Inspection on 20/04/05 for Riverlea House

This inspection was carried out on 20th April 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Riverlea House 20/06/07

Riverlea House 27/06/06

Riverlea House 03/08/05

Riverlea House 19/01/05

Riverlea House 02/09/04

Riverlea House 06/02/04

Riverlea House 13/11/03

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Riverlea House 105b/107 Lower Road, River Dover Kent CT17 0QY Lead Inspector June Davies Unannounced 20/04/05 at 10:00am 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. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Riverlea House Address 105b/107 Lower Road, River, Dover, Kent CT17 0QY 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) 01304 823935 Choicecare 2000 Limited Mrs Elizabeth Kinge, Acting Manager. Care Home 44 Category(ies) of OP 44 registration, with number of places Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2005 Brief Description of the Service: Riverlea is a large detached 44 bedded care home for the elderly situated in the village of River, on the outskirts of the town of Dover. Local amenities include a village shop, and a public house, and public transport is easily accessible. The home is situated on two floors, and there is a passenger to lift to the first floor, four pleasant communal lounges are situated on the ground floor. The grounds of the home are small, with two patio areas and two lawned areas, which back onto the river. There is a small parking area at the front of the property and one to the rear of the property. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at Riverlea Residential Care home on Wednesday 20th April 2005, the inspection took 7 hours. Eight residents, six staff, a district nurse and two visitors were spoken to during the course of the inspection. The inspector spent part of the inspection looking into the requirements made at the last unannounced inspection in January 2005, and looking at residents files and other documents in relation to the standards inspected. A number of requirements have been made throughout this report. What the service does well: What has improved since the last inspection? What they could do better: Residents and staff have concerns about the staffing levels in the home. There was also concern expressed by residents and some staff regarding the level of maintenance in regard to communal areas, namely the main hallway, garden, Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 6 and the renewal of the entrance and hall carpet. Documentation in respect of staff recruitment and the protection of vulnerable adults needs to improve. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 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 Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 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) 2, 3,5 Residents are appropriately assessed prior to admission, and are given the choice through introductory visits to decide if this is the home they wish to reside in. Thorough pre-admission assessment ensures that there is a good basis to prospective residents care plans. EVIDENCE: Copies of signed contracts were available with resident’s documentation in the office. The contracts are clearly printed, and inform the resident of the room they will occupy in the home, what the resident can expect for the fee paid, the contract also sets out the rights and obligations of the resident and registered provider together with the terms and conditions of occupancy. Comprehensive pre-admission assessments from the care manager and the homes acting manager and deputy manager are available within the residents records, evidence from these assessments are used as the basis of the resident’s plan of care. Once the assessment has taken place the prospective resident is invited to visit the home, and take advantage of a trial stay to assist them in making a decision, and this can be evidenced on the resident’s records. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 9 Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 10 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 need to be easy to read, with clear concise information, duplicated and conflicting information can only lead to errors in care. All old risk assessments need to be replaced with the new risk assessment format, to ensure that areas of risk are appropriately addressed. Personal hygiene care given to individual residents should be appropriately recorded to ensure that all elements of care are addressed. EVIDENCE: Each resident has a plan of care, but there was too much duplicated evidence, and in some cases conflicting evidence on several sheets of paper, there is no provision for supplying evidence that all personal care given is recorded. While staff said that they are aware of what personal hygiene care should be given to the residents, this is not evidenced in writing, and therefore personal hygiene needs could easily be neglected. Three residents stated that staff were very good at helping them with their personal care. Risk assessments with the plans of care were excellent and well written for residents who had been admitted into the home in the last six months, and there were clear guidelines for staff to follow in reducing the risk. Six staff spoken to stated that they were finding the new risk assessments easy to use and write. The risk assessments of the residents who have resided in the home for more than Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 11 six months were not specific in stating what steps staff need to take in reducing the risk identified. Discussion with residents confirmed that when necessary health care professionals visit the home to attend to wound dressing, their continence needs, and their feet. Two residents said how the optician visits the home to test their eyes. Staff spoken to said that if they had concerns in regard to any resident’s psychological health this would be reported to the G.P. who would then refer the resident to the CAST team. While residents said that they were weighed, evidence on the plan of care suggested that nutritional screening is not carried out regularly. Medication was seen to be well managed in the home, with all MAR sheets being appropriately completed, evidence is available on plans of care and MAR sheet when a resident was self medicating, together with risk assessments for self medication. Controlled drugs were being appropriately administered and recorded by two members of staff. A staff member described how all new staff receive induction, and part of this induction includes respecting the privacy and dignity of the residents. Residents spoken to stated that staff always knock on the door before entering the bedroom, toilet or bathroom. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 12 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, and 15 Residents are clearly given choice in relation to daily living, but this can sometimes be limited according to staff availability and demands on staff time. The activities programme is varied and meals are well balanced and meet the needs of the residents in the home. EVIDENCE: Six residents spoken to stated that they were able to have choice of getting up in the morning and going to bed at night, they also said that they were very happy with the care that staff gave to them, but that because staff were so busy they often had to wait for attention. All the residents said that there are a good selection of activities on offer in the home and that they were able to choose which activities they took part in. The home employs a part-time activities co-ordinator, and a four-week rota of activities is displayed on notice boards throughout the home. Notices were also posted on the notice boards for other events that were programmed to take place during the forthcoming months, this included entertainment from outside entertainers, parties and fetes. Residents said that visitors were always welcomed into the home, and that they were able to entertain visitors in their own bedrooms if they wished. Several residents stated that the meals they received were good, and that they were given choice. The menus were inspected found to be varied, well Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 13 balanced and nutritious. meal. Residents are able to choose where they have their Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 14 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 and 18 Complaints within the home are well handled in accordance with the homes complaints policy and procedure. The home has good policies and procedures for protecting vulnerable adults. EVIDENCE: The home has a comprehensive complaints policy and procedure, and residents said that they would know how to complain, if the need arose. A visitor to the home has recently made a complaint to the acting manager, this was investigated and acted upon in a timely manner. The outcomes of this complaint were recorded appropriately and feedback was sent to the complainant, and to CSCI. Policies and procedures are in place for dealing with the protection of vulnerable adults and whistle blowing, some staff said they have attended training in protecting elderly from abuse. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 15 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, 20 and 26 In some parts of the building the cleanliness has improved but other areas need more attention. The decoration and maintenance of the building and furnishings need to be kept in good repair. EVIDENCE: The cleanliness of the home has improved since the last unannounced inspection. Some of the vacant bedrooms have been decorated, but the main entrance hall and hallway leading off is becoming very drab, wallpaper is torn in places, woodwork and skirting boards have badly chipped paint. The carpeting in this area is very worn, and dirty and in some places is beginning to bubble, which in time will pose a risk to the residents. During a tour of the home it was noted that double rooms did not have screens in situ, one doubleroom which was vacant at the time of inspection had a chest of drawers in a bad state of repair, drawers in furniture were dirty and unhygienic, and there was an odour in the room. Some of the resident’s rooms seen during the inspection were pleasantly furnished with personal items of furniture, ornaments and pictures. Residents said that they had been given choice in regard to having a key to their bedroom door, and lockable space within their Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 16 bedrooms for items of value, this information was also backed up by information within the care plans. During inspection of the building it was noted that some toilets did not have swing bin/pedal bins for used paper hand towels, and a resident’s room needed a swing bin/pedal bin for placing incontinence pads in. The kitchen was in poor decorative order, and appliances in the kitchen were dirty. Some radiators in residents rooms and in communal areas had not been covered. One resident commented on how untidy the garden was looking, because there was nobody to do the garden. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 17 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, 29 30 Improving staff levels in the home must be a priority, to ensure that residents receive quality personal and social care. Recruitment procedures need to improve to protect the vulnerability of the residents. EVIDENCE: Residents said that there were not always enough staff on duty, and they often had to wait some time when they needed help from the staff. one resident said that you do not like to disturb the staff unless it is really necessary because they are always rushing around. The duty rota for the home showed that the home used 347 care hours per week, which included the acting managers hours, this figure was compared with the residential forum figures, which says that the minimum care hours used in the home should be 478.08 hours per week. Staff spoken to during the visit, voiced concerns in regard to the low staffing levels in the home, especially early morning, late evening and at weekends. Staff said that weekends were especially difficult, because the domestics do not work at weekends, and there is no laundress for the laundry on Sunday, therefore care staff need to go off the floor to carry out domestic and laundry tasks. All staff said that they had completed their mandatory training, and in some cases where staff had been employed for a number of years, their mandatory training had been updated as and when required. Those staff who had been employed for more than one year still have no Criminal Records Bureau checks, and more recent staff have not had POVA first checks prior to taking up employment, therefore the protection of the residents is not adhered to. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 18 Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 19 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) 31 The acting manager needs a clearly defined rota as to when she will be carrying out her management duties in the home. EVIDENCE: The acting manager has been in post for eight months and has applied for her registration, she has previous experience as a State Enrolled Nurse, five years experience in management and has obtained her City and Guilds 325/3. Residents, staff and two relatives made positive comments about the manager and the changes she had brought about in the home. Staff did comment that since the acting manager had been written into the care staff rota, it was sometimes difficult to know what role she was carrying out. Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 1 x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x x Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 21 YES 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 8 Regulation 12 Requirement All aspects of personal hygiene given to residents by staff should be clearly recorded. (Timescale of 1/03/05 The premises are kept clean, hygienic and free from offensive odours throughout (Timescale of 1/02/05. New staff are confirmed in post only following completion of a satisfactory POVA first check. Proof of identity should also be held on personnel file for all staff. (Timescale of 1/02/05). Care plans need to specific in regard to health, personal and social care. Mainhallway and kitchen in bad state of decoration. Carpet in main hallway needs replacing. The grounds of the home require tidying up.. Screening is provided in double rooms to ensure privacy for personal care. All radiators in the home to be covered Staffing numbers should reflect the assessed needs of the residents The acting manager operates a Timescale for action 6/05/05 2. 26 12, 13, 16, 23 19 6/05/05 3. 28 30/05/05 4. 5. 7 19 15 16, 23 3/06/05 3/06/05 6. 7. 8. 9. 24 25 27 29 12, 16 13, 23 18, 19 19 3/06/05 3/06/05 3/06/05 30/05/05 Page 22 Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 thorough recruitment procedure ensuring the protection of the residents. 10. 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 Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 11th Floor, International House, Dover Place Ashford Kent TN23 1HU 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 Riverlea House H56-H05 S23537 Riverlea HouseV221856 190405 Stage 4.doc Version 1.20 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!