CARE HOMES FOR OLDER PEOPLE
Rivercourt Residential And Nursing Home Explorer Drive Watford Hertfordshire WD18 6TQ Lead Inspector
Marian Byrne Unannounced Inspection 14th December 2007 10:00 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 Rivercourt Residential And Nursing Home DS0000019511.V356670.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. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rivercourt Residential And Nursing Home Address Explorer Drive Watford Hertfordshire WD18 6TQ 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) 01923 800178 01923 230 891 kanes@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Janet Susan Arberry Care Home 120 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60) of places Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. This home may accommodate (in Gade House) 30 older people with dementia who require personal care. This home may accommodate (in Colne House) 30 older people who require personal care. This home may accommodate (in Chess house) 30 older people who require nursing care. This home may accommodate (in Hampermill House) 30 older people with dementia who require nursing care. 21st June 2007 Date of last inspection Brief Description of the Service: Rivercourt Residential and Nursing home is a purpose-built care home owned by BUPA Care Homes Limited. It is situated in a residential area close to the town of Watford. There are local shops and transport facilities nearby. The home is registered for 120 residents in the Old Age category, some of whom may require nursing or dementia care. The buildings are set around a central courtyard with parking facilities. Facing the entrance to the courtyard is the central administrative office block; The main kitchen, laundry and hairdressing facilities are in the administrative block. The Residential Units are to the right and the Nursing Units are to the left of the courtyard. Each building has 2 floors served by a lift. The home may accommodate 30 residents who require residential care (Colne House on the first floor), 30 residents with dementia (Gade House on the ground floor), 30 residents who require nursing (Chess House on the first floor) and 30 residents who require nursing and dementia care (Hampermill House). All bedrooms have en-suite toilet facilities and they are all of single occupancy. The surrounding grounds have mature trees and gardens with seating. The grounds are wheelchair-accessible. The home charges £406 - £1030 per week. Further information can be obtained from the Statement of Purpose and the Service User Guide. A copy of the CSCI inspection report should be available in the care home. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Four inspectors carried out this inspection over a half day. On the day of the inspection three units out of the four in the home were open and caring for service users. Time was spent in each unit where practice was observed and staff and service users spoken with and appropriate records were examined. What the service does well: What has improved since the last inspection?
The Manager and staff of Rivercourt have clearly worked very hard since the last inspection and are to be congratulated on their achievements. All aspects of care within the home have improved. The environment has been improved and new furniture provided for the benefit of the people who live there. Staff were observed to meet service users needs in a caring, compassionate manner. Service users were occupied appropriately. The care of people who have dementia has changed since the last inspection from poor to excellent. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 6 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. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 7 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 Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 8 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that the home can support them as an accurate assessment of their needs has been carried out. EVIDENCE: A full assessment of needs is carried out prior to the resident being admitted to the home. This assessment is ongoing and is reviewed at six weeks. Where possible the resident or their relatives (or representatives) are involved in the process. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 9 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 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home receive the care they need and are treated with dignity and respect at all times. However the medication auditing systems in place were not robust enough to pick up an error, which may mean that service users could get the wrong medication and it would not be noticed. EVIDENCE: Care plans were good and contained very good detail on all the people who live there. The care plans contained detail on how the people living there wanted to live and how they wanted to be treated. There was good personal history in place. This allows staff who care for people who have dementia to gain a better understanding of them and therefore able to offer better care. Health care needs were identified and were met. We (the Commission) observed people being treated with respect and dignity at all times.
Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 10 There were systems in place to ensure medications were administered and recorded appropriately. An error was made in the recording or administration of one person’s medicines this was not picked up in an audit that had recently been completed. The purpose of an audit is to ensure mistakes are picked up and protect the people who live there from over or under medicating. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 11 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be treated as individuals with their dignity and rights respected. They can take part in activities that are appropriate to their needs and culture, keep in touch with family and friends and be as independent as they can be and most are given the opportunities to make the most of their abilities. People who use the service can be assured that they will have healthy, wellpresented meals and snacks at a time that suits them. EVIDENCE: People have opportunities to live their lives as they choose, staff are aware of people’s needs and abilities. Staff were observed to be pro-active in ensuring people were not left alone and isolated. In Hampermill where people with dementia are cared for we observed staff ensuring all people were attended to. For example one woman was upset and worried about her son visiting, a member of staff spent time with her reRivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 12 assuring her that her son was going to visit and then went and got a letter her son had written and read it to her. She was not left alone until she was calm and relaxed. On the day of the inspection there was a constant stream of visitors to the home. People had access to food and snacks at all times. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 13 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people who use the service have concerns with their care they or people close to them know how to complain, their concern is looked into and action taken to put things right. This service safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: Complaints were investigated and allegations of abuse investigated. A recent investigation resulted in five staff members being dismissed from their posts. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 14 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic and meets their needs. EVIDENCE: The environment is clean, bright and fresh. The home is part way through a complete refurbishment. The home is offers safe accommodation to the people who live there. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 15 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that there are enough competent, qualified staff on duty at all times who have been appropriately recruited, supported and supervised to meet their needs. EVIDENCE: An effective staff team, who understand what to do and what is expected of them, supports people who use the service. This was particularly evident in Hampermill where the nurse in charge has very good skills in caring for people who have dementia and leads a highly skilled team of care workers. This results in people who have dementia living in a home where they are valued for what they can achieve, provided with comfort, identity and acceptance. Staff are recruited appropriately. There was enough staff on duty to meet peoples’ needs. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can have confidence that the care home is run and managed appropriately, with their needs and wishes being central to how the home reviews and develop and its practices. EVIDENCE: The very positive changes in the home since the last inspection indicate that the home is well managed and run in the best interests of the people who live there. The manager provides strong leadership and staff spoken with stated that she was very supportive and easy to talk to.
Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 17 Appropriate safety checks had been carried out on fire equipment and water systems. Cleaning materials were found left unprotected in one unit. This could put confused people at risk. Call bells were left out of reach of some frail people. Checks were carried out regularly on these people by staff. However, people who use the service would be unable to summons help if they needed it. The manager assured us that these matters would be dealt with as a matter of urgency. Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 18 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X x 2 Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement To ensure the safety of service users any gaps in the Medication Administration Chart must be accounted for using the contemporaneous notes written and signed at the back of the MAR charts by the person(s) responsible. To ensure that their continued welfare is met all service users who live in the home must be able to summon staff for assistance when they need to. To ensure the safety of service users all cleaning substances must be locked away when not in use. Timescale for action 14/01/08 2. OP38 12(1)(a) 14/01/08 3. OP38 13(4)(a) 14/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 20 Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Rivercourt Residential And Nursing Home DS0000019511.V356670.R01.S.doc Version 5.2 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
