Inspection on 25/10/06 for River Meadows Nursing Home Limited

This inspection was carried out on 25th October 2006.

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.

Other inspections for this house

River Meadows Nursing Home... 15/08/07

River Meadows Nursing Home... 02/03/07

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

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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 Announced Inspection 09:50 5th October 2006 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.V304113.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.V304113.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.V304113.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 Elderly Persons, of whom 10 may be Persons with a Physical Disability. The home may accommodate one person, aged under 65 with Dementia, who is named in the attached Schedule (not to be displayed). 1st February 2006 Date of last inspection Brief Description of the Service: River Meadows is a Care Home Registered with the Commission for Social Care Inspection to provide accommodation, nursing and personal care, for a total of up to 44 older people and young adults, of whom one may have a dementia related illness, 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. All areas are maintained and furnished to a high standard, providing welcoming and comfortable surroundings. The home is set in well-maintained 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 (The Commission for Social Care Inspection) Inspection report is also freely available at the entrance of the home for people to look at. The current fees charged vary between £420 and £620 per week depending on River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 5 the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. River Meadows Nursing Home Limited DS0000022268.V304113.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 unannounced and carried out by one inspector over a period of eight and a half hours. A few weeks before the inspection was carried out, CSCI (The Commission for Social Care Inspection.) wrote to the home manager to request some necessary information to assist with the inspection. 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 22 people living there, two visitors, and eight of the staff on duty at the time of the inspection. 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. Three residents and six relatives also made some written comments for the inspector about the home, and after the inspection, another four sets of written comments were received from residents and staff. The Registered Manager, Ann Mc Mullen was on duty at the time of the inspection. Everyone, including residents and staff were very welcoming and helpful throughout the day for which CSCI extends its thanks. A total of 30 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. What the service does well: The home works well at meeting the care needs of individual residents in a flexible and effective manner. Staff build good relationships with service users, their families and supporters. Comments from residents and relatives were particularly complimentary about the staff team. One person wrote to CSCI to say: ‘The staff really do need congratulating. We feel mum is looked after very well.’ It was positive to overhear and observe good ‘hands on’ care being delivered to people with a variety of nursing needs. One of the home’s major strengths is the excellent way the team make sure residents are encouraged to participate in a variety of activities which suit their tastes, preferences and abilities. The home has the ongoing support of an area manager who audits the standards within the home regularly, and sends detailed information in reports on a monthly basis to assure CSCI of the home’s performance. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 7 It is positive to see that the home management team acts upon the suggestions and opinions of its residents – showing the home is acting wherever possible to promote residents centred care. What has improved since the last inspection? What they could do better: 5 of the 11 statutory requirements made at last inspection have not been fully met, and as a result of this inspection another 12 requirements have been made, making a total of 17 the home has to meet. Listed below is an overview of shortfalls to report as a result of this inspection: Attention to detail on important paperwork is required so 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 need to have more explicit details including a breakdown of the fees the home charges. The records kept at the home do not reflect the standards of care delivery seen. 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. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 8 Systems to maximise resident privacy and dignity need to be further developed – ‘home made’ care instructions seen to be taped on bedroom walls need to be located and displayed in a more acceptable manner. Deterioration in the condition of the bathrooms has needs action to make sure hot water is supplied at safe temperatures, and that the bath surfaces are repaired. The procedures for the way the home keeps valuables and any lost property safe on residents behalf needs to be improved. Lack of safe working systems in the home alongside shortfalls in procedures for the recruitment, training and supervision of staff means that the well being of residents is not safeguarded at all times. Accident management procedures need to be more robust. Discussions with the management team took place throughout the day and feedback about the conclusions of the inspection was given at the end. 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. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 9 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.V304113.R01.S.doc Version 5.2 Page 10 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): 2&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Necessary paperwork used as part of the home’s admission procedures need additional information to show residents have been fully assessed before moving in, and they are aware of all the terms and conditions of living at the home. EVIDENCE: When the records of four residents were looked at, similar omissions of information were seen when the home was inspected in February this year. When the information is collected about a person thinking about moving into the home, the form it is recorded on is not signed or dated by the person filling the form in. Other information was also seen to be missing, with specific parts of the forms left blank, and some that were filled in did not have enough detail upon which a care plan could be devised. For instance, the assessment of a River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 11 person with known continence challenges did not have details about how this was being managed written down. When this was discussed with the manager, it was confirmed that Springcare, the company which owns the home, had already recognised this to be an issue. As a result of this, the home is in the process of changing over to use a much more comprehensive form for this matter, which has been used successfully in other homes within the company. The way contracts of residence are set up between the home and service user needs to be further improved. This process needs to make sure all residents are provided with the correct financial information it costs to live at River Meadows. There is no proper breakdown of who is responsible for paying what part of the fees, such as the nursing contribution by the local authority. In addition, one person admitted since the last inspection had not been issued with a contract until two months after being admitted. These issues were also discussed with the manager at the end of the inspection. It is of note to further improve the admission process; the manager has compiled a ‘welcome booklet’, which supplements the information provided by the homeowners. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plan recording does not provide staff with the information they need to satisfactorily meet service users needs. The health needs of service users are met with evidence of multi disciplinary working taking place. The medication at this home is professionally managed to make sure it promotes good health for residents. The attitude of staff is excellent and service users are treated with dignity and respect. EVIDENCE: During the visit staff were seen and heard to treat service users with dignity and respect. Comments from residents and relatives were all complimentary about the way people are cared for in the home. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 13 One relative stated; ‘I appreciate the kindness, helpfulness and friendliness of the staff. They all work together and look after my Mum very well’ Feedback for visiting professionals about the home was also positive. One community nurse wrote that;‘River Meadows have an open and honest policy when involving other professionals in the care of their residents’ A speech and language therapist wrote to say the staff:‘Were always aware of the needs of the residents.’ In view of the above comments it was of note to see that work is being carried out to improve the recordkeeping for the care being carried out in the home. At present this does not clearly reflect all of the needs and preferences of the people living at River Meadows. One of the nurses on duty introduced the inspector to an individual who had been transferred from another home in a very frail, bedridden condition. The lady was seen to be sat up in the lounge, able to stand, and was joining in with social activities. Discussion with a visiting relative for this person confirmed delight at this person’s improvement. This clearly demonstrates a good standard of care is being carried out at the home for that individual. However, the care records to account for this progress and to guide staff about her changing needs did not show this. The findings of a recent audit of care plans by the company’s Area Manager, Sarah Kaye, were similar to those when care records of five people were looked at in depth on the day of the inspection. Care records lacked specific details for basic care such as personal and oral hygiene, as well as information for people with more complex needs such as oxygen therapy, and wound care. Evidence of resident involvement in this process was also scanty and has been lacking. This is reflected in the minutes of a recent residents and relatives meeting where individuals were requesting for aspects of their personal care needs to be resolved in the forum of a communal meeting. New care plan documentation is in the process of being launched in the home, and discussion with two nurses confirmed that they had recently received recordkeeping training by the Royal College of Nursing, as well as specific training about the new care plan documentation in preparation for this task. Review of the new care plan format shows that way it will be organised and laid out in future will make it much easier for residents as well as staff to read and understand. Staff were also in agreement about this. A very knowledgeable nurse assisted with the assessment of how the home currently manages its medication systems. Storage and recordkeeping arrangements have improved and are satisfactory. Another nurse was River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 14 observed to be carrying out a medication administration round in an effective professional manner, with evidence of some residents administering their own medication safely. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents enjoy a variety of opportunities to participate in activities to meet their needs and preferences. Residents have many opportunities for community/family contact, which enables them to make a choice about who they see and when and where they see them. 