Inspection on 04/07/06 for River View

This inspection was carried out on 4th July 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 found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

River View 10/07/07

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 4th July 2006 09:20 DS0000065612.V302969.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 DS0000065612.V302969.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. DS0000065612.V302969.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 DS0000065612.V302969.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). This was the first inspection of the service. Date of last inspection Brief Description of the Service: River View is registered to provide accommodation 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 downstairs 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. Fees for the home are currently £725 per person per week. The registered providers of River View are Angela Bennett and Tracey Pike. Angela takes responsibility for the day-to-day management of the service. DS0000065612.V302969.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 that took place over the course of nine hours on two weekdays. There are currently four service users living at River View. River View was registered as a residential care home in December 2005. Therefore, this was the first inspection of River View. The purpose of the inspection was to assess all key National Minimum Standards. Information for this report was obtained from discussion with the Registered Manager, conversations with three of the four service users, observation of staff interactions with service users, inspection of service user records and medication records and a guided tour of the home with access to two of the residents’ bedrooms with their consent. As part of the inspection process, surveys and comment cards were sent to the home by the Commission and then distributed to service users, relatives, General Practitioners and social care professionals in order to obtain their views about the service. Comments from these sources will be reflected throughout the report. The twenty-two key standards were assessed at this inspection. What the service does well: River View was registered as a care home in December 2005. Since this time the registered providers have worked hard to establish systems in the home and meet the needs of service users. Individual support plans are in place for service users which take account of their individual needs and preferences. Service users are involved in making decisions about what they do and aspects of their home environment which enables them to have some control over their lives. Risk assessments are in place which offer clear guidance to staff in terms of the action they should take to minimise risks to service users while promoting their independence. The home offers positive lifestyle outcomes for service users with regards to activities and promoting access to their community. Service users have contact with their family and friends and relatives are welcomed in the home. Service users’ rights and responsibilities are recognised in their everyday lives with individual needs forming the basis of support given and service users being encouraged to do as much as possible for themselves. Service users are encouraged to participate in grocery shopping and meal preparation and make choices about what they want to eat. One social care professional commented DS0000065612.V302969.R01.S.doc Version 5.2 Page 6 ‘The support at River View is of a high standard. The service users I have placed there enjoy a good quality of life. Staff are caring and professional’. Documentation is in place to ensure that service users’ preferences are included in their daily routines and there is enough information available to staff regarding individuals’ personal care requirements. Service users are supported to access generic and specialist health care services to meet their needs. Service users feel their views are listened to and acted upon by staff and there was evidence to demonstrate that service users feel able to approach the Registered Manager of the home with any queries they have. The home presents as clean and there are systems in place to promote good hygiene. There is a management structure in the home which offers clear lines of accountability to service users and staff and promotes the smooth running of the home. What has improved since the last inspection? What they could do better: As a result of this inspection six requirements and five recommendations have been made. In the service user records sampled, there was no evidence of an assessment having been carried out by the home prior to the service user’s admission. This is necessary for the home to be sure they can meet the service user’s needs. The Registered Manager is looking to prepare a suitable framework for such an assessment in order to meet this requirement. The registered provider must ensure that all service users and their relatives know how to make a complaint. The complaints procedure should be updated so that it refers to the Commission for Social Care Inspection. The decoration and flooring of the en-suite facility to the downstairs bedroom must be completed to ensure that it is homely, safe and well maintained for the service user concerned. Staff recruitment procedures must be reviewed to ensure that information on application forms is clarified at interview and that proof of identity for each member of staff is held on file. DS0000065612.V302969.R01.S.doc Version 5.2 Page 7 As the home is a ‘new service’, the quality assurance process in the home has yet to be implemented to monitor the home’s success in achieving its aims and objectives and ensure