Inspection on 19/01/09 for Rivelin Residential Care Home

This inspection was carried out on 19th January 2009.

CSCI found this care home to be providing an Poor service.

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 12/08/08

Rivelin Residential Care Home 13/11/07

Rivelin Residential Care Home 17/11/06

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Rivelin Residential Care Home 17/21 Albert Road Cleethorpes North East Lincs DN35 8LX Lead Inspector Theresa Bryson Key Unannounced Inspection 19th January 2009 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.V373787.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.V373787.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 P/F01472 692132 J and LD Hayes Limited Manager post vacant 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.V373787.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. 12th August 2008 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. 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. Fees are renewed annually. 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.V373787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means that the people who use this service experience poor quality outcomes. This was an extra key inspection due to information given to us as part of a safe guarding investigation being undertaken by the Local Authority. There was no time, therefore, to send out survey forms or ask the home to submit an Annual Quality Assessment Audit (AQAA). The last key inspection was in August 2008 and information from the last AQAA submitted was checked prior to this inspection. A number of health and social care professionals were spoken to prior to the site visit which took place over one day in January 2009. A number of people resident in the home, some relatives and staff were spoken to on the day. Records and documentation, covering a number of outcome areas, kept in the home was checked. The Acting Manager was present throughout the site visit day and the Director of Operations and owner of the home for part of the day. All were present during the feedback session. What the service does well: What has improved since the last inspection? Since the last inspection the home has commenced recording the temperatures in the drug storage area and fridge. This will ensure it is stored at the correct temperature and safe to give. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 6 What they could do better: There has been a lack of recording and evaluating in the care plans kept on each person living in the home. This could result in their needs not being met and them being put at risk of harm. The home has also failed to inform us about incidents, accidents and deaths in the home to enable us to make a judgement as to whether they had taken appropriate action. Where necessary the help of other health care professionals must be sought to ensure people are receiving the best care to suit their individual needs. To ensure people are not isolated the home must ensure that events are available to fulfil the social, cultural and religious expectations of people living there. There must be suffiecnt staff on duty at all times to ensure that the needs of each individual can be met. These staff must have suitable safety checks to ensure they are safe to work with people in the home and that they are supervised and trained in their job roles. This will prevent people being looked after by ill equipped staff. The process for recording complaints and concerns must be reviewed to ensure that each event can be accurately recorded and time scales met for investigation each time. Action plans and contingency plans must be in place during the continuing building work to ensure it is a safe place to live and work. This must correspond to a new maintenance plan for the building, for areas not affected by this new work. All equipment in the home must be fit for purpose, especially the commodes. To prevent cross infection and people being put at risk of harm. Risk assessments must be in place to ensure people have been correctly assessed for the use of various pieces of equipment and where possible their permission or their next of kin’s sought and recorded. The Responsible individual for the Company must ensure that they check continually that the home is being run for the benefit of the people living there and that all their needs are being met. The home must be safe to live and work in and this person must ensure that policies and contingency plans are in place so people are free from risk and harm. Please contact the provider for advice of actions taken in response to this Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 7 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.V373787.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.V373787.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): Quality in this outcome area is adequate. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 3 and 6 were checked. Information is available to enable people to make informed choices about the services the home provides. EVIDENCE: Information is available to enable prospective users of the home to make informed choices about whether it is suitable for them and can meet their needs. The Statement of Purpose and Service Users Guide are comprehensive documents detailing all available resources at the home, fees and how the Company runs the home. It can be made available in other than the standard format to enable those who have no knowledge of the English launugage or Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 10 who do not or cannt read the written word. For example in Eastern European languages and audio (on request). The admissions and discharge register showed no admissions since June of last year, so