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. EVIDENCE: Findings on the occasion of this inspection are of a similar commendable standard of those reported following the inspection of February this 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 interests. All written comments received about the home confirmed those opportunities for leisure activities continue to improve. Residents are actively assisted in maintaining contact with relatives, friends and the local community, and the continuation of religious practices. The River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 16 regular weekly visit by a complementary therapist was continues to be popular. It is of note to be informed again, that the provision of transport links have continued to improved at the home to get people out and about. Improvements of 1: 1 activities with residents have also been reported, – one person spoken to was complimentary about the support he received to use his laptop and improve his information technology skills. The home has also launched its own magazine, and one of the resident’s is the editor. Staff and residents all commented they looked forward to it being published. A choice of attractive and nutritious were meals seen being ordered, prepared and served in various parts of the home. The inspector was present when lunch, afternoon tea and suppers were being prepared and served. All meals seen appeared appetising, and all residents’ verbal and written comments confirmed they usually enjoyed their meals. One resident commented that the food was; ‘In the top four of the best things about living at River Meadows.’ Another said:‘They feed you well here, sometimes too much.’ Residents were observed to be assisted to feed themselves independently with the provision of some specialist equipment, and the discrete, dignified support from the staff. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 17 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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” Recordkeeping for the satisfactory complaints system needs 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 resident’s well being is safeguarded at all times. EVIDENCE: Review of the complaints management system shows that the company complaints policy welcomes this type of issue in order to improve the service it provides. This is clearly displayed in communal areas of the home. The way this procedure has been handled at River Meadows has resulted in the manager not being able to provide all the information necessary for inspection. Information was requested to confirm that all complaints for the past 12 months have been fully investigated by the home. A computer failure was reported to be the cause of this. It is of note that the home now has a complaints logbook as a ‘hard copy’ of these records to make sure this does not happen again. When this was examined, the complaints information sent to CSCI before the inspection did not match details written in the log book. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 18 Since the last inspection there has been an incident at the home, which resulted in an adult protection investigation. This issue has provided CSCI with the opportunity to monitor how the home manages such a challenge. The home manager carried out the majority of the actions expected to be carried out, with the exception of one necessary improvement, to make sure that all new temporary staff including agency workers got an appropriate health and safety introduction to the home. Discussion of this matter confirmed the manager had not taken action for this, as it was a company matter. It was agreed that if emergency agency staff were used services users would not be fully safeguarded. As a result, immediate action was taken to ensure changes in the home working policies would make this happen in future. When staff training for adult protection was explored it was confirmed by the manager that this was an area in need of improvement. It was reported that two members of staff out of the 36 care team members had undertaken training for this matter in the past year. The training matrix the manager compiled on the day of the inspection from her computer data showed this matter was not being monitored in line with other necessary and mandatory and training staff need to do their job properly. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24, 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 has a welcoming, clean and tidy appearance with a ‘homely atmosphere’. The large conservatory provided as a designated smoking area for residents has been completed and now has adequate floor covering and heating. It was seen that a call bell is awaiting installation for this area, and the roof had to have developed a leak on the day of the inspection – remedial work for these issues are in hand. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 20 Work on the deteriorating condition of the bathrooms seen at the last inspection has yet to be carried out, although the manager did state they were on the ‘priority list’ to be improved. Repeated testing of the hot water supply to the first floor bathroom confirmed the temperature needed to be adjusted from 47 degrees Centigrade to the region of 43 degrees Centigrade. Steam was visible when this hot water supply was tested. A bathroom on the ground floor on West Wing had similar problems. The home maintenance man was on site and made aware of the issue to be actioned as a priority. On the tour of the home, a wealth of specialist equipment was seen in use to maximise the opportunity for people to be as independent as possible. It was noteworthy to hear of the continued input by an occupational therapist about such matters. Some of the specialist seating in the home is beginning to show signs of wear and tear and needs to be monitored to make sure it doe not pose an infection control of fire safety risk. One specialist chair seen in use had foam exposed where its outer covering had split. The inspector saw an excess of twenty bedrooms. All were well furnished and decorated, although unprofessional signage seen ‘Sellotaped’ to bedroom walls did not enhance the appearance of them. Consideration needs to be given to this matter for at least one individual to ensure staff guidance for positioning the person and her feeding regimes was displayed more discreetly. This was discussed with one of the nurses on duty that introduced the inspector to people in their bedrooms during the latter part of the inspection. Review of the recent infection control audit the home had carried out by the Health Protection Agency confirmed the home was making good progress to meeting the recommendations to improve standards in the home. It is of note the kitchen got a 100 score for its good practices on this matter. However, further work is needed to make sure that feeding equipment is kept clean managed the way it has been advised. A pump seen in use was soiled with dried feed debris. The home was seen to be using a ‘Sangenic’ disposal system for continence pads. This again is a hand-operated piece of equipment. It is recommended advice be sought from the infection control nurse about using this equipment. Improvements in the way the home stores its clean bedding now means infection control measures have improved in the home. Arrangements for the home to accommodate its pet cats mean they enhance the lifestyle of the people at the home. The timescales for the further building works are planned to improve the resources at the home have not yet been finalised. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. 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 standards of vetting and recruitment practices need further improvement as not all appropriate checks being carried out. This does not ensure that suitable staff are employed to care for service users. Lack of safety training for staff does not ensure that service users are always 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. The layout of these rotas have been improved and redesigned to clearly identify all hours the staff team, including the manager are on duty in the home. The majority of feedback from residents,’ relatives and staff confirmed they thought the home was sufficiently staffed, although three did comment that more staff on a morning would be welcomed. A positive comment received from a visiting professional to the home stated she felt that it was:- ‘Due to the good employment practice in the home and its River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 22 good staff retention that all the members of the staff team are aware of the residents needs.’ Examination of the records for two new staff members showed that the recruitment and selection practices are not as robust as they were in February when the home was last inspected. There are no interview checklists in both sets of files. The information in one application showed no account for an employment gap of years between 2002 – 2004.The other applicant had not completed the ‘education and employment section of the form’ so there were no dates to establish the previous career history of this person. It is positive that 18 out of 27 carers employed at the home have attained NVQ Level 2 or above, which means over two thirds of the home team to have this qualification. A training matrix sent to CSCI before the inspection for the period of January to December 2005 did not identify dates staff members had undertaken training. A training matrix the manager started to compile on the day of the inspection from her computer data was incomplete and did not list all of the staff team names. Analysis of the data for 23 staff members listed showed that all of them needed some form of their mandatory training refreshed. For example 11 of the 23 were in need of moving and handling training. As recorded earlier in this report, staff training was an issue identified to be improved as part of an adult protection investigation. These findings are similar to the findings at the last inspection when it was reported; ‘the new starters have not had all the necessary mandatory training expected, including that for moving and handling.’ The above evidence shows the matter needs to be a priority for remedial action. It is therefore; good to be informed the company has recently appointed a trainer who will assist in addressing this matter. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 23 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, 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. 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. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 24 EVIDENCE: Since the last inspection, Springcare Ltd, the company who owns the home, has undertaken some reorganisation of its management structure. This has had a positive impact on River Meadows as the registered manager, Ann McMullen can now focus all of her energies on the day to day running of the home. Additional monitoring the new area manager has carried out recently has further enhanced the quality audit systems already in place. This has been a very thorough process and has identified both positive practices as well as areas for improvement. This has resulted in River Meadow’s satisfactory policies and procedures to be in the process of being updated to be more robust and in line with all of the company’s protocols. These new systems will resolve many of the issues identified to be addressed as a result of this inspection. Once put into practice, they will enable staff to develop and be aware of further good practice. It is of note to comment that the detailed reports of the monthly visits by the area manager continue to keep CSCI informed about how the home is performing. Inspection findings confirmed the home was already listening and acting upon residents’ and staff comments and opinions of ways to improve the home. A resident’s request to sort something out to deter the flies from the neighbouring farmers fields resulted in the home obtaining pest control machines for this purpose. Residents and staff commented that this equipment had made life a lot better during the hot summer months. Likewise, a staff member is currently researching a safer more presentable option for the staff identity badges, following concerns raised when their current badges have become accidentally unfastened while staff have been caring for residents, and when their identity has been challenged when escorting residents on appointments away from the home. The above examples show positive moves being undertaken to make the management of the home resident focussed. In terms of safe working practices, several issues emerged which are putting service users at risk. Examination of two staff members’ records alongside discussion with a group of staff on duty confirmed that the 1:1 supervision of the team members has not been as regular as it should be. Supervision ensures that staff are competent to do their job and that competency is maintained. This also needs to be improved as priority. Attempts to improve systems for managing residents monies and valuables are evident, and show they need further development to include actions to take when valuables and lost property are held by the home for safekeeping. The policy seen for this matter did not outline the arrangements for the key to the River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 25 safe in the absence of the manager for annual leave etc. Residents identified this as a challenging issue at the last inspection. Most of the