that an annual development plan is in place that focuses on outcomes for service users. At the first day of inspection some shortfalls were identified in relation to the recording of fire safety checks and drills. In addition, although fire procedures had been covered in the staff induction programme, formal fire training had not been arranged for staff. By the second day of the inspection the Registered Manager had taken steps to address the shortfalls by introducing a new recording framework and organising fire training for staff. Implementation of these will help ensure service users’ safety in their home. Records of service users’ medical appointments need further expansion to include sufficient detail about the outcome of each appointment. This will provide a meaningful record and provide further evidence that service users’ health care needs are being met and any concerns are followed up. A series of recommendations have been made regarding medication practices in the home to ensure service users are fully protected. These include review of the home’s medication policy to include sufficient information and guidance for staff and the provision of accredited training for all staff in the administration of medicines. Medication administration records which are produced by the home should also be signed by two members of staff to ensure their accuracy. A homely remedies list and patient information leaflets should be kept on file to provide information to staff on the medicines they administer to service users. The training programme for staff should be developed further to ensure that staff access training on abuse awareness and also specialist training to meet the individual needs of service users. All staff working at the home should have achieved an NVQ in Care or be working towards one to ensure their competence in their work with service users. Training in moving and handling, infection control and basic food hygiene should be arranged for all staff to promote safe working practices in the home. 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. DS0000065612.V302969.R01.S.doc Version 5.2 Page 8 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 DS0000065612.V302969.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was insufficient evidence on record to demonstrate that service users’ needs are fully assessed prior to their admission to the home to ensure that their needs are identified and can be met. EVIDENCE: One service user file was inspected for evidence of assessment documentation prior to the admission of the service user to River View in February 2006. The file contained a core assessment by the Local Authority issued in January 2002 but there was no evidence of a new assessment being undertaken since this date either by the Local Authority or the home. Discussion with the Registered Manager demonstrated that there had been good liaison between the service user’s previous home and River View prior to admission so that staff at River View had some knowledge of the service user’s needs and preferences. The manager had also visited the service user at her day centre to obtain information about her activities and support needs there. However, this had not been documented in the form of an assessment which is why this outcome area has been judged as ‘poor’. In response to this the Registered Manager is developing a framework for assessment to ensure that the needs of prospective service users are fully assessed and documented. DS0000065612.V302969.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans are in place to identify how service users’ needs and preferences will be met by the service. Service users are involved in making decisions about their daily activities and their home which enables them to have some control over their lives. Risk assessments are in place to promote the safety, welfare and independence of service users. EVIDENCE: A service user plan was examined. This included information on the service user’s social and family contacts, religion and culture, eating and drinking, communication, support with managing money, getting out and about, daily activities, likes and dislikes, keeping safe, health and personal care. The plan had been signed by the service user. The section on ‘health problems’ had not been fully completed. DS0000065612.V302969.R01.S.doc Version 5.2 Page 11 Monthly house meetings are held to promote service users’ involvement in decision-making. Copies of minutes were seen and demonstrated that service users are involved in making meal choices, deciding on outings, scheduling of laundry and gardening tasks, visitors and use of the garden. Four completed service user surveys were received. All four service users had indicated that they can do what they want to do during the day, in the evenings and at weekends. One service user stated in the survey ‘They ask me what I want for dinner. They ask me if I want to go out. They ask me where I want to go.’ Three relatives or friends of service users indicated in comment cards that they had also been consulted about their relative’s care. For one service user case tracked there was evidence of a joint risk strategy by the local NHS Trust and Local Authority. The home had also carried out a series of risk assessments for a range of home-based and community activities to identify potential risks to the service user, situations in which they could occur, the likelihood of it happening and the implications. The assessments identified clear actions to be taken by staff to minimise risks. DS0000065612.V302969.