there were no new contracts to check as this was prior to the last inspection. The home is currently closed to Local Authority admissions due to an on going safe guarding adults’ investigation. On checking this register it listed 3 people who had died since the last inspection. CSCI had not received any Regulation 37 notices about these deaths, which is a requirement on the part of the home. This enables us to ensure the circumstances of any death, accident or untoward incident have been correctly recorded and any action taken has been suitable in each circumstance. There had also been a failure to notify the Commission of incidents that might affect the welfare of service users.This was discovered whilst tracking care plan notes of individuals, checking of accident records and speaking to staff, and health and social care professionals. The home does not provide intermediate care and therefore Standard 6 is not applicable. Rivelin Residential Care Home DS0000002844.V373787.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): Quality in this outcome area is poor. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 7,8,9 and 10 were checked. The poor evaluation of care needs of individuals has lead to people being put at risk of harm. EVIDENCE: Prior to the site visit to this home, we had been alerted by health and social care professionals that people living in the home potentially were being put at risk due to a lack of evaluation of their needs. This had resulted in a safe guarding adults’ investigation being commenced, which was still on going at the time of this site visit. During the course of this visit we were able to look at 4 care plans of people living in the home and a number of other records associated with their care needs. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 12 The documentation was of a poor standard. The records showed that only recently had some care plans been updated and action taken to ensure they were not at risk of harm. For example on one person’s plan of care the daily records indicated that they were at risk from falls and had been for a number of months but the assessment for client handling and consent to bed-rails had not been completed until the day of the site visit. On another plan a person’s mental health needs were well documented in the daily report sheets, yet the care plan for these needs stated there were no issues to address, even though the person’s mental health status was seriously affecting their ability to maintain a good healthy lifestyle. There were also a lot of inconsistencies in the documentation in use. For example some night care plans were in use for some people but not all. Staff said to us that some people “they preferred” to keep in their bedrooms until mid morning, but there was no indication on those person’s records that it was their personal wishes or that of their next of kin (if they could not make informed decision). Whist touring the home during the course of the day at 10am there were still 6 people in their night attire in their bedrooms, some still in bed with their curtains drawn across, blocking out day light. At 12:00 there were still 6 in their rooms – 1 of which said they wanted to stay in bed, another who was normally in bed all day, according to the care plan. No explanation could be given by staff as to why the others were still in their bedrooms, 2 still in night attire. And nothing to indicate their wishes in their care plans. This lack of understanding of peoples needs could result in them becoming isolated and not aware of the progress of a normal day and make them disorientated to time. Whilst speaking to social and health care professionals we were informed that staff had not accessed their help when people’s health had started to deteriorate. For example the care plan notes and the information we had been given stated that one person’s mental health needs was affecting their ability to maintain a healthy diet. No assistance had been requested of the local GP or local dietician or Community Psychiatric Nurses. The recording of this person’s weight had been spasmodic, and where recorded showed fluctuations in weight. In another set of notes it had been recorded that one person was at serious risk of falls. The accidents had been inconsistently written in the records. For example on some occasions a note had been made in the daily report sheet and accident record, on other occasions it had been written in one or the other, but not both as the home’s policy indicated. On speaking to staff they could not give any explanation as to why this had occurred. No attempt had been made to involve the local falls coordinator of the Health Trust or GP to assess this person’s needs. Some people spoken to during the course of the visit said at times they feel isolated and when asked whether staff come to sit with them the general Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 13 comment was “rarely, they don’t seem to have enough time”. One person said “staff are lovely, on the whole, but I spend a lot of time in my room and they take a very long time to answer my bell, especially at night”. A lack of accurate recording and evaluations in the care plan notes is resulting in some peoples needs not being met and putting them at risk of harm. The recently appointed management team are starting to address some of these issues by implementing new care plan documentation and reminding staff of the Company processes which are in place. Care must be taken that staff and people using the service have “ownership” of these records as the few seen where new assessments have been put in place had been signed only by the management team. There was no indication that this was with the agreement of individuals or their next of kin, except the bed