Inspection on 10/07/07 for River View

This inspection was carried out on 10th July 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

River View 04/07/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 River View Throop Road Throop Village Bournemouth Dorset BH8 0DQ Lead Inspector Heidi Banks Key Unannounced Inspection 10th July 2007 16:00 River View DS0000065612.V345060.R01.S.doc Version 5.2 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 View DS0000065612.V345060.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 Adults 18-65. 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 View DS0000065612.V345060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service River View Address Throop Road Throop Village Bournemouth Dorset BH8 0DQ 01202 431614 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) Mrs Angela Bennett Mrs Tracey Pike Mrs Angela Bennett Care Home 5 Category(ies) of Learning disability (5) registration, with number of places River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named service users (known to CSCI) may be admitted to the two bedrooms without en-suite facilities (bedrooms 2 and 3). 4th July 2006 Date of last inspection Brief Description of the Service: River View is registered to provide accommodation and care for five adults who have a learning disability. The home is located in the semi-rural area of Throop in Bournemouth and comprises of a family-style home with gardens at the front and rear of the property. There is an area for parking at the front of the property. Four of the bedrooms are located upstairs and one bedroom is located downstairs. Three of the five bedrooms have en-suite facilities. There is a separate ground floor toilet facility that is adjacent to the utility area. The home is situated a short drive away from a local shopping centre and community facilities. The home is staffed 24 hours a day with one member of staff sleeping in at night. At the time of the inspection, fees for the home ranged from £745 and £850 per week depending on individuals’ assessed needs. Fees were reported to exclude personal toiletries, washing powder and petrol. Guidance on fair terms in care homes contracts may be obtained from the Office of Fair Trading – www.oft.gov.uk The registered providers of River View are Angela Bennett and Tracey Pike. Angela is the Registered Manager and takes responsibility for the day-to-day management of the service. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service. The inspection took place over approximately nine hours on 10th and 13th July 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last inspection of the service in July 2006. At the time of the inspection there were five people living at River View. During the inspection we were able to take a guided tour of the home, meet all five people who use the service and observe some interaction between them and staff. Discussion took place with the Registered Manager. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment was completed by the provider and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care managers and health care professionals on behalf of the Commission. A total of twelve surveys were received and information from these sources is reflected throughout the report. A total of twenty-two standards were assessed at this inspection. What the service does well: The home makes sure that people’s needs have been thoroughly assessed before they are offered a place in the home. This ensures that people’s needs can be met by the service and that River View is a suitable place for them to live. People who use the service have comprehensive care plans which include information about their daily routines. This helps promote continuity of care and ensures their needs are met. They are involved in making choices and decisions about their everyday lives and their independence in the home and community is facilitated with due regard for safety issues. People are given opportunities to do activities they enjoy both at home and in the community. Where people had particular interests before coming to the home, they have been encouraged to continue with these and maintain links River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 6 with people and places that are important to them. The home is particularly strong at promoting people’s rights and recognising diversity and has established contact with a local self-advocacy organisation to look at ways of ensuring this is promoted. People benefit from a high standard of personal care which takes account of their needs and preferences. They are enabled to access a range of health care services and are given the support they require with medication to ensure their needs are met. People who use the service and their relatives know who to speak to if they have a concern and there is a system in place to respond to complaints. Service users told us they feel safe in the home and staff are aware of what action to take if they are concerned someone is at risk of harm. The environment offers people a spacious and clean place to live that meets their individual needs. Care workers receive good induction training and have access to ongoing training that helps them meet people’s needs. Service users commented that they like the staff and several positive comments were received from visitors to the home about the friendly, professional and caring attitude of the staff team. Managers have consulted with people who use the service about how the home can improve. They have also taken on board shortfalls identified at the last inspection, responding promptly and effectively to ensure that they were addressed. Health and safety training and practices are sound which ensures that risks are identified and managed and people live in a safe home. What has improved since the last inspection? The home has ensured that there is evidence on file that people have been assessed before they move in to the home and that support offered is based on needs identified during the assessment process. A requirement made at the last inspection for the home to ensure that everyone using the service has a copy of their complaints procedure has now been addressed so that people are aware of how to raise concerns. The decoration and floor of one person’s en-suite facility has now been completed so that it is a suitable and safe environment for him. The home has ensured that people who are employed by them give a full employment history and that proof of their identity is kept on file. These checks help ensure that there is enough information available for the home to make safe recruitment decisions. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 7 The home has taken steps to review and monitor the quality of the service they provide and seeks the views of people who use the service to inform this. This has helped ensure that the home is run in service users’ best interests. Record-keeping in relation to health and safety training and checks has improved and demonstrates the home’s commitment to keeping people safe. The documentation of health care appointments for each service user now includes more detail about the outcome of the appointment so that it is clear how people’s needs are being met. Medication practices have been reviewed to ensure that procedures are robust and that training provided to staff is accredited which promotes service users’ safety in this area of their care. The home has reviewed the training they provide to staff. Care workers now have access to a structured induction programme, nationally-recognised qualifications and specialist training to ensure that they have the skills they need to work with service users. What they could do better: One requirement and three recommendations have been made as a result of this inspection. The home must review their procedures to ensure that the Commission is notified of any event in the home where the welfare of a service user is adversely affected. This will help ensure the protection of people who use the service. Individual support plans should contain more detail about people’s health care needs and how the home will meet these. Although staff attend training in the administration of medication, it is also recommended that a system is put in place by which care workers are deemed ‘competent’ at following the home’s medication procedures and administering medication to service users. This will further promote service users’ safety in this area of their care. A shortfall in recruitment procedures was identified during this inspection. The home should ensure that they only allow care workers with a satisfactory PoVAFirst check to work with service users to ensure that they are fully protected. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 8 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 View DS0000065612.V345060.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures that the needs and wishes of prospective service users are fully assessed prior to moving in. This ensures that their needs can be met by the service and promotes a smooth transition. EVIDENCE: Discussion with the Registered Manager indicated that there has been one new person admitted to the home since the last inspection. The person’s records were inspected for evidence of assessment documentation. On file there was a core assessment which had been undertaken by the placing local authority the month before the admission. The home had also carried out its own assessment of the person’s needs and preferences. This information had been collected in a ‘Pre-admission booklet’. The home has made an effort to make the document user-friendly with symbols to promote understanding. Areas covered included communication, family and friendships, daily activities, leisure, mobility, personal care, life skills, managing money, religion and culture, health needs, medication, diet and safety issues. The document had River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 11 been completed by the service user and the Registered Manager. There was evidence on file that the service user had visited the home both for short tea visits and overnight stays in the weeks before admission. There was also evidence that reviews of the person’s needs had been carried out both three months and ten months following admission. Two care managers indicated in surveys that the home ensures that accurate information is gathered so that the right service is planned and given to individuals. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from individualised plans of care that take into account their personal needs and preferences, offers them choices and gives them opportunities to take appropriate risks. EVIDENCE: The care plans for two service users were seen. These contained comprehensive information about people’s needs, preferences and choices in relation to activities of daily living, for example, keeping safe, mobility, managing money, eating and drinking, relationships and communication. Of particular note there was information about individuals’ daily routines which was comprehensive in detail, offering the reader a good overview of how people want to be supported, this helping to promote consistency and continuity of care; ‘X goes upstairs to get ready for bed at 10pm. X will…get ready for bed in the bathroom (and) at 10.15 (on the dot) X will wait in her River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 13 room for you to help set her alarm clock.’ Discussion with the Registered Manager indicated the importance of care workers sticking to these routines to minimise the person’s anxiety. The manager gave a verbal account of the emotional support in place for one person before they go out in the community. However, this had not been documented in the care plan. It was suggested to the manager that this is included to promote consistency between care workers and therefore ensure the person’s needs are met. Discussion took place regarding the home’s aim to make care plans more accessible to people who use the service. To date, they have made use of a symbols package but are looking to identify further ways of improving accessibility, therefore increasing service users’ ownership and involvement in their plans. The home has made links with a local advocacy organisation, representatives of which are liaising with residents to develop the personcentred planning process. It was discussed that where information has been handwritten, this could be replaced with a large sized printed font and symbols could be replaced by pictures and photographs that are recognisable to service users. Discussion with people who use the service and observation of them in their home showed that they are encouraged to make decisions about their lives and are treated very much as individuals. The minutes of recent residents’ meetings were seen. It was evident that during the meetings residents had discussed events in the home including activities and outings, a recent holiday, timings of meals, house rules, the roles of key workers and the promotion of a member of staff. The minutes offered a very clear account of individuals’ contributions and feedback on issues in the home. Things that people would like to achieve have been documented in their care plans. One care plan seen indicated that the service user would like to go to the theatre, cinema and to the New Forest Show. Discussion with the service user and the Registered Manager confirmed that these opportunities had been made available. It was discussed with the Manager that how personal goals are followed up could be documented more clearly. Positive feedback was received from relatives of service users with all respondents to the survey indicating that the care home meets the person’s needs; ‘X has gained confidence, X makes choices and has become more assertive.’ A care manager who has contact with a service user also commented that the home ‘understands residents’ needs and aspirations’. A sample of risk assessments for one service user was seen. These showed clear consideration for promoting people’s independence in their home and community while safeguarding their welfare. General risk assessments had been completed by the home for aspects of personal care and daily living, for example, shaving, use of the bath, answering the door, cooking, helping with household tasks, accessing the community and making use of various facilities such as the theatre, gym, pub and swimming pool. Where there are specific River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 14 risks regarding a person accessing the community there was an individual risk strategy on file that had been compiled by the Community Learning Disability Team detailing how risks should be managed. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service enjoy a lifestyle that meets their individual needs and preferences, promotes their independence and participation in the community and respects their rights to an ordinary life. EVIDENCE: All five service users at River View attend day services on either a full-time or part-time basis. The Registered Manager confirmed that through their day services individuals are supported to attend a range of activities including gardening, cooking, yoga, swimming and participation in an environmental project. Discussion with the Manager, an review of records, evidenced that service users attend different day services and where people had moved to the home, they had continued to attend day services they were familiar with to offer them continuity in their lives. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 16 Discussion with the Registered Manager indicated that the home has recently employed a chef who visits the home once a week to facilitate a cookery session. Two service users spoken with reported that they had enjoyed the session. Discussion with one service user indicated that they enjoyed knitting, doing jigsaws and going to the pub. They told us that they had been given the opportunity to do all of these things which they were pleased about. The daily records for service users were inspected to obtain information about the range of community activities people are supported to engage in. These showed that in the previous week individuals had gone horse-riding, to the pub for lunch, for a walk by the river, a drink in a local café, to a market in a nearby town, a local shopping centre and the supermarket. Service users also have membership of a local holiday park where they can use leisure facilities and join in entertainment events. Discussion with the Registered Manager demonstrated commitment to ensuring that service users are supported to do things they want to do as individuals. One service user who expressed a wish to attend the New Forest Show was given one-to-one support to be able to go. Four service users choose to go to the gym each week while one service user, who does not wish to go, is given one-to-one support to pursue another activity of their choice. It was clear from discussion that efforts are made to ensure that holidays arranged for the group also cater for the individual needs and preferences of each person. All four relatives responding to surveys indicated that the home always supports people to live the life they choose; ‘X does a wide range of activities and enjoys them all’; the home does ‘everything to support the needs of individuals with their lives enabling them to be part of the community.’ This was echoed by two care managers in surveys, one commenting that the home ‘provides a person-centred service, operates on ordinary life principles and promotes community access and presence’. River View has a policy on contact with family and friends which states that this is encouraged and ‘visitors are welcome at all reasonable times’. It goes on to say that residents have the choice of who to see and when and can choose whether they invite visitors to their own rooms or to use the ‘quiet room’. The people whom each service user wishes to keep in contact with are detailed in their care plan. One service user had expressed a wish to maintain contact with people from a previous residential placement. A conversation with the person confirmed that she had been empowered to do this. All four relatives responding to the survey indicated that the home helps their relative to keep in touch with them. The home’s policies and procedures state that ‘every resident has the right to live their life how they would like to’ and indicate that all bedrooms have a lockable door, all bathrooms have a privacy lock and that there is a strict policy in the home of ‘knocking and waiting’. Observation of people in the home River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 17 indicated that they have free access to all communal areas of the home and are comfortable in coming in and out of the office area to talk with staff. Care plans indicate whether each person has chosen to have a key to their bedroom and one service user was seen letting himself in the front door with a key. Care plans also demonstrated where service users have exercised choice in having their names or photos on their bedroom doors. The manager has obtained guidance on the Mental Capacity Act from the Department of Health which is being shared with staff to promote their awareness of issues around capacity and consent. The manager stated that guidelines on equality and diversity were in the process of being drawn up in association with a local advocacy organisation. These will cover people who use the service, staff and volunteers. The health care records for one service user showed that where they had declined a specific health screening procedure this had been respected but further advice was being sought regarding capacity issues. A relative of a service user told us that they felt the home was particularly sensitive to diversity, respecting differences and ensuring people’s individual needs are met. Records of meals that have been eaten by each service user are maintained. Review of daily records indicated that they are enabled to eat out on a regular basis and minutes of house meetings showed that they contribute ideas to the menu and assist with grocery shopping. All five service users responding to the survey told us that they liked the food at the home. On the evening of the inspection, one person had chosen to eat a different meal from the others. This had been provided. One service user has a specific food allergy which is clearly detailed in their care plan. Also detailed in care plans is information about people’s needs for support at meal-times, for example, ‘X has cereal for breakfast…mash it a little…so X can pick it up with a spoon’; ‘X drinks a mug of tea, make sure he knows where this is placed and remind him it is hot.’ Observation showed that people are encouraged to take part in meal preparation and service users are able to prepare drinks for themselves, and their visitors, where they are considered safe to do so. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service receive personal and health care support that meets their individual needs and promotes their welfare. EVIDENCE: Care plans seen offered good levels of detail about people’s personal care needs to promote their independence, for example; ‘X needs you to put their clothes on the chair at the end of the bed at night-time; trousers first, then T shirt, then jumper…X’s socks should be put in X’s shoes and these put under the chair.’ All service users told us in surveys that they felt well cared for in the home and that staff treated them well. All relatives responding to the survey stated that their relatives were given the support and care that they would expect. Positive comments were received in surveys about the support received by people who use the service; the home gives X ‘all the care and support he needs’; ‘…He is content with life…Mrs Bennett and staff understand each resident’; ‘Staff are very careful about X’s needs, about his skin and hair River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 19 care and dietary requirements’; ‘I cannot think of any way they can improve, the care that X gets from them is fantastic.’ The care plan for one service user stated that the service user does not have any health problems that care workers need to be aware of. However, further inspection of the person’s records evidenced that they attend regular reviews with a Consultant Psychiatrist regarding their prescribed medication, regular Chiropody appointments and routine dental check-ups, this indicating that the person does have health care needs requiring support and intervention. The dates and outcomes of various appointments had been recorded. It was discussed with the manager that care plans should contain more detailed information on people’s health care needs and the support they require to ensure their needs are met. This was echoed by a health care professional who indicated in a survey that care plans could be amended to improve information on people’s oral hygiene regimes. Both care managers responding to surveys indicated that they felt individuals’ health care needs were properly monitored and attended to by the care service, one also commenting that there was good liaison about care issues with professionals. A health care professional commented that the home has been attentive to any issues they have raised regarding personal care and staff ‘are always conscientious and helpful’. The home’s medication procedures were inspected. The home has a policy on the administration of medicines which covers ordering of medication, receipt of medication, storage, administration, record-keeping, disposal of medicines, refusal , medication errors, administration of homely remedies and selfadministration. The manager confirmed that at the present time no service users in the home administer their own medication and all medication is stored in lockable metal cabinets which are fixed to the wall of the office. Each service user was seen to have their own medication cabinet. A care plan seen at this inspection included a list of the medication taken by the service user and some information on the support that needs to be put in place by the home to ensure safe administration; ‘X takes his tablets at the table with a glass of water’. Following the last inspection of the service, guidelines have been put in place regarding the administration of PRN (as required) medication for one person. Medication is supplied by a local pharmacy, mostly in monitored dosage systems. Records showed that incoming medication is checked and documented by the manager. One service user was reported to visit family on a regular basis and a format is in place for booking out medication. Discussion with the manager indicated that medication was being re-dispensed into a separate, labelled dossett box for the person to take with them for the weekend. Re-dispensing is not considered good practice and the manager was advised to contact the pharmacy to arrange for this medication to be dispensed by them into a separate container. Following the inspection, the manager River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 20 confirmed that this had been actioned with immediate effect. For one service user whose medication is supplied in a box, there was evidence of an audit trail being recorded on the box showing how many tablets should be left. The amount of medication was checked and corresponded with the number documented. It was suggested to the manager that the audit trail is documented on a form specifically for this purpose rather then the medication box to ensure that it can be read easily. Medication administration records are produced by the pharmacy. A sample of these were checked – all medication had been signed for appropriately suggesting that medication had been given as prescribed. A copy of a homely remedies list for each service user was forwarded to the Commission following the inspection. These detail the names of medication to be administered, the recommended dosage and precautions. Lists had been signed by service users’ general medical practitioners. Patient information leaflets on the various medicines taken by service users were seen on file. The manager confirmed that the home’s co-owner, Tracey Pike, undertakes a regular audit of medication procedures which includes a review of storage and checks on recording systems. The induction programme for care workers covers an introduction to medication and health care procedures. This is supplemented by further accredited training, specifically tailored to medication administration in care homes, organised by the pharmacy which involves completion of a workbook. The manager confirmed that completion of the training is followed by a period of two weeks’ shadowing of an experienced member of staff. It is recommended that the process of shadowing and deeming a member of staff ‘competent’ to administer medication is clearly recorded as part of the overall training offered. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s procedures on complaints and abuse promote service users’ rights to speak up and be protected from harm. EVIDENCE: A copy of the home’s complaints procedure was seen. Although there is some use of symbols in the procedure the manager was aware that more could be done to ensure the policy is fully accessible to people who use the service. Three people spoken with during the inspection reported that if they were unhappy about something in the home they would speak to either their key worker or the manager. In service user records seen there was evidence that they had been given a copy of the home’s complaints procedure. All four relatives stated in surveys that they knew how to make a complaint about the care provided by the home if they needed to. They also told us that the home had always responded appropriately if they had raised concerns about their relative’s care. The home’s complaints record was reviewed. This has now been expanded to include the reporting of concerns. Three concerns had been documented since the last inspection, two of which had been raised by staff regarding building and water supply issues. The record included information about how the manager had responded to the concerns raised. No complaints have been received by the Commission about the service in the past twelve months. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 22 A copy of the local multi-agency adult protection policy was available for reference at the home. Training records for care workers showed that they have attended training on abuse awareness held by the local authority. There have been no adult protection concerns at the home since the last inspection of the service. The home has also established links with a local advocacy organisation in adopting a document, ‘Stop Bullying Guidelines’. This offers guidance on bullying and harassment and emphasises the need for everyone in the home to behave in a respectful way of each other and to tell someone if they see anyone being treated badly. All five service users who responded to the survey told us that they felt safe in the home. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. River View provides a homely, comfortable and clean environment for people to live in that meets their needs. EVIDENCE: A tour of the communal areas showed the home to be clean and in good decorative order. Accommodation is provided on two floors, four bedrooms being on the first floor and one bedroom being on the ground floor. Three of the five bedrooms have en-suite facilities. The ground floor also comprises a spacious kitchen and dining area, a utility room, two lounges and office. There is a large patio area to the rear of the property which leads to the garden. There is a further garden area and driveway to the front of the home. Three service users showed us their bedrooms, these being well-equipped and personalised to meet their needs and preferences. One person told us how much they love their room. It was evident that the service user had been River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 24 supported to purchase additional furniture for their room to make it a comfortable area to relax in. Another service user told us in a survey that their bedroom was ‘alright’ and they liked the fact there was ‘no noise’ at River View. The home’s Annual Quality Assurance Assessment document indicates that they have a policy on infection control. New care workers to the home now access an induction programme run by the local authority which includes infection control training. A sample of other care workers’ records seen also showed evidence that they had received this training in the past year. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures that people who use the service are supported by suitable staff who have received training for their roles. EVIDENCE: Out of four care workers employed at the home, two have recently completed National Vocational Qualifications (NVQs) to Level 2 standard. The Registered Manager reported that two other staff are currently working towards professional qualifications in Social Work. It was discussed with the manager that these care workers may still benefit from training that is specific to supporting people with learning disabilities and this could be reviewed to ensure that they have the knowledge they need to work in their current role. Since the last inspection of the service, two new care workers have been recruited by the home. The home’s records were inspected for evidence of safe recruitment procedures. It was apparent that in both cases, two written references had been obtained prior to the care worker commencing work with service users and there was evidence of a full employment history and proof of River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 26 identity on file. Both records seen showed evidence that an enhanced disclosure from the Criminal Records Bureau (CRB) had been obtained. However, it was noted that one had been issued eleven days after the person’s start date and there was no evidence of a PoVAFirst check having been undertaken to ensure the individual’s suitability to work with vulnerable people. Discussion with the manager and review of the home’s diary indicated that the person had been shadowed in the interim period and had also undertaken their induction programme off-site. The manager was reminded that she must ensure that, where prospective care workers are not in receipt of a full CRB disclosure, a PoVAFirst check is carried out prior to the person starting work. The manager informed us that she would review the home’s procedures as a matter of urgency to ensure that this is carried out for future employees. The manager has developed a ‘Staff Training and Development Plan’ for the service. To achieve the goals set out in the plan the home has established links with a local authority’s training department. New care workers now attend a six-day induction programme that meets Skills for Care standards. Certificates on file showed that this includes training in the principles of care, the role of the worker, health