries and sponges, this gives an impression of communal usage. There was no hot water from the tap in toilet 1. When asked: Is the home fresh and clean? All 8 people who returned questionnaires responded ‘always.’ Bedrooms were seen and personalised, the people were happy with their private space, it was evident that people who use the service had not been offered lockable storage, a lockable facility was in place but the service user had not been offered a key. The same applied to bedroom doors, there was no evidence within care plans to show that a choice had been offered. The home has a designated laundress and the area was organised and all clothing is individually returned to avoid misplacement. Laundry was 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 there 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. There is a large garden to the property, which is well maintained, some people who use the service stated they enjoyed sitting outside, a smoking area for residents and seating are available. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The services failure to obtain the necessary employment checks was not safeguarding the people who lived there. Whilst staff have received some training there were areas that had not been addressed which meant that they did not always have the necessary knowledge or skills to meet peoples needs. EVIDENCE: We talked to the staff and it was confirmed there was always a nurse on duty, during the mornings there were two. It was very difficult to ascertain if the number of staff on duty during the inspection was satisfactory to meet the needs of the people who use this service. This relates specifically to the stimulation of people who use the service on a day-to-day basis. This home is registered to care for terminally ill people but all the staff spoken to verify there is not enough time available to offer one to one support, whether that be to read the paper to someone, sit at their side and talk, or any other support that the individual may require. It is recognised that this can be dependant on a number of varying factors, however the service has a responsibility to meet individuals needs and that may mean that other members of staff are required at core areas of the day. Checks on 3 files showed that the service was not undertaking required pre employment checks. Two of the 3 files seen did not have a Protection of Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 24 Vulnerable Adults First or Criminal Record Bureau disclosure. In addition a further 5 staff had Criminal Record Bureau disclosures from other sources of employment. Criminal Record Bureau disclosures are not portable. Files seen did not contain 2 references or proof of identification. Application forms were not always suitably completed with gaps in employment history were evident. The service must now audit all staff files and take any action necessary to safeguard the people who use the service, the manager must be satisfied that staff members are suitable to work with vulnerable adults. The manager has recorded on the Annual Quality Assurance Assessment (this is a legal document that must be completed by the home for the Commission for Social Care Inspection) that “ We encourage staff to undertake National Vocational Qualification and any other training and all staff have a training record in their file”.” It would be beneficial to record these on a training matrix because it was very difficult to ascertain if the staff within the home have received all the necessary mandatory or specialist training. Training records were not seen and staff files did not always contain the necessary certificates. A requirement for the manager to audit training for all staff has been made. The registered manager is in the process of completing the Registered Managers Award, this is a legal requirement for managers of a care service. During the time we spent at the service we spoke to a number of staff and observed them supporting people. We found they were treating people with respect and there were positive and engaging interactions between those people living at Rider House and staff members. People who use the service and their visitors were keen to share their views, they reported they were very happy with the quality of care: “ The staff are superb.” We spoke to people who use the service about their relationships with staff they said; “they are sensitive to my needs.” “ The staff are excellent at explaining things they tell me exactly what they are going to do.” Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered person needs to promote safeguarding and make certain that health and safety requirements and legislation are met this will ensure the wellbeing of people who use the service. EVIDENCE: The registered manager has worked at the home for a number of years but has only recently fulfilled this role as it was previously undertaken by the director who has now resigned. Prior to the inspection the registered person had completed an Annual Quality Assurance Audit for the Commission. The information recorded did not always correspond to the specific outcome groups. The registered person must ensure Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 26 that this is completed in conjunction with the National Minimum Standards and accurately records the service provided for each Outcome group. When asked what the home could do better under this section the service has written, “ We