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users participate in a range of activities that are meaningful for them and that meet their individual needs. Service users are supported to access their local community on a regular basis which enables them to lead ordinary lives. Service users have regular contact with their families and are supported to maintain friendships and contact with people they knew before coming to live at River View which offers them a sense of belonging. Service users’ rights and responsibilities are recognised by the home and they are encouraged to make choices and decisions about issues that affect them as individuals and as a group. Service users are offered a suitable diet to meet their needs and make choices about what they eat. DS0000065612.V302969.R01.S.doc Version 5.2 Page 13 EVIDENCE: All service users at River View attend various day services on either a parttime or full-time basis. There was evidence that where one service user, who has an interest in gardening, has identified that he wants to go to work the home are liaising with a horticultural centre to support him with meeting this goal. The Registered Manager expressed her commitment to ensuring that service users have the maximum opportunity to go out in their local community and access a range of facilities including local shops, pubs, clubs, discos, leisure centres and restaurants. One service user spoken to confirmed that if he asks to go out to a specific place staff will support him to do so. Another service user stated in a survey ‘They take me swimming when I ask to go. I can go shopping. I can stay in in the evening if I want. I can go out to lunch at the weekend. I can go to the pub if I want.’ Service users are encouraged to participate in tasks around the home. One service user was observed to be doing her laundry during the inspection while another was being supported to prepare lunch for himself. Two service users’ rooms were seen and observed to be personalised to their individual tastes with televisions, radios, DVDs, CDs and magazines which they reported that they enjoy in their leisure time. One service user who has a visual impairment stated that the manager supports him in obtaining talking newspapers and books which he enjoys listening to. Conversations with service users, the manager and inspection of daily records demonstrated that service users’ contact with family and friends is encouraged. One service user’s records indicated that she had informed a member of staff that she wished to maintain contact with people she used to live with prior to coming to River View. There was evidence that she had been supported to do this and had returned to her previous residential care home to visit staff and service users. Comment cards received from relatives and friends of service users indicated that in all cases they felt welcomed in the home at any time. One service user spoken to stated that he keeps in touch with his sister through visits and telephone calls for which he can use the home’s cordless telephone. This enables him to take the telephone into his own bedroom so that he can have privacy. The cost of telephone calls are included in the home’s fees. As well as their individual bedrooms and a communal lounge there is a ‘quiet room’ where service users can meet their visitors. Discussion with service users and observation of staff interactions with them indicated that service users’ rights are recognised in the home. All bedrooms are lockable and service users are able to have their own key if they wish. DS0000065612.V302969.R01.S.doc Version 5.2 Page 14 Service users are able to access all communal areas of the home without restriction. Service users are encouraged to make choices about how they spend their time and are involved in making choices about what they want to eat. All service users indicated in their surveys that staff treat them well and one service user spoken to stated that he likes all the staff and that they treat him with respect. Service users are encouraged to take responsibility for the home and undertake various household tasks; one service user commented in the survey ‘I don’t like gardening so I don’t have to do it. I like to do my own washing. Staff help me.’ Prior to the inspection the home did not have a menu plan as it was felt that this would possibly restrict service users’ ability to choose what they wanted to eat. Service users are encouraged to participate in the preparation of meals and once a week service users take responsibility for preparing a meal for themselves and their fellow service users with support from staff. This includes them deciding what they want to cook and purchasing the ingredients. The Registered Manager reported that service users take it in turns to use the internet ordering facility of a local supermarket to place an on-line order of groceries but they also go to local shops to purchase fresh ingredients on a regular basis. Inspection of the food stores in the home showed a good range of foods being purchased. It was noted that the freezer contained some ‘ready-meals’ which the Registered Manager confirmed are only eaten by service users approximately twice a week. This is done in order to maximise the amount of time service users have to access their community. It was suggested that the manager review the menu to ensure that service users have home-cooked meals as often as possible. The manager has since implemented a system of menu planning to ensure that service users are offered a good range of meals and that enables staff to prepare meals in advance on days when service users are busy in the evenings. Daily records indicated that service users go out for meals on a regular basis. One service user stated on the survey ‘They ask me what I want for dinner…I can go out for lunch at the weekend’. Service users spoken to stated that they enjoy the food that is offered to them at the home. During the inspection it was evident that staff were researching products suitable for individuals with a nut allergy as there is a possibility that a service user with this allergy may be admitted to the home in the future and therefore staff need to prepare themselves to meet his specific dietary requirements. DS0000065612.V302969.