and safety, medication and health care, communication and record-keeping. Training in challenging behaviour and key working has been purchased from an external trainer and there was evidence on file that staff have been supported to attend total communication training with the local authority. Training records also showed that training in epilepsy had been provided by a representative of the Community Learning Disability Team for which the home are awaiting certificates. A health care professional responding to a survey told us that care workers at the home have attended oral health training days at a dental clinic in order to increase their awareness of supporting people with this area of their personal care. All four relatives responding to surveys indicated that they felt care staff at the home have the right skills and experience to look after people properly. Several positive comments were received from relatives of service users about staff at the home; ‘Care staff are very professional and caring at all times’; ‘X speaks very highly of all the staff and gets on well with them’; ‘We are delighted with River View and the staff’; ‘Staff are always polite, happy and very caring’. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home consults with people who use the service to ensure that it is run in their best interests with due regard for their safety and welfare. EVIDENCE: The manager of the home, Mrs Angela Bennett, has a professional qualification in Social Work and is currently working towards her Registered Manager’s Award. She is supported in her role by the home’s co-owner, Mrs Tracey Pike, who carries out regular visits to the home to talk with residents and staff, carry out a buildings inspection and audit documentation. At the last inspection of the service in July 2006, six requirements and five recommendations were made. At this inspection there was evidence that the home had taken appropriate measures to meet all requirements and recommendations in full. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 28 Comments received from service users, their relatives and care managers in surveys at this inspection indicate a high degree of satisfaction with the support offered at the home and the attitudes of the manager and staff. In addition, files and records in the home are well-organised and completed to a good standard. The home has implemented a quality assurance process to measure people’s satisfaction with the service provided. In November 2006 questionnaires were sent to residents, their family and friends, day centres, health and social care professionals and staff to identify how the home is progressing in meeting its objectives. Areas covered by the questionnaire included activities, access to health care, the home environment and standard of cleanliness, staff attitudes, choice and standard of food, level of privacy and the handling of queries and complaints. This had been adapted into a symbols format for people with reading difficulties. From responses to the questionnaires the service had produced a review of their first year since registration, which was in simple text and symbols. An annual development plan had also been produced comprising objectives for the service to work towards during 2007. It was evident from discussion with the Registered Manager that the home was making good progress in meeting these goals. A member of staff at the home has completed a ‘Fire Marshal’ course and has responsibility for undertaking various health and safety checks in the home. These include regular checks of smoke detectors and visual checks of fire doors, escape routes and fire safety equipment. Mrs Tracey Pike also audits these records on a regular basis. Records showed that fire training is carried out twice a year for all staff by an external fire safety agency. This is supplemented by in-house training. Records showed that residents had been involved in some training sessions. Examination of records also showed that fire drills are carried out on a regular basis in the home. These had been carried out at various times of the day including after 10pm and the names of everyone participating in the drill and details of the evacuation had been recorded. The Registered Manager had carried out a fire risk assessment, although this had not been dated. The manager was aware that the risk assessment would need updating where they had recently identified that one service user was unlikely to comply with an evacuation at night. The manager agreed to liaise with the local Fire and Rescue Service to identify ways in which they can safeguard the person’s welfare in the event of a fire at night. Thermostats have been fitted to water outlets to regulate water temperature and records showed that these are tested weekly. Documentation showed that temperatures ranged from 39–43 degrees Centigrade. One outlet was tested during the inspection and was found to be at a safe temperature. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 29 A record of incidents and accidents is maintained in the home. However, these had not been reported to the Commission as required by the regulations. The Registered Manager has been given relevant guidance on making Regulation 37 notifications as published on the Commission’s website. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 2 X River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 31 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 YA42 Regulation 37(1) Requirement The registered persons must review their procedures to ensure that the Commission is notified promptly of any incident in the home, which adversely affects the welfare of service users. This will help ensure that service users are protected. Timescale for action 31/08/07 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. 2. Refer to Standard YA19 YA20 Good Practice Recommendations Care plans should contain more detailed information about the health care needs of people who use the service and how these are to be met. The home should ensure that there is a system in place to record in-house medication training that is given to staff. A process should be in place by which care workers are deemed ‘competent’ to administer medication to service users in the home. The registered persons should ensure that all appropriate recruitment checks are carried out on prospective care DS0000065612.V345060.R01.S.doc Version 5.2 Page 32 3. YA34 River View workers before they commence working with service users. River View DS0000065612.V345060.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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