rails permissions. During the course of the day we were able to observe staff giving personal care to people and assisting them with their mobility and at meals times. Staff appeared very fraught and tended to rush around the building. It was only at late morning that we discovered that the staffing rota was short by one member of staff, the acting manager was not aware of this and had to be requested to ensure there were sufficient staff on duty to meet each person’s needs. One member of staff was identified to the management team as it had been observed that they were abrupt with one person, in front of the inspector. The individual resident appeared unsure of what actions to take and was then assisted by someone else and looked calmer. We have also referred this to the safe guarding adults team. The communal space is all on the ground floor and consists of 3 sitting rooms, an open area with a couple of chairs and a dining room. On continually walking around the home there were people in each of these areas (except the open area) through out the day. At no time did staff go to observe those people or sit with them. They would not have had known the wishes of those people or if they were in need as all call bells were out of reach. This could put people at risk of harm and that their needs could be ignored. We checked the medication records with a senior member of staff who was able to tell us the process of administering medication, the ordering system and how medication is stored. This is a new storage area since the last inspection and was untidy but clean. Temperature recordings are now being taken to ensure medication is stored correctly. The controlled drug register was checked and there was none in use. The administration sheet recording was generally good with few signature gaps. Some individuals’ records were pointed out to the management team at the handover, as there appeared to be some inconsistencies in the dates when Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 14 medication had been dispensed, the amounts given and what was left in the bottles. Also timing of some medication did not follow guidance as detailed for individual drugs and staff could not give any explanation as to why certain times had been stated and handwritten by them. We had also been informed by other agencies visiting the home that some people were self-medicating some of their drugs. This was also stated by staff in the home. There was no indication on the drug administration sheets who these people were and they did not have assessments in place when the care plan documentation was checked. The management team had not yet commenced the auditing process for drug administration but stated their purpose in doing so, as soon as possible to monitor practise in the home. On checking staff training records all staff administering drugs had valid certificates or letters to state course completion, but the management team were reminded that someone should be on duty 24hrs a day to be able to respond to peoples needs. The Company also needs to ensure that to assist staff an up to date reference book should be in place, as there was not one in place. At the time of the site visit health and social care professionals were assisting the home in re-assessing those people resident with the most complex needs and ensuring that there was none resident who did not fit into the categories the home is registered for. A lot of work needs to be undertaken by the management team at the home to ensure the needs of every individual is evaluated and that all their needs are being met constantly and no-one is at risk of harm. Work also needs to take place to ensure there are suffiecnt staff on duty to meet those needs and that they can competently do their jobs. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 12,13,14 and 15 were checked. There was insufficient evidence to support people’s social, cultural and religious expectations were being met. EVIDENCE: During the course of the site visit there was little stimulation available for people resident in the home. In each sitting room area a television was on all day, but staff made no attempt to sit with people or ask them what they wanted to do that day. We asked to see the social needs assessments and records of social activities on each person. These records were obtained by the lunch time period as they were being kept at the personal home address of a member of staff. The management team were made aware that this practice must stop as it could break confidentiality of each person if notes were not kept in a secure environment. Other staff would also need to access these notes, as part of the Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 16 care programme of each person, and had been prevented from doing so. There consequently had been little updating on some notes for some time. For example several peoples notes had not been updated since June 2008. There was no supporting evidence to show any range of activities taking place recently and peoples individual needs bring addressed. One person said how they like going out and do go out, but there was no assessment of this person’s need and when events had taken place. The Company does provide a document for staff to detail the date when an activity takes place, and evaluation of that event and room for signatures. Those seen that had been spasmodically completed showed very repetitive events such as bingo, entertainers, games and beauty sessions. They were not in place for everyone currently resident in the home. Due to staff extended leave the home was currently not identifying a staff member to facility social, religious and cultural events in the home and have failed to complete the outstanding requirements, laid out at the last inspection. There was evidence in the personal bedroom areas of a selection of rooms seen that they had been able to personalize them. One person said how this had helped them settle into the home with, “my bits and bobs around me”. Another person said how with the help of staff they had changed the layout of the room to suit their need and tastes. Another said how, when well enough, they get great pleasure still in dusting their prized ornaments and photographs. Due to the lack of evidence to support that peoples social, religious and cultural needs are being met, there is a risk that people living in the home will become isolated from the Community and not have their expectations met. Rivelin Residential Care Home DS0000002844.V373787.