CARE HOMES FOR OLDER PEOPLE
Rivercourt Residential And Nursing Home Explorer Drive Watford Hertfordshire WD18 6TQ Lead Inspector
Yoke-Lan Jackson Key Unannounced Inspection 9th June & 4th July 2006 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.V299268.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.V299268.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.V299268.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 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. The home may accommodate two (named) service users who have not reached the age of 65 years. 15th September 2005 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 closed to the town of Watford. There are local shops and transport facilities nearby. The home is registered for 120 service users in the Old Age category, some of whom may require nursing or dementia care. The home charges from £550 - £1000 per week. The buildings are set around a central courtyard with parking facilities in front. 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 service users who require residential care (Colne House on first floor), 30 service users with dementia (Gade house on ground floor), 30 who require nursing (Chess House on first floor) and 30 service users 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. Rivercourt Residential And Nursing Home DS0000019511.V299268.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 with a monitoring visit on 11/05/06, followed by further visits on 09/06/06 and 02/07/06. The general manager and all the care managers were present during each visit. The home has no registered manager at the present time. Each of the 4 houses was inspected. The inspection began with a tour of the premises. Time was spent observing staff interaction with the service users. Several service users, relatives and staff were interviewed. Detailed discussions were held with the general manager following each visit so that issues raised can be resolved efficiently to the benefit of the service users. The Commission (CSCI) received 2 written correspondence raising concerns about the quality of care and service since the last inspection. The management has dealt with the issues that were raised. (See below for details of the inspection findings). What the service does well: What has improved since the last inspection?
There is a structured training programme for all staff, including training around communication issues and record keeping. Service users, relatives and staff are encouraged to use the catering comment forms as part of quality monitoring of menu and food served in the home. The lounge in each house is being extensively redecorated and refurbished. There is an ongoing redecoration programme for the bedrooms.
Rivercourt Residential And Nursing Home DS0000019511.V299268.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. Rivercourt Residential And Nursing Home DS0000019511.V299268.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.V299268.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Standard 6 is not applicable. Prospective service users have the information they need to make an informed choice. A comprehensive pre-admission assessment is made. A trial period is given. However, not all the service users’ needs are being met. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Service User Guide has been revised and the Commission for Social Care Inspection (CSCI) has been given a copy of the revised version. The care manager of each home carries out the pre-admission assessment. Currently there are a number of service users who require urgent specialist assessment as their health care needs are not being met in the home. Some may not be under the registered category. The management has assured the inspector that all future admissions will be within the registered category. (See Statutory Requirements and Health and Personal Care section)
Rivercourt Residential And Nursing Home DS0000019511.V299268.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Each service user has a written care plan. However, there are a number of service users whose health care and nursing needs are not being met. Medicines are administered in accordance with legislation and the Guidelines from the Nursing and Midwifery Council. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The written care plans have been revised. However, some of the nurses were not sure when the service user and/or their relative should sign the reviewed care plans. The nurses themselves review the care plans monthly. The relatives were informed however of any changing needs. It was suggested that the service user (whenever capable) and/or relative should sign and date the reviewed plan of care when the needs change. On the day of the inspection (09/06/06) there were a number of service users (in Hampermill House and Colne House) who required urgent review by the Community Psychiatric Unit.
Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 10 There were a number of incidents involving other service users (in Gade House and Hampermill House) and one member of staff was physically injured resulting in hospital treatment. Referrals have since been made leading to the transfer of one service user to the Community Psychiatric Assessment Centre (Prospect House). Others are waiting to be transferred. The general manager has assured the inspector that risk assessment and the review of care needs of all service users are being undertaken in all the 4 houses to ensure that the correct placement is being made. It was noted that there remain a high number of service users in the Nursing Unit (Hampermill House and Chess house) who require adjustable beds (profiling beds). These should have been provided to the service users at the time of their admission or when their needs were identified at the time of care review. Since the inspection visit (09/06/06) a risk assessment has been carried out on every service user to determine the exact number of service users who should be nursed on a profiling bed. Since the inspection, the required number of profiling beds have been purchased. In the meantime, the general manager has agreed to stop any new admission that requires the use of a profiling bed unless arrangements can be made for the immediate provision of the profiling bed. The management should ensure that staff are not placed at risk of back injury due to non-adjustable beds. A trained nurse administers the daily medication. The Nomad system is used for prescribed medicines for each service user. All records of supply and administration of medicines are maintained and recorded accurately. On the day of the inspection, the temperature recorded in the storage room for medicines (Gade House) was well above 25 degrees centigrade. 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. (See Statutory Requirements). Rivercourt Residential And Nursing Home DS0000019511.V299268.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Service users are helped to exercise choice and control over their lives. Their preferences and choice are respected. There is a choice of menu but not all the service users are satisfied with the food served to them. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: On the day of the inspection there were several service users who were assisted by members of staff during lunchtime. One service user had prawn cocktail that was attractively presented. The main course for lunchtime was shepherd’s pie and freshly cooked vegetables followed by a dessert. Prior to this inspection, a number of relatives have expressed dissatisfaction about the food served in the home. Since then all service users, relatives and staff are encouraged to use the catering comment forms as part of quality monitoring of menu and food served in the home. Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 12 There is a regular Residents/Relatives meeting to discuss topical events and any concern raised is dealt with accordingly. The manager hopes to invite guest speakers, such as a representative of the Alzheimer’s Society to future meetings. The home’s activities are improving. There are a number of activity coordinators (some recently recruited) to assist the staff in each home. They organised daily indoor activities and garden parties for the service users. One co-ordinator has hired a ‘Barbara Bus’ to take service users on a weekly one hour sightseeing tour. Planned trips have been made for Thursday and Friday for service users, including wheelchair users, who wish to go. Some service users had a day trip to Woburn Safari Park in May of this year. Rivercourt Residential And Nursing Home DS0000019511.V299268.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 The home has a robust complaints policy and procedure. Service users’ legal rights are protected. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Commission (CSCI) received 2 written correspondence raising concerns about the quality of care and service since the last inspection. The management has dealt with the issues that were raised. Staff have training on issues concerning the protection of service users from abuse. The home follows the Hertfordshire Social Service’s procedure on POVA. The management provides access to available advocacy services, including the local Alzheimer’s Society, whose member has had meetings with the management on behalf of a service user and their relative recently. Rivercourt Residential And Nursing Home DS0000019511.V299268.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 26. Service users have access to safe indoor and outdoor facilities. The bedrooms appeared comfortable. However, adjustable beds were not always provided for service users receiving nursing care. (See Health and Personal Care section). There is an ongoing maintenance and redecoration programme. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home appears generally tidy and clean except for the toilet facilities by the office in Hampermill House, which require immediate attention. The staff attended and rectified the situation immediately. There is an ongoing maintenance programme to redecorate all the interior of the building including the corridors, staff rooms and bedrooms. Other maintenance work is being carried out throughout the building.
Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 15 The flooring in the lounge in all the 4 houses have been replaced with non-slip materials. New curtains, blinds and furniture have been ordered and the refurbishing work will be completed over the next few weeks. Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 16 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, 28, 29, 30. There is a training programme for all the staff. The number and skill mix of staff ensure that service users are cared for appropriately. The home’s recruitment policy and practices comply with legislation. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: All staff have the basic induction training in the first six weeks of their employment. Such training includes Health and Safety, COSHH, Dementia, Fire Safety, Manual Handling and Food and Hygiene. The home has appointed a clinical service manager who ensures that good nursing and care practices are maintained. A number of training issues have been identified such as Falls Prevention and Communication Skills. Some staff have registered for the English Language course. This will improve their communication and interaction with the service users in their care. Some training has already taken placed including the Protection of Vulnerable Adults and Activities Awareness training. The nurses have maintained their training and this included the Administration of Medicines, Skin and Wound Care, Diabetes and Dementia. Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 17 On the day of the inspection, all the houses had adequate staffing. The staffing level in the Nursing Unit comprises 2 trained nurses on each shift and they were assisted by 4-5 carers. Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 18 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): 31, 32, 33, 34, 35, 36, 37, 38. In general, the standard of administration and management of the home has improved since the last inspection. However, the management must ensure that the home complies with the condition of registration. The service users’ care plan records were not kept in a secure place. The quality assurance and monitoring system are in place. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 19 EVIDENCE: The general manager has implemented many positive changes since her appointment (end of 2005) She had identified a number of service users who may be out of the registered category and others whose needs may not be met in the home. She had taken the necessary steps to ensure that each house complies with the condition attached to their registration. Staff deployment and appropriate training have taken placed to improve efficiency in care and service. Care managers and staff are encouraged to improve their communication skills. Staff feedback indicated that both the general manager and the clinical service manager are “approachable and helpful”. The standard of documentation, including written care plans, has improved. However, it was noted that all care plan files were kept on an open shelf in the office. The only office that remained locked when not in use was Gade House, a residential unit for service users with dementia. All service users’ personal files should be securely kept and used in accordance with the Data Protection Act 1998. The home has regular quality monitoring of its service. A copy of the Care Home Resident survey and the Quality Survey by the proprietor, BUPA, for 2006 were received by CSCI. (See Statutory Requirements and Health and Personal Section). Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 20 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 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 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 3 18 3 2 3 3 3 3 2 3 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 3 X x 3 2 2 Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 21 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 OP3 OP4 Regulation S.24 Care Standard Act 2000 Requirement Timescale for action 09/06/06 2 OP8 OP38 13(4)(c ) 13 (1)(b) 3 OP8 12 (1)(a) Admitting a service user who falls outside the registration category is an offence under Section 24 Care Standards Act 2000. The registered person must ensure that all admissions are within the registered category henceforth. 09/06/06 The registered person must ensure that unnecessary risks to the health and safety of all service users and staff are identified and so far as possible eliminated. Arrangements must be made for service users with changing needs to receive appropriate psycho-geriatric assessment from a specialist doctor so that appropriate advice and treatment can be made without unnecessary delay. (This situation has been rectified) The provider, BUPA, must ensure 09/06/06 that proper provision is provided in the home to promote the health and welfare of the service users.
DS0000019511.V299268.R01.S.doc Version 5.2 Rivercourt Residential And Nursing Home Page 22 4 OP24 16(2)( c ) Adjustable beds (Profiling beds) 09/06/06 must therefore be purchased immediately for the service users who require them. (The Provider, BUPA, has agreed to purchase the required number of Profiling beds, which have been ordered). All care plan files should be kept secure and used in accordance with the Data Protection Act 1998. (This situation has been rectified). 5 OP37 17 (1)(b) 09/06/06 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 OP7 Good Practice Recommendations Service users and/or their representative should be invited to sign care plans and revised care plans. Rivercourt Residential And Nursing Home DS0000019511.V299268.R01.S.doc Version 5.2 Page 23 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
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