Inspection on 05/10/07 for Rivelin House

This inspection was carried out on 5th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rivelin House 04/04/08

Rivelin House 19/04/06

Rivelin House 10/08/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rivelin House 498 Bellhouse Road Sheffield South Yorkshire S5 0RG Lead Inspector Ms Shelagh Murphy Key Unannounced Inspection 5th October 2007 09:30 Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 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 Rivelin House DS0000063343.V347180.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 Adults 18-65. 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. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivelin House Address 498 Bellhouse Road Sheffield South Yorkshire S5 0RG 0114 2577911 0114 2577933 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) http/www.milburycare.com/home.html Milbury Care Services Limited Post Vacant Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specific service user with Learning Disabilities, over the age of 65, named on variation dated 2nd October 2006 may reside in the home. 19th April 2006 Date of last inspection Brief Description of the Service: Rivelin House is a care home providing personal care and nursing care for eight residents. The home is owned by Milbury Care Services Limited and is situated in the Shiregreen area, of Sheffield. It is close to local shops and amenities and on a main bus route. The home is not fully accessible for all people who are wheelchair users, as the kitchen and laundry facilities are very small. There are eight bedrooms rooms for single occupancy situated on two floors the upper floor is accessed by a lift. All bedrooms have an en-suite facility accessible for wheelchairs and fitted with overhead tracks for hoists. One of the rooms has its own kitchenette, lounge/dining room, bedroom, ensuite and its own fenced garden area. The garden areas are accessible to all residents, these areas are private and appropriate garden furniture is provided. The scale of charges ranges from £1700 to £3400 per week. Additional charges include travel costs, hairdressing, social activities, additional meals and holidays. Prospective residents and their families can get information about Rivelin House by contacting the home manager. Copies of the statement of purpose, the service users guide and the latest CSCI inspection report are also available. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out an unannounced visit to the service over a day and the total time spent on site was fourteen hours. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. The homes manager completed an Annual Quality Assurance Assessment report (AQAA), detailing what the strengths and areas for improvement are in the service prior to our visit. Two people who live at the home completed surveys on the day of the inspection. One of us observed three people who had communication difficulties to gauge, how staff at the home supported them. This method is called a Short Observational Framework of Interaction, (SOFI observation). It gave us an insight into how staff interacted with people, how people are supported by the staff and also an indication of peoples’ well being. Some time was spent with all of the people who use the service. It was difficult to conduct conventional interviews with some people, due to their learning disabilities. However, most people were able to let us know their feelings using their specific ways of communication to let us know their thoughts about the home and the staff. Staff, relatives and health professionals were sent surveys to give us their views of the service. A check was made of the environment, including some bedrooms and all communal areas. A range of records was checked including: three peoples individual plans of care, daily records, staff training records and medication administration records. Throughout the inspection feedback was given to the acting manager and some other information was given to the area manager for the service. Due to ongoing concerns about staff practices, lack of staff training, safeguarding adults’ referrals; two random visits have been carried out since May 2007; Requirements were made at these visits in order to ensure peoples’ safety. The random visits will be referred to as appropriate throughout this report. What the service does well: Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 6 Everyone who came to live at the home had their needs assessed prior to being offered a place, to identify if the home can meet their needs. People had individual care plans. They were supported, to make some decisions and were offered choices about their lifestyles. Staff had carried out risk assessments, in order to protect people and to encourage some people to become more independent. People are able to carry out meaningful activities of their choice and develop independence skills, when there are adequate numbers of staff on duty. One health professional said that the staff were good at, “providing a supportive and cheerful environment”. People were dressed in a way, which appropriately reflected their age and culture. A relative said about her son, “he is well-dressed and always kept showered, shaved and has his hair cut. This is nice to see when we visit”. There were up to date policies and procedures for complaints and safeguarding adults. One person, who lived at the home, said they would speak to their key worker if they had a complaint. People live in a clean, homely and comfortable environment. Their bedrooms were well decorated and furnished in a personalised way to meet the needs and choices of the individuals. What has improved since the last inspection? The management team have acknowledged shortfalls in the service and have addressed some of the concerns. However, they are aware that more work is needed to improve the services for people. Some of the improvements that have been made over the last six months include, the statement of purpose is now in a pictorial format, so that it is more user-friendly. People now have individual contracts setting out the levels of support they need, their fees and information about the services they should receive from the home. This protects their rights. Some staff practices were observed to be excellent in supporting a person who was presenting challenges. Confidential records were kept in a safe and secure manner to protect peoples’ rights. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 7 People were offered more opportunities to do activities and go on outings. During our visit, two people were being supported, (by two staff) to visit the coast for a day trip. Another person was being supported to visit a local shopping centre with their key worker, to buy clothes. Two people said they enjoyed the meals and could make choices. Staff said they were aware of peoples’ likes and dislikes. They were also aware of the need to ensure that some individuals, who needed special diets such as meals in a soft consistency, had this provided. The complaints procedure for people at the home had been produced in a pictorial format called, ‘letting us know what you think’. This reflected the efforts by the management to make the documents accessible to the people. All of the staff surveyed said they were aware of the adult protection procedures. Some had completed training. This should better protect people from abuse. The manager said she was now in the process of recruiting a cleaner so that it would allow care staff to focus more on peoples’ personal care and support. Regular staff meetings and staff supervision had recently been re-introduced, this had enabled the manager to listen to the staff and seek their views, to monitor staff practices, support staff and address problems. People who had physical disabilities had been provided with new hoist slings and staff had completed manual handling training to enable staff to move them safely. Hazardous chemicals and other household cleaning materials were stored in a safe and secure manner. A new alarm call system has been fitted in the home. The staff said that having a reliable call system made them feel safer when calling for their colleagues support. What they could do better: The way the service has been managed and organised until very recently has not provided good overall outcomes for the people who live there. The statement of purpose and service users guide must be reviewed as at present it states the home is accessible to all of the service users, but this is not the case as wheelchair users do not have access to the kitchen or laundry areas of the home and this limits peoples opportunities to develop independent living skills. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 8 During our visit staff told us some people who required 1-1 or 2-1 staff support, were not always receiving this level of staff support. This does not meet people’s assessed needs and could place people and staff at risk. People need to receive the services and staff support that has been agreed in their contracts. Some stakeholders said peoples’ needs were, ‘not always’, met at the home. For example, one relative said they felt their child’s needs were only, “sometimes” met by the home. Therefore the management need to ensure they allocate appropriate staffing levels to meet people’s needs at all times. One health care professional said they were, concerned about a lack of meaningful activities and they believed this had resulted in an increase in challenging behaviour. Therefore, people need to be given regular opportunities to take part in activities, in and out of the home to meet their social and leisure needs. The manager had introduced a new format for recording into the care plans. However, there was no evidence that the care plans had been reviewed by involving the individuals or their representatives. For those who were unable to communicate verbally, there was little information about how staff used alternative methods to find out people’s wishes and include them in the planning of their care. In order to protect the peoples’ dignity and welfare, behaviour management plans need to be devised for those people who present challenges. Staff need training in how to support people in order to protect the person and staff from harm. Not all staff were competent in understanding how to meet the needs of people with more complex needs especially those who have limited communication skills. Staff need training and support in order to enable people with limited verbal communication to make choices. All the staff need to be more aware of peoples’ right to privacy and the importance of letting people see visitors in private if they so wish. Nurses need to ensure that the medication records contain appropriate information as to why people have been administered medication, ‘as required’. This will protect people’s welfare. The complaints procedure in the service users guide checked was incomplete. It had the address of the local CSCI office in Stockton. The management must make sure that the correct Commission for Social Care Inspection address is published and that all key workers are aware of the formal complaint procedure. The staff files must be checked and a more robust system for recruiting staff should be introduced to ensure that all of the appropriate information required Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 9 by the regulations is contained in the files. This should enable the organisation to employ staff that are suitable and able to support people appropriately. There was evidence to indicate that the previous managers and line managers had not listened to or acted upon concerns raised by staff and other stakeholders in the past. Therefore, the organisation needs to become better at listening to people and their representatives in order to improve its services for people. An internal investigation in to why the whistle blowing policy was not adhered to is ongoing. When it is concluded an action plan of how to address any shortfall must be put in place and shared with the local CSCI office to ensure that people’s welfare is protected in future. 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. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is poor. People were given accessible information in a service users guide, however, some of the information was incorrect. People had their needs assessed before they moved in to the home. This was to make sure that the service could meet their needs. But some stakeholders didn’t think that people’s needs were being met at the home. People had individual written contracts to ensure that they knew what services they were entitled to, but they did not always receive these services. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users guide was checked. It had been reviewed on 16.7.07. The guide contained some information that was incorrect, including, it says that the home has been made accessible to everybody, however, one person who lives at the home and their key worker, told me they cannot access the laundry room and the kitchen work surfaces are too high for them to reach as they are a wheelchair user. Therefore, this limits their ability to develop independence skills and limits their opportunities and access within the home. Other information required to be included in this publication were also missing including, the amount and method of payment of fees, a summary of the complaints procedure and the correct address and telephone number of the Commission for Social Care Inspection (CSCI). Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 12 Three peoples needs assessments were checked and were comprehensive. They clearly identified people’s needs and how these needs should be met. However, there were concerns from a health professionals survey about whether their client’s needs assessments had been followed. One relative said they felt their child’s needs were only, “sometimes” met by the home. This they said was due to the high turnover of staff and the fact that they are, not supported by staff to visit their parents on a regular basis. During a random inspection in May 2007, we asked to check all of the contracts for people who lived at the service. This was because staff were telling us some people who required 1-1 or 2-1 staff support, were not always receiving this level of staff support. At this time the information was not available. However, since this time the contracts for everyone had been put in place and these were seen during this visit. We checked if people were now being offered the appropriate levels of support they had been assessed as needing at this visit. Two staff told us, that one person who required 2-1 staff support was still not receiving this level of support at all times. They said, only earlier in the week they had been asked to work alone with this person. This does not meet peoples assessed needs and could place people and staff at risk. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is adequate. People’s needs were only partially reflected in their individual plans. People were supported to make some decisions but more needs to be done, to ensure people can participate in all aspects of life at the home. People had risk assessments in place to protect them from harm. Confidential records were kept in a safe and secure manner to protect peoples’ rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We checked a sample of care plans and these included information about people’s assessed needs. The manager had introduced a new format for recording in care plans. However, there was no evidence as part of this to demonstrate that the care plan meetings had involved the individual person, or their representatives. Two systems were used to follow and record people’s care. Nurses’ recorded people’s clinical procedures in a handover file. People’s information was easy to Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 14 find and understand, and the nurses archived the information in people’s individual files after. (This was good practice because it managed people’s information in a confidential and secure way). The second and main system was the care plan files. These contained a lot of people’s past and present information, as well as their plans of care and risk assessments. The files were very large and cumbersome and the home required support staff to enter daily information about people’s meals and activities. Some of the information in the files was inappropriate, it disclosed personal information that staff did not need to know, especially agency and bank staff. This did not respect people’s confidentiality and their dignity. The care plan files did not follow good person centred principles. There was a lot of information but very little of this included people’s personal wishes, likes and dislikes. For people who did not communicate verbally, there was little information about how staff used alternative methods to find out people’s wishes and preferences, and include this in each plan of care. This kind of approach will help people to receive better; more personalised, and dignified care. And it will help give staff the right information to do this. The plans did not help people to understand the information about them. For example they did not have pictures, symbols or photos. They need to be made more accessible to meet people’s needs. In practice we found that one person with complex needs and behaviour, which challenges, did not have a behavioural management plan to advise staff how to support them appropriately. (The staff and the manager said this was in the process of being devised by a local health professional.) This could place people at risk of harm. We spoke to the regular staff supporting this person. They said they had not been given any physical intervention training. We checked why this was and were advised that some appropriate training had been planned for later in the month. This person had lived at the home for some time and therefore, it was concerning to find out that staff had been working with this person without appropriate knowledge or skills to meet the persons needs. This will need to be addressed as a priority in order to protect the person’s dignity and welfare and to protect the person and staff from harm. The acting manager stated in their own annual quality assurance assessment report, (AQAA) that people are not supported to participate in all aspects of life within the home. To address this they have said they intend to introduce, Person Centred Planning, service user meetings and plan to devise a service users charter. This could offer people the opportunity to make decisions about the way the home is organised, to meet their needs. Earlier this year, (May2007) an incident occurred at the home. As a result of this a person who lived there sustained serious injuries. CSCI and the Health & Safety Executive carried out inspections to check staff practices in relation to Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 15 moving and handling people. At this time a police investigation, an adult protection investigation and Milbury Care’s own, disciplinary investigation in to the incident, were being carried out to identify how the incident occurred. These investigations are not yet concluded; therefore they will be reported on in future inspection reports. During this visit we again checked that people had appropriate moving and handling risk assessments in place and staff and the manager confirmed they had received appropriate moving and handling training and knew how to support people safely. People’s confidential records, were observed to be kept in a secure manner within the home. This protected their confidentiality. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. People had not always been offered regular or consistent staff support to meet their needs, as the minimum staffing levels do not appear to allow for peoples individual needs and wishes to be met regularly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the visit there was one nurse and four support workers on duty to offer support to six people. This is the present minimum staffing level the home usually operates at. (Another nurse was called in to the service because of our visit.) During the visit we observed and were told by staff that, two people were going to be supported by two staff to visit the coast for a day trip. One other person was being supported to visit a local shopping centre with their key worker. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 17 Another person was receiving the 2-1 staff support identified in their contract. This meant that there were five of the staff team supporting four people. This was positive to see as it showed that there were occasions, when there were, more than the minimum staffing levels, available to support people to access the community. However, it raises the issue of whether the home is adequately staffed generally, as the usual minimum staffing levels in the home are four carers and one nurse on each shift to support six people with complex needs and high levels of physical dependency. (See standards 31-36) There were two people who had no planned activities for the day. They were observed, being supported by staff to get up and have breakfast. One person was then watching T.V. in the lounge and numerous staff and other visitors to the home walked in and out throughout this time, talking to each other, apparently unaware they were walking through someone’s lounge that was trying to watch a programme. This did not respect the person’s home and their privacy. Another person with very complex physical and learning needs was placed in the lounge in a chair, a staff member kept coming in and opening the patio doors, without asking permission, then walking out. The people sat in their lounge were observed to show signs of being cold. One of these people tried to close the doors on two occasions and the other person was sat there shivering. This was pointed out to the staff concerned. This did not respect people’s rights. People need to be offered more privacy as a health professional said in their survey, “When I have visited the person I am working with, we have initially been given privacy (by the staff), we have been put in the dining room, however, then follows interruptions from staff members then wanting to use the dining room”. This therefore did not protect peoples right to privacy and to see visitors alone. One person who lived at the home told me they were going to be moving in to their own tenancy in the near future as they felt the home could not always give them the access to their home or the local community they wanted. They said, “I can’t always go out when I want, its because of the staff, they don’t always have the time to take me out at night”. This limited this person’s opportunities for an independent lifestyle. Other people said they were concerned about a lack of meaningful activities for people including a health care professional who stated in their survey, they said, “following a review of my service users placement, I have concerns about the lack of stimulating activities which in the case of the service user I am working with, is strongly suspected of resulting in an increase in challenging behaviour”. One of the support workers also said the person they supported, “was not always given the support”, they had been assessed as needing due to, “staff shortages”. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 18 People were not always supported appropriately to keep in contact with their relatives, one relative told us, “when (my son) first went to Rivelin, there was an agreement to help with transport for him to come home regularly. This worked well (with the first manager) but since then, very rarely, is there any driver’s on duty for transport. So now we either have to fetch him ourselves and as I don’t drive this can’t be often, or I pay around £25 per week for taxis to go to Rivelin, which I do every week now”. This did not help the person to maintain his relationship with his family. Relationships between the staff and people who lived at the home were observed during a two-hour period of the SOFI observation. In general, staff were kind and supportive of people’s needs, some staff were exceptional in the way they supported peoples complex needs. Other staff appeared to need more support. Staff were observed to have difficulty in understanding, how to communicate with and meet the needs of people with limited verbal communication needs. Some staff also needed advising on how to respect people rights within their home. As it was these people who were observed to get very little input from staff, other than staff meeting their physical needs. The manager said people did not have take away meals like they used to. She said people had not asked for them since she had stopped them and that she was encouraging staff to focus on healthy options and a varied diet cooked fresh at the home. She said that a pictorial menu had been devised to help people make choices about the meals they had. Two people said they enjoyed the meals at the home and could make choices. Staff said they were aware of peoples’ likes and dislikes and the need to ensure that some individuals received a soft diet. They said they would follow the swallowing assessments in order to ensure people ate food of the correct consistency. These assessments were available in peoples care plans. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. There was some evidence that people were supported in the way they preferred, however, this area needs to be developed. Overall people’s physical needs were met but more needs to be done to show how people’s emotional needs are being met. The medication system was in the main good, however, more could be done to improve the safety of the system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People were observed to be well dressed, people said they had bought their own clothing which they had chosen and this appropriately reflected their age and culture. A relative said about her son, “he is well-dressed and always kept showered, shaved and has his hair cut. This is nice to see when we visit”. There were differing views expressed by health professionals as to whether people’s health needs were met at the home. A health professional wrote in the survey, “ I do not feel confident at this point in time that my service users health needs are being met adequately by the care service”. Another health professional surveyed said that the service “always”, sought advice and acted upon it to manage and improve peoples’ health care needs. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 20 People who live at the home were asked about their medication. One person said, “staff help me to take my tablets, they help me to have a bath and to get ready”. One relative said “ because of the rapid change in staff at all levels sometimes I find staff that don’t understand my son’s behaviour or seizure patterns, that is quite worrying. He sometimes misses out on outings because the staff aren’t trained in, Stesolid management and he can only go out with carers who are” (trained). This was checked at a previous random visit and at this time, we were advised that staff were to be trained in how to support this person appropriately. We understand that some staff have now been trained to administer this medication if required. The inspector checked the medication systems, in the main; these were in good order, including medication storage, records and administration. However one person’s medication instruction from the pharmacist was not accurate. This meant that nurses had to hand write the correct instruction on the records. This was not safe practice, the inspector advised the