CARE HOMES FOR OLDER PEOPLE
Riverhead Hall Nursing and Residential Home Riverhead Driffield East Yorkshire YO25 6NU Lead Inspector
Rosalind Sanderson Unannounced 13 September 2005 09:30 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. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Riverhead Hall Nursing and Residential Home Address Riverhead Driffield East Yorkshire YO25 6NU 01377 253863 01377 257665 info@riverheadhall.karoo.co.uk Mrs Jean Cameron Jordan 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) Mrs Diana Elizabeth Robinson Care home with nursing 34 Category(ies) of DE (E) Dementia - over 65 (34) registration, with number OP Old age (34) of places PD(E) Physical disability - over 65 (34) TI (E) Terminally ill (34) Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8/3/05 Brief Description of the Service: Riverhead Hall is registered to provide nursing care and accommodation for up to 34 people. The registration allows the home to admit older people who require nursing care who have a disability, who are terminally ill, or who suffer from a dementia. The home is situated in beautiful grounds on the outskirts of the market town of Driffield. There are parking facilities within the grounds. The home provides two lounges, a dining room and a conservatory. There is also a patio area overlooking the garden. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted for seven hours including preparation time. The registered provider, Mrs Jean Jordan, and the deputy manager, Mrs Diane Hogg, were available to assist during the inspection. The inspection process involved speaking with service users and staff, looking at service user and staff records and health and safety records. Service users communal and private areas were looked at with their permission and the kitchen and laundry areas were also inspected. The atmosphere within the home was warm and welcoming and all of the service users looked happy and content. What the service does well: What has improved since the last inspection?
The majority of staff have received training in Dementia care and awareness. The training has affected and improved the delivery of care in the home Service users who wish to look after and administer their own medication are provided with lockable facilities to enable safe storage of the medication. Risk assessments are in place for these service users. There is evidence within the care plans that the service users are involved and give consent for them. Signatures evidence this. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 6 What they could do better: 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. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 7 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 Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 8 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 Service users can be confident that their needs will be assessed prior to admission and once admitted these needs will be met. EVIDENCE: Service users care plans showed that a pre admission assessment is carried out either prior to admission or as soon as possible following admission. The assessment includes all nursing care needs, activities of daily living and also social and recreational needs of the service users. The needs assessment is carried out with the co-operation of the resident or their families. Signatures were present in some cases to show involvement of the resident. One visitor stated, ‘I was very happy with my relatives admission. The manager visited her and chatted with her about her care. She felt happy coming here as there was a familiar face’ Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 9 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) 7,8,9,10 Care plans are in place to ensure that service users assessed health care needs and social needs are met in a way that promotes privacy, respect and safety. EVIDENCE: The care plan records looked at gave information about the service users physical, personal care and health care needs. There was information about the type of specialised equipment necessary for the prevention of pressure sores and for moving and handling. The qualified nurses and the care staff record on a daily basis the care and treatments delivered to the service user. Specific care plans were in place for service users who are at risk from and/or who have pressure ulcers. The record of the treatments and interventions were recorded consistently on the evaluation sheet. The qualified nursing staff are responsible for the treatment of pressure ulcers and had attended training and update sessions in relation to this. There is a monitored dosage medication system in operation and all medication is safely stored. There was one service user who self medicates and a risk assessment was in place and she had been supplied with secure storage for the medication.
Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 10 Service users spoken with confirmed that staff respected their privacy and always knocked on bedroom and bathroom doors before entering and this was observed during the inspection. Staff were observed interacting well with service users and calling them by the name they prefer in a respectful way. One service user commented, ‘I left once but soon came back, that’s how good this home is’ Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 11 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) 15 Meals provided at the home are varied and nutritious. Mealtimes are unrushed and relaxed offering social opportunity for service users. EVIDENCE: The service users nutritional needs are assessed and the menu is devised to meet their needs. The cook shows great interest in providing a healthy diet and caters for individual service users’ likes and dislikes that are established on admission. Menus are varied and are made available to service users individually so they can make a choice about what they eat. Service users who were in their rooms were seen to have a copy of the week’s menus. A recent visit from the environmental health officer had commended the food operations at the home and recommended that the home be put forward for the ‘Heartbeat’ award for providing healthy food alternatives. Lunch time was observed and staff were observed attending to people appropriately and in a way that promotes dignity. Where service users needed one to one assistance this was carried out in a sensitive way. The lunchtime was unhurried and service users were offered sherry or beer to take with their meals Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 12 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) 18 Lack of training in the protection of vulnerable adults means that there is potential that service users may be put at risk. EVIDENCE: Staff spoken with were clear about the forms of abuse that could occur in the care setting however when asked about reporting procedures when a disclosure is made the staff were very vague. Staff cover this area within their NVQ qualification but this is not a taught programme. This was discussed with the registered provider and deputy manager and it was agreed that training will be provided within six weeks to key members of staff who will then cascade this to all staff. This will ensure that service users will be safe and fully protected Since the last inspection the majority of staff have received training in Dementia awareness to ensure that they are equipped to care for service users with these needs. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 13 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) 26 The home is clean, pleasant and hygienic. EVIDENCE: The home is very pleasant and clean. There are no unpleasant odours and there is plenty of natural ventilation. Hand washing facilities are sited around the home and personal protective equipment is provided for all staff and service users. Infection control is paramount to the manager and there are ‘hand washing’ signs in evidence throughout the home. Training has been provided in this area. The laundry is situated away from the main building and the equipment provided ensures that soiled laundry is washed appropriately. Walls and floors in the laundry are readily cleanable. The sluice room is kept locked to ensure service users do not have access to COSHH materials. There is a sluice disinfector. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 14 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) 27,30 Staff, in sufficient numbers and who have the necessary skills, care for service users. EVIDENCE: There are ample staff on duty on each shift and this was the case on the day of the inspection. Staff rotas show that there is a good skills mix on each shift. It was observed at lunchtime that there were adequate numbers of staff to enable service users requiring help to receive this. All new staff receive induction training that meets the NTO requirements. Staff confirmed that they receive up to four paid training days per year. The training provided equips staff to meet the needs of the service users. Since the last inspection the majority of staff have received training in Dementia awareness to equip them to care for service users having a dementia care need. Similarly trained nurses had undergone palliative care training. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 15 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) 38 Service users and staff have their health and welfare promoted. To ensure this continues and they are safe the requirements within this report must be addressed. EVIDENCE: The registered manager and her deputy have allocated time to undertake management duties including the supervision and training of the staff. The home has a health and safety policy and procedure in place and mandatory training is up to date to make sure that service users are safe. All trained nurses are qualified first aiders so ensuring that a first aider is available at all times. Many of the staff have undergone the ‘Train the Trainer’ training for moving and handling and they then train other staff. Despite this it was observed during the inspection that a service user was moved in a wheelchair without
Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 16 foot plates in place. This was discussed with the provider and deputy manager and they were required to address this issue with the staff concerned. All certificates relating to the equipment and services within the home were current. Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 17 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 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x x x x x x x 1 Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 18 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 18 Regulation 13(6) Requirement The registered manager must arrange for staff to receive training in the Protection of Vulnerable Adults The registered manager must ensure that wheelchairs are used safely and correctly at all times Timescale for action 31/10/05 2. 38 13(5) On receipt of this report and maintained thereafter. 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 Riverhead Hall Nursing and Residential Home J53-J04 S948 Riverhead Hall V243594 130905 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross YORK YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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