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Inspection on 15/09/05 for River Court Residential And Nursing Home

Also see our care home review for River Court Residential And Nursing Home for more information

This inspection was carried out on 15th September 2005.

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

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

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

What the care home does well

Service users spoken to said they were very happy with the care provision in the home and praised the staff. The interaction seen between staff and residents was very good and there was a pleasant and calm atmosphere in all the "Houses". Staff said they enjoyed working at the home and said training levels were very good. The staff also said they appreciated the daily visits made to all units by the deputy Manager and that staff moral was high.

What has improved since the last inspection?

Staff agreed that the appointment of the new Manager had made a difference to the home and said the Manager was "hands on" and felt she would be supportive and approachable. The Care Manager and staff of Chess unit have improved the care planning and recording and this is now of a high standard. The issues about meal provision have now been addressed and service users said they had good choices of food and enjoyed the meals.

What the care home could do better:

The fabric of the building is beginning to need some refurbishment and some carpets and chairs need replacing. There are some odours in the units, which also need addressing. There are no automatic door closures on bedroom doors in the home and, as many of the service users like their doors left open, this issue needs addressing with the fire service. Outcomes should be clearly recorded and conveyed to all staff members.

CARE HOMES FOR OLDER PEOPLE Rivercourt Residential And Nursing Home Explorer Drive Watford Hertfordshire WD18 6TQ Lead Inspector Pat House Unannounced Inspection 15th September 2005 7:00 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.V254500.R01.S.doc Version 5.0 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.V254500.R01.S.doc Version 5.0 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 BUPA Care Homes Limited 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.V254500.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. This home may accommodate (in Hampermill House) 30 older people with dementia who require nursing care. 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. The home may accommodate two (named) service users who have not reached the age of 65 years. 5th April 2005 Date of last inspection Brief Description of the Service: Rivercourt is a purpose-built care home providing services to 120 elderly people. The home’s residential facilities are sited in two buildings, which face one another, each of which has two floors and a passenger lift. Each floor of the buildings is managed as a separate unit, or “House”, and provides specialist care for the differing service user needs. Gade House is home for those with a dementia; Chess House provides nursing care; Hampermill House provides nursing care for those with dementia and service users not in these categories live in Colne House. There are 30 bedrooms in each “House” and all are single occupancy and have en-suite facilities. Between the two buildings is a central service block, which houses the main kitchen, the laundry and administrative services. The three buildings are set around a central courtyard and parking area, with ample car parking spaces. There are well-maintained gardens around the home with easy access for the residents. The home is situated in a residential area near to the main town of Watford with its extensive facilities. There are local shops, a public house and bus services nearby. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during one evening and there were four inspectors who each visited one of the “Houses”. Most service users were still sitting in the lounge areas and many spoke to the inspectors. The premises were checked and care plans were examined. Other records were not checked on this occasion, but had been seen at the previous inspection and were all in order. A new Home Manager had been appointed since the previous inspection but was not on duty that evening. Staff were spoken to and feedback, at the end of the visit, was given to the senior member of staff who was on duty that evening. What the service does well: What has improved since the last inspection? 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. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 6 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.V254500.R01.S.doc Version 5.0 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. Standard 6 does not apply to this home. All new service users have their needs fully assessed before entering the home and are able to visit the home before admittance. In this way both the service user and the care staff can be sure that the home can meet these needs. EVIDENCE: A new resident had been admitted to Chess House the previous day and records showed that the family had visited the home and the Care Manager had been to see the service user in hospital. A thorough assessment had been completed and the Care Manager said that a review would take place after six weeks, or sooner if necessary. A resident who had entered another unit of the home two weeks before, also had full assessments in place and a thorough care plan had been completed. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. All service users in the home have thorough care plans completed and updated so that their needs can be identified and staff can ensure that all social and health needs are met. EVIDENCE: A requirement had been made at the last inspection that care plans in Chess House were not adequate. A considerable amount of work has clearly been done to update these plans and the Care Manager in charge of this unit has introduced a new system for how they are completed. Individual residents have a named key worker who is responsible for all aspects of their daily care, including their supplies of toiletries and the standards of cleanliness in their bedrooms. The Care Manager said that this resulted in the key worker being more involved in the care plan recording and in reviews. The Manager also said that he tries to link individuals with appropriate care staff and that, fortunately, the unit has enough staff of both sexes for service users to also have a choice in the gender of their key worker. Up to date property lists have also been completed for residents and reviews and risk assessments were in place. The risk assessments seen were appropriate and very thorough. Care plans in the other units were also well documented and covered individual histories, social needs, “Falls” assessments and body charts. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 9 Monthly reviews had been recorded and all records examined were relevant to the individual service user needs seen during the inspection. Health checks were recorded on care plans and service users confirmed they had sight and hearing checks when appropriate. It was noted, however, that some service users, in one unit had inappropriate foot wear, which could contribute to falls. Staff agreed they would review the footwear in this unit. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Service users are satisfied with the activities and daily routines in the home and enjoy the food and snacks which are available at all times and which add to the residents’ well being. EVIDENCE: Service users’ interests were seen recorded on care plans and those spoken to felt that there were a good variety of activities offered in the home. Residents on one unit said they had had a quiz earlier in the day and that they played dominoes and had regular “beetle drives”. Other residents said they played bingo and there were prizes, and newspapers were seen around the home. Records were being kept of service user participation in activities. Many of the service users were still in the lounge areas during the visit and said they could go to bed and get up when they chose. One relative was visiting and confirmed she could call at any time and was very satisfied with the home and its routines. Some service users said they went out to the town and also went to the pub and staff said these outings had been risk assessed. One resident who was over 90 was virtually bed-bound but said she had “everything she could want” around her. The lady had a table over the bed and was reading with an efficient reading lamp nearby. Her call bell was nearby and the resident said she was washed daily and had her hair done regularly. Some service users said they had “tea and toast” in the lounge before getting ready for bed, and they then watched the television in their bedrooms. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 11 However, those who were asked said they did not have regular residents’ meetings, and would appreciate these. It may be that the new Home Manager will re-establish these meetings, and this will be checked at the next inspection. No meals were seen during the visit, but residents said they enjoyed the food and were asked for their choice of meal the day before. One resident had some bottled beer beside him, which he said he enjoyed at appropriate times. One group of residents confirmed that there had been complaints about the food, but that the chef had gone round and spoken to people and the meals were much improved. Menus were displayed on the walls and the meals looked well balanced and appropriate. Some service users said they could make their own drinks if they wanted and the evening tea trolley was being taken round just after 8.30 p.m. On one unit at least, a large industrial teapot was being used to serve tea, and milk had already been added in this pot. Staff were advised to ensure that all service users liked tea served this way, as it is usually more acceptable to add milk to taste. Kitchenettes on the units were well stocked with bread and supplies for drinks so that the night staff could prepare snacks if required. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home’s complaints procedures enable service users to feel comfortable about voicing concerns and therefore help to protect the residents from abuse. EVIDENCE: Those service users spoken to said they would feel comfortable telling staff of any concerns or complaints they might have, and were sure their concerns would be listened to. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26. Service users in the home live in reasonably comfortable surroundings but some areas are in need of refurbishment and some furniture needs replacing to ensure this comfort continues. Not all areas of the home are sufficiently clean and this is unpleasant for residents and visitors. EVIDENCE: Although the fabric of the home is generally adequate, there are areas, which are beginning to need redecoration, and some areas needed more thorough cleaning. There were some unpleasant smells apparent in Gade House, the kitchen was in need of refurbishment and the dishwasher was leaking. Furniture here appeared to be sparse and the floor in the dining was uneven to walk on. In Hampermill House some of the furniture was worn with seat pads on chairs split and the curtains did not appear to fit properly. Again there were some unpleasant smells around the rooms and some of the carpets were sticky to walk on. The base of one toilet was worn and stained and there was a broken rail in another toilet. Radiators here were unguarded and it was not clear if they had low temperature surfaces. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 14 This will be checked at the next inspection. One bathroom was also being used as a storage area, and staff were asked to clear this room. The laundry was not seen on this occasion but staff said there was always a good supply of vinyl gloves and the home has a policy for the use of gloves. It was felt, however, that wearing disposable gloves to serve cups of tea was not appropriate and staff were asked to review this practice, seen during the visit. There are separate lounges in the home for residents to smoke and call alarms in bedrooms were appropriately placed. Service users confirmed that call bells were always answered within reasonable lengths of time. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. There are sufficient numbers of well trained staff working in the home to ensure that service users’ needs can be met. EVIDENCE: There were two nurses and three care workers on duty on the units providing nursing, during the inspection. Staff said that there would be one nurse and two care workers on duty at night. Service users said that they felt that staffing levels were adequate. Staff spoken to said the recently introduced “Twilight Shift” of an extra member of staff working between 5 and 11 p.m. had made a big difference to care provision and felt that staff numbers were now adequate. The residents spoken to praised the staff and said they always provided professional care. Staff training is particularly thorough in the home. All those staff members spoken to had received recent Moving and Handling training and one care worker, employed since May had completed all mandatory training as well as courses in POVA and Dementia. Staff were all aware of Adult Abuse and Whistle Blowing policies. Senior staff had all received Medication training and said this was regularly updated and one senior had completed a six week Advanced Medication course at college. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Staff procedures for dealing with fires are good but the prevention of fires policy in the home should be reviewed to ensure service user safety. EVIDENCE: Staff said that they take part in monthly fire drills in the home and service users confirmed that the alarms were regularly tested and that drills take place “with firemen”. Service users also said that the fire doors always close automatically during these tests. However, the bedroom doors in the home do not have automatic closures fitted and service users said that some remain open at night. Staff were advised that to ensure fire safety, bedroom doors should be fitted with automatic closure devises and that this issue should be discussed with the Fire Prevention team and outcomes recorded. As already stated, staff were also advised that bathrooms must not be used for storage. Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 17 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 2 x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 2 Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 18 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 OP19 Regulation 23(2)(b)& (c) Requirement The Registered Provider must ensure that the home is adequately maintained and must repair the dishwasher and broken rail in the toilet and must produce an action plan covering decoration and refurbishment. The Registered Provider must replace all worn furniture in the home. The Registered Provider must keep all areas of the home clean and free from offensive odours. The Registered Provider must provide automatic door closures for bedrooms in the home or must ensure that bedroom doors are kept closed or that written procedures are agreed with the Fire Prevention service. The Registered Provider must provide suitable storage in the home. Timescale for action 01/12/05 2 3 4 OP20 OP26 OP38 16(2)(c) 16(2)(k) 23(4)(a)& (c)(i) 01/12/05 15/09/05 01/12/05 5 OP38 23(2)(l) 15/09/05 Rivercourt Residential And Nursing Home DS0000019511.V254500.R01.S.doc Version 5.0 Page 19 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.V254500.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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