manager to ask the pharmacist and G.P to correct the instruction. When a person had medication “as required” for example pain relief; nurses had not recorded the full information overleaf on the same record. This meant that information on the front was squashed and illegible, this was not safe practice. The manager said she carried out a medication audit every week to make sure nurses follow safe administration practices. We looked at a sample of medication competency assessments. The manager uses these to make sure nurses continue to follow safe practices. To promote people’s dignity and independence we advised the manager to include making the following observations: • • • the nurses approach to people, when administering medication. Did they respect people’s dignity and confidentiality? did they encourage the person to have as much independence as possible? (For example, do they support people to put tablets in their mouth themselves, rather than the nurses do this) and are there any practices that involve covert medication? (Giving people medication without their knowledge or approval). If yes, is there a care plan and multidisciplinary decision to support this. Has the nursing team reviewed it? Since May 2007, two nurses have been suspended pending a disciplinary investigation in to the misadministration of medication on two separate Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 21 occasions. One investigation has been completed which resulted in disciplinary and other action being taken. The other is still being investigated. One health professional wrote, “ I have recently become involved with Rivelin House as I have been asked to review the placement of a service user where an adult protection concern was raised by the manager, regarding unsafe handling of medication. Since this time I am aware that the service has been seeking advice from the G.P. and consultant psychiatrist to clarify the administration of PRN medication”. This showed the management had been proactive in addressing these concerns to ensure peoples health and welfare. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is poor. Complaints and safeguarding systems are in place but have not always been instigated appropriately or adhered to appropriately. This judgement has been made using available evidence including a visit to this service. (There are currently two adult protection investigations ongoing regarding all of the people who live at this service. Therefore, until outcomes have been identified as well as any action to be addressed, this quality outcome area has been assessed as poor to reflect the ongoing nature of the investigations) EVIDENCE: The complaints procedure in the service users guide checked was incomplete. It had the address of the local CSCI office in Stockton in it. The service has produced a complaints procedure for people at the home in a pictorial format called, ‘letting us know what you think’. This was positive and showed that attempts were being made to make the document accessible to people. One person, who lived at the home, said they would speak to their key worker if they had a complaint but was not really aware of the formal procedure. This needs to be publicised wider and more information needs giving to people for it to become a ‘live’, document they can use. All staff said they knew how to support people to make formal complaints but said that usually complaints are dealt with informally. This makes it difficult for the service to identify patterns or reoccurring issues, which, people may wish Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 23 to complain about for example lack of transport, support to visit relatives and lack of activities at night and at the weekends. The manager stated in the annual review report (AQAA) that no complaints had been made over the last year. However, there have been allegations made in the last four months about poor staff practices at the home, which allegedly directly impacted upon the people who live at the home. There was some evidence to indicate that previous managers and line managers have not listened to and/or acted upon concerns raised over the last year. These include concerns raised by their own staff, health professionals and the CSCI and acted appropriately with this information e.g. there was some evidence to suggest that the whistle-blowing procedure was not instigated appropriately earlier this year. However, this has subsequently been instigated at the request of CSCI. Investigations in to this are ongoing internally. There were also concerns raised by health professionals about peoples care and support needs not being met. The professionals felt that inadequate action was taken to address some of these concerns. Social workers and other professionals stated they had aired concerns about, levels of care and support for people who lived at the home and although they had not used the formal complaints procedure they had formally lodged issues at peoples review meetings etc. They said that their concerns had been listened to at the time, by the manager, the Area Manager and in one case the Managing Director, but that no reasonable action had been taken to address their concerns in the longer term. This did not protect people’s welfare. In the last key inspection, in April 2006, CSCI had made requirements to ensure staff were appropriately trained in moving and handling people, these were not complied with by the organisation. This did not protect people’s health and welfare. All of the staff surveyed said they were aware of the adult protection procedures procedure and that training on this subject had been planned for all of the staff before the end of the year. The manager confirmed this. There is also a whistle blowing procedure at the home. We interviewed three staff; some staff were not able to explain the organisations whistle blowing procedures. This means that they may not know how to take the right action if they want to report to the organisation any serious concerns. This could place people at risk. One service user with complex needs and behaviour which challenges did not have a behaviour management plan to advise staff how to support them. Staff said this was in the process of being devised by a local health professional. The Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 24 regular staff supporting this person had not been given any physical intervention training, however, they said this was planned for later in the month. This will need to be addressed as a priority in order to protect the person’s dignity and welfare and the person and staff from harm through inappropriate physical interventions. Two adult protection referrals have been made relating to all of the people who live at the home and are presently under investigation. The outcome and actions to be taken as a result of these investigations will be reported on in future reports. The inspectors checked a sample of people’s finance records. The system was easy to follow and gave people a clear account of their deposits and withdrawals. One receipt showed that someone had paid for a meal. The persons contract says that they do not have to pay for meals unless they are in addition to the meals already provided by the home. The manager confirmed the person should have not had to pay for the meal and said she would make sure they were reimbursed. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29 and 30. Quality in this outcome area is adequate. People live in a clean, homely and comfortable environment. However, the home is not accessible to all of the people who live there. This limits their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit six people lived at the home, five people live in the main house and one person, lives in a self contained flat. Two people who lived at the home said they thought the house was homely and they liked their bedrooms. One health professional said that the care service was good at, “providing a supportive and cheerful environment”. Another professional said, “The environment is always clean”. The communal environment in the main house was checked. The home was clean, homely and well decorated and furnished. However, consideration should be given to making the lounge a quieter, more homely environment as on the day of the inspection there were staff and builders walking in and out of the room speaking to each other to access the office, which, was disturbing to people sat quietly watching the T.V. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 26 The kitchen was clean and tidy, but the kitchen units are looking tired and will need replacement in the near future. This had also been identified by the manager in the, self-assessment report (AQAA) sent to CSCI. The kitchen and laundry rooms were not accessible to people who were wheelchair users. One person who lives at the home was asked if he was supported to cook meals and wash their own laundry said “night staff do all the cleaning, I’m always in the way all the time”, “In the kitchen, I can’t get in”. “I can wipe the tables though and vacuum my bedroom, but I can’t cook”. This limited the person’s opportunities to develop everyday living skills, such as meal preparation. The support staff reported that it was presently their responsibility to clean all areas of the home and to do all of the laundry for people who lived in the home. At a recent random visit, a requirement to review this was system was made. During this visit the manager said a review of this had taken place and she was now in the process of recruiting a cleaner. This would allow staff to focus more on people’s care and support, and give the home a cleaning routine in order to keep the home fresh, clean and free from odours. It was acknowledged that this would go some way to ensure there is more time for staff to spend on direct care and support for people each week. Three people’s bedrooms were checked all were well decorated, homely and individually personalised. The manager had identified as an area of weakness in the home that not all appropriate people had a key to their own rooms and this should be addressed to protect people’s rights to privacy. The bathrooms checked were clean and appropriately adapted to meet peoples’ needs. The flat was homely, well decorated and furnished to meet the needs of the person who lived there, however, there was a strong odour in this area and the need for increased cleaning of this area was brought to the managers attention to address as a priority. People who had physical disabilities and required support to be moved in and out of wheelchairs had recently been given two new slings each to enable staff to move them safely. There was a, recently fitted, call system in the home which was observed to work well and staff said this had made them feel safer when calling for their colleagues support. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is poor. Over the last year people had not received a good service. There had been a lack of staff training, staff support and supervision along with insufficient staffing levels. This had led to poor staff practices and in turn this meant that the staff team had not provided people with good quality care and support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the visit the majority of the staff we met were new to the service. Some of the staff working at the home were from agencies and others were from other Milbury care homes. This was because a number of staff had been suspended prior to internal investigation and adult protection investigations being carried out. Some other staff had recently left the service. It was clear that the team would be able to work more effectively if a static staff team were in place to provide a consistently high quality of service to the people who live in the home. However, to limit the effects of this on the people who live at the home, the manager had ensured that a core team of agency and bank staff are being used as they are familiar to people and can provide more consistency to people. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 28 We asked staff about their understanding of how they met people’s individual needs. One staff member explained the procedures they followed to meet a persons care needs. This person needed two staff to help them to move in and out of their wheelchair, and this occurred more than once a day. As a result staff said they had to leave other people in the house without supervision. This was not safe practice; some people in the home need constant supervision because of their physical, health, and emotional needs. The manager said she had arranged for someone to move into a ground floor bedroom, and this should help the situation. The inspectors acknowledged that this would be better, but it still left people unattended for periods of time. From the people who use the service, regular staff, relatives and health professional surveys it was clear that people still have concerns about whether the present minimum staffing levels of four carers and one nurse on each day shift is adequate to meet the needs of six people with complex/high support needs. • A person at the service was asked about whether they had adequate staff support to ensure they could access the community. They said, “I can’t always go out when I want, its because of the staff, they don’t always have the time to take me out at night and weekends”. One person’s relative said “I would like to see more continuity of staff and enough staff to be able to spend time with clients going out or doing indoor activities”. From the staff surveys one staff said there was, ‘always’ adequate numbers of staff on duty, Five staff said there was ‘usually’ enough staff on duty, and the other two staff said there was either ‘sometimes’ or ‘never’ enough staff on duty. One member of staff, when asked how the service could be improved said, “deployment of more staff to cope with the high demands of care for our clients”. One nurse said, I feel that staffing levels should be higher to allow nurses more time to do paper work, which at times is lengthy and tiring. The staff nurse often feels torn between the office and the residents. The residents are obviously the priority but paper work is also vital as good record keeping is a sign of good practice. • • • • The manager said that a staff training and development program had been being introduced in to the service. There was written evidence that over the past few months’ staff training has improved considerably. There is now a staff-training plan in place to ensure that all staff receive appropriate support to carry out their roles safely and competently. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 29 The manager and the staff training records confirmed, that most of the present staff had completed moving and handling training, (the manager confirmed that those who have not would not be asked to carry out such procedures). Other training that had been either planned or completed included, induction training, NVQ2 awards, managing challenging behaviour, adult protection, and all of the mandatory training for example moving and handling, first aid, fire safety, infection control and food hygiene. Therefore staff training in the service is an area, which has improved significantly over the past three months. Milbury Care Services had provided the home with a learning resource for staff that covers the basic mandatory training. Staff use a laptop to access the training. The training covers basic safe working practices and protecting vulnerable adults. The manager is able to monitor which staff have completed the courses and how much time they have spent on the system. This should enable staff to develop the skills and knowledge they need to support people appropriately. Staff training which still needs to be completed includes, supporting people who present challenges to keep people safe and in supporting staff to appropriately communicate with people with limited verbal communication skills. The manager said and the staff confirmed that regular staff meetings and staff supervision had recently been re-introduced in to the service. Records supported this. This should enable the managers to more closely monitor staff practices and address any problems. Recruitment records were asked for, however, the area manager said she had checked these files and informed us they had not been adequately maintained, as there was information missing, therefore, it was agreed that she was taking urgent action to address this as this does not protect peoples welfare. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 and 43. Quality in this outcome area is poor. This home had good policies and procedures. But this did not always result in good practices, as people who live in this service have not benefited from a well-run service. The quality monitoring systems in place have not been effective in identifying problems or in addressing concerns effectively. There were systems in place to address health and safety issues but they had not always been adhered to. This placed people at risk of serious harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The way the service has been managed and organised until very recently has not provided good overall outcomes, to the people who live there. The provider has started to address concerns in a proactive manner they have appointed a whole new line management of people to the service. The new acting manager, area manager and Director of care have made some positive Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 31 progress in recent months in order to ensure the home is being well managed, is safer and is providing more opportunities to enable people to have fulfilling lifestyles. There is still a long way to go, but this open approach is positive and shows that the organisation has acknowledged some shortfalls in the service and wishes to address them. They have identified bad practices and taken appropriate disciplinary action and have put a considerable amount of resources in to addressing these issues. However more needs to be done to improve outcomes for people. The organisation is still not delivering care and support in a person centred manner, to meet their individual complex needs, for example a lack of behavioural management plans and staff training in the appropriate way to deal with physical challenges or peoples communication needs. The new acting manager is appropriately experienced and qualified and had completed the registered managers award. She is planning to leave this temporary post in the near future. A new manager, will need to apply to register with the Commission as soon as possible. This should encourage stable leadership and management of the home. The service has good policies and procedures in place and staff knowledge of these were generally good but from findings at this and previous random visits, it was found that these are not always put in to practice. For example in recent months the whistle blowing policy was not activated at the appropriate stage and this potentially placed people at risk. An internal review of why this occurred will need to be carried out to prevent it reoccurring. The home has appropriate health and safety policies in place however, at the previous random inspection in August 2007, many requirements were made to address health and safety breaches in the home including the safe storage of hazardous substances, the safe and appropriate storage of prescribed creams, dressings and medications. It was positive to see that all of these issues had been addressed and no breeches of the regulations were seen during this visit. A nurse told the inspector about safe working practices such as moving and handling; and said that they felt, “training has improved immensely”. They said they were satisfied that staff now followed correct procedures to move people and this includes two staff when using the hoist. The nurse said they had also had other equipment checked and serviced, for example the assisted bath. We spent time with the senior manager looking at some of the systems the organisation has introduced in order to improve practices at the home. This has included a file that managers expect all staff to refer to for day-to-day running information. The file is used at handover to make sure staff pass on important information about people’s needs and the running of the home. The file included information such as people’s health and welfare, delegated duties Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 32 for staff, contact numbers for emergencies and the on-call procedure. This was a positive move and was in place to ensure consistency for people. Action had been taken to improve the way the staff team are managed and staff are now more accountable to people and this has improved some of the quality of the support people