Inspection on 17/11/06 for Rivelin Residential Care Home

This inspection was carried out on 17th November 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rivelin Residential Care Home 02/07/09

Rivelin Residential Care Home 19/01/09

Rivelin Residential Care Home 12/08/08

Rivelin Residential Care Home 13/11/07

Rivelin Residential Care Home 27/01/06

Rivelin Residential Care Home 14/09/05

Rivelin Residential Care Home 22/02/05

Rivelin Residential Care Home 10/11/04

Rivelin Residential Care Home 17/02/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Rivelin Residential Care Home 17/21 Albert Road Cleethorpes North East Lincs DN35 8LX Lead Inspector Mrs Jane Lyons Unannounced Inspection 17th November 2006 09:00 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 Rivelin Residential Care Home DS0000002844.V308336.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. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivelin Residential Care Home Address 17/21 Albert Road Cleethorpes North East Lincs DN35 8LX 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) 01472 692132 J and LD Hayes Limited Mrs Linda Diane Hayes Care Home 42 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (42) of places Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accept specified service user CH under the age of 65 years and this will apply until they reach the age of 65 years or they terminate the contract with the home if prior to that date. 27th January 2006 Date of last inspection Brief Description of the Service: Rivelin Residential Care Home is situated in the centre of the attractive seaside town of Cleethorpes, close to all local amenities. These include a library, post office, local shops and the seafront promenade. Local buses provide frequent services to all areas of the town and also to Grimsby town. The home provides residential care for up to forty- two service users in the category of older people. The accommodation consists of four adjoining houses covering three floors and serviced by two passenger lifts. There are communal bathrooms, shower rooms and separate WC facilities situated on each of the three floors. The service users have the use of four lounges (one of which is a smoking room) and a large dining room, all of which are located on the ground floor. There is a small courtyard to the rear of the building and three small car parks. Parking is also available on the road. The home is owned by Mr J and Mrs LD Hayes, the registered manager is also Mrs LD Hayes. Weekly fees are: £329. The home does not operate a system whereby the fees for single accommodation include a third party contribution. Additional charges are made for the following: toiletries, newspapers/magazines, hairdressing and chiropody. Information on the service is made available to prospective and current service users via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are available on request. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 17th November. • The visit to the home lasted from 9 a.m. until 5.30 p.m. • Twelve residents spent some time chatting to the inspector. Six staff, eight relatives, a district nurse, a physiotherapist and the manager/ owners also talked to the inspector. Records about the care provided, and other records about the running of the home were looked at. Questionnaires about the home were sent to all the residents, staff, twenty relatives and three healthcare professionals involved in supporting residents. Fifteen of the resident’s questionnaires, nineteen of the relatives ones and fourteen of the staff ones were returned at the time this report was written. The inspector observed how staff and service users worked together throughout the day. People’s views about the home and what was found during the visit have been used to write the report and make judgements about the quality of care. • • • • What the service does well: The home was welcoming and had a relaxed and homely atmosphere. Residents were observed to be very settled and comfortable in their surroundings. Three of the residents said that they had lived in the home very happily for several years. One of the relatives wrote in the survey “This home is a very homely and hospitable place and the staff are extremely helpful and attentive at all times.” Residents and five relatives spoken to said the care provided was very good; one of the relatives wrote “a very pleasant place with caring staff.” One of the residents said “I cannot fault the care I get in any way” and another resident described the care as “marvellous”. All of the residents spoken to said they liked living in the home. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 6 The home maintains positive relations with outside agencies; a district nurse and community physiotherapist told the inspector that the communications with the home were very good, staff were very helpful and that the standards of care were very good. The home is situated close to the centre of Cleethorpes and residents said they were encouraged and helped to visit local facilities, shops and the sea front, thereby helping them to maintain their independence and lifestyles. Residents liked the food provided, are well fed and encouraged to eat a healthy diet. What has improved since the last inspection? The management have finished the programme to fit locks to all the residents room doors; which will better promote their privacy and rights. Improvements to the facilities in the home continue with the replacement of the bay windows at the front of the property. Storage of medications has improved although consideration should be given to providing one suitable storage area which would better protect the residents. The management have ensured that the appropriate accident records are completed. Records of further action taken following accidents in the home are now maintained but these could be more detailed which would better demonstrate how the management are working to ensure resident’s safety is promoted and protected. The management have obtained a new induction programme for new staff to complete however it does not comply with care standards and they now need to source and obtain the appropriate induction programme which will promote the skills and competence for the new staff. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 7 What they could do better: 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 Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with an opportunity to visit the home and their needs are fully assessed prior to admission however information documentation needs to be updated to ensure they are provided with sufficient information to help them decide if the home is right for them EVIDENCE: The home has a range of information for prospective residents and their families however the statement of purpose and service user guide documents need review and updating to reflect the current service provision at the home. The service user guide does not contain all the information to comply with the NMS 1.2 and the registered provider was informed of the sections, which require improvement. Surveys and discussions with service users indicated Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 10 that they were satisfied with the information given by the home prior to admission. Four service user files were case tracked; the home had obtained copies of the local authority assessment/ care plan for all residents who were publicly funded. Pre- admission assessments were evidenced, and service users confirmed that they were either assessed in their own homes or in hospital by the manager. The pre assessment documentation is comprehensive however those case tracked evidenced a tick- box format and advice was given to provide more written detail of individual need/ problems. Staff spoken to were able to describe the care needs of residents, there was evidence that staff had accessed service specific training in dementia and continence however more training of this type will help ensure they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. Some of the service users spoken to said that they had taken the opportunity to visit the home prior to admission although most said that their families or friends had visited the home to assess its suitability, which had been a satisfactory arrangement. Relatives and service users told the inspector that they had chosen the home for a variety of reasons such as: friendly atmosphere, locality and smoking facilities. One service user told the inspector that she had come for respite care and liked it so much she stayed. The home does not charge top-ups. Signed contracts and terms and conditions documents were in place for two of the files examined; the manager confirmed that the documents are issued following the six-week trial period. The home does not provide intermediate care support Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning system in place that provides staff with the information they need to satisfactorily meet the service users needs. Service user’s health and personal care needs were well met. Medication policies and procedures need to improve to ensure staff have access to all the information they need. EVIDENCE: Case tracking took place for four service users. The methodology used was an examination of risk assessments, care plans, discussions with residents and staff, written surveys to service users, relatives and health care professionals, discussion with two family members, two health care professionals and direct observation during the day. In addition information provided by the manager prior to the visit was also consulted. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 12 Residents told the inspector during the visit that they were very satisfied with the standards of care provided; they described the carers as kind and attentive. All service users had detailed care plans in place; they had been well maintained and updated to reflect any changes to care provision. All plans had been evaluated regularly. It is clear that all new residents have their needs fully assessed however a number of the new files examined evidenced that a some sections of the assessment record detailed “see plan”; it is important that the assessment document is completed in full, recording all residents individual needs and that the plans of care are developed from this. There was appropriate use of risk assessments; assessments for moving/ handling, falls, tissue viability, nutrition and general issues were in place and reviewed regularly. The majority of high-risk areas had associated plans of care in place; one service user was receiving support from the district nurse and therefore a more detailed plan of care should be in place to support the care staff interventions e.g. monitoring of dressings and management of dressings/ wounds during bathing. Records to support visits by health and social care professionals were evidenced to be up to date and well maintained. There was evidence that service users needs had been formally reviewed and that they had access to health care services that met their assessed needs both within the home and the local community. The inspector spoke to the community physiotherapy manager during the visit who said that she and her team were very pleased with the home; the staff were very helpful and accommodating, always ensuring the visits were private and that they always stayed to support and assist. She had observed very positive staff interaction with the residents and that the residents were very settled at the home. The inspector also spoke to a visiting district nurse and auxiliary nurse during the visit who said that the home has good communication systems in place, the staff are helpful and prompt and that the standards of care are good. Evidence from returned surveys and discussions with families during the visit confirmed that the staff kept them informed of any changes. Service users told the inspector that the staff always arranged visits with the G.P. promptly when required; this was evidenced during the visit with the staff arranging a G.P visit for a service user whose condition had deteriorated that morning. Residents told the inspector during the visit that they were satisfied with the standards of care provided; they considered that the staff listened to them and always treated them with dignity and respect. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 13 The medication policies and procedures have not been reviewed which is now essential as those in place are too minimal and do not clearly describe in detail current procedures to support all elements of the system and staff practice. Improvements have been made to the storage of medications; all MDS cassettes are now securely locked away and also storage of internal and external preparations are now held separately. This storage review now means that there are three separate areas where the medications are held and consideration should be given to providing one suitable storage room/ area for all the medications. Stock control has been reviewed and is managed more effectively. Administration records were checked and found to be satisfactory with no gaps in the signatures; records of receipt and medication returns were clearly maintained. The management need to monitor the room temperatures where the medication is stored to ensure the temperature does not exceed the manufacturers guidelines. Senior care staff have accessed accredited medication training. Care records detailed that the home had arranged for residents to have their medication reviewed; one of the returned relative survey’s described how vigilant she considered the manager had been in recognising that the dosage of a certain medication was having a devastating effect on the resident and the manager had followed the issue up with the G.P. for a successful outcome. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Visiting arrangements are good and residents are able to choose how they spend their lives although the activity programme could offer more variety. Residents receive a healthy, varied diet according to their assessed needs and choices. EVIDENCE: Resident’s social, recreational and psychological needs were identified in assessments, care plans and daily records. However current recreational interests could be recorded in more detail, which would feed into the activity programme. Resident’s religious needs were identified on admission and detailed in their care plan. The home provides a formal activity programme but there was little evidence that the residents had been consulted in recent times on the types and variety of sessions provided. The programme listed sessions for: music, Bingo, hairdresser and gentle exercises. Outside entertainment and church services Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 15 are held monthly and both of these sessions were held during the visit and were seen to be well attended by the residents. Of the fifteen resident’s surveys returned; five residents indicated that the home “always” provided activities that they could take part in; four residents indicated “usually” and six residents indicated “sometimes”. A number of residents are supported by staff to visit the shops in St Peters Avenue and the sea front often on a daily basis; these residents told the inspector how much they liked the trips out especially one resident who enjoys visiting the arcades. Staff told the inspector that many of the residents were not interested in joining in with the activities and entertainment; this was confirmed by three of the residents the inspector spoke to. Staff had not had any particular training in organising and arranging activity programmes. This would be useful in assisting staff to assess and plan activities particularly for more dependent residents including those who have developed needs associated with dementia. The home has a resident cat, budgies and the deputy manager’s two dogs visit the home regularly; all residents spoken to said that they liked the animals. Observation during the day and the visitor’s book evidenced that there are a high number of visitors to the home on a daily basis. Care plans and discussions with staff and service users evidenced that the home supports residents to maintain contact with family and friends. All visitors spoken to told the inspector that the staff were always very friendly and made them feel very welcome and they were always offered tea or coffee. One of the relatives had enjoyed lunch with her mother that day and told the inspector that the manager and staff had gone out of their way to make her feel welcome. Service users at interview confirmed that the staff supported them to maintain their independence and exercise personal choices. There was evidence during the visit from interviews with staff and observation that service users were consulted about their care provision and supported to make decisions about their activities of daily living from care support to choices with clothing, meals and activities etc. Service users rooms were seen to be personalised to the extent chosen by the individual. Information leaflets on advocacy and financial support were available in the hall. Menus continue on a two week rota, which appears to be working well. Two main meals are always offered at lunchtime and service users are able to make