CARE HOMES FOR OLDER PEOPLE
RIVERVIEW CARE CENTRE Rodway Road Off Oxford Road Tilehurst Berkshire RG30 6TP Lead Inspector
Julie Willis Unannounced 18 June 2005 @ 10:30 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Riverview Care Centre Address Rodway Road Off Oxford Road Tilehurst Berkshire RG30 6TP 0118 9728360 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Life Style Care plc Care Home 137 Category(ies) of Older Person (OP) - 76 registration, with number Dementia over the age of 65 years (DE(E)) - 61 of places Dementia (DE) - 5 Physical Disability (PD) - 5 RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users under the age of 60 years not to be admitted to category DE and PD. Date of last inspection 21/02/05 Brief Description of the Service: Riverview Care Centre provides nursing care to 137 users of both genders aged 65 years and over. The home has been purpose built to meet the needs of its users. The home is situated in the Tilehurst area of Reading and has accommodation on three floors. The home was first Registered in May 2004 for 61 people with dementia and 76 people who have needs associated with older age. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Saturday morning and afternoon over a period of 7 hours. The inspector toured the parts of the building that are currently occupied by users, examined service user documentation and spoke to 17 service users and 5 relatives at length. At the end of the inspection feedback was provided to the Homes Manager about the findings of the inspection. There were no outstanding recommendations and requirements from previous inspections. What the service does well:
The feeling of the home appeared warm and welcoming and staff appeared cheerful and happy in their work. The staff are providing a good range of entertainments to keep users occupied and most users said that they had been provided with the opportunity to join in if they wished. The food at the home is pleasantly presented and there are a good variety of foodstuffs available. Choices are available at each mealtime and users can choose to eat in their rooms or the main dining room. The record keeping has improved overall and staff are provided with the information they need to provide good quality care to the residents. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
There is a need to review the staffing levels on Unit 3 to provide effective care to the residents and to avoid risks to their safety. The care plans on Unit 2 should be completed as soon as possible following admission to ensure staff have enough information to provide care effectively to residents. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 7 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. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All service users are fully assessed prior to admission to ensure that the home will be able to effectively meet their needs. EVIDENCE: Examination of ten service user care plans evidenced that all service users are fully assessed by the home prior to their formal admission. The assessment tool used by the home was comprehensive and holistic in content and identified the users dependency level, health, personal care and social and emotional needs. The information was gathered from a variety of sources including the user, their relatives and various health & social care professionals. A copy of the Social Services Care Management assessment is also provided to the home by the purchaser of the service. The information gathered preadmission forms the basis of the care plan upon which care will be delivered. Several service users told the inspector that they had been visited in hospital by staff of Riverview prior to admission and found the meeting helpful, as they
RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 10 were able to ask questions about the home and meet staff before they were admitted. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 Service users are provided with care in a manner, which maintains their right to dignity, privacy and choice. EVIDENCE: The ten care plans that were examined at the time of inspection were in the main well developed and included nursing tools to assess the risks associated with manual handling, nutrition, skin integrity, falls and use of restraints such as cot sides. Where a risk was identified risk reduction measures were in place and appropriate equipment had been provided to reduce the risk identified. The first floor consists of 3 units, which have been dedicated to caring for older people with mental frailty. A number of the staff have recently undertaken specialist dementia training to enable them to meet the needs of these users more effectively. It is evident that staff have been working hard to improve the care plans in relation to service users on this floor and the behaviours and mental health needs of users are being assessed and recorded more robustly. Unit 2 on the first floor is currently taking all admissions of those users who have a diagnosis of mental frailty. Several of the care plans on this unit were not fully completed as users had only recently been admitted. There is a need
RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 12 to ensure that all parts of the care plan are completed as a priority as soon as possible following admission to aid clarity for staff. Unit 3 currently has a number of users with behaviours that on occasion challenge the service. There have been several recent incidents where users have entered other people’s rooms without invite, which have resulted in episodes of shoving or fisticuffs between the users. The home has been proactive in seeking assistance from psychiatrists, psychologists and Community Psychiatric Nurses to resolve the issues identified and their input is evidenced in the care and treatment plans. There is an urgent need to review the staffing levels on this unit to prevent accidents and incidents and to protect service users. A number of users have recently been admitted from hospital suffering from pressure sores. Treatment plans were in place and support and assistance had been sought from Tissue Viability Nurses when needed. The use of body maps to identify the size and position of any wounds or sores on admission was evidenced. It would be helpful if photographs could be provided at regular intervals, to evidence resolution of graded pressure sores and other skin lesions. The home continues to experience difficulties in relation to the allocation of General Practitioners and it is clear that this is having a detrimental effect on services provided to users, particularly in relation to the acquisition of repeat prescriptions. The home is consultation with the PCT to resolve this issue. The home had recently experienced difficulty with an ambulance crew that had refused to take a service user to hospital following a fall. The user was later found to have fractured their hip. This episode has resulted in a complaint to the Ambulance Service which is yet to be resolved. On the day of inspection it was very hot day. Several users were complaining that the lounge on the second floor was “too hot” “a sun trap” and “exhausting to sit there”. There is a need to provide some fans or air conditioners for these rooms to make it more comfortable for users. It was clear that staff were mindful of the need to provide users with sufficient fluids during the hot weather as all users in the home had jugs and glasses of orange juice within reach and those that needed assistance were being provided with regular drinks by staff. The inspector spoke to service users and their relatives who confirmed that staff were mindful of the need to maintain users privacy and dignity at all times and to offer personal care in a discreet and sensitive manner. Service users said, “that staff were lovely”, “kind and caring” and always responded to their calls.
RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 13 RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 Services are provided flexibly around the needs of users. Service users are provided with the opportunity to engage in a range of leisure pursuits, which provide mental and physical stimulation. EVIDENCE: Residents confirmed that the home runs flexibly around their needs. Service users may rise and retire at a time of their choosing. Although the mid-day meal tends to be at a fixed time it can be adjusted to meet the needs of individuals. Service users are offered a variety of leisure pursuits provided by the activities organisers. A daily record is kept of those users who participate. The home regularly has visiting entertainers and there are advertisements displayed in the home, which gives a schedule of dates and times. The current poster displays the date and time of the next production ‘All the nice girls love a sailor’. Service users relatives confirmed that they are free to visit the residents at any time and are offered appropriate hospitality during their visits RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are taken seriously by the home and are investigated fully with written outcomes provided to complainants. EVIDENCE: Examination of the complaint record indicated that there have been 6 complaints since the 1st April 2005. All were well documented. One complaint has been investigated fully by management, but is yet to be fully resolved. The home and the Local Authority are dealing with the matter RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 The home provides safe, comfortable and spacious accommodation for residents, which is clean, hygienic and free from residual odours. EVIDENCE: Riverview is a large home which can accommodate up to 137 users on its three floors. There is a large sloping garden to the rear and a car park to the front of the building. The home is equipped with security cameras to provide visual security of the exterior of the building. The home has a key code access and all floors are key coded. The key codes are changed from time to time to aid security. The home is aware of the need to prevent cross infection. All staff have recently received training from the Infection Control Nurse who provides assistance and support to the home when necessary. Two of the current users are being barrier nursed, as a precaution to prevent cross infection and alcohol based hand rub is available for use by all visitors to the home and to staff. Staff are routinely provided with a range of personal protective equipment
RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 17 including disposable gloves, aprons and masks. All soiled laundry is laundered using the ‘red sack system’. At the time of inspection there were no residual odours noted and all parts of the home were clean and hygienic. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 There are insufficient staff on Unit 3 to maintain the safety of service users. EVIDENCE: Although recruitment and selection of staff were not the focus of this inspection the inspector spoke with a number of staff and observed care practice throughout the home. All of the staff were working effectively as a team and seemed committed to providing quality care. Staff appeared cheerful and positive as they went about their work. They appeared to relate to users in an effective and caring way and said that they enjoyed working at the home. They told the inspector that they were being provided with excellent opportunities to undertake further training to enhance their knowledge and skills. There were no agency workers on duty at the time of inspection and the home was fully staffed with the homes permanent staff. The Manager confirmed that agency staff were still being used to fill gaps in the roster due to sickness, holidays and training events, but that agency staff were being kept to a minimum to aid continuity for the users. A new member of staff confirmed that they were currently undertaking induction and core skills training and that they would be undertaking National Vocational Qualifications in forthcoming months.
RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 19 The home has recently started to provide an English language course for staff of the home. The course takes place at the home twice a week and is available to all staff members. Two qualified staff told the inspector that they were finding the English language training very helpful and felt that there understanding of ‘every day’ language had improved significantly. Service users were in the main complementary about the staff and confirmed that they were “caring kind and attentive”. There is a need to review the staffing levels on Unit 3 in light of the recent admission of people whose behaviours may at times challenge the service. The current levels are not providing sufficient staff to effectively monitor the users and as a result a number of serious incidents and ‘near misses’ have been recorded. RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards in this section were inspected on this occasion. EVIDENCE: RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 27 Regulation 18 (1) a Requirement Ensure that a review is carried out in relation to staffing levels on Unit 3 to ensure the safety of users. Ensure that all parts of the care plans are completed as soon as possible following admission. Provide fans or air conditioning units to communal areas Timescale for action By 18.7.05 2. 3. 7 25 15 23 (2) p By 19.6.05 By 19.6.05 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 Good Practice Recommendations RIVERVIEW CARE CENTRE H51-H01 60077 Riverview V228848 180605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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