Inspection on 21/06/07 for River Court Residential And Nursing Home

This inspection was carried out on 21st June 2007.

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

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

Other inspections for this house

River Court Residential And... 05/11/08

River Court Residential And... 14/12/07

River Court Residential And... 09/06/06

River Court Residential And... 15/09/05

River Court Residential And... 05/04/05

River Court Residential And... 16/11/04

River Court Residential And... 18/05/04

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

CARE HOMES FOR OLDER PEOPLE Rivercourt Residential And Nursing Home Explorer Drive Watford Hertfordshire WD18 6TQ Lead Inspector Yoke-Lan Jackson Unannounced Inspection 21st June 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.V344144.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.V344144.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) 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.V344144.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. 9th June 2006 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.V344144.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced on 21/06/07 and it was completed on 28/06/07. The home manager was present. Each of the four houses was inspected. The inspection included a tour of the premises. Time was spent observing how staff interacted with the residents. Several residents, their relatives and staff were interviewed. The inspection included discussions with the managers and staff. Records were examined. Two inspectors were involved on the first day of the inspection. One of the inspectors spent two hours in the dementia and nursing unit, Hampermill House, observing the care being given to five residents, using a Short Observational Framework for Inspection (SOFI). (See below for details of the inspection findings). What the service does well: The home was maintained to a good standard of cleanliness. The surrounding grounds are well maintained with beds of attractive plants. Residents interviewed seemed satisfied with the care and service given. One resident commented, “Not a lot to complain about. I am quite satisfied.” Residents were particularly pleased with the meals provided, and mealtimes seem to be the highlight of the day. One resident said, “The care is OK. I have Weetabix and fried eggs for breakfast. The carer assists me in the mornings.” Another said, “I have my own menu. My daughter helps me fill in the forms every Sunday.” In the residential unit, a bingo session was well received by residents who were served sherry during the session. A number of visitors were interviewed. They also appeared to be satisfied with the standard of care. A relative said, “I appreciate the care given.” However, one visitor said, “The staff are always busy. I often help to change the pads for (the resident), which are often wet when I arrive. I don’t mind. This is the best I can do for her.” Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are a number of concerns about the care practice and the management of the home. However, the newly appointed manager has only been in post for four months. During the visit, it was noted that there was a difference of opinion between the staff in one of the units and the home manager over a planned admission. This was resolved by the admission not taking place. It was also evident that some staff are experiencing great difficulty in adjusting their daily work practice and stated to the inspector that they felt unsupported by management. As part of the inspection, the Short Observation Framework for Inspection (SOFI) was used in the nursing and dementia unit for two hours by a second inspector. The SOFI assessment indicated that the unit is very poor in the management of residents who have dementia. It further indicated that staff lack experience in understanding the behavioural issues of residents with dementia. As such, the residents’ needs are not fully met. These residents were not treated with respect or dignity. The two-hour observation indicated that the quality of care given is inadequate. It is of concern to the Commission that the training programme for nurses and carers in the care of residents with dementia appears to be inadequate. Practically all the staff apart from a very small number were given a selflearning pack by BUPA, called “Understanding Dementia” which they were told to read. This was followed by a 30-minute discussion with the unit manager or the clinical manager. Feedback from all the staff spoken to was that they need more training on dementia care. Other concerns included poor wound management of leg ulcers and pressure sores in the nursing units and substantially high numbers of falls in the residential units, some resulting in fractures. The latter are mainly in the Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 7 residential unit and the residential dementia unit. The number of fall incidents among the residents in the nursing units was minimal. There is poor communication and a lack of co-operation between the four units. It would benefit residents and the service itself if nurses and carers could share their expertise, knowledge and skills for the benefit of the residents. The only group of workers who seemed united in sharing their expertise in caring for the residents were the activity co-ordinators. (See Statutory Requirements and Recommendations) 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.V344144.