their choice of meal at the time. Each service user is offered three full meals a day, the food was hot and attractively presented with time given between courses to ensure everyone was able to eat at their own pace. The majority of residents take their meals in the dining room and up to eight of the more Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 16 dependent residents choose to have their meals in the sun- lounge. Staff were observed to be patient when assisting service users with their meals. All the residents spoken to told the inspector how much they enjoyed all the meals and that the quality of the cooked meals and home baking was especially good. All surveys returned indicated a very high satisfaction with the meal provision. The cook confirmed that the home was currently only providing specialist dietary requirements in the form of diabetic diets but that they would be able to meet any specialist, religious and/or cultural dietary requirements of residents. The Environmental Health Officer’s report detailed a number of requirements and recommendations. This is covered in more detail in the management and administration section. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although relatives and service users knew who they would make a complaint to efforts should be made to better inform relatives of the process. There were satisfactory arrangements for protecting residents from abuse. EVIDENCE: The home’s complaint procedure was clear and displayed in the entrance hall: it had appropriate timescales for resolution and included contact details of other agencies. The service users and relatives spoken to felt able to make any complaints they may have either to the manager or staff members. Of the twenty surveys completed by relatives eight indicated that they were not aware of the home’s complaint procedure; therefore the management need to address this. The home had not received any complaints since the previous inspection. The home had policies and procedures to cover adult protection and prevention of abuse, whistle blowing, restraint and management of service users money and financial affairs. When asked about abuse, what it was and what they would do if they saw a service user being abused, the staff stated that they Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 18 would report it. Interviews with staff and records evidenced that staff had been provided with formal adult protection training. Since the last inspection the responsible local authority had received one adult protection referral. Allegations were found to be unsubstantiated. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the décor and furnishings within the home provides residents with a homely place to live in however more regular cleaning of carpets in the communal rooms would provide a more hygienic and comfortable environment. EVIDENCE: The home provides comfortable facilities. The home was in reasonable decorative order. Furniture and fittings are of a reasonable quality, although some furnishings and the décor of some rooms particularly bathrooms and toilets are showing signs of age. A partial tour of the home was carried out. The carpets in the communal areas on the ground floor, particularly the hall, inner hall area and sun lounge were Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 20 dirty, marked and odorous. This issue has been identified at the two previous inspections and does not provide a pleasing environment for the service users. All bedrooms seen were clean and tidy and furnished and decorated in a homely style; the sink in room 14 was cracked and requires replacement. The residents spoken to said they were happy with their rooms. Many people had furnished their bedrooms with a range of personal items. The bay windows in the ground floor lounges have been replaced with UPVC type and works to fit all service users room doors with privacy locks has now been completed. Staff at interview stated that there was satisfactory provision of moving/ handling equipment and pressure relieving equipment was accessed through the community team. Care records detailed provision of specialist equipment. The current fire risk assessment is brief and advice was given to develop the format to provide a more detailed document. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents are satisfied with the level of care provision the staff are struggling at times to maintain the standard; staffing levels at the time of inspection did not meet the recommended guidance. Staff recruitment and training generally promote the safety of service users in the home. EVIDENCE: The occupancy in the home has steadily increased since the previous inspection and the home had 36 residents at the time of the visit. The management have implemented the Residential Homes Forum assessment tool however the registered provider needs to ensure that regular calculations are made and recorded to support the changes in occupancy numbers and individual service user dependency weightings. The calculation made on the day evidenced that there was a small shortfall of hours provided- 12 per week, which the provider confirmed he would address although one of the service users was scheduled for discharge the following day. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 22 On the day of the visit there was a shortfall of two staff that morning due to rostering changes and staff sickness; the manager confirmed that she had tried to cover the shortfall but had been unable to. Staff at interview told the inspector that there was enough staff on shifts to manage the care needs if everyone turned up; examination of rotas evidenced that sickness levels were generally low and cover had usually been provided when needed. The majority of staff surveys indicated that they felt there was not enough staff on duty to meet all the resident’s care needs and to allow them to spend enough time with the residents yet all the resident surveys returned indicated that the staff were always available and that they received the care they needed. Therefore the management need to review the staffing levels more regularly inline with the occupancy and dependency and maintain the skill mix of staff to ensure that the staff are not struggling to maintain the quality of care they are providing. The manager confirmed that she had recruited more care staff to cover for maternity leave. There has been a shortfall in cleaning staff for the last twelve months, which coupled with contractual changes, has caused some moral issues; the manager confirmed that they had now recruited another cleaner. Recruitment files for four of the most recently recruited care staff were examined; these were found to be in good order and contained all the relevant documentation to comply with Schedule 2 of the Care Standards with the exception of one file which contained only one reference. There was evidence that the home had obtained Pova First checks for staff prior to obtaining a new CRB check however the registered provider needs to record the dates these checks were received. Where appropriate staff work permits were included in the file and seen to be up to date. Staff training records evidenced that they were up to date with mandatory courses for moving/ handling, fire safety and food hygiene. Staff have also accessed training on first aid, infection control, health / safety, adult protection, dementia and continence. In recent times much of the training that staff have accessed has been through in- house video packages however staff have now started to access a number of the courses via the local authority, which is providing more variety in approach. The management still need to review the level of service specific training for staff and look to providing training in common conditions relating to older people. New staff complete an in-house induction programme which was evidenced in the staff files. To comply with Care Standards new staff must also complete an induction programme to NTO standard, which was previously accessed by the home staff externally via Learn Direct. The registered provider had recently purchased a new induction programme for this purpose however it does not comply with the NTO standard and advice was given to obtain the Skills for Care common induction programmes. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements must be made in providing staff and residents with opportunities to influence how the home is run. This said, residents were satisfied with the service provided and considered that they lived in a home that was well managed EVIDENCE: The registered manager is also one of the registered providers and is experienced in this care setting. The registered manager has no plans to complete the Registered Manager’s Award as she is nearing retirement age; Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 24 and is currently trying to recruit a manager to take over the running of the home. The manager’s daughter is the deputy manager who is currently on maternity leave and hoping to return to work in the New Year. Service users were very complimentary about the management and how the home was run. All service users spoken to commented on how friendly and supportive the management team in the home were. Staff confirmed that moral was generally good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews and surveys indicated that most staff consider the management to be very open and approachable whilst others feels less so. The management do not hold regular staff meetings, which is important for staff to have the opportunity to contribute to the way in which the service is delivered. Formal resident meetings are not held; therefore the inspector was unable to assess how requests and suggestions were discussed and actioned. Residents were not able to give any information on how their views influenced what happened in the home in a structured way. A number of the key policies and procedures were examined which evidenced that the majority now required complete review. Procedures for areas such as moving/ handling, medication, care of the dying resident, health and safety etc were minimal and require more detailed information to support staff in all aspects of their practises. Consideration should be given to provide a greater selection of policies to support equality and diversity issues. The majority of service users in the home require support with the management of their personal monies. There was evidence that the manager audits the accounts quarterly. Two accounts were checked; one account was satisfactory with receipts corresponding to expenditure whilst the other account had an excess of £100. The manager audited this account following the inspection and confirmed that there had been an error with the financial calculation which had been identified and addressed. The management have made little progress since the previous inspection towards the implementation of a formal quality assurance system. Surveys on meals were carried out in February, care plans in May and in March a number of room checks were carried out; action plans were not developed to support any deficiencies identified therefore there was no record of improvements in these areas. Weekly audits are carried out in the kitchen areas however these have not identified the cleaning issues raised in the EHO report earlier in the year. Systems also need to be implemented which effectively gain service users, relatives and stakeholders views about the service provision. An annual development plan needs to be developed to support the quality assurance programme. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 25 The staff supervision has been maintained with evidence that the staff are receiving the appropriate number of sessions. The records demonstrate that many of the recent sessions have included regular issues for all the staff such as: phone calls, holidays, handover, uniforms etc which would be better addressed at staff meetings. The staff appraisal programmes identifies areas for development. Records showed that staff were up to date with mandatory training in fire safety, health / safety, basic food hygiene, first aid and moving/ handling. The fire safety equipment and checks were all in place and up to date. Fire drills were carried out regularly. The fire risk assessment should be reviewed to provide a more detailed, comprehensive assessment of the home. Regular checks on hot water temperatures and bed rails were maintained. Risk assessments were in place for all safe working practices. Records evidenced that service checks had been completed for all installations and equipment. There was evidence that the management had actioned the majority of the requirements and recommendations identified in the report; however effective standards of cleaning in a number of areas remain a problem such as cutlery holders and shelving which needs addressing. Accident recording still requires some further review, accident reports should be held in the individual service user’s files. Advice from the previous visit to record in more detail all further action taken to further reduce risks of accident/ falls reoccurrence has been implemented in part. The inspector advised the management to contact the falls prevention co-ordinator for specific advice and support in this area and that the accident audit records are maintained by the manager and not the registered provider who is not involved in care management. Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 26 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 3 X 2 Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 27 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 OP33 Regulation 24 and 12(2)3 Requirement The registered person must ensure that a system for monitoring the quality of care provided is developed and implemented. Previous timescale of 31/01/05 and 31/03/06 unmet. The registered person must ensure that a system for service users to influence the running of the home is formalised and documented. Previous timescale of 05/11/05 and 31/03/06 unmet The registered person must ensure that the carpets in the communal areas are kept clean and a regular cleaning schedule is put in place. Previous timescale 10/10/05 and 27/01/06 not met. The registered person must ensure that the Service User Guide contains all the DS0000002844.V308336.R01.S.doc Timescale for action 01/03/07 2. OP33 12(2)3 31/01/07 3. OP26 23(2)d and 16(2)j 30/11/06 4. OP1 4 and 5 15/01/07 Rivelin Residential Care Home Version 5.2 Page 28 5. OP27 18(1) a 6. OP32 12(5)a appropriate information to comply with NMS 1.2 and that the Statement of Purpose is updated to reflect the current service details. The registered person must ensure that appropriate levels of staff are on duty to meets the needs of the residents at all times in line with the The Residential Forum Staffing dependency tool. The RFS tool calculations must be carried out at least monthly and records maintained. The registered person must ensure that a system for staff to influence the running of the home is formalised and documented. The registered person must ensure that two written references are obtained prior to new staff starting work at the home. The registered person must ensure that new care staff are provided with induction training that meets current NTO standards. The registered person must review the key policies and procedures in the home such as medication, moving/ handling, health/ safety etc to ensure that they are detailed and reflect current legislation and best practise. The registered person must ensure that the appropriate standards of cleaning in the kitchen areas are maintained. 17/11/06 31/01/07 7. OP18 OP29 19 17/11/06 8. OP30 18(1)c 31/01/07 9. OP33 OP9 OP38 12 and 24. 28/02/07 10. OP38 16(2)j 30/11/06 Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 29 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 OP31 OP30 Good Practice Recommendations The registered manager should gain the RMA NVQ level 4 qualification. The registered person should include more service specific training in the training and development programme such as activity provision and conditions common to the elderly. The registered person should ensure that records are maintained of all further management action taken following accidents in the home especially falls and access the community falls advisor for guidance. The records should be maintained by the manager/ senior carer involved in the care management. The registered person should further review the storage arrangements for the medications looking to provide one appropriate area where all the medications could be stored and regularly monitor the room temperature where medication is stored. The registered person should have the homes fire risk assessment checked by a competent person. The registered person should review the format for the pre- assessment and assessment documentation to ensure that all sections are fully completed. The registered person should ensure that relatives are fully informed of the complaint procedures. 3. OP38 4. OP9 5. 6. 7. OP38 OP3 OP16 Rivelin Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Residential Care Home DS0000002844.V308336.R01.S.doc Version 5.2 Page 31 - 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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