Inspection on 02/03/07 for River Meadows Nursing Home Limited

This inspection was carried out on 2nd March 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 Meadows Nursing Home... 15/08/07

River Meadows Nursing Home... 25/10/06

River Meadows Nursing Home... 01/02/06

River Meadows Nursing Home... 11/10/05

River Meadows Nursing Home... 11/10/04

River Meadows Nursing Home... 18/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE River Meadows Nursing Home Limited Edgebolton Shawbury Shrewsbury Shropshire SY4 4EL Lead Inspector Janet Adams Key Unannounced Inspection 2nd March 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 River Meadows Nursing Home Limited DS0000022268.V329480.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. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service River Meadows Nursing Home Limited Address Edgebolton Shawbury Shrewsbury Shropshire SY4 4EL 01939 250700 01939 250118 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) Springcare Limited Mrs Ann Elizabeth May McMullen Care Home 44 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (33), Physical disability (10) of places River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home must comply with the Staffing Notice issued by Shropshire Area Health Authority dated 24 October 2001. The home may accommodate a maximum of 44 service users. The home may accommodate a maximum of 43 Persons, of whom 10 may be Persons with a Physical Disability. The home may accommodate one person, aged under 65 a learning disability. who is named in the attached Schedule (not to be displayed). 25th October 2006 Date of last inspection Brief Description of the Service: River Meadows is a Care Home Registered with the Commission for Social Care Inspection (CSCI) to provide accommodation, nursing and personal care, for a total of up to 44 older people and young adults, of whom one may have learning disability, and ten may have a physical disability. The home also currently accommodates two pet cats. The home is in the village of Edgebolton, on the outskirts of Shawbury with good road links to the larger towns in North Shropshire. There is a limited bus service which runs near the home from Wellington and Shrewsbury. Set in its own grounds, the home enjoys views of the surrounding countryside from most aspects of the building. It is a prime site for bird watching. The accommodation comprises an original two storey converted country house, and a more recently added purpose built single storey wing. The home is divided into two ‘wings’ and has a variety of communal areas comprising of three communal lounges, and a conservatory designated for residents who wish to smoke. The majority of bedrooms are for single occupancy, and many benefit from en -suite facilities. All areas are maintained and furnished to a high standard, providing welcoming and comfortable surroundings. The home is set in wellmaintained grounds with lawns, flowerbeds, and seating areas, which are accessible to residents of various physical abilities. The home is owned by Springcare Ltd, the Managing Director being Mr Lee Cox. Springcare Ltd makes the services of River Meadows known to prospective residents in their statement of purpose, and its brochure/service user guide. A copy of the most recent CSCI report is also freely available at the River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 5 entrance of the home for people to look at. The current fees charged vary between £420 and £620 per week depending on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out by one inspector and lasted a total of eight and a half hours on two separate days. The main purpose of the inspection was to follow up progress made with the seventeen statutory requirements made at the last inspection on October 5 2006, as well as to follow up actions the home was expected to carry out as part of a recent adult protection investigation. Some time before the inspection was carried out, CSCI wrote to the home to request comment cards be circulated to residents’ relatives and any visiting professionals, to assist with this process. This meant that although River Meadows knew the inspection was imminent, they were not aware of any date or time. The inspection included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, observing, talking and listening to over half of the 44 people living there, including the two residents who also specifically requested to speak to an inspector. Seven of the staff on duty at the time of the inspection also shared their views about working at River Meadows. Discussions with people were carried out in private with people on their own, or together in groups in the lounges. Everyone was happy to share valid comments, which are included in the main body of the report. Twelve residents and one relative also made some written comments for the inspector about the home. The newly promoted deputy manager assisted the inspector on both visits to the home. It was positive to meet the Registered Manager, Ann Mc Mullen who returned from long-term sick leave on the second inspection day. Everyone, including residents and staff, was very welcoming and helpful throughout both days, for which the CSCI inspector extends her thanks. A total of 28 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. Discussions with the management team took place throughout and feedback about the conclusions of the inspection was given at the end of both inspection days. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Between the October 2006 inspection and the dates of this inspection, the Registered Manager has been on long-term sick leave, which has left the responsibility of the day to day running of the home to the newly promoted Deputy Manager, with the support of two of the company Area Managers. CSCI recognise their effort and commitment during this time, and as a result, a total of 10 statutory requirements and one recommendation made following the October 2006 inspection have now been met. Paperwork with regard to admission procedures has greatly improved. Additional detail on important paperwork shows that it can be established that people thinking about moving into the home are properly assessed before they are admitted. Contracts of residency at the home now more explicit details including a breakdown of the fees the home charges. The home now has a robust system to show it records and investigates any complaints it receives. Systems to check hot water now make sure it is supplied at safe temperatures throughout the home. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 8 Staff training needs have been thoroughly reviewed, and plans are in motion to get all staff the training they need to do their job to care and support service users effectively. Accident management procedures are now professionally documented. What they could do better: Seven of the 17 statutory requirements made at last inspection have not been fully met, and as a result of this inspection an additional requirement has been made. Although the recent efforts of the home management team show there has been great improvement, lack of safe working systems in the home means that the well being of residents at River Meadows is not safeguarded at all times. It is a concern that the home is not carrying out all of actions that were expected and they agreed to do, in response to recent two adult protection investigations. The records kept at the home do not reflect the standards of care delivery seen and discussed with the inspector. Recordkeeping in care plans needs to be expanded to ensure all necessary information is kept up to date to realistically reflect the care the residents need to get to keep them safe. Although CSCI are aware that residents and relatives have been verbally involved with some aspects of their care planning, evidence of this is also lacking in individuals’ care records. Guidance for staff to safely move and handle residents must be clear and accurate to ensure staff have this knowledge to carry out all aspects of care including what to do in the event of falls. The home management team must ensure safe working systems are carried out at all times by making sure any new staff including agency staff are introduced to the home in line with necessary health and safety legislation such as fire safety and manual handling operations. Staff clearly have not had their performance and development needs monitored to show they get the necessary support and supervision they need to carry out their job to expected standards. Some requirements which have not been met on this occasion have outstanding from precious inspections. For instance, deterioration in the condition of the bathrooms needs remedial action, especially with regard to the bath surfaces. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 9 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. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 10 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 River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 11 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): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission procedures clearly demonstrate the home can meet needs of people thinking about moving into River Meadows. This makes sure if prospective residents and relatives choose this home, it will meet their needs. EVIDENCE: When the care records for two residents who had recently been admitted to the home were looked at, they showed that there has been a great improvement in recordkeeping for admissions to River Meadows. The home now uses ‘Springcare’ (the company who owns the home) corporate paperwork for this process. Anyone assessing potential residents now has the benefit of a well-designed assessment tool, which provides detailed prompts to ensure staff collect as much information as is necessary for the home to decide whether they can meet the person’s needs. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 12 Three residents who recently moved into the home told the inspector they felt they had enough information about the home in readiness for moving in. Two of them confirmed their family members had visited the home on their behalf. It was good to see that admissions are now backed up with a suitable contract of terms and conditions for residents as they move into the home. The contract now used and seen in the records of the home’s latest admission is also a ‘Springcare’ designed document. It is well laid out and easy to read and understand especially with regards to details about whom pays the fees for the individual’s care. The above information means that the statutory requirements made about these issues at the last inspection have now been met. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Omissions in recording of information have the potential for not fully meeting all of a persons health care needs. The medication at this home is satisfactorily managed to make sure it promotes good health for residents. The attitude of staff is satisfactory and service users are treated with dignity and respect. EVIDENCE: When the records of five residents were looked at, similar omissions of information were seen when the home was inspected in February and October last year. The care plan records kept at the home do not reflect the standards River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 14 of care delivery seen and expected. They are not up to date and do not realistically reflect the nursing and personal care the residents need to get. All records looked at lacked the necessary relevant information to keep people safe. The company who owns the home have provided staff with good paperwork to record necessary care details, however, many of this was either blank or had not been completed appropriately. CSCI are aware work started at the time of the October inspection to improve the recordkeeping for the care being carried out in the home, and findings show progress with this task has been slow, and as a result does not safeguard or benefit resident well being. For example; • Discussion with senior nurse about a lady seen with a heavily bandaged leg confirmed that the wound was healing very well. However, when the care plan for the person was examined it showed there was a lack of recordkeeping by nursing staff to account for how this leg wound was being managed. This is a particular concern as the outcome of a complaint received at the home in November 2006 confirmed how another person had poor wound care management. This means the home has not taken appropriate remedial action to improve its wound management processes for all residents with similar needs to improve standards in the home. • The care records for a person who had experienced serious injuries as a result of a fall whilst being transferred into a chair had not been properly updated to make sure it had accurate information to guide staff how to carry out such a manoeuvre. One part of the care plan stated three carers were needed for the task, whereas another