receive. Staff comments about the organisation were mixed, some were positive including the fact that people felt well supported by the new manager, they were receiving training and got on well with the new manager, that they now had an opportunity to support people going out more. The negative comments included the issue of poor communication, lack of adequate staffing levels and management not listening to staff came up several times. One person said, “The organisation is only interested in penny pinching”…. “That’s why we don’t have enough staff”. There was very little evidence of service user involvement in the quality assurance practices and this will need to be developed to meaningfully involve people in the review and future development of the service. The area manager said a review of the present quality monitoring system has already been instigated, as the company wants to find out why the system did not alert them to problems in the home at an earlier point. This is a positive approach and the findings if implemented could help protect people in the future. Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 1 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 1 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 1 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 2 1 1 X 1 2 Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes 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 YA1YA3 Regulation 4 (1) (b) 5 (1) (a) Requirement Timescale for action 31/12/07 2 YA5 4.1(b) 5.1(b) 5.1(a) 16.1 The home must ensure they can meet peoples assessed needs before offering them a place at the home. Therefore the service users guide and the statement of purpose must be changed to make it clear that not all areas of the home are accessible to people. The home must ensure that 31/12/07 people receive the services, support and staffing levels as identified in their assessments and agreed in their contracts and terms and conditions. People must be given opportunities to be involved in social and leisure activities. This must meet the agreements outlined in people’s contracts. 31/12/07 2 YA12 12.1(b) 3 YA14 YA13 12 (b) 18 (a) The home must ensure that sufficient staff is available to ensure that service users can partake in activities, in and out of the home, on a regular basis. 31/12/07 Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 35 4 YA20 13 (2) 5 YA35 YA32 18.1(a) When recording that medication has been administered, as required, staff must record the reasons for this clearly to protect people’s welfare. Staff should receive training that is specific to meet people’s diverse needs. For example • Individual communication needs • Dealing with complex behaviours This will better protect people’s dignity and their rights. 31/12/07 31/03/08 6 YA33 18 (a) The home must review the care staff hours and must take into account the details of the contracts, which guarantee that staff will be allocated to specific service users throughout the day. 31/12/07 7 YA34 19 (1) (b) Paragraph 1-7 Schedule 2 13 (6) Staff recruitment files must be 30/11/07 checked and ensure they contain all of the documentation required to ensure peoples welfare. The organisation must carry out 31/12/07 an internal review of why the whistle-blowing procedures were not activated appropriately in the home. A written copy of the findings and an action plan to address any issues must be submitted to the local CSCI office to ensure such incidents do not re-occur. The organisation must ensure all 31/12/07 staff are aware of the correct policies and procedures to follow relating to all health and safety practices. 8 YA38 9 YA40 18 (1) ( c ) (i) Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s and should be given serious consideration. No. 1 2 Refer to Standard YA1 YA2 Good Practice Recommendations The service users guide should be reviewed and contain appropriate information to protect peoples rights. Assessments should include people’s likes, dislikes and preferences so that the home can help people meet their aspirations. Assessments should include a format that encourages people to be involved in and understand the information about them. For example pictures and symbols. 3 YA6 Care plans should include people’s likes, dislikes and preferences. They should include a format that encourages people to be involved in and understand the information about them. For example pictures and symbols. Care plans should include better information about people’s limitations on freedom and choice. 4 YA7 YA9 There should be enough staff available to make sure people can make real choices and decisions about what they want to do in their daily lives. There should be better opportunities and better staffing levels to enable people to follow the choices and decisions they make. People should be enabled to participate in making decisions that relate to all aspects of living in the home. People should be given opportunities to continue their education/ training opportunities or to take up employment opportunities. 5 6 YA8 YA12 7 8 YA13 YA15 People should have better opportunities to participate in community activities on a regular basis. Staff should offer people appropriate support to visit their DS0000063343.V347180.R01.S.doc Version 5.2 Page 37 Rivelin House 9 10 11 YA16 YA18 YA19 relatives. People should be offered privacy within the home when having visitors. Introduce Person Centre Planning Principles in to the Care Planning Process to meet peoples individual needs, wants and wishes. People should have access to Health Action Plans, so that they can take more control over their health care needs. Information is available at: www.doh.gov/ 12 13 YA22 YA23 The manager should remind people, their relatives and their advocates about how to make complaints through the homes procedure. The manager should continue to closely monitor people’s finances to check that people are only paying for appropriate meals etc. The home should consider making the lounge a more private area with less chance of people being interrupted. The home needs to consider making the home more accessible, if not consider if the home can meet people’s present needs. The manager should continue to closely supervise staff to ensure staff are using good practice in their dealings with people. The home needs to recruit an appropriately qualified and experienced manager for the home. This will provide more stability to the home. The provider visit reports need to contain better written detail about the outcomes of the visit. The home needs to consider how to develop user involvement in the monitoring of the service on a regular basis. The manager needs to continue to closely monitor all Health and Safety. 14 15 16 17 18 YA28 YA29 YA36 YA37 YA39 19 YA42 Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Rivelin House DS0000063343.V347180.R01.S.doc Version 5.2 Page 39 - 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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