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is sufficient evidence to show that personal support is given to service users with attention to their individual requirements and preferences. Service users are supported to access generic and specialist health care services to meet their individual physical and emotional health care needs. However, expansion of medical appointment records to include the outcome of appointments is needed to provide more evidence of this. Further development of the home’s policy and procedures around medication administration will help promote the safety of service users. EVIDENCE: Individual support plans were seen to take account of individual needs and preferences in relation to personal care. In addition service users’ daily routines have been documented separately in terms of the time they prefer to get up in the mornings, their personal care routine including attention to oral hygiene, breakfast needs and preferences and preparing for bed. This information gives a good overview to staff of the support service users need to maintain their well-being. DS0000065612.V302969.R01.S.doc Version 5.2 Page 16 All three social care professionals responding to comment cards indicated that staff at River View demonstrate a clear understanding of the needs of service users and they are satisfied with the overall care provided to service users they have placed in the home. All three relatives responding to comment cards also indicated that they are satisfied with the care provided. A record of service users’ medical appointments was seen. This demonstrated that service users are supported to attend generic and specialist health care services as required to meet their individual needs. This included dental appointments, chiropody appointments and GP appointments. The documentation did not include sufficient information about the outcome of each appointment to provide a full record. In response to this the Registered Manager has developed a new framework for the appointments record to ensure this information is included. There was evidence on file that liaison was taking place between the home, a service user’s GP and her previous residential placement regarding preventative health screening for a female service user. Regular recording of a service user’s weight had also been documented for monitoring purposes. The home’s medication policy and procedures were reviewed. The policy includes information on self-administration and the use of non-prescription medication but needs further expansion to cover other aspects of medication practice. Guidance on writing a medication policy has been provided to the Registered Manager. Service users each have a metal medication cabinet allocated to them in the staff office. Medication is collected from a local pharmacy once a month. A booking in and checking out procedure is in place to record medication entering and leaving the home. The home has devised their own medication administration record (MAR) charts. The member of staff on duty takes responsibility for administering medication to service users with a second member of staff signing to confirm that medication has been administered. If a second member of staff is not present on that shift, the next shift will check and sign that medication has been administered. The Registered Manager confirmed that procedures are reviewed at the home on a regular basis to maximise effectiveness and safety. It was noted that one service user’s dosset box was not large enough to accommodate her Sodium Valproate medication. Therefore the medication had been re-dispensed by the manager from their original boxes and stored as separate doses in separate envelopes. The envelopes had been labelled with the service user’s name, the medication and dosage and time of administration. It was pointed out to the Registered Manager on the first day of inspection that this is an unsafe practice which required urgent review. By the second day of the inspection the Registered Manager had liaised with their Pharmacist regarding the provision of larger dosset boxes. As an interim DS0000065612.V302969.R01.S.doc Version 5.2 Page 17 measure Sodium Valproate is now being dispensed directly from the original boxes as provided by the pharmacy until larger dosset boxes can be obtained. Other medicines dispensed from boxes did not have the date of opening written on the label to provide an audit trail. Medication practices are covered in the staff induction programme. On the first day of the inspection it was noted that there was no accredited training available to staff but the Registered Manager has since made contact with a Pharmacist to arrange training for all staff. This training will be accredited with the National Pharmacy Association. There is no homely remedies list at the home to specify any over-the-counter medicines used, the dosage, indications and contra-indications for the information of staff. Patient information leaflets have not been included in service users’ files to provide information to staff on specific medicines and their side effects. One service user has been prescribed diazepam PRN. On the first day of the inspection there was no written information available to staff on administration of this medication. Guidance was developed by the Registered Manager by the second day of the inspection. This includes guidance for working with the service user when he is anxious and indicates the need for staff on duty to provide regular updates to the manager on-call and obtain authorisation for administering PRN medication. Specific instructions for administering PRN medication have also been developed which include the need for the reasons for administration and effects of the PRN medication to be documented. DS0000065612.V302969.