Inspection on 03/05/05 for Rivers Reach

This inspection was carried out on 3rd May 2005.

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

Other inspections for this house

Rivers Reach 31/05/06

Rivers Reach 09/02/06

Rivers Reach 25/11/04

Rivers Reach 04/06/04

Rivers Reach 22/04/04

Rivers Reach 07/05/03

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

CARE HOME ADULTS 18-65 Rivers Reach Fontley Road Titchfield Fareham, Hampshire PO15 6QX Lead Inspector Laurie Stride Unannounced 03/05/05 9.55am 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rivers Reach Address Fontley Road, Titchfield, Fareham, Hampshire, PO15 6QX 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) 01329 842759 Rivers Reach Care Limited Ms Karen Hurt CRH 5 Category(ies) of LD registration, with number of places Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25/11/05 Brief Description of the Service: Rivers Reach is a large family bungalow situated in a quiet residential area. The premises include a large garden, activities room and field so residents may spend time outside the home. Accommodation is provided in single rooms on two floors. There is a large lounge and lounge/diner for communal activities. The home provides care for adults with mild to moderate learning disability and challenging behaviour. Residents are encouraged to be as independent as possible and to participate in the day-to-day running of the home by helping with shopping, cooking and cleaning. There are opportunities to access day care provision outside the home and to make contact with other homes owned by Rivers Reach Care Limited. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit that lasted five and a half hours, during which the inspector met and spoke with two service users, members of the management and staff team and viewed some of the home’s records. Since the last inspection a good deal of progress has been made in meeting the previous requirements, and it is anticipated that the requirement that remains outstanding will be completed in a short time. What the service does well: What has improved since the last inspection? Since the last inspection the registered manager and staff team have completed work on a number of areas in order to meet previous requirements. Pre-admission assessments are now being carried out using a new format along with information from the care management assessment. Care plans have been revised and updated with particular reference to behavioural strategies and risk assessments. Copies of resident’s terms and conditions are held on file in the home. The medication policy and staff records have been updated. Resident meetings and health and safety checks on water temperatures have been resumed. A new structured induction pack has been issued to all staff and rotas have been reviewed to facilitate residents’ evening activities. Three new fire doors have been fitted. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 and 5 Service users have their needs assessed and have opportunities to visit the home prior to admission and each service user has a statement of terms and conditions. EVIDENCE: The home had received a new referral. The registered manager had visited the prospective resident to begin assessing the person’s needs and compatibility with existing residents and the aims of the service. The person’s social worker had visited the home and provided further information and a relative had also viewed the home to see if it was suitable. The care management assessment and discharge information had been obtained in order to get as full a picture as possible of the person’s needs, abilities and aspirations. Funding was being agreed as part of the process. Dates had been arranged for the prospective resident to visit the home a number of times in order to see if it was suitable. This will also provide an opportunity for staff to further assess the person’s compatibility with existing residents and whether their needs can be met by the home. Copies of terms and conditions of residence were now being held in residents’ personal records. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 There is a clear and consistent support planning system in place to provide staff with the information they need to satisfactorily meet service user’s needs and promote an independent lifestyle. EVIDENCE: Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 10 Care plans and risk assessments for the current three residents were seen. Individual files contained key details such as significant relationships and contact numbers, daily support needs, contact records including liaison with service users’ family and relevant professionals, risk assessment and risk management plans. Daily support records completed by staff identify the person’s personal care needs, what has been carried out and what activities they have been involved in. Care plans followed the same format and were therefore not completely person centred. A resident confirmed that they are involved in their care planning. Care plans had been revised and behavioural strategies with regard to one resident had been updated with clearer guidelines for staff to follow. A member of staff commented that they were satisfied with the guidelines and continued to monitor and raise any concerns or need for changes with the manager. Along with care plans, individual risk assessments and management guidelines were continuing to be further developed. The manager had been in consultation with relevant external agencies, for example a care manager and senior community team nurse, in relation to developing clear and comprehensive guidelines. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14 Community links have improved with more flexible staff rotas being provided to ensure residents have opportunities to access evening activities outside of the home. EVIDENCE: Care plans detailed resident’s involvement in attending activities in the community, for example social clubs on Wednesdays and Fridays, and information about their interests and hobbies. One resident was a member of a bowling league. A resident had been out on the day with the key-worker to obtain a bus pass and was planning to get out more. The staff rotas have been under review and changes made in order to ensure adequate staff cover to support residents can attend evening activities of their choice. It was noted that day shifts in general had reverted to 8pm finish times following consultation between the manager and staff which was recorded. However, later finish times were pre-arranged on set days to provide suitable cover for planned evening activities. Whilst meeting a previous requirement, this will need to be continually monitored by the manager in the light of plans changing and providing scope for unplanned Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 12 activities in the evenings. The manager and staff were aware of the need for maintaining flexibility and an agreement had been recorded in this respect. Two residents reported that they were getting out and about during the daytime and evenings. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The health needs of residents are well met with good multi agency working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure service user’s medication needs are met. EVIDENCE: The registered manager was aware of the need for liaison with relevant agencies in order to fully meet the complex needs of service users. There was evidence of this within the home’s records and through discussion with the senior community team nurse who was visiting the home. A consultant was also visiting on the day to review resident’s medication needs. A resident said he had an appointment with his care manager and also saw the community nurse quite frequently. A member of staff demonstrated the medication procedures for monitoring and recording incoming and outgoing medication, storage and administration. The medication policy had been updated and included recommendations made as a result of the pharmacist’s inspection earlier in the year. The doctor or consultant now signs for any changes to residents’ medication. Staff were aware that creams and lotions prescribed for one resident should not be used for another resident. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 14 Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this occasion. EVIDENCE: Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The service provides a homely, safe and comfortable environment, with suitable laundry facilities and infection control procedures to safeguard residents. EVIDENCE: The premises appeared to be safe, clean, bright and comfortable, and accessible to all service users. Furnishings and fittings were of good quality and domestic in appearance. The home provides transport for service users to access local amenities and relevant support services. The premises are in keeping with the local community and have a style and ambience that reflect the home’s purpose. Staff reported that rats were coming into the garden from the adjoining fields. The relevant agency had been contacted to deal with the problem. The home’s utility area is situated off the kitchen area and laundry is currently transported through the kitchen. There is a written procedure for the transporting of laundry through food preparation areas and personal hygiene of staff and service users following completion of the washing task. Colour coded mops and buckets are used. The laundry area has washable walls and flooring, a hand washing facility and paper towel dispenser. Cleaning materials are kept in a locked cupboard. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 17 Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 and 36 Residents are supported and protected by suitable numbers of trained staff and the home’s recruitment and supervision policies and practices. EVIDENCE: The manager reported that four members of staff were currently undertaking NVQ training awards in care. A senior staff member had completed an NVQ3 and her certificate was displayed in the hall. The manager was working on an NVQ4 Registered Manager Award. Staff rotas have already been mentioned in relation to standard 13. Staff work a variety of shift patterns including twelve hour days, although these are now less frequent. The home employs one awake and one sleep-in member of staff covering nights. The manager is available in the home during weekdays and shares on-call duties with other managers. Staffing levels had recently decreased in line with the number of residents currently accommodated. The manager stated that staffing levels would change again in order to meet the assessed needs of any person newly referred to the service. Records were kept of staff team meetings. A sample of three staff records was looked at and these contained the required information, including evidence of Criminal Records Bureau (CRB) checks and references, terms and conditions of employment and, where applicable, work permits. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 19 Staff records also included individual records of induction and further training. The home has introduced a structured induction and foundation training programme based on the Training Organisation for the Personal Social Services (TOPSS) standard. Existing members of staff have also been asked to complete the programme. A record of the programme completed by a senior staff member also demonstrated knowledge of the home’s policies. A new member of staff was present on the day in a supernumerary capacity and confirmed that she was taking part in the induction process. Examples of training undertaken by staff include autism, challenging behaviour, breakaway techniques and statutory health and training. An external company had been providing abuse and neglect training and this was now to be facilitated by one of the other managers from the group. During the visit the home’s manager was arranging training sessions with the other homes for moving and handling, abuse and neglect, food hygiene and challenging behaviour. First aid training for two new members of staff was being arranged through a local college. The pharmacist visits the home once a year and provides medication training for staff. The community team provides staff with specialist guidance about specific resident issues. Staff supervision records were held on file. Staff sign a supervision agreement which outlines the nature and intent of the process. The manager supervises the senior staff, new staff and with regard to any identified issues. The two senior staff supervise the support staff. One senior staff member had formal supervision training in May 2005 and the other senior member had received guidance from the manager. It is advised that formal training is provided for all supervisors of staff. Supervision included identification of training needs and monitoring of work with individual residents, but records did not demonstrate that person centred approaches to supporting residents were discussed. A wall chart showed support and supervision meetings planned for 2005. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The home is putting systems in place to obtain views and promotes safe working practices to protect residents and staff. EVIDENCE: The company director of operations had developed a quality assurance questionnaire survey aimed at obtaining stakeholders’ views about the services provided. This system had not been fully implemented at the time of the visit. Some questionnaires had still to be sent out and returned so that a full report could be made and any subsequent action taken. A resident confirmed knowledge of the survey and a partially completed resident survey form was seen. The requirement for a quality assurance monitoring system was made at the previous three inspections. Another extension has been given in order for the organisation to complete the process, collate all the evidence and report on the findings. Senior managers were conducting regulation 26 visits. Residents meetings and staff team meetings were being held and recorded. There was ongoing liaison with the community learning disability team and social services. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 21 A wall planner in the office showed that dates were set for staff to attend training updates in food hygiene, first aid and infection control. An environmental risk assessment had been carried out in relation to the laundry. Checks on water temperatures were being recorded and relevant risk assessments were in place. This standard will be further assessed at the next inspection. Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 x x x Standard No 31 32 33 34 35 36 Score x x 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rivers Reach Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 23 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 39 Regulation 24(1)(3) Requirement A quality monitoring system is developed to ensure feedback from service users and their representatives is obtained to assist the home in meeting its stated aims and objectives. This was a requirement at the previous two inspections. Timescale for action 11/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 24 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton, Hampshire SO15 1GW 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 Rivers Reach H54 s11923 Rivers Reach v223143 030505.doc Version 1.30 Page 25 - 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. 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