are always open to ways to improve.” Under the heading our plans to improve in the next 12 months no comments are recorded. When we asked the question, does your manager meet with you and give you support? One said hardly ever, another said sometimes and 2 said regularly. Records of some supervision were evident but appraisals have not been completed, there is no paperwork in place as yet bit the manager said, “they were in the process.” The home has a quality assurance programme that covers a number of aspects to do with living in residential care, it was last undertaken in May 2006, however quality assurance monitoring is not regarded or implemented as a core management tool. The manager confirmed the results are not presently evaluated or made available to the people who use the service, this needs to be undertaken and will demonstrate that the home strives to ensure that people who use the service are aware of the facilities, resources, options and activities available to them. The home should be mindful of the Mental Health Capacity Act, which came into force in October 2007. The responsible person will need to ensure that all decision making processes undertaken by the home clearly demonstrate that it is in the person’s best interests. Rider House should also consider seeking the views of staff, professionals and other stakeholders to further improve their quality assurance programme The registered person has not met their legal obligation of recording the monthly unannounced Regulation 26 visits. Not completing these means the responsible individual is not able to demonstrate they have formed an opinion of, or monitored the standard of care provided at Rider House. There was evidence to confirm that the manager has completed the necessary Regulation 37 notifications as required. We checked the water temperature records for communal areas because one hot tap ran cold, there were no temperatures recorded and it was impossible to evidence their location as only ticks had been put in place, robust records need to be completed on a monthly basis. It was clear that all the necessary Legionella were not being completed. We did not check all maintenance Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 27 records but we have been informed by the manager on the Annual Quality Assurance Assessment the dates of all required tests. There are no records in care plans of fire risk assessments for the people who use the service, there was no documentation to show consideration as to how to manage people with a sight or mobility impairment should there be a fire at Rider House. The manager confirmed these had not been completed but that the fire officer has recently visited this service, it is strongly recommended that they be contacted to ensure the home does not need to complete further written documentation for the people who use the service in the unlikely event of a fire. Where the home is responsible for resident’s money it works to a safe system and maintains clear records. A sample of individuals’ money was scrutinized on this visit and all records tallied. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Requirement Timescale for action 31/12/07 2 OP3 3 OP7 4 OP7 5 OP9 (5)(1)(bb) The fees must be included within (bc)(c) the Service User Guide so people who use the service know the appropriate cost and what is included. 14(1) The needs assessment must (a)(c) contain all the elements required to ensure the service has all the information necessary to make a decision as to whether than can meet those peoples needs. 15(1) Plans of care for people who use the service must evidence consultation with individuals or their representative to demonstrate that the plans have been agreed by the person 13 Risk assessments need to offer (4)(b)(c) clarity around the management of risk and include evidence of the service users involvement or their representative. This ensures everyone is clear on how to manage the risk whilst, where appropriate, empowering the individual to take reasonable risk. 13(4)(b) People who use the service and administer their own medication DS0000022364.V352164.R01.S.doc 31/12/07 31/01/08 31/12/07 07/12/07 Rider House Nursing Home Version 5.2 Page 30 6 7 8 OP9 OP9 OP12 13(2) 13(4)(b) 16 (2) (n) 9 OP16 22(2)(4) (6)(7) 10 OP19 23(l) 11 OP19 13(4)(a) 12 13 OP21 OP24 13(3) 16(l) 14 OP25 13(4)(a) must complete an assessment and consent form. This is to ensure everyone’s safety and understanding. Oxygen must be appropriately stored to meet with safety standards. Staff who administer medication need to complete a signature sheet to offer an audit trail. Activities and stimulation must be provided for all of the people using the service who wish to participate, including those with more complex needs to ensure a high quality of life for all the residents. The complaints procedure must be appropriate to the needs of the people who use the service, include timescales and offer up to date information. The home needs to provide suitable storage for the purposes of the care home, the bathrooms are not an appropriate place to store hoists, glideabouts or zimmer frames. An assessment of whether it is safe to keep the treatment room door unlocked must be undertaken to ensure the safety of the people who use the service. Bathrooms and toilets need to be upgraded and conform to infection control standards. Evidence must be available to confirm people who use the service have been offered an opportunity of