part of the care plan stated two were needed. The falls risk assessment for this person was also blank. There was no reference to a splint a service user was seen to have insitu on her leg. This meant there was no guidance to make sure staff knew how to currently care for the person in a safe manner. Four out of the five sets of care records did not have any details of resident or relative involvement. This does not reflect the actual situation, as CSCI are aware of several relatives being involved in care planning for their family members. During the visit staff were seen and heard to treat service users with dignity and respect. Most comments from residents were complimentary about the way they are cared for in the home. Ten responses out of the twelve comment cards residents sent to CSCI confirmed that they felt well cared for and liked living at the home. All of them responded they felt safe, however two residents who specifically requested to speak to the inspector confirmed other comments that they had to wait a long time for call bells to be answered. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 15 Assessment of the home medication management systems showed they are generally satisfactory. However, the care records for a resident who has the responsibility to administer medication unsupervised does not have any record keeping to clarify this matter in her care plan. It is recommended all residents who have a degree of independence with regard to their medications have appropriate risk assessment and planning of such matters. The above findings clearly demonstrate priority must be given to care planning and management systems to ensure adequate standards of care and support is being provided for all people living at the home. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. Residents enjoy a variety of opportunities to participate in activities to meet their needs and preferences. Recordkeeping for Resident’s opportunities for community/family contact, which enables them to make a choice about who they see and when and where they see them needs to be further expanded in order for staff to have clear guidance about what visitors residents prefer to receive. Dietary needs of residents are very well catered for with a balanced and varied selection of food available that meets service users tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Findings on the occasion of this inspection are of a similar standard of those reported following the inspection of February and October last year. The home team works hard to be effective at involving all residents in a comprehensive range of leisure opportunities, consistent with their abilities and River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 17 interests. All written comments received about the home confirmed those opportunities for leisure activities continue to improve. One person wrote that the festive period at the home was ‘outstanding’ and that there had been a variety of celebrations with excellent activities complimented by home cooked seasonal fayre.’ Another person wrote, ‘my relative is doing things we never thought she would do – joining in activities and preferring to spend time with other residents rather than in her own room’ Many aspects of the inspection findings confirmed that residents are actively assisted in maintaining contact with relatives, friends and the local community, and the continuation of religious practices, although resident recordkeeping for this matter did not demonstrate this. When the issue of staff managing the specific request of a resident with regard to accepting visitors was explored, there was no clear guidance for people to follow for this matter. This does not respect residents’ wishes or safeguard their privacy. It is recommended care plan records for all individuals living at the home are reviewed to make sure staff have full guidance in this matter. A choice of attractive and nutritious were meals seen being ordered, prepared and served in various parts of the home. An improvement in practice since the last inspection is the provision of the menu of the meals offered at the home being prominently displayed around the home, including the reception area. The inspector was present when lunch was being prepared and served. All residents’ verbal and written comments confirmed they enjoyed their meals. One resident commented that the food was ‘like a five star hotel’, and that the cook provided her with an amazing variety of meals which catered for her diabetes and milk intolerance challenges. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management systems to complement the home complaints system need to be more robust to fully evidence that service users feel that their views are listened to and acted upon. Management procedures at River Meadows need further action to fully demonstrate residents’ well being is safeguarded at all times. EVIDENCE: Review of the complaints management system shows that the company welcomes this type of issue in order to improve the service it provides. The information to welcome complaints and comments is clearly displayed in communal areas of the home. The service has a complaints procedure that is up to date, clearly written, and is easy to understand. All comments received form service users surveyed and spoken with said they would know who to talk to if they wanted to make a complaint. Two concerns have been raised within the home since the last inspection, and are clearly accounted for in the home complaints register. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 19 When the systems the home has in place to safeguard its service users was explored, it was positive to be informed that 10 staff members have been nominated for adult protection training in March, and further plans are in place to ensure all of the team will be undertaking this type of training. However, CSCI remain concerned the home is not doing all it can to safeguard service users. Since the Summer of 2006 there have been two incidents at the home, which have resulted in an adult protection investigations. Findings show that the home management team have not fully carried out all the actions it should have. For example:• There was a lack of evidence to show that all new and temporary staff including agency workers got an appropriate health and safety introduction to the home. This issue was a recommended action following the first adult protection investigation in Summer 2006. Although the company have a policy and