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted on by staff but the home’s complaints procedure needs distribution to all relatives and representatives of service users so that they know the process by which they can raise concerns and complaints. Systems are in place at the home that promote the protection of service users from abuse, neglect and self-harm but all staff should access abuse awareness training to ensure that they have the knowledge and skills to recognise and respond to abuse. EVIDENCE: River View has a complaints procedure. This states that the aim is to ‘provide a copy of the complaints procedure to the person that will be living with us’ and explain the procedure in a way that the person can understand. The procedure refers to the fact that on receipt of the complaint the manager will instigate a full enquiry and involve others if this is appropriate, for example, an advocate or Social Services. The procedure refers to the headquarters and local office of the National Care Standards Commission, the former name of the Commission for Social Care Inspection. All four service users responding to the survey indicated that they knew who they would speak to if they were not happy. Three out of the four stated that they knew how to make a complaint. One service user stated that he would speak to the manager as he feels comfortable talking to her. All service users DS0000065612.V302969.R01.S.doc Version 5.2 Page 19 indicated in surveys that they feel that staff at the home always listen to them and act on what they say. Two out of three relatives indicated in comment cards that they are aware of the home’s complaints procedure. None indicated that they have needed to make a complaint. The Registered Manager confirmed that they have received no complaints about the service since it opened in December 2005. It was discussed that the complaints procedure should be expanded to include concerns received by the service. By the second day of the inspection the Registered Manager had set up a record of complaints and concerns which included details of a recent issue that had arisen regarding use of the telephone that had led to a change of practice in the home. A policy on ‘Adult Protection and the Prevention of Abuse’ is available in the home. This states that in the event of abuse being witnessed or reported, staff must inform the home’s management team and relevant authorities must be notified. Staff have access to the multi-agency policy ‘No Secrets’ and written information on the various types of abuse that can occur. Formal training on abuse awareness had not been organised for staff but the Registered Manager has made contact with the Local Authority to ensure that the home is on the mailing list for future training opportunities in this area. DS0000065612.V302969.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s décor and furnishing is of a high standard but completion of decoration and flooring in the en-suite facility of one service user’s bedroom is required for the standard to be fully met. Systems are in place to ensure that good hygiene is maintained and service users benefit from a clean and hygienic environment. EVIDENCE: River View opened as a residential care home in December 2005. The home is in good decorative order and offers spacious communal accommodation for service users that meets their needs. Kitchen furnishings are domestic and unobtrusive. Service users have been able to personalise their own rooms to their own taste and have been supported to purchase their own additional furniture where they have chosen to do so. There is a downstairs bedroom and en-suite accommodation for one service user who has a visual impairment. Inspection of this bedroom indicated that the decoration and flooring of the ensuite shower, basin and toilet facility requires completion. DS0000065612.V302969.R01.S.doc Version 5.2 Page 21 The home presents as clean. All four service users responding to the survey indicated that the home is always fresh and clean. Soap and paper towels are available at all hand basins for hand-washing. Gloves and aprons are available for staff who support service users with personal care tasks. The home has a copy of ‘Infection Control Guidelines for Residential Care Homes’ issued by the Health Protection Agency for the information of staff. DS0000065612.V302969.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is working towards ensuring that staff achieve NVQ qualifications in Care which will ensure they are suitably qualified and competent to meet the needs of service users. Some shortfalls in recruitment practices means that procedures are not sufficiently robust to fully protect service users. Further development of the home’s training programme for staff will ensure that all staff have training in areas specific to the service user group to be able to meet their individual needs. EVIDENCE: There are five permanent care staff working at the home, all of whom are employed on a part-time basis. The Assistant Manager is working towards her NVQ 3 qualification and is looking towards doing her NVQ 4 next year. Two Support Workers are commencing their NVQ 2 qualification. The home’s job specification states that an NVQ Level 2 qualification in Care and training in first aid, moving and handling and food hygiene are essential to undertake the Support Worker post. DS0000065612.V302969.R01.S.doc