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): Quality in this outcome area is poor. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 16 and 18 were checked. There is no robust system in place to protect people from harm. EVIDENCE: Since the last key inspection in August 2008 there had been one concern raised to us and one serious allegation. The concern was being dealt with by the Local Authority Complaints team and the serious allegation by the Safe Guarding Adults team locally. Both were on going at the time of the site visit. We checked the complaints log whilst on site and nothing had been recorded. The file was blank. No explanation could be given why both the above had not been recorded or that Regulation 37 notices had not been sent to CSCI. The complaints process had been updated and gave people clear information about how to make concerns known and who to refer these too, but staff had no guidance steps to follow as the Safe Guarding Adults Protocol, for use in this area, we were informed was missing. Arrangements were made by us to have copies sent to the home. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 18 The training records of staff showed a large shortfall of staff who have not received updated training in the protection of vulnerable adults. This could people at risk if staff are not aware of what constitutes an abusive situation and how to respond quickly in the event of an occurrence. Rivelin Residential Care Home DS0000002844.V373787.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): Quality in this outcome area is poor. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 19 and 26 were checked. There is no auditing process in place to ensure the environment is a safe and comfortable place to live. EVIDENCE: On this visit there was still extensive building work in progress, which was causing some disruption to people living in the home. The noise level was very loud and some people sitting in a sitting room closest to this particular piece of work complained of having “headaches”. A link corridor had also been made by the builders between units to be less obtrusive for people as work continued. This had an uneven floor surface and was very Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 20 cold. There was no evidence to support that a fire risk assessment had been completed for this temporary structure. A fan heater currently in use to heat this area had to be taken out of commission during our visit as it had not been PAT tested and would cause a trip and heat hazard where positioned. There was no evidence to support the Company had written to people living in the home and their visitors to discuss this work and lay out the plans to them. There was also no plan in place or risk assessment completed about the phases of the work and what contingency plans would need to be in place to cause little disruption to peoples lives. On touring the home it appeared clean, but some carpets were stained and some furniture in a poor state of repair. Some beds appeared not to be fit for purpose and were very small, low and narrow. At the last inspection we made a requirement that all commodes should be fit for purpose. No new commodes were seen and those that were seen were still not fit for use. This could put people at risk from harm and cross infection. Showers were available in the home but none could be used, if required by any individual living there, as they were being used as storage areas. This gives people limited choices as to bathing facilities. The linen was in a poor state of repair, but we were assured by the management team this was an area currently being addressed and on the list of items to be audited. As part of the safe guarding adults’ investigation the local fire officer had been asked to attend the home to give advice about fire safety and evacuation. There was no updated policy in place or personal evacuation plan for each individual. The Company had been asked to give particular attention to those resident with complex needs on the 2nd and 3rd floors of the home. As part of this review the home had identified that an unsuitable locking device was on a fire exit door and were addressing this issue during the visit. Only a brief tour of the kitchen had taken place as the Environmental Health officer (EHO) had visited recently and given the home a 4 star rating. The report had been sent to us prior to the visit. We did find that not all staff training records were up to date, but this had been accepted by the EHO as they had found “practises are good”. The new management team is addressing training. Food appeared to be being prepared in a clean and safe environment and a choice of menu was available. No one could confirm how temperatures are recorded for food being taken to the third floor levels and it is recommended that a system be put in place to ensure it is safe to eat. People living in the home said meals “are good and filling” and “I get what I want”. The management team appeared unaware of the disruption to the home environment due to the work in progress. Throughout the day there were Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 21 continually visitors to the home, wishing access to the builders. This was causing disruption to staff duties and as several people resident at the home said to us “we don’t know who is walking around any more”. There is no general maintenance plan in place, which is an outstanding requirement from the last inspection and no new plan to cover the current extra work. At the time of the visit the noise levels were very high from the work in progress and the home did not look comfortable or homely. There was no indication of how long this work would take, which could result in people living in some disruption for some time. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is poor. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 27,28,29 and 30 were checked. There are no robust systems in place to ensure sufficient staff are on duty to meet people’s needs and that they are competent to do their jobs. EVIDENCE: During the course of the site visit we had to ask for the management team to ensure that there were sufficient staff on duty to cover the needs of people living in the home. According to their own staffing rota there were insufficient people on that day. No one could tell us how the current staffing levels had been assessed as no one knew how to calculate this need and the dependency levels of each individual resident, which aids this process, in the home was not up to date. This could put people at significant risk of harm if there are insufficient people on duty to fulfil their needs. No calculation had been made in the current staffing rota for disruption to staff duties to respond to the needs of the builders and disruption to the working day whilst the extensive building work is being completed. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 23 There was also a short fall in the hours required to complete the laundry duties and staff were being taken away from their caring role to complete laundry tasks at weekends. No contingency plans had been made to cover the hours required to provide social activities and this element of a person’s care was largely being ignored. One of the duties for night staff, on their job description was “to carry out minor domestic duties as required by the home”. Staff confirmed this was generally washing and ironing and some cleaning. This will take the 2 staff allocated to look after the 28 people in the home away from their caring role and put those people at risk, in a building with 3 floors, with numerous staircases and corridors. The configuration of the building will have to be taken into consideration when calculating staff hours. A training matrix was produced during our visit but this showed large gaps in the amount of statutory training, which had been missed over the last 6 months and showed no individualised training to suit staff needs. Major training gaps were seen in such topics as infection control, manual handling, health and safety, fire, first aid and care planning. Some had taken place for limited numbers of staff in topics such as dementia, stroke awareness and diabetes. If staff are not trained to do their jobs they could people at risk by not knowing how to care for them correctly. Three staff personal files, which were tracked, appeared to mainly have sufficient evidence to show safety checks had been completed and people were safe to work in the home. One person’s file only showed one reference and this name was identified to the manager. The personal files were currently being audited to ensure the previous management team had completed all checks and that every one employed was safe to work at the home. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 33,35,36 and 38 were checked. The Company is trying to ensure that all auditing process are put in place to identify that the home is being run for the benefit of those living there and it is a safe place to live and work. EVIDENCE: Since the last inspection there has been a change in the manager of the home and a change to the Responsible Individual for the Company, this has now reverted back to the owner. The new manager had only been in post 8 weeks. There was also a new tier of management with a Director of Operations Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 25 recruited. The team expressed their wishes to work with CSCI and have issued an action plan to look at the most urgent requirements, which have arisen due to the safe guarding investigation. An admission was made verbally to us on the day, by the above team, that no work has been completed in the last 6 months towards the Company quality assurance programme or consultation with people using the service or other stake holders. The outstanding requirement for quality auditing will remain open. There were no Regulation 26 site visit forms available in the home so we could see when the Responsible Individual was visiting and what action was being taken to ensure the home was running correctly and for the benefit of people living there. A number of other records were seen covering safety aspects of running the building such as certificates for hoists, lifts and gas. All appeared to be in order and there was accurate weekly testing of fire alarms and monthly testing of water temperatures to ensure they were safe to use. The records showing peoples personal allowance money and use of the Comfort fund were seen. There appeared to be no inappropriate use of these funds, but they had not been audited for some time. It was recommended that this take place due to the change of management. The supervision records of staff were also seen and the yearly matrix for each staff member. Sessions had taken place, but were very spasmodic. Topics covered each time were similar and there was no recording of any observational supervision. Staff need to be supervised at different levels to ensure they can do their jobs and be safe in looking after peoples needs. There was a lack of evidence to support this was in progress. Rivelin Residential Care Home DS0000002844.V373787.