Inspection on 27/09/07 for Rivers

This inspection was carried out on 27th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Rivers Blythe Road Oldcotes Worksop Nottinghamshire S81 8HU Lead Inspector Steve Benson Key Unannounced Inspection 27th September 2007 09:00 Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivers Address Blythe Road Oldcotes Worksop Nottinghamshire S81 8HU 01543 442500 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) riversmilbury@tiscali.co.uk www.milburycare.com Milbury Care Services Fiona Birkett Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to provide personal care for service users of both sexes whose primary need fall within the category of Learning Disability (LD) The maximum number of service users to be accommodated is 7. Date of last inspection N/A Brief Description of the Service: Rivers is a care home providing personal care and accommodation for up to 7 younger adults who have a learning disability. The home is owned by Milbury Care Services and owns a number of other homes. The home is located in Oldcotes between Worksop and Retford close to shops, a pub and other amenities. The home was opened in December 2006 and consists of an adapted domestic dwelling. All of the home’s bedrooms are single, and have en-suite facilities including a bath or a shower. Bedrooms are located on 2 floors.. The home has an enclosed garden that is well maintained and easily accessible. There is ample car parking available. The manager said on 27/09/07 that the fees for the service range from £1,266 - £1,698 per week depending on dependency needs. Further information about the home is available from the manager or the website: www.milburycare.com Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first visit to the home since it opened in December 2006 by The Commission for Social Care Inspection. Prior to the visit an analysis of the home was undertaken from information gathered since the opening including that from the Annual Quality Assurance Assessment they completed. . The visit centred on looking at the key National Minimum Standards for younger adults. The site visit lasted for 3 ½ hours and the main method of inspection used was called case tracking which involved selecting 2 residents and tracking the care they receive through the checking of their records. One resident with restricted speech was observed for periods and the other resident stayed in his room as he had a disturbed nights sleep. A discussion was had with the manager, staff on duty and care practices were observed. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. . The registration certificate was checked and found to be correct. What the service does well: Prospective new residents are assessed before moving into to the home to make sure that the home is able to meet their needs. Arrangements are made for residents to attend day time activities outside of the home. Visitors are welcome to the home and can take residents out. Residents are supported to use community based resources and meet up with friends. The routines of the home are flexible and take into account the individual preferences of residents. Medication is given out following the recommended safe procedures to make sure that residents are not put at risk when being given their medication. The home is well laid out and adapted to suit the needs of the residents whilst maintaining a clean and homely environment. There are sufficient staff on duty who are provided with training to meet the needs of the current resident group and the correct safety checks are carried out as part of the recruitment of new staff. Thee is a suitably qualified and experienced manager in post. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 6 Regular checks and tests are carried out on the building and equipment to protect the health and safety of residents. What has improved since the last inspection? 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. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 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. New residents are assessed before they come to live at the home. EVIDENCE: The care files were seen for both residents and these included an initial assessment. The provider employs a senior care planner who is responsible for carrying assessments on prospective new residents. The assessments seen were completed prior to the residents moving to the home and information was being gathered on another resident who is expected to move into the home next month. The manager said that she is also involved in the assessment process and goes to meet the prospective resident, their family and attends relevant meetings. A member of staff said that the assessment process for the two current residents had been completed before she started working at the home, but she had been told about the prospective new resident. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 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. Care plans could be made easier to use and risk assessments must be updated when a change occurs. EVIDENCE: Each resident has two files, which are structured according to company policy. One file contains an information sheet, a weekly activity planner, a weekly menu, a personal hygiene check list, daily diary sheets, a plan of support, and forms to record healthcare appointments. The second file contains a lot of archived information, a contract, a personal health plan, risk assessments, details of finances and any correspondence. This meant that information needed to support residents was held in two separate files, making it more difficult to refer to and is a possible explanation why some tasks identified had not been done. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 10 The manager said the provider had informed a manager’s meeting the previous day that a new system of care planning is being introduced, which is to be implemented by the end of this year. Thee was no information seen in one file about contact arrangements with family, which the manager said took place. A member of staff said she did not know why care files were split they way they were and that she had just started to keywork one of the residents and needed to prepare some new plans. The plan of support was written in a person centred manner showing that the resident had been involved to some level in its preparation. The manager said that staff try to include residents in decisions, including how they spend their money. The manager said they are involved in planning their weekly menu and activity plan, although there were not any pictorial or other aids to assist with this which would increase the opportunities for residents to make choices. A member of staff said residents are able to choose the food they want and if they want to go out. One resident will usually answer ‘pub’ if asked what he wants to do. A member of staff said that the two residents do not have to choose to do the same thing, one prefers to spend more time in his room, but both enjoy listening to music and going to karaoke. A resident was seen choosing his breakfast and then sitting in the lounge listening to music. The other resident remained in his room. The manager said staff try to encourage residents to develop independent skills and they are encouraged to help cook and make drinks. The manager said that she looks for the worst possible scenario when preparing a risk assessment and then look to see how this can be minimised. An incident occurred in the home’s people carrier 2 days previously. A risk assessment was seen for going out in a car but this had not been updated following the incident. The manager said that this was going to be done today as both the deputy and herself, who are the people who update risk assessments were not at the home yesterday. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 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. Residents decide how they spend their time and make us of the local facilities. Residents’ rights are respected but more could be done to promote a healthy diet. EVIDENCE: Both residents have places at a local day centre, although staff said that one resident has chosen not to attend the full programme he has been offered, instead he attends the sessions that he enjoys. The residents’ weekly planner showed when they attended the day centre. The manager said that she has gathered information from local colleges on courses that may be suitable for the current and future residents, including courses on independence skills, cooking and information and technology. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 12 The manager said they look to access the local community whenever they can and they have been bowling, to the cinema and attended various clubs. The manager said that it is intended to develop some pictorial and other visual aids to help increase the residents’ ability to choose what they wish to do. Member of staff said that they have taken residents to local parks, shops, to access healthcare services, local miners welfare and the pub, where they have been made welcome and the bar staff now know what they like to drink. The residents’ weekly planners showed that they have regular opportunities to use community resources, examples being going out for a meal, going food shopping and going for a picnic. A member of staff said that residents can change their planners at short notice if they wish to. The manager said that families can visit whenever they want to and are able to take residents out. One resident has regular phone calls with his relative. The manger said they try to forge relationships with friends and families as this is positive for residents. A member of staff said that residents are able to meet friends they have known for a long time at the various clubs they attend and at the day centre. The manager said that the daily routines are flexible depending upon what is happening that day. A member of staff said they follow what is in the residents care plan for what they do each day, they like to have their set routines. A member of staff said that one resident likes to get up between 9.00 am and 10.00 am, get washed and come down for his breakfast whereas the other likes to spend more time in his room, and this is what happened. Both residents care plans referred to needing to provide a healthy diet to help with managing their weight. A sample of weekly menus were seen and these showed a choice of meal each day. Dishes included lasagne, spaghetti bolognaise, different chicken dishes and burger and chips. There is usually a roast dinner on Sundays. The menu planner showed that the residents regularly did not have one of the choice of meals on the menu planner but both had another alternative. There was no evidence that the planning of the residents’ diet was done in conjunction with a healthy eating plan. There was not any pictorial or other visual aids to help promote greater choice. The manger said that they do try to promote healthy eating. Staff said they often have a take away or go for a meal out on Friday evening. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 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. More could be done to promote residents well being through a more proactive approach personal and health care. EVIDENCE: Entries in care plans showed that residents are able to attend to their own personal needs with prompting by staff. There was a management action plan in each case file and this listed tasks that needed to be done, including providing a picture board of scheduled activities and a communication passport to be in place which had not been done. The manager said that the current residents are able to manage their own personal care with prompts from staff. The manager said that staff are expected to promote residents’ privacy and dignity and should always knock on their bedroom door and say who it is. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 14 A member of staff said that the residents may need a bit of help getting in or out of the bath and to wash their hair but otherwise they can manage for themselves as long as they are reminded. Each resident had a health action plan which summarised tasks needed to be done and by when. These included making a chiropody referral and registering with a dentist. There was no evidence of these being done, but the manager said these were being worked upon but there had not been are record made of the phone calls made. Another entry said a resident should be encouraged to follow a programme of light exercise but there was no evidence of this being done. The Medicine Administration Record book listed the staff that have been trained and assessed as being competent to give out medication. The Medicine Administration Records were fully completed. There is a designated medicine room, which has a locking cupboard and fridge. There was correspondence seen one file where a resident was noted as retching and vomiting when taking tablet medication and this was changed to liquid and dissolvable. The manager said that when the next resident moves into the home they will be moving onto a monitored dosage system. A member of staff said that the manager had assessed her as being competent to administer medication and that she stays and supports the resident to take their medication. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 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. More could be done to promote the home’s complaints procedure. Systems to safeguard residents are being put into place. EVIDENCE: The home has a complaints procedure and a book to record any complaints in, but thee was no information about this displayed in the home. No complaints have been made yet, and the manager said that she intends to introduce a system where comments can be made that fall short of full complaints. A member of staff knew that she should respond to any complaint but was unsure of the process. There was a copy of the Adult Protection procedures in the office and the manager was aware of the Adult Protection Unit’s website. The home has a whislteblowing policy. The manager said that safeguarding adults is one of the topics in the computer based training programme they have and staff will be doing this course over coming weeks. The manager said there have not been any allegations of abuse. A member of staff said safeguarding adults had been included in her induction but she had not had the full training yet. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 16 A resident was observed looking comfortable and relaxed in the company of staff. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 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. Residents live in a homely, comfortable and safe environment, which is kept clean and hygienic. EVIDENCE: The building has been converted to make a suitable environment for the residents and it provides homely and spacious accommodation. At present there are still minor outstanding snags being dealt with by the builder, however once these have been completed the home will report any repairs through to a call centre, which will arrange for them to be done. The home was well decorated and clean. A member of staff said that staff do the cleaning with some assistance from residents and that protective clothing is available. A member of staff was seen cleaning the home. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 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. Residents are supported by competent and qualified staff and supported and protected by the home’s recruitment policy and practices. Residents’ needs are met by appropriately trained staff. EVIDENCE: The home has assessed their minimum staffing levels to be 2 care staff during the day and 1 care staff sleeping in at night. The manager said that staffing levels will be kept under review as occupancy increases and will be amended accordingly. A member of staff said that there is always two staff on duty during the day, which is sufficient at present. The home follows their equal opportunities policy when recruiting new staff. The correct checks including references, Protection of Vulnerable Adults and Criminal Records Bureau checks are carried out. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 19 The manager said that staff who are all white British, are of varying ages and that one male staff is employed. A member of staff said she had been through a selection process, had provided references and had a Criminals Records Bureau check carried out before starting. Training is provided through a computer based learning programme and the manager said that only the more recently appointed staff have not completed all the mandatory training. There are two staff who have completed National Vocational Qualification level 2 and a further two have completed National Vocational Qualification level 3. The manager said that the remaining staff are registered for level 2 but they are currently looking for an assessor. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 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. The management systems have not been fully tested yet to ensure for the smooth running of the home. EVIDENCE: The manager opened the home in December 2006 and completed National Vocational Qualification level 4 in April 2005. The manager said it has been slow going getting the home up and running due to the slow referral rate but hoped things were now getting into place. There are residents meetings held, but these have been limited due to the lack of residents. Visits to the home are carried out in accordance with Regulation Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 21 26 (Care Homes Regulations 2001). A service review is undertaken by the provider and the manager said ways of involving g residents in these in the future will be established. The manager said that the provider has block contracts in place for carrying out all the health and safety checks and tests required. A member of staff confirmed that the fire alarm is tested weekly. Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 2 X X X 3 X Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 23 N/A 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 YA6 Regulation 15(1) Requirement Care files must be organised so that staff can identify care practices required by residents and include detail of contact arrangements with families Suitable pictorial and other aids must be available to assist residents to exercise greater choice There must be a system in place for promptly updating risk assessments if the need arises Residents must be offered a healthy diet in accordance with their assessed needs When it is identified that resources are required these must be provided Where healthcare needs are identified arrangements must be made for these to be met Measures must be put in to place so that all staff and residents are aware of the home’s complaints procedure There must be an effective quality monitoring system that seeks the views of residents Timescale for action 01/01/08 2 YA7 12(2) 01/12/07 3 4 5 6 7 YA9 YA17 YA18 YA19 YA22 12(1)(a) 16(2)(i) 16(1) 13(1)(b) 22(2) 15/10/07 01/11/07 01/11/07 01/11/07 01/11/07 8 YA39 24(3) 01/12/07 Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI Rivers DS0000069332.V348078.R01.S.doc Version 5.2 Page 26 - 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. 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