Version 5.2 Page 23 Training records inspected showed evidence of an induction programme being in place for staff which covers various employment issues, safety and welfare, accidents, fire safety, security, confidentiality, record-keeping and medication. A foundation training package has also been purchased but has yet to be implemented. There was evidence that some staff have undertaken training in epilepsy awareness, moving and handling and food hygiene. Two staff that had not undertaken moving and handling and food hygiene training at the time of inspection have since been booked onto this training by the Registered Manager. All staff have undertaken emergency first aid training. At the present time formal accredited training to meet the needs of service users has not been identified for staff. The Registered Manager has, however, sought guidance from external sources, for example a Community Nurse and a Sight and Hearing Team, to ensure staff have information that helps them to meet the individual needs of service users. Recruitment documentation for three members of staff was examined. Application forms did not always contain sufficient information regarding individuals’ previous or current employment and there was no evidence on file to indicate that this had been clarified at interview. Evidence of a Criminal Records Bureau Enhanced Disclosure check and two written references were on file for all three staff. There was no proof of identity on file for one member of staff. Guidance from the Home Office for United Kingdom employers on changes to the law on preventing illegal working was provided to the Registered Manager so that the home can ensure that they comply with the law regarding document checks. DS0000065612.V302969.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management structure of the home offers service users and staff clear lines of accountability. The home’s quality assurance strategy needs to be fully implemented so that there is an annual development plan for the home that focuses on outcomes for service users. Some shortfalls in health and safety practice identified on the first day of the inspection meant that service users may be put at risk. Prompt action was taken by the Registered Manager to address these issues but this will need to be sustained for the standard to be considered fully met. EVIDENCE: River View is run as a partnership by Tracey Pike and Angela Bennett. Angela Bennett is also the Registered Manager of the home. DS0000065612.V302969.R01.S.doc Version 5.2 Page 25 Angela has experience in working with vulnerable adults and in running an adult placement scheme for people with learning disabilities. She has a Social Work background and has plans to further her knowledge by undertaking a Post Qualifying Award at Bournemouth University. Angela is registered with the General Social Care Council. Angela has not yet commenced her NVQ Level 4 qualification in Care or Registered Managers’ Award. Tracey Pike supports Angela in her management role and takes responsibility for some administrative duties. Angela has delegated some responsibilities to her Assistant Manager who also takes charge of the home in Angela’s absence. All service users spoken to indicated that they would talk to Angela if they were unhappy about any aspect of the home. During the course of the inspection it was evident that service users felt able to approach Angela with any queries they had about their care. Positive responses from service users’ relatives indicate that they are satisfied with the way in which the home is run with one relative commenting ‘My son, X, moved into River View when it opened in December 2005. It is a small, very caring establishment. Everyone’s individual likes and abilities are taken into account. X is happy and therefore I am happy. Angie and Tracey are to be congratulated.’ The Registered Manager has responded promptly to issues raised during the inspection and some issues raised on the first day of the inspection had been addressed by the second day. This is further evidence to support that the registered providers are committed to meeting the Regulations and National Minimum Standards and achieving positive outcomes for service users. The home is in the process of developing a system for measuring the quality of the service provided to service users. The Registered Manager has drafted a questionnaire which will be distributed to service users, their relatives, day centres, the staff team and health and social care professionals in order to obtain feedback on the service and identify areas in need of improvement. The questionnaire is not currently in a format that is accessible to service users but the home is purchasing a computer package which will enable documents, including the quality assurance questionnaire, to be adapted into an easy-toread / symbols format. The home does not currently have an annual development plan. Fire safety records were inspected. These showed evidence that in February, March and April there were some gaps in the weekly smoke alarm checks but since the task has been delegated to another Support Worker they had been checked each week. There was no evidence of appliance checks taking place at the first day of the inspection but since this time the Registered Manager has developed a new recording system to ensure that this is carried out. Fire procedures are covered in the home’s induction programme. Formal fire training had not been arranged for staff by the first day of the inspection but DS0000065612.V302969.R01.S.doc Version 5.2 Page 26 by the second day the Registered Manager had identified an external agency to provide fire training the following week. The Registered Manager confirmed that she is planning to