lockable storage and a key to their room to promote privacy, dignity and choice. Radiators and pipework within the home must be assessed for the risk they present to the people who use the service and DS0000022364.V352164.R01.S.doc 07/12/07 31/12/07 12/01/08 31/12/07 12/01/08 07/12/07 30/12/07 30/12/07 30/12/07 Rider House Nursing Home Version 5.2 Page 31 15 OP26 13(3) 16 OP27 18(1)(a) 17 OP29 19(1)(b) (i) Schedule 2 18 OP29 19(1) (b)(i) Schedule 2 19 OP29 19(4)(b) 20 OP30 18(1)(c) (i) action taken to minimize the risk. Health and safety audits of the environment need to be completed and address any areas that would compromise any resident’s safety, in this instance not recording communal water temperatures on a monthly basis, the unsuitable flooring in the downstairs bathroom which does not stop the ingress of liquids and the need to remove toiletries, sponges and soap from these areas. The service must demonstrate it has sufficient staff on duty to fully meet the needs of the people who use the service. The service must audit the staff files and provide evidence to the Commission that the Home has obtained results of a Protection of Vulnerable Adults check for all staff and that a Criminal Records Bureau has either been received or is applied for. This is to ensure that the people using the service are fully safeguarded. The manager must undertake an audit of all staff files to ensure the staff have the required pre employment checks and where there are gaps the service must take action to ensure all checks are completed. This will make sure people who use the service are protected. The home must evidence that staff are appropriately supervised between the receipt of a Protection of Vulnerable Adults First record, and the subsequent Criminal Record Bureau disclosure The home must provide evidence to confirm that mandatory and DS0000022364.V352164.R01.S.doc 30/12/07 30/12/07 06/12/07 12/12/07 30/12/07 05/01/08 Page 32 Rider House Nursing Home Version 5.2 21 OP33 26(2)(3) (4) 22 OP33 24(2) 23 OP38 12(1)(a) specialist training offered to the staff is up to date to ensure they can demonstrate they can meet the needs of the people who use the service. A responsible person must carry 30/12/07 out the unannounced monthly visits and complete an appropriate record of such visits to comply with regulation. Monthly regulation 26 visits must demonstrate the registered person has carried out interviews with people who use the service and their representatives The results of surveys completed 29/02/08 by the people who use the service need to be published and made available to current and prospective users and their representatives. This gives people confidence and shows the homes willingness to continue to develop. This must also include the quality of nursing where nursing care is provided at the care home. The service must ensure that all 30/12/07 health and safety records are recorded appropriately RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP4 Good Practice Recommendations The home should develop a more user friendly Statement of Purpose and Service User Guide to assist people who use the service with diverse and/or complex needs. 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. DS0000022364.V352164.R01.S.doc Version 5.2 Page 33 Rider House Nursing Home 3 OP7 4 5 6 OP7 OP9 OP9 7 8 9 OP15 OP15 OP16 10 11 12 13 14 15 16 OP18 OP29 OP30 OP30 OP30 OP33 OP38 It is recommended that some of the information in the care plans be expanded to ensure that staff know exactly what support is required for each individual and any associated risks. These should be recorded in plain English Plans of care should be developed to evidence a person centred approach. A record of the maximum and minimum temperature of medication stored in the fridge should be recorded, this can be achieved with a digital thermometer. The home may wish to develop a programme to assess and monitor the staffs’ competency in administering medication to the people who use the service. This will assist in evidencing good practice and ensuring staff continually adhere to policy. Records of the food provided should be in sufficient detail to enable anyone inspecting them to determine whether the diet offered promotes choice. The home should check with Environmental Health to confirm whether fly screens are required at the kitchen windows. The home could improve upon the recording of complaints, however minor they may appear, including the outcome, this will further evidence the homes openness and transparency. The home should ensure they have a copy of the Safeguarding of Adults policy. The home may wish to improve the content of their application form so it fully conforms to recent legislation. The home should consider offering staff training in equality and diversity. The manager should consider implementing a training matrix with an indication of when updated training will be necessary. The home should continue to consider ways in evidencing equality and diversity within their service. The home should consider involving staff, professionals and other stakeholders within their quality assurance programme. The home should seek advise from the fire officer. This is to establish if individual records need to be in place for the people who use the service should a full evacuation be necessary. Rider House Nursing Home DS0000022364.V352164.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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