forms to complete for temporary staff members for this matter, the deputy manager was not aware of such protocols. Examination of the policy folder confirmed the information and forms for both trained nurses and carers was available to use. This shows the home management had not cascaded this information to senior team members who are regularly in charge of the home and responsible for any new staff . • Care plan recordkeeping as described earlier in the report confirmed the records of a person involved in the second adult protection investigation had not been appropriately updated to make sure staff were fully aware of changes to the person’s care practices to keep that individual safe. The above issues mean there is inconsistent knowledge and practice within the service and does not benefit the safety and well being of the people living at the home. Remedial action for the statutory requirement made in October 2006 for River Meadows to ensure any actions and outcomes the home has to carry out as a result of any adult protection investigation must be carried out as priority. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 20 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, 21,23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is generally good providing service users with an attractive, homely and hygienic place to live. EVIDENCE: Overall, the home smelled fresh and had a welcoming, clean and tidy appearance with a ‘homely atmosphere,’ which gives the impression it is well kept. The home has an ongoing programme to keep it maintained, and recently has had a security review as part of this process. There is a selection of communal areas, which means that service users have a choice of place to sit quietly, meet with family and friends or be actively River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 21 engaged with other service users. The large conservatory provided as a designated smoking area for residents has been completed and has a portable nurse call pendant for use in this area. Work on the deteriorating condition of the bathrooms seen at the last two inspections has yet to be carried out. It is positive to report that following testing of the hot water supply in bathrooms temperatures are maintained within safe limits in the region of 43 degrees Centigrade. Some of the specialist seating in the home seen beginning to show signs of wear and tear at the last inspection have deteriorated and now pose an infection control and fire safety risk. Two were seen in this condition during the tour of the home. The inspector saw an excess of fifteen bedrooms. All were well furnished, decorated, maintained and adapted to meet the wishes of the present service user. Service users seen in their rooms stated that they were satisfied with the cleanliness and décor. It is positive to report that infection control measures have improved in the home to ensure appropriate cleaning of equipment for service users who need to be ‘tube fed’. All clinical waste is now properly managed and stored. Arrangements for the home to accommodate its pet cats mean they enhance the lifestyle of the people at the home. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs supportive staff to meet the needs of residents. The robust standards of vetting and recruitment practices means all appropriate checks are being carried out which ensures suitable staff are employed to care for service users. Improved training systems now assure service users that they are in safe hands. EVIDENCE: Rotas examined for the fortnight before and after the inspection confirmed the home is adequately staffed with the appropriate skills of nurses and carers to meet the needs of residents. Some agency staff are still employed at the home, mainly for night duty. The additional managerial duties of the deputy manager appears to have been one of the reasons for poor care plan record keeping, as this person has River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 23 continued to be the ‘named nurse’ responsible for the upkeep of care plans of nine service users throughout this time. Administration practices for recruitment show there has been an improvement in this system. Examination of the records of only new starter since last inspection demonstrated a robust process for this matter. It is positive to report that many aspects of staff training has improved in recent months. A staff training folder has an up to date record of all training staff have undertaken as well as future course they have been nominated for. These records show that all staff members are up to date with their mandatory training with the exception of the nursing staff who have no evidence of basic food hygiene qualifications - this matter is now in hand . Discussion with two staff members confirmed that they had been nominated for various training including adult protection training booked for March 2007, and that they had all learned a lot at a recent continence pad training session. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37, & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An experienced, suitably qualified individual who carries out her responsibilities satisfactorily manages the home. The Registered Provider has ensured the staff team including the registered manager are properly supported to further improve the day-to-day management of River Meadows. The organisation continues to improve and make progress towards raising the standards in all areas for the benefit of its service users. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 25 Systems for the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to meet changing needs as well as necessary legislation. EVIDENCE: It is positive to report that the Registered Manager has returned to work following long-term sick leave. In her absence, the newly appointed deputy manager assumed this role, with the additional management support from both Springcare Area Managers. This has meant a lot of work has been carried out to address important administration tasks, which were in need of updating. As a result, all records necessary to carry out the inspection were available on this occasion. Internal auditing as seen in the monthly visit reports by the Area Manager show that many areas of improvement in the home continue. However, the quality the service the home provides will only improved when staff receive appropriate monitoring and supervision of their working practices. When the files of 4 staff members were spot-checked to review the