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Inspection on 05/04/05 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 5th April 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

River Court provided a good range of training to all staff, including domestic staff. The training records were well maintained and ensured that staff received regular updates in mandatory training. All administrative records were generally well maintained. With the exception of the deputy the home was fully staffed and as a result agency use was kept to a minimum. Those service users and relatives spoken to were generally satisfied with the service provided.

What has improved since the last inspection?

What the care home could do better:

A number of issues were identified the majority of which the manager was already aware of. The service user care plans that were seen were generally muddled and not up to date, regular reviews were not taking place. Although systems were in place to ask service users about the food provided it was clear from discussion with them that they were unhappy with some aspects of the food provision. The pharmacy inspector reported no major concerns with medication but did highlight a number of areas for development. Service users and relatives reported that although they were generally satisfied with the service provided did feel that the attention to detail could be improved.

CARE HOMES FOR OLDER PEOPLE Rivercourt Residential & Nursing Home Explorer Drive Watford Herts WD18 6TQ Lead Inspector Alison Marshall Unannounced 05 April 2005 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 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 & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Rivercourt Residential and Nursing Home Address Explorer Drive, Watford, Herts, WD18 6TQ Telephone number Fax number Email 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 230891 BUPA Care Homes Limited Care Home with Nursing 60 Category(ies) of DE(E) 60, OP 60 registration, with number of places Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate (in Hampermill House) 30 older people with dementia who require nursing care. 2. This home may accommodate (in Gade House) 30 older people with dementia who require personal care. 3. This home may accommodate (in Colne House) 30 older people who require personal care. 4. This home may accommdate (in Chess House) 30 older people who require nursing care. 5. The home may accommodate two (named) service users who have not reached the age of 65 years. Date of last inspection 16 November 2004 Brief Description of the Service: Rivercourt is a purpose built care home providing both nursing and personal care and accommodation for 120 older people. It is owned and registered under Care First Health Care Limited. The home is part of a modern development located on the outskirts of Watford. Local shops and a public house are located nearby.The home was opened in 1996 and comprises of four 30 bedded self-contained ‘houses’ each of which take up a complete floor of a two-storey building (residential provision being at one end of the complex and the nursing provision being located at the other end). Situated between these facilities is a central service block that includes the main kitchen, laundry and administration services. There are ample parking spaces provided within the grounds and on the off-road. All the home’s bedrooms are single accommodation with ensuite facilities. There are passenger lifts provided and the home has well maintained gardens which are easily accessible. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. River Court has undergone some major changes since last summer: the long standing manager left, then the deputy acted up for a number of months, a new manager was appointed but was only in post for 10 weeks, the deputy manager again acted up and left two weeks before this inspection took place. The current manager had been in post for 6 weeks. At the beginning of year there were a number of complaints and incidents reported to CSCI. These mainly concerned Chess House. These were investigated by BUPA and various actions were taken as a result. The inspection focused on Chess House to determine whether the action taken had improved the service and to offer support to the new manager. Two inspectors plus a specialist pharmacy inspector carried out the inspection. The pharmacy inspector spent two and half-hours in Chess and Hampermill House. Of the other inspectors one spent three and half hours on Chess talking to service users, relatives and one member of staff and inspecting service user care plans. The other inspector checked general records relating to staff recruitment and training, health and safety, the complaint log. Discussion took place with the manager regarding the issues identified during the inspection. What the service does well: What has improved since the last inspection? This was difficult to assess as the home had been through eight months of disruption and three different managers with very different approaches and style. The new manager had identified a number of areas that needed improving and was due to formalise this into a development plan in the near future. The manager had introduced a twilight shift (one person working from 5pm –11pm) on Chess House in response to a concern that service users were Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 6 Being left unattended for long periods at this time. This appeared to have been very successful. The manager had changed the job description for the deputy post and was looking to recruit a Clinical Services Manager. This person would take a more active role in monitoring and developing clinical and care practice within the units. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed on this inspection. EVIDENCE: Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Service user care plans needed further work to ensure they reflected current needs. Health care needs appeared to be satisfactory. There were no major concerns regarding medication. EVIDENCE: In order for care staff to ensure that appropriate care is provided for each service user, it is important that up to date information is recorded and easily accessible on each care plan. Service user care plans were muddled, not up to date and did not reflect actual care practice. Care plans had not been reviewed for a number of months, including risk assessments. Not all relevant risk assessments were in place. For example, one care plan said that bed rails were to be used but there was no associated risk assessment. Another service user had recently slipped and fallen on the vinyl floor in their bedroom but there was no risk assessment for this either. A review held for one service user in June 2004 identified that the person was not eating or drinking properly. An intake chart was established but this had not been completed since December 2004. It was not possible to identify if this had been a positive decision to stop recording or if it had just not been done. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 10 The home did not have service user meetings; instead there was an individual review for each person every three months. The care plans did not evidence that these were happening. In one care plan there were notes for a meeting held in October 2004. The notes said that a further meeting would be held in four weeks time but there was no evidence that this had taken place. The notes also stated that the service user would be referred to a physiotherapist again there was no evidence that this had taken place. Discussion with service users and relatives suggested that they felt that generally health needs were met satisfactorily although referrals to outside services could take time. The pharmacy inspector produced a separate report with a number of requirements and recommendations. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 There was a good range of social activities on offer. All service users spoken to expressed some dissatisfaction with the food. EVIDENCE: The home employed four part time activities co-ordinators. They ran a number of different activities through out the week and organised for outside entertainment to come in on a regular basis. These were well publicised on notice boards around the home. During the morning of the inspection service users were receiving hand massage. Good interaction between the service users and co-ordinators was observed and it was clear that they know the service users on an individual level. Service users spoken to reported that breakfasts were good. At lunchtime the soup and pudding was good but that they found it very difficult to chew the meat. All service users said that they always had sandwiches at teatime. On checking the menu, it was apparent that there was always a hot choice at teatime. It appeared that service users were choosing sandwiches over the hot choice, as this was generally something like pizza, sausages or chicken nuggets and so possibly not suitable for people of advancing years. The chef manager stated that a member of the catering team spoke to most of the service users on a monthly basis to discuss food and records were taken. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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 standard(s) 16 There was a well-maintained complaints log which showed that service users and relatives were aware of and used the procedure. EVIDENCE: The manager kept a detailed complaints log. This showed that there had been a number of complaints since the beginning of the year. The log contained details of the complaint, and investigation undertaken and the response to the complainant. All complaints were investigated within 28 days. The log showed that some complaints had been upheld. The complaints procedure was clearly displayed around the home. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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 standard(s) 19 Chess House was clean, tidy and well maintained. EVIDENCE: An inspection of the whole premises was not undertaken. Nor was every room in Chess House seen. However, those areas seen were clean and presentable and adequately decorated. The grounds were well maintained. The dishwasher in the kitchenette in Chess House was not working and looked in poor condition. Some service users and relatives spoken to said that the conservatory part of the lounge could get very warm during the summer. The manager was aware of this and said that this would be considered as part of the development plan for the home. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The home was virtually fully staffed. Good recruitment procedures and records were in place. A good standard of training was provided. EVIDENCE: With the exception of the deputy who had recently left, the home was fully staffed. There were interviews arranged for the deputy position. The home had recruited a number of bank staff for both care and housekeeping positions and so agency use was kept to a minimum. Staff recruitment records were well maintained and securely kept. Three files of recent starters were inspected. These were found to have all of the required documentation in place. Notes from interviews were taken but of the three seen, none had been signed or dated. The home had a good training programme in place which ensured that staff received regular updates in mandatory training. BUPA had produced comprehensive training packs for new staff on basic food hygiene and health and safety. Medication training had been provided for staff following some medication errors being made in the past. A domestic staff spoken to confirmed that they had received a wide range of appropriate training. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Good quality assurance systems were in place. Health and safety records were generally satisfactory. EVIDENCE: There were a number of quality audits in place across the home including medication audits, training audits and health and safety audits. In addition the home carried out a questionnaire with service uses and relatives on an annual basis. In addition BUPA had recently surveyed the relatives and service users of the home. The manager was still awaiting the results of this. There was no development plan for the home. The manager having only just started was familiarising herself with the home, service users and staff before starting on this. A range of health and safety records were seen and found to be in order. The fire log showed that regular checks of equipment were made but the last identifiable fire drill had taken place in July 2004. The chef manager stated that one had taken place in January 2005. BUPA had recently provided a new Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 16 fire log and it appeared that information was being stored and recorded across a number of logs and files: these needed to be centralised. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x 3 Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 18 No Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Timescale for action 01/08/05 2. 15 16(2)(i) The registered person must ensure that service user care plans are up to date and reflect current needs. Service user plans must be reviewed regularly and must contain all relevant risk assessments. The registered person must 01/08/05 ensure that the food provided reflects the needs and wishes of the 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. 2. 3. 4. 5. Refer to Standard 19 19 29 33 38 Good Practice Recommendations The registered person should repair or replace the dishwasher in the kitchenette in Chess House. The registered person should consider ways of reducing temperature in the conservatory area of Chess House during the summer. The registered person should ensure that interview notes are signed and dated. The registered person should produce a development plan for the home. The registered person should ensure that the fire health I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 19 Rivercourt Residential & Nursing Home and safety records are stored in a central file. Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts 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. Extracts may not be used or reproduced without the express permission of CSCI Rivercourt Residential & Nursing Home I52 s19511 Rivercourt Residential & Nursing Home v219062 050405 Stage 4.doc Version 1.20 Page 21 - 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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