organise internal training for staff twice a year and formal training by an external agency twice a year. Fire drill records indicated that there had been a drill in January 2006. One drill arranged for June 2006 had been postponed until July. Fire drill records were not sufficiently detailed to name those present at the drill, the time of the drill and the time taken to evacuate the building. By the second day of the inspection the Registered Manager had introduced a new framework for recording fire drills to ensure that all relevant information is documented. Health and safety records showed that portable appliance testing had taken place in the home in May 2006 and an inspection of electrical installation had taken place in March 2006. The home’s boiler had also been serviced in March 2006. Records showed that water temperatures are checked on two different outlets each week. Each outlet is individually controlled by a thermostat. Thermometers are situated at all water outlets. On the first day of the inspection the water temperatures from the bath and hand basin taps in the upstairs bathroom were checked. These were found to be 49 degrees Centigrade. The Registered Manager was informed of this and took prompt action to adjust the thermostats to ensure that water temperatures remain close to 43 degrees Centigrade. Twice daily checks were then carried out for a week to ensure that temperatures remained constant. On the second day of the inspection, water temperatures were checked at five different outlets – all were found to be around 40 degrees Centigrade. The Registered Manager confirmed that water temperatures will continue to be monitored on a weekly basis. Risk assessments have been carried out on various household products used at the home. These products were seen to be contained in a lockable cupboard in the kitchen. The home has a copy of Control of Substances Hazardous to Health Regulations issued by the Health and Safety Executive for the information of staff. The Registered Manager is looking to identify suitable training on infection control for all staff. Four staff, including the Registered Manager, have up-to-date training in food hygiene and there are plans to enrol two further staff on this training to ensure service users are protected by practices. DS0000065612.V302969.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 1 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 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 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 1 X X 2 X DS0000065612.V302969.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Full assessment of service users’ needs must be carried out prior to admission to the home, by someone who is competent to do so, to ensure that their needs are clearly identified and can be met by the service. The home’s complaints procedure must be distributed to all service users and their relatives / representatives so that they are aware of the process by which complaints and concerns can be raised. The home’s complaints procedure must be updated to show the name of the Commission for Social Care Inspection. The decoration and flooring of one service user’s en-suite facility must be completed. Recruitment practices must be reviewed to ensure that prospective employees give a full employment history and any gaps in employment are explored at interview. Proof of staff’s identity must be kept on file. DS0000065612.V302969.R01.S.doc Version 5.2 Page 29 Timescale for action 1. YA2 14 01/09/06 2. YA22 22 01/10/06 3. YA24 23 01/10/06 4. YA34 19 01/09/06 5. YA39 24 6. YA42 23 The home’s quality assurance process based on seeking the views of service users must be fully implemented to ascertain how well the service is meeting its aims, objectives and Statement of Purpose. Health and safety records must be maintained to include inspection of fire appliances and sufficient information regarding fire drills and fire training (including the content of this training). 01/11/06 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations It is recommended that the medical appointments record for each service user includes more detail about the outcome of each appointment. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. The home’s medication policy should be expanded to include sufficient guidance to staff on all aspects of medication practice within the home. When MAR charts are printed in the home or handwritten, a second competent person should sign to confirm that all the details of prescribed medicines are correct. All staff with responsibility for administering medication to service users should undertake accredited training. The date of opening on boxes / bottles of medication should be recorded to provide an audit trail. Patient information leaflets regarding service users’ medication should be included in their records to provide information for staff. DS0000065612.V302969.R01.S.doc Version 5.2 Page 30 2. YA20 3. 4. YA23 YA32 A homely remedies list should be produced with details of all over-the-counter medicines used at the home. This should include information about the dosage, indications and contra-indications for each medicine. All staff should access training on abuse awareness. All care staff should hold an NVQ to at least Level 2 standard or be working towards one by an agreed date. All staff should receive foundation training to Skills for Care specification within six months of appointment. Specialist training should be arranged for all staff to reflect the individual needs of service users. 5. YA35 DS0000065612.V302969.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000065612.V302969.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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