extent of supervision they had received, findings show this has not been carried out, resulting in poor practices not being improved. For example:• The outcome of a complaint investigated by the home in November 2006 shows that although River Meadows acknowledged there had been a less than satisfactory service, lessons have not been learned to make sure there had been appropriate remedial action to permanently improve its standards. an incident when there was a complaint about wound care in the home, shows that systems were not implemented to make sure the nursing team’s knowledge and skills for such matters were reviewed. • Review of the paperwork and records for the regular maintenance of essential equipment such as lifts and hoists show this to be all in order. The home has its own maintenance man who has been issued with a corporate maintenance record book to make sure all essential checks for tasks such as emergency lighting are carried out. It is positive that several aspects of Health and Safety management have improved. • The home is making good progress to meet the requirements of the last inspection by Shropshire Fire and Safety Service in October 2006. All staff get robust fire safety instruction, which lasts a whole day. • Moving and handling practices are being improved in line with advice from Health and Safety Executive who recently visited River Meadows upon the request of the home. A colour coding system for hoist slings is DS0000022268.V329480.R01.S.doc Version 5.2 Page 26 River Meadows Nursing Home Limited to be launched to help the care team remember the appropriate adjustments and positioning for each resident. • The home now has a satisfactory accident recording system, although the quality of how they are monitored is variable. Records for one resident who had a fall showed that the accident had been properly followed up and documented to raise staff awareness to minimise the risk of it occurring again, whereas analysis of the findings of the accident which resulted in an adult protection investigation confirmed that further monitoring of such accidents is necessary by management. The above examples show that the home is moving in the right direction to provide the foundations of a good service. However, it is clear that the management of health and safety issues for safe working systems is not fully supported by appropriate recordkeeping and consistent working practices. In order to maximise service user safety at all times, all specific risk assessments which are implemented following an accident need to be monitored to make sure they are kept up to date with relevant information. This must match the advice of any specialist guidance given for equipment when caring for residents, and staff must ensure their care practices adhere to the guidance written down. Lack of appropriate actions have meant such systems have not been followed. For example: • Risk assessments to move and handle people are not updated with additional information should a resident experience an accident or fall. • When a person fell out of a wheelchair, staff took all the right actions to get the chair checked before it was used again, then failed to document the outcome and guidance of the wheelchair specialist who examined this equipment. The home management team must make these issues a priority, to assure the safety of all service users who live at the home is safeguarded in line with relevant health and safety legislation. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 27 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 2 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 2 River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 12(1) 13(1 Requirement All care plans must include details of all aspects of a persons care needs, especially with regard to individual’s safety during moving and handling procedures. (Previous timescale of 23/05/06 and 27/02/07 not met.) Timescale for action 02/05/07 2 OP7 15 (2)(c) 3 OP8 12 (1) 13 (1)(b) 4 OP18 13(4)(b) 13 (6) Service users or their 02/05/07 representatives must be involved in their care plan reviews. (Previous timescale of 27/02/07 not met.) Care plan records must contain 02/05/07 enough details to guide staff about all health and nursing care issues including wound management, and splint care. The registered manager must 21/04/07 ensure all necessary evidence is recorded in staff and service user records to maximise resident safety and well being. This includes: • The outcomes from any adult protection investigation are satisfactorily managed to DS0000022268.V329480.R01.S.doc Version 5.2 Page 29 River Meadows Nursing Home Limited 5. OP22 23 (2) (c) 6. OP36 18 (2) 7. OP38 13 (4)(c) make sure all agreed actions are carried out. • Resident (Previous timescale of 27/02/07 not met.) Systems must be implemented to make sure essential specialist equipment such as seating is kept in good repair and does not pose any infection control or fire safety risk. (Previous timescale of 27/02/07 not met.) Care staff must receive formal supervision at least six times a year - the home must instigate a plan for providing supervision in line with this standard (Previous timescale of 27/02/07 not met.) Safe systems of work must be improved to ensure there is a good understanding of the accident management systems for the home. The management must monitor any specific risk assessments regarding resident health and safety are kept up to date and match working practices in the home. Previous timescale of 27/12/06 not met. 31/05/07 30/06/07 21/04/07 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 OP13 Good Practice Recommendations It is recommended that resident recordkeeping clearly gives written guidance for staff to follow especially if individuals express not to have specific visitors in order to DS0000022268.V329480.R01.S.doc Version 5.2 Page 30 River Meadows Nursing Home Limited 2 3 4 OP9 OP38 OP22 make sure their choices and feelings are being respected. It is recommended all residents who have a degree of independence with regard to their medications have appropriate riak assessment and planning of such matters. It is recommended the company review its hot water testing policy in line with Legionella risk guidance. All bathroom facilities used by service users must be easy to clean and in good repair. This includes the surfaces of the baths. River Meadows Nursing Home Limited DS0000022268.V329480.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. 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