necessary service and maintenance records requested were seen to be up to date and complied with necessary health and safety legislation, although recordkeeping for water temperatures has not been carried out as often as it should be. Discussion with the home maintenance man told the inspector that hot water temperatures have been recorded monthly rather than weekly as necessary, and that he was not aware of this. The manager needs to make sure this is monitored more closely. Information provided by the home for this inspection stated that the fire officer had visited the home in July of this year. This report was not available for examination. Mrs McMullen stated she would forward a copy to CSCI when it had been located. This has not yet been received. Shortfalls in accident management system shows home not doing everything it can to keep people safe. A new accident recording system was implemented September, and is not being completed properly by staff. This makes it non compliant with health and safety and data protection legislation, and does not have enough detail to demonstrate all accidents have been fully explored with appropriate actions taken to minimise the chance of them happening again. Discussion of this matter with the manager showed that she also had limited working knowledge of the recent changes to this system, and her actions to remedy the accident records failed to demonstrate her full understanding of the matter. This issue also needs to be acted upon so it is put right at the earliest opportunity. When risk assessments to guide staff in the event of an emergency were explored, it was reported the home did not have a strategy in place for staff to follow should the lift breakdown. All of the above issues were discussed with the manager during the inspection and feedback about the conclusions of the inspection was given when it ended. This meant a start could be made on the remedial actions to be carried out whilst waiting for this report to be available. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 26 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 3 X 2 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 2 2 2 River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5A (1), (2) Requirement Timescale for action 27/12/06 2. OP3 14Sch 3.1 3. OP7 12(1) 13(1 4 OP7 15 (2)( c) Evidence must be available to show each service user is issued with a contract of terms and conditions at the point of moving into the home, which fully outline all necessary details including the financial arrangements for fee payment. All residents records including 27/12/06 those who are self funding must have evidence that their needs have been fully assessed by a person competent to do so. (Previous timescale of 23/03/06 not met.) All care plans must include 27/02/07 details of all aspects of a persons care needs, including and details of any advice given by clinical specialists, including speech and language specialists. (Previous timescale of 23/05/06 not met.) Service users or their 27/02/07 representatives must be involved in their care plan reviews to minimise them having to resort to use the communal forum of a meeting to express their care DS0000022268.V304113.R01.S.doc Version 5.2 River Meadows Nursing Home Limited Page 28 5. OP16 22(3) (8) 6. OP18 13(4)(b) 13 (6) needs. The registered persons must: • Ensure written information about complaints clearly accounts for all those received. • A written format must be available which evidences a summary of the actions taken in response to all complaints received in the past 12 months. The registered manager must ensure all necessary evidence is recorded in staff and service user records to maximise resident safety and well-being. This includes:• Staff training for vulnerable adults. • The outcomes from any adult protection investigation are satisfactorily managed. 27/02/07 27/02/07 7 OP22 8. OP21 23 (2) ( c) 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. 23(2)(j) All bathroom facilities used by service users must be easy to clean and in good repair. This includes the surfaces of the baths. (Previous timescale of 28/02/06 not met.) Hot water outlets accessed by service users must be regulated to keep them at approximately 43 Degrees Centigrade. This must be monitored and recorded at least weekly. Unprofessional signage outlining care guidance must not be DS0000022268.V304113.R01.S.doc 27/02/07 27/02/07 9. OP21 23(2)(j) 27/12/06 10. OP24 12 (4)(a) 27/12/06 Page 29 River Meadows Nursing Home Limited Version 5.2 11. OP26 13 (3) 12. OP29 19 13. OP30 18(1)(c) displayed in residents’ private living accommodation. The home must meet the recommendations of the Health Protection Agency infection control audit, especially with regard to guidance about specialist feeding equipment. The registered persons must make sure all vetting and recruitment practices are robust, and all gaps in employment records are explored. Priority must be given to ensure all staff receive appropriate mandatory training. (Previous timescale of 28/02/06 not met.) The home must improve the system for managing residents valuables, including assuring the availability of their finances in the absence of the manager. 27/02/07 27/01/07 27/02/07 14. OP35 Sch 4.9 27/02/07 15. OP36 18 (2) 16. 17. OP37 OP38 17 Schedules 3 & 4. 13 (4)( c) Care staff must receive formal 27/02/07 supervision at least six times a year – the home must instigate a plan for providing supervision in line with this standard Records necessary for inspection 27/02/07 must be made available at all times. Safe systems of work must be 27/12/06 improved to ensure: • The manager and staff have a good understanding of the accident management systems for the home. Environmental risk assessments cover strategies for emergencies including equipment breakdown, such as the lift. Version 5.2 Page 30 • River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc 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 OP26 Good Practice Recommendations It is recommended advice be sought from the infection control nurse about using the ‘Sangenic’ hand operated pad disposal system. River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE 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 River Meadows Nursing Home Limited DS0000022268.V304113.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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