Inspection on 04/10/07 for Riverhead Hall Nursing Home

This inspection was carried out on 4th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Riverhead Hall Nursing Home 05/10/06

Riverhead Hall Nursing Home 09/01/06

Riverhead Hall Nursing Home 13/09/05

Riverhead Hall Nursing Home 01/03/05

Riverhead Hall Nursing Home 05/10/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Riverhead Hall Nursing Home Limited Riverhead Driffield East Yorkshire YO25 6NU Lead Inspector Eileen Engelmann Key Unannounced Inspection 4th October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverhead Hall Nursing Home Limited Address Riverhead Driffield East Yorkshire YO25 6NU 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) 01377 253863 01377 257665 info@riverheadhall.karoo.co.uk Wellburn Care Homes Limited Mrs Dianne Jean Hogg Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (34), of places Physical disability (4), Physical disability over 65 years of age (34) Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E); Old age, not falling within any other category - Code OP; Physical disability - Code PD and PD(E); The maximum number of service users who can be accommodated is: 34 Service users admitted under the category of (PD) to be aged 50 years upwards and require nursing care. 5th October 2006 2. 3. Date of last inspection 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 and provides people living in the home with two lounges, a dining room and a conservatory. There is also a patio area overlooking the garden. There are parking facilities within the grounds. Currently the home is undergoing extensive building work, which will result in there being additional bedrooms up to a total of 45. The work should be finished by the summer of 2008. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager during this visit indicates the home charges fees from £420.00 to £660.00 per week depending on the type of room required, the nursing input needed and the source of funding. There is a topup fee payable weekly and further information about this cost is available from the manager. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information has been gathered from a number of different sources since the last visit to the home in October 2006, this has been analysed and used with information from this visit to reach the outcomes of this report. The unannounced visit was carried out with the manager, staff and people living at Riverhead Hall. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files and records relating to the service. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people using the service and staff and their written response to these was good. We received 14 back from relatives (70 ), 9 from staff (45 ) and 7 from people using the service (35 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. What the service does well: What has improved since the last inspection? People who work in the home have got better at medication record keeping and administration and this is making working practices safer and keeping people using the service well and healthy. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 6 The people working in the home are writing down what care each person living in the home needs to make their life and health better. They are talking to the people more to find out what they like and how they want to be looked after and writing down any risk factors that are part of the daily living tasks. This helps the people living in the home to have choice in how they are cared for and helps them stay as independent as possible. The person in charge of the home makes sure that she gets two satisfactory references for any new member of staff before they start work within the home. This protects people living in the home from risk of harm. 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. The summary of this inspection report can be made available in other formats on request. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: Information from the surveys shows that the majority of people received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. A number of people within the home are self-funding and their files show that information about fees and fee increases is sent out to the person responsible for each individuals finances and sufficient notice of changes to the prices is given in writing. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 9 Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Discussion with the manager indicated there is a formal, written process of offering placements to people who are interested in using the service. Those people at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of their specific problems/abilities and the care given on a daily basis. Discussion with people showed that they were satisfied with the care they receive and have a good relationship with the staff. Comments from the surveys said ‘the staff care for people very well’, ‘the staff manage my relative’s dementia appropriately’ and ‘our relative’s disabilities are well catered for’. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. The home employs one member of staff from overseas. People using the service are unable to make a choice of staff gender when deciding whom they would like to deliver their care, as the home only has female staff delivering care. This is due to a lack of suitable male applicants and the home has employed male care staff in the past. The manager said that she would discuss this with people wanting to use the service during the assessment process. Information from the Annual Quality Assurance Assessment and discussion with the people using the service indicates that all of the people are of white/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 10 The home does not accept intermediate care placements so standard six is not applicable to the service provided. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people who live in the home are clearly documented and are being met by the service and staff. EVIDENCE: At the last visit in October 2006 two requirements were made ‘With regard to the care plan discussed during the site visit, the following action must be taken: • A risk assessment must be completed for the use of bed rails, to ascertain whether or not they should be used The care plan in place in relation to the recorded action to be taken by staff with regard to the restriction of mobility must be reviewed’. Checks at this visit found the requirement to be met. ‘During the planned introduction of new care planning material, priority must be given to those service users’ care plans and associated risk assessments, Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 12 which are incomplete, missing, or not regularly reviewed. This includes risk assessments for bed rails, tissue viability and nutritional screening’. Checks at this visit found the requirement to be met. Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Relatives commented that ‘the staff provide good nursing care, general care and a comfortable living environment’, ‘the staff care for my relative in a sympathetic and professional manner and there is a good atmosphere in the home’. The care of four people was looked at in depth during this visit and included checking of their personal care plans. These are detailed and include specific information on an individual’s health and their medical conditions. The plans are updated regularly and include risk assessments. Any changes in care are documented and actioned by the staff. Information about the person’s social interests, likes and dislikes, spiritual needs are included within the individuals care plan. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that people have input to this process (where possible), and family/representatives are also invited to the reviews with the person’s permission. This process of review is carried out by the home, for self-funding people. Relatives are satisfied that the home keeps them up to date with any changes in their loved one’s care. Individuals said ‘anything serious is notified to us immediately’ and ‘I am happy with the care my relative receives. His health has improved a great deal since he came here and he loves the cheerful staff and the food’. People have good access to their GP’s, chiropody, opticians and other external services. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. Entries in the care plans specify where individuals have dietary needs, including PEG feeds and special diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Nutritional risk assessments are in place and are updated regularly by the staff. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. A requirement was made at the last visit in October 2006 that: Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 13 ‘Medicines must only be administered to the person for whom they have been prescribed, labelled and supplied. The medication stock must be checked on a regular basis, and out of date stock removed. The date at which eye drops must no longer be administered must be clearly recorded, and the medication disposed of’. Checks at this visit found the requirement to be met. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and their MDS system of medication is in use. Observation of the medication records show that there are two areas of practice that need to improve and these include: • Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. • Where medication is prescribed on a PRN basis (as and when required) the staff are not bringing forward the amounts of medication kept in stock from one MAR chart to another. It is important to have up to date records of medications within the home, to help people audit the system and ensure errors do not occur. Checks of the controlled drugs and register showed that these medicines are monitored carefully, stored correctly and records are accurate. Temazepam is being stored and recorded as a controlled drug; this was a recommendation in the last report (October 2006) and is now met. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were that ‘People are treated with respect and dignity. Staff pay attention to detail and personal preferences are catered for’, ‘I am satisfied with the staff, they are professional and caring. They treat people as individuals at all times and respond well to their specific needs’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. People with dementia or sensory impairment are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities to suit their interests or abilities. EVIDENCE: A recommendation from the last report (October 2006) was that the registered person should consider the provision of an activities co-ordinator. This has been partially met in that a member of staff has some supernumerary hours to organise a programme of activities, but it remains the responsibility of the other staff to ensure these are carried out. Given that the home is expanding in size there will be a greater need for an activities co-ordinator whose role is to organise and carry out social activities on a daily basis especially some 1:1 input for those with dementia, physical disabilities and sensory impairment. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 15 Six members of staff have attended training on providing activities within a care home setting and a monthly events flyer is given to each person living in the home, showing a list of daily activities. On the day of this visit the home had invited in a company specialising in motivational/recreational activities to entertain the people using the service. A group of people were seen to be participating in different games and clearly enjoying the session. The manager has recognised that there are some people who remain in bed or have dementia needs, which prevent them from joining in with the daily activities and a different type of input is needed to provide these individuals with stimulating social contact. One relative commented that ‘we would like to see more in-depth activities and entertainment. The entertainer last week was wonderful, everyone was singing and clapping along even those who do not usually take part’. Another said, ‘There is a need for more stimulating activities especially for those in their rooms who do not get many visitors’. Records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that people are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. There are monthly in-house church services from the Church of England, and the Catholic priest will visit anyone wishing to take communion on request. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to us showed a high level of satisfaction. Individuals said ‘ the home provides a caring and supportive environment. The atmosphere is relaxed with plenty of laughter’, ‘there are good activities and entertainment provided, and relatives are made to feel welcome. Any requests for people to be ready to go out are met and we are always informed if our relative requires anything such as clothes or toiletries’. The manager is in the process of obtaining advocacy information and leaflets from a local group, but these have not yet arrived. She is able to discuss advocacy and local services with anyone who requires this type of service, but the contact information needs to be on display or in the service user guide for easy access. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. People Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 16 spoken to are satisfied that they can access their personal allowances when needed. Comments from the people living in the home and their relatives are on the whole very positive about the meals and kitchen service provided. Individuals commented that ‘the food is excellent’, ‘the home has an excellent cook who provides good wholesome food’ and ‘the meals are superb and a good variety’. The lunchtime meal was well presented and offered a good choice of food, menus were available and the dining room was welcoming and spacious. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who needed help with eating and drinking. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples’ views are listened to and acted upon. EVIDENCE: A recommendation was made at the last visit that: ‘The complaints procedure should be posted in a public area of the home’. Checks at this visit found this has been met. The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home and all of the survey responses from people using the service showed individuals have a clear understanding about how to make their views and opinions heard. People told us that ‘we would talk to the staff or Dianne if we had any problems’. Checks of the complaints records in the home showed that the manager has dealt with one formal complaint since the last key visit in October 2006, around staff attitudes. The manager spoke to the staff concerned and the complainant was satisfied with the outcomes. Fourteen relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 18 with quickly. Two people said ‘we have never had to make a complaint as the manager quickly deals with issues as they arise’. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. On the day of this visit the operations manager was arranging Safe Guarding of Adults (abuse) and Dementia training for all staff. These are booked to take place in November and December 2007. Staff survey responses show that individuals have a good understanding of their role and responsibilities around the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: A requirement was made at the last visit in October 2006 that ‘In light of recent changes in fire legislation, the registered person must consult with the fire officer to check that the systems for maintaining the security of the building at the main entrance and conservatory remain acceptable to the fire authority. Following consultation, the registered person must update their fire safety risk assessment, and take any remedial action necessary following any recommendations and timescales made by the fire officer’. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 20 Checks at this visit show this requirement has been met. We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the manager was able to show us the work that has been completed in the past six months and discuss work that is planned for this year. Building work is ongoing to create an extension to the premises, which will provide a total of 45 beds within the home when completed. The date for building work to finish is summer of 2008. Health and safety precautions are in place regarding the building site and where people’s bedrooms are affected by the work, the individuals have been consulted and moved to alternative accommodation within the home. People told us that the building work has impacted on their daily lives, but this is not a problem as staff and the management team have worked hard to keep this to a minimum. One lady has refused to move from her room and although the noise of the work is evident within her room, she told us that she was happy and content to stay where she was. All areas within the home are warm, safe and comfortable. The domestic staff do an excellent job of keeping the premises clean and odour free and visitors told us that ‘the environment is wonderful, full of fresh flowers and lovely pictures on the walls’. Comments from the day of this visit indicate that the people using the service find the home to be spotlessly clean and they are satisfied with the laundry service provided by the home. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of recruitment, induction and training of staff are good with appropriate employment checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that people are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: Comments from the people using the service and relatives are on the whole very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. Survey responses said ‘the staff are warm, welcoming and friendly’ and ‘ the staff succeed in providing everyday kindness, patience and practical good heartedness’. One relative told us that ‘staff are very good at tackling problems and answering questions. You are never made to feel that your interest or worry is misplaced or overdone’. At the time of this visit there were 24 people living in the home as some rooms are out of action due to the building works. The staffing rotas show that there are the following levels of staff on duty: Morning – One nurse and six care staff Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 22 Afternoon – One nurse and four care staff Night – One nurse and two care staff The manager said staffing levels would be reviewed and increased as the new bedrooms became available and places filled. Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. There is an induction course for new members of staff, and 31 of the care staff have achieved an NVQ 2 or 3, with 2 working towards this award and another 3 waiting to start the training. The home provides a mandatory stafftraining programme and this includes some more specialised training to help staff develop their skills and knowledge around pressure care, wound care, palliative care, dementia and safeguarding of adults. The manager said that training in Equality and Diversity has not taken place although it is discussed informally at staff meetings and supervision. It is recommended that the responsible individual should try to source some equality and diversity training for staff members. A requirement was made at the last visit in October 2006 that: ‘The registered person must ensure that, prior to deployment of staff, they have obtained two satisfactory references relating to the applicant’. Checks at this visit found the requirement has been met. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: Dianne Hogg is the registered manager of Riverhead Hall, she is a trained nurse with an active registration with the Nursing and Midwifery Council and she has achieved her Registered Managers Award. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 24 Dianne has access to training and support from the Wellburn Care Home management-training programme and has regular contact with her operations manager. At the last visit in October 2006 a recommendation was made that ‘The home should continue to develop the quality assurance systems at the home, seeking the views of service users, relatives and others with an interest in the home, such as visiting professionals. Consideration should be given to carrying out a survey, which seeks the views of service users about staff availability and the provision of activities’. Checks done during this visit found that the recommendation has been met. The home has achieved the local councils quality award (QDS) parts one and two and Investors in People status. Meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the responsible individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is available within the home for inspection. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires, and the manager is in the process of producing an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Checks of the finance systems within the home found that handwritten records are kept for people’s personal allowances; the administrator on a daily basis up dates these. The majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the person’s individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 25 money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. At the last visit in October 2006 two requirements were made that ‘The registered manager must ensure that the weekly checks of fire alarms and emergency lighting are carried out. The kitchen final fire exit must be kept clear at all times. All bed rails must be checked before next being used to ensure that they are safe and properly fitted. Record must be kept to evidence that the equipment is checked on a regular basis. The acting manager must carry out an assessment of risk based on the vulnerability of service users to ascertain: • Those service users who are able to manage their own denture cleansing tablets safely • To take appropriate action where the assessment concludes that the service user is not able • To ensure that denture cleansing tablets are kept in suitable locked facilities The risk assessment must be formalised. Checks at this visit found the requirement has been met. ‘A system must be devised in order that the delivery temperatures of meat can be obtained, and subsequently recorded. Action must be taken in order that the following systems are serviced, and/or a satisfactory certificate obtained: • Electrical fixed wiring • Gas landlords certificate • Legionella certificate Checks at this visit found the requirement has been met, except that a risk assessment for Legionella within a care home setting has not been completed, nor has the responsible individual consulted with the environmental health department about this issue. The responsible individual must make sure that this is done as soon as possible and any action required by the environmental health department is carried out. A recommendation made at the last visit in October 2006 was that ‘It is recommended that the fire safety training records are reviewed, so that they identify clearly who has had training, when it has been received, and when an update is required’. Checks taken at this visit show that the recommendation has been met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 26 Staff have received training in safe working practices or are due to attend later in the year, and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Riverhead Hall Nursing Home Limited DS0000000948.V352335.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2)(m) (n) Requirement The responsible individual must ensure that appropriate activities are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. The responsible individual must consult with the environmental health department about solutions to control risk of Legionella within a care home setting. To ensure the health and safety of people using the service and working within the service is protected and promoted. Timescale for action 01/01/08 2. OP38 13(3)(4) (6) 01/01/08 Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 29 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 OP9 Good Practice Recommendations The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The manager should make sure that where medication is prescribed on a PRN basis (as and when required) the staff bring forward the amounts of medication kept in stock from one MAR chart to another. The registered person should consider the provision of an activities co-ordinator. The manager should make sure that advocacy services contact information is kept on display and/or put into the Service User Guide. 50 of care staff should have achieved an NVQ 2 by the end of December 2008. The responsible individual should try to source some equality and diversity training for staff members. 2. OP9 3. 4. 5. 6. OP12 OP14 OP28 OP30 Riverhead Hall Nursing Home Limited DS0000000948.V352335.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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