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 3 Rivelin Residential Care Home DS0000002844.V373787.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 OP3 Regulation 37 Requirement All notifications of accidents, deaths and untoward incidents must be sent to CSCI without delay. Timescale for action 19/03/09 2 OP7 17 This is to ensure we can make a judgement that appropriate action has taken place. All records must be kept by the 30/03/09 home on each person living there and follow the guidance set out in the Care Standards Act 2000. This is to ensure accurate records are kept to be able track correct delivery of care for each person. A service users plan must be kept on each individual and this plan evaluated regularly to ensure their current needs are being met. Where necessary the assistance should be sought of other health care professionals to ensure people are being looked after correctly. These events should be accurately recorded. DS0000002844.V373787.R01.S.doc 3 OP7 15 30/03/09 4 OP8 13.1. a and b 30/03/09 Rivelin Residential Care Home Version 5.2 Page 28 5 OP9 13.2 6 OP10 12.5.b 7 OP12 16.2.m.n All people administering medication should use safe practises when administering medication and records kept on how this is monitored. Staff should receive training in dignity and respect to ensure they treat each person with care at all times. Activities must be arranged to meet the diverse needs of the client group and be accurately recorded. (Previous time scales of 30/03/08 and 07/12/08 not met). Research must be completed to ensure people living in the home can assess local community events to suit their needs and they feel an integrated part of the community. (Previous time scale of 07/11/08 not met). Staff must be made aware of the procedure for referring complaints so that each event can be investigated thoroughly. All staff must have received up dated training in safe guarding adults to ensure they are aware of what constitutes abuse and can respond appropriately should the need arise. An action plan and contingency plan must be put in place during the current extensive building work. This will ensure people are not put at risk and it is a safe place to live. A maintenance plan must be in place and work detailed to ensure people live in a comfortable environment. (Previous time scales of 30/03/09 30/03/09 30/04/09 8 OP13 16.2.m.n 30/04/09 9 OP16 22 30/04/09 10 OP18 13.6 30/04/09 11 OP19 23.2.b 19/03/09 12 OP19 23.2.b. 19/03/09 Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 29 13 OP26 23.2.b. 30/05/08 and 07/11/08 not met). The laundry must be refurbished to allow staff to work in a safe and clean environment to enable them to provide a good service to people living in the home. (Previous time scales of 30/03/08 and 07/11/09 not met). All commodes in use must be fit for purpose and safe to use to prevent cross infection. (Previous timescale of 07/02/09 not yet reached. There must be sufficient staff on duty at all times to meet the needs of people in the home. All staff must be competent to do their jobs and appropriate training put in place to ensure this is so. A failure to do so could result in people being put at risk from being cared for by inappropriately trained staff. In the absence of a Registered Manager the Responsible Individual must ensure that site visit reports are completed and these are open for inspection. This will ensure we can monitor how well the home is being looked after. A quality assurance programme must be in place to ensure the home is being run for the people living their, it is safe and their views have been taken into consideration. (Previous time scales of 30/05/08 and 07/02/09 not yet reached). All staff must receive supervision, which must be a balance between discussion and supervision to ensure they are DS0000002844.V373787.R01.S.doc 30/04/09 14 OP26 23.2.b 19/03/09 15 16 OP27 OP30 18.1.a 18.1.c 19/03/09 30/04/09 17 OP31 26 30/04/09 18 OP33 24.1. 19/03/09 19 OP36 18.2. 30/04/09 Rivelin Residential Care Home Version 5.2 Page 30 capable of doing their jobs. (Previous timescale of 07/12/08 not met). 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 3 4 5 6 7 Refer to Standard OP7 OP7 OP9 OP9 OP15 OP29 OP35 Good Practice Recommendations If a quick reference guide is to be used in the care plans this should be dated when evaluated to ensure it reflects current needs. People living in the home must be able to contribute to the care plan in place and if unable to do so a suitable advocate found. A suitable reference book should be found to ensure staff administering medication have some guidance to refer to. An auditing programme should be in place to ensure safe practises are being used in the administration of medicines. A method of food temperature recording should be put in place to ensure food taken to up floors of the home is safe to eat. An auditing process should be put in place to ensure staff files contain the necessary information to ensure people are safe to work with people living in the home. An auditing process should be put in place to ensure personal allowance money and “Comfort Fund” money is correct at all times and there is on fraudulent use of funds. Rivelin Residential Care Home DS0000002844.V373787.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V373787.R01.S.doc Version 5.2 Page 32 - 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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