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 Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have the information they need to make an informed choice. A full assessment is carried out before a prospective client is admitted, to ensure that their care needs can be met. However, this practice could be undermined should residents whose needs cannot be met are admitted. EVIDENCE: Relatives spoken to said that they had enquired and had visited the care home before the prospective resident decided to move in. On the day of the inspection, a couple were being shown around in one of the houses by a senior carer. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 10 The pre-admission assessment documents were seen in the care plan files examined. The unit manager in each house carries out the assessment before a prospective client is admitted. During the inspection, it was noted that arrangements had been made for the admission of a prospective client that same afternoon even though the home was not able to meet all the assessed needs. In addition, staff were apprehensive about administering oxygen in a unit where there are a large number of residents with dementia. Some of these residents tend to wander into bedrooms. On the same day, a resident was particularly restless and was showing behavioural problems and getting physical with a member of staff. Furthermore, staff have not dealt with a resident on continuous oxygen for three years. Risk assessments had not been completed. The plan to admit was abandoned following a discussion between the home manager and the inspector. (See Statutory Requirements) Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deficiencies in the care of residents with dementia, in wound management and in the management of residents who are prone to falls were identified. Each resident has a written care plan. However, the written care plans for residents with dementia lack details about their condition. Medicines are not always administered in accordance with legislation in the residential units. EVIDENCE: The home is in the process of changing the care plan format to an updated version called ‘Quest’ which is more detailed and comprehensive. Appropriate training will be given to all relevant staff by BUPA prior to the change. In the interim, the home must maintain all current care plans and update them accordingly. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 12 The care plans relating to five of the residents who were observed under SOFI lack details about their dementia condition. Therefore their care needs may not have been fully met. A trained nurse administers the daily medication in the nursing units. In the residential units, it is the senior carer who administers the medication. The ‘Nomad’ system is used for prescribed medicines for each service user. All records of administration of medicines are maintained and recorded accurately in the nursing units but not in the residential units. A senior carer on day duty had noted that a member of the night staff (bank worker) had not signed for the medication administered very recently. It appears that staff were not aware that it is an offence to sign the Medication Administration Record (MAR) chart at a later date. There was a medication error in the residential dementia unit earlier in the year. The storage room temperature in three out of the four units was registered at 25-26 degrees centigrade. This could rise in the hot weather. All medicines should be kept in a storage room where the temperature is below 25 degrees centigrade. Since the inspection, new air conditioning units have been installed in all clinical rooms where medicines are stored. Currently there are a number of residents in the nursing units with grade 2 and grade 3 pressure sores. Not all the nurses have wound management training. In one case, there was confusion among the nurses over the instructions given by a specialist doctor (dermatologist) and the BUPA tissue viability nurse. The home manager has confirmed that the nurses should follow the BUPA tissue viability nurse’s instructions rather than the dermatologist’s direction. There was no evidence of communication between the management and the dermatologist. The prescribed treatment has not been followed throughout because the nurses at Rivercourt were not trained to apply compression bandage. The district nurses were involved at one stage. Meanwhile the resident may not be receiving appropriate care. The provider needs to clarify this issue urgently for legal reasons. The home has a high number of fall incidents. In the residential dementia unit, there were 16 fall incidents in April 2007, 28 fall incidents in May 2007 and 15 fall incidents in June 2007. In the residential unit, there were 16 fall incidents in May and 12 fall incidents in June. The figure for April was not readily available. The numbers of fall incidents in the nursing units were minimal. Some of the residents had sustained fractures and they are currently in hospital. In the nursing and dementia unit, an assessment was undertaken using Short Observation Framework for Inspection (SOFI). The SOFI assessment tool was used by CSCI to try to gain an impression of what it is like to live in Rivercourt. The aim of the observation is to assess how the care needs of the residents are being met. The assessor spent two hours observing the daily routine, staff interaction, communication, stimulation, activities, behaviour and movements Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 13 of five residents in the lounge. The observations were recorded every five minutes using a recording tool, designed specially for the exercise. The twohour observation indicated that the quality of care given is inadequate. Residents were seen to be treated as objects without needs, wishes or emotions. They were not treated with respect and dignity. The assessor was not able to identify the comfort, identity, attachment and inclusion aspects sought in the SOFI record chart. Residents were observed to be sitting in rows in armchairs that were arranged and placed against the wall in the lounge. The residents observed were left sitting in their respective chairs for the entire two-hour observation. One resident who was walking about was discouraged from walking but told to sit down. However, she ignored the instruction and continued to walk about. There were no stimulating objects such as books, magazines, or any tactile objects of preference for the residents to touch and explore. It was noted that residents were not offered biscuits with their beverages during morning coffee time. A resident was woken up for toileting before she was given a cup of tea, even though the resident had said that she did not want to go. She wanted a cup of tea instead. During the two-hour observation, the resident in question was not given the cup of tea that she wanted. Similarly, a male resident, who requested an ice cream, remained waiting. Staff did not come back to serve either resident in spite of telling them that they would. A resident was woken up for toileting and before she was fully awake, staff had hoisted her. It was hurried without any respect and dignity being given to the resident. The two staff conversed throughout with each other and ignored the resident. There was a resident in the lounge who was swearing as she related a story that appeared to distress her. The member of staff present was not listening but laughed at her instead. A member of staff was observed wearing apron and gloves as she clipped a resident’s nails. There were times when staff were standing around and were not interacting with the residents. At one stage the nurse in charge pointed to a member of staff and said, “She has no shoes on” but did not refer to the resident by name. (See Statutory Requirements) Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This would have been good except for the poor provision of care and activities in one of the dementia units. This judgement has been made using available evidence including a visit to this service. In general, residents are helped to exercise choice and control over their lives. However, in the dementia units, residents’ preferences and choice are not always respected. There is a choice of menu and residents receive a wholesome and appealing balanced diet. EVIDENCE: On the day of the inspection it was noted that the residents were served a three-course meal. There were choices given. Several residents spoken to gave positive feedback about the food. One said, “I have more than enough to eat.” Another said, “The food is very good.” Some residents were assisted at mealtimes. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 15 The home has an activity co-ordinator for each of the units. They organised daily indoor activities and garden parties for the residents. The co-ordinators also organised sightseeing tour and other day trips for residents, including wheelchair users, who wish to go. The residents seemed to enjoy the group activities such as bingo and sing-a-long. In some units carers assisted with activities but this in not consistent because of current staffing levels. Staff assisted whenever they can. Knowledge about appropriate activities for residents with dementia is currently being expanded. The activity co-ordinators interviewed said that they have not had training on dementia care. However, one activity co-ordinator said that they work closely with the Alzheimer’s Society. There were some visitors present during the time of the inspection that gave positive feedback about the care provided. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 16 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, 17, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints policy and procedure. Residents’ legal rights are protected. EVIDENCE: The Commission has received information from whistle-blowers. There are a number of Adult Protection issues that are currently being investigated by the Adult Protection team from Hertfordshire Social Services. Staff have training on issues concerning the protection of residents from abuse. The home follows the Hertfordshire Social Service’s procedure on Safeguarding. The management provide access to advocacy services, including the local Alzheimer’s Society. A relatives’ meeting was set up recently to highlight awareness of the service. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in safe and comfortable surroundings. They have access to safe indoor and outdoor facilities. There is an ongoing maintenance and redecoration programme. EVIDENCE: The home appears generally clean and tidy. The surrounding ground is well maintained with attractive flowering plants. There is an ongoing maintenance programme. The flooring in the lounge in all the 4 houses has been replaced with non-slip materials. New curtains, blinds and furniture have replaced old ones. Some units have new carpets. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 18 Residents interviewed said that they are quite pleased with their bedrooms. The domestics appeared to have done a good job with the daily cleaning programme, which was well managed. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. All staff have the basic induction training in the first six weeks of their employment but not all staff have adequate training in the care of residents with dementia. As a result, residents with dementia are not being cared for appropriately at all times. EVIDENCE: The staff training record shows three members of staff with more than a day’s training on dementia. This meant that the majority of nurses and carers have training on dementia by way of a self-learning pack, provided by BUPA. Some of the carers in the nursing-dementia units have not cared for residents with dementia before. They too are expected to learn from the booklet, followed by a 30-minute teaching session from a unit manager. Staff have been injured by residents in the course of their work in the dementia units, yet staff have not had training on how to cope with residents with behavioural problems. Recently two senior staff attended training called Breakaway. Activity coordinators interviewed said that they have not had any training on dementia care, yet these workers are assisting residents with dementia. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 20 Members of staff were eager to speak to the inspector and to give their viewpoints about the management and training issues in the home. The home has not had a registered manager for three years and the staff that care for residents need support and clear guidance. Staff work 12-hour shifts over a 42-hour week. In the nursing and dementia unit, it was noted that a resident was restless throughout the day. He was moving chairs around and lifting them up in the lounge, when there were over 15 residents present. It took at least two staff to assist him at times. At one stage, he pointed his fist at a male nurse and gave him a gentle punch in the chest. The resident apologised afterwards. However, staff availability was not increased as a result of this incident. The nurse on duty said that she is not allowed to increase the staffing level. In another nursing unit, the inspector was told that the only time a “twilight” carer is used is from 4-8pm and not at any other time. There is a need for BUPA to review its staffing formula if residents are not receiving good quality care in a consistent way or staff are at risk. (See Statutory Requirements) Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 37, 38. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The standard of care seemed not to have improved since the last inspection. Overall, staff morale appears to be low, particularly in the nursing units. There is conflict in decision-making, conflict of facts and poor interaction between the management and some groups of staff. EVIDENCE: The new manager has yet to make application to register and commenced work on 29/02/07. The administration side of the service is maintained, but there appears to be internal communications issues that the management needs to address as a matter of urgency. Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 22 There are also a number of concerns in regard to wound management, dementia care and prevention of falls. There is poor communication and a lack of cooperation between the four units. In the nursing units, it was noted that nurses do not share their expertise and skills between the two nursing units. When asked about wound care management, the reply from a nurse was “I am not sure what they do in the other unit.” It would benefit residents and the service itself if nurses and carers could co-operate and share their expertise, knowledge and skills for the benefit of residents. The new manager is endeavouring to overcome any sense of isolation by encouraging staff to work across other units wherever practicable. (See Summary Section and Statutory Requirements) Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 23 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 3 3 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 3 X 3 1 Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 24 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 OP8 Regulation 13 (6) Requirement The registered person must make suitable arrangements, by training staff or by other measures, to prevent service users being harm or suffering abuse or being placed at risk of harm or abuse. (Wound management, falls prevention, dementia care etc.) All gaps in the Medication Administration Chart must be accounted for using contemporaneous notes written and signed at the back of the MAR charts by persons responsible. This has subsequently been rectified. Adequate staffing level must be maintained consistently in all the units. Appropriate training on dementia care must be arranged for all staff. Timescale for action 22/08/07 2. OP9 13 (2) 22/06/07 3. OP27 18 (1)(a) 12 (1) (a)(b) 30/09/07 4. OP30 18 (1)(c) 30/09/07 Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 25 5. OP32 12 (5)(a) The provider, BUPA, must ensure 30/09/07 that the management approach of the home creates an open, positive and inclusive atmosphere; maintain good personal and professional relationships with staff and with service users. 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that all carers who administer medicines have accredited training in the administration of medicines. It is recommended that BUPA arranged for all staff to have refresher course about the Whistle-blowing policy. 2. OP30 Rivercourt Residential And Nursing Home DS0000019511.V344144.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area 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.V344144.R01.S.doc Version 5.2 Page 27 - 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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