Inspection on 24/06/05 for Riverside

This inspection was carried out on 24th June 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 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

Riverside 03/08/09

Riverside 16/05/07

Riverside 02/02/06

Riverside 30/11/04

Riverside 19/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Riverside Westbury Sherborne Dorset DT9 3QZ Lead Inspector Gloria Ashwell Unannounced 24 & 28 June 2005 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. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Riverside Address Westbury Sherborne Dorset DT9 3QZ 01935 812046 01935 812046 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) Riverside Nursing Home Limited Mrs Judith Alison Maidment Care Home with Nursing 39 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 30th November 2004 Brief Description of the Service: Riverside is located on the outskirts of Sherborne, within level walking distance of the town centre. The home is owned by Riverside Nursing Home Ltd; the director and responsible person is Mr Farhad Pardhan. The home is registered to provide residential nursing care to a maximum of 39 people. A registered nurse is on duty throughout each 24-hour period. Mrs Judith Maidment is the registered manager; she is a trained nurse with extensive experience of nursing in a residential setting. Accommodation is on the ground and first floors and provides 25 single and 7 shared bedrooms, a lounge/dining room on the ground floor, conservatory, first floor lounge and an additional visitors’ area. A passenger lift provides level access to all parts of the home. A section of ground floor corridor is slightly sloped, to overcome the necessity for stairs between the original building and a later constructed extension. Assisted bathroom and toilet facilities are provided and most bedrooms have en-suite toilets. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was one of the two statutory inspections required in accordance with the Care Standards Act 2000. Since the last inspection the Commission has been involved in the investigation of one complaint against the home; following investigation by Dorset Social Care & Health the complaint was not upheld. The inspection took place over two days; the inspector arrived (unannounced) at 10.10 on 24 June 2005. During that visit she spoke to 16 residents, 7 nursing staff and a visiting relative. The inspector observed staff interaction with residents, the carrying out of routine tasks and toured the premises, departing at 13.45. The inspector left a selection of ‘Comment Cards’ and prepaid envelopes (for return to the Commission) with residents and the home manager. Additional information used to inform the inspection process included monthly reports routinely provided to the Commission by the registered provider and formal notifications of events provided to the Commission by the home. As agreed with manager Mrs Maidment, the inspector returned to the home at 10.00 on 28 June 2005 and together with the manager considered other evidence relating to the National Minimum Standards, as described in this report. On this occasion the inspector spoke to four residents, including two not spoken to during the earlier visit, and to two visiting relatives. The duration of the inspection (both days combined) was 7 hours and 20 minutes. What the service does well: Riverside provides residents with good nursing care and social care in comfortable surroundings. Residents feel the care is very good and are satisfied with all aspects of the home; one emphatically said to the inspector “I could tell you what’s bad about it: Nothing! I think it’s particularly good….it’s excellent”. Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with the local community. Meals are appetising and of good quantity and quality. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 6 The premises are comfortable, with two lounges, a conservatory and a dining room; there are car parking spaces at the front of the house and a small attractive garden at the rear. Staff are kind and helpful to residents. Residents are treated with respect, their privacy is protected and staff understand and meet their needs. Residents feel safe and well cared for. The home provides a good range of social and recreational activities, including opportunities for residents who wish to, to go out of the home. Medicines prescribed by doctors are safely stored and administered to residents by trained nurses. Residents wishing to do so may store and administer their own prescribed medicines. What has improved since the last inspection? What they could do better: Some improvements to record keeping associated with medicine handling are necessary to ensure that residents continue to receive the correct medicines and that all medicines held in the home are properly accounted for. Staff recruitment systems must be improved to ensure that persons unsuited to working with vulnerable people are not employed and that residents are not placed at risk of harm or neglect by such persons. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 7 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. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 8 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 Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 Standard 6 is not applicable because the home does not provide intermediate care. When a new resident moves into the home they are provided with a statement of terms and conditions giving knowledge of the fees and what they do and do not cover. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them; the home then writes to the prospective resident confirming the ability to properly care for them. EVIDENCE: The records of a recently admitted resident included details of a pre-admission assessment carried out by the manager when the resident visited the home to view the home and the available rooms. Following pre-admission assessment, if the home decides to offer a place to a new resident, the manager then writes to the person stating that the home will Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 10 be able to meet their assessed needs; a copy of the letter sent to the resident whose records were being case tracked was shown to the inspector. With the letter was sent a contract and statement of terms and conditions of occupancy, stating the number of the bedroom the resident had selected, to ensure no misunderstanding occurs. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The standard of health, personal and social care is very good and is delivered in accordance with a written plan of care ensuring staff have information necessary to provide correct care to each resident. Doctors and other health professionals visit the home to carry out specific actions for individual residents, enabling their health care needs to be fully met. Residents receive prescribed medicines at the correct times and in correct amounts. Some improvements to record keeping associated with medicine handling are necessary to ensure that residents continue to receive the correct medicines, that all medicines held in the home are properly accounted for and adequate safety precautions are taken. Residents said they are treated with respect and their privacy and dignity is protected at all times. EVIDENCE: Residents feel well cared for; comments included “They look after me well”. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 12 During the inspection call-bells were periodically heard, having been activated by residents requesting staff assistance; they rarely sounded for more than a few minutes before ceasing (indicating that a member of staff was now with the resident). A resident said “if we want a nurse, they always come”. A recently admitted resident with complex health needs does not frequently use the communal lounge or day room, remaining instead in the bedroom. In consequence, to maintain the resident’s safety, staff make ½ hourly checks which are recorded in writing. During these visits they talk to the resident, adjust the seating posture and ensure a suitable drink is within reach. Staff to whom the inspector spoke were aware of each residents health and social care needs. Doctors visit residents unable to attend their surgeries for consultation. As necessary, individual residents in the home are visited by other health professionals e.g. nurse specialists, opticians, chiropodists. . Risk assessments form the basis for comprehensive and clear care plans and daily records describe the care of each resident. Records are kept of all accidents. Accidents are handled in accordance with an established protocol providing a reliable system for identifying and minimising risks to residents prone to falling or other harm. The home uses a monitored dosage system; the dispensing pharmacist provides printed administration charts. The manager said that residents wishing to manage their own medicines are assessed for their ability to do so. Records indicated that medicines had been accurately administered but the records must be improved to ensure that residents continue to receive correct medicines and doses, and that the home can properly account for all medicines held. Medicine administration records (MARs) did not state the allergy status (to medicines) of every resident, handwritten amendments to the printed MARs were not signed and dated and the reason for as required administration was not always stated on the MAR. The administration instruction for one resident continued to direct regular administration of a particular medicine, weeks after its regular use had ceased; the medicine has not been incorrectly administered. The home has extensive clear and accurate written policies and procedures for the storage, administration and recording of medicines. Since the last inspection the room in which medicines are stored has been relocated, to ensure that the temperature of the medicine storage area does not rise above the acceptable level. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 13 Residents are treated with respect, their privacy is protected and staff understand and meet their needs. One resident said she was so satisfied with Riverside that “I don’t want to go anywhere else – not even home”, and another added “I’d rather be in my own home of course, but the next best thing, I think, is here”. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The quality of daily life in the home is very good with residents assisted to maintain as much independence as possible. Social and leisure activities are varied and suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. Most residents take meals in the dining room; some receive them in their bedrooms. EVIDENCE: 25 hours are allocated each week for the provision of social and recreational activities for residents; 15 of these hours are regularly provided by a designated Activities Coordinator and the remaining 10 hours are organised and led by a staff member who is separately employed as a cleaner for 15 hours each week. There is a flexible programme for activities, regularly including flower arranging, darts, board games, reminiscence sessions, one-to-one attention for conversation, walks into the nearby town centre and public gardens. During Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 15 the inspection one resident went with the activities organiser to eat ice creams in nearby gardens, and another separately went out with the organiser for a fish and chip lunch. Some residents have participated in gardening projects using the home’s greenhouse; one resident proudly said “I’ve got a couple of cucumber plants and a nice big geranium!”. These plants will be entered in the home’s gardening competition, to be judged by staff of the nearby garden centre in July, during a cream tea to be held at the home. A visitor observed that “sometimes (the resident) felt imprisoned – so now they take her out”, and the resident added “They try so hard; they’ve got a programme (of) all sorts of activities”. A ‘trolley shop’ is operated weekly and on request enabling service users opportunities to purchase toiletries, confectionary and stationary items. Visitors are permitted to visit at any time and residents can go out of the home whenever they wish, and can choose how and where to spend their time. They can rise and retire at their preferred hours. A resident said “They don’t pull you out of bed…(but are instead available to assist residents when they want to get up)…and at night, at the time you want….but I can get into bed anytime I like”. Meals are served in the dining room or in resident’s bedrooms, at their individual preference. Residents said that food is of good standard, for quality, choice and quantity. Many emphatically favourable comments were made about the food provision, including “I can’t resist it – if they put lovely food in front of me what can I do? I have to keep buying bigger clothes!”, and “The food is good and there’s plenty of it”. The inspector was present at the serving of lunch on the first day of this inspection. The meal was appetisingly presented and clearly enjoyed by the residents. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 16 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 Complaints are managed properly and residents said they are confident their concerns are listened to and taken seriously. EVIDENCE: Residents feel they are safe, and well cared for; comments included “Everybody’s nice and pleasant, well-behaved and very kind”. Residents feel confident that if they had concerns or complaints they will be listened to and taken seriously. One resident described a recent mishap resulting in a minor accident, which had involved inappropriate staff handling (while assisting the resident to move). The resident knew that the manager had investigated and taken appropriate action to minimise risks of similar accident to themselves, or any other resident in the home. A visiting relative said that Riverside is keen to know their opinions and views about the home; “we are quite frank….they encourage it”. The home keeps records of all complaints received and investigated. Since the last inspection 7 complaints have been received; 2 related to aspects of care, 2 to staff behaviour and the remaining 3 arose due to misunderstandings of invoices received from the registered provider e.g. one person had been sent two invoices but had overlooked them, become worried about falling into debt and consequently complained that no invoice had been sent. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 17 A complex complaint regarding standards of care, involving aspects of Adult Protection, was investigated by Dorset Social Care & Health; it was not upheld. Another complaint about care standards was investigated by the manager and partly upheld. The manager also investigated 2 complaints about staff behaviour, including the aforementioned accident. Both complaints were upheld and remedial action promptly taken. The registered provider dealt with the complaints about invoices; the complaints were not upheld. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 18 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) 25 & 26 20, 21, 23, 24, The home is comfortable, clean, well equipped and suited to the needs of the residents. EVIDENCE: Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 19 The home is located on level ground and has a layout generally suited to the needs of older people; sections of quite narrow corridors may cause difficulties for wheelchair users. The home has a passenger lift providing level access to all parts of the registered premises. Extensive refurbishment and upgrading of the premises has taken place in recent months and remains ongoing in accordance with an annual development plan; records are kept of progress to date. During June 2005 20 new beds and 13 new chairs have been installed, and the conservatory has been fitted with a ramp providing access to the rear garden without the necessity to negotiate steps. With two exceptions all bedrooms have an en-suite facility including a toilet. Each bedroom has a wash-hand basin. Aids including bath hoists are in place to assist frail residents. The home is in the process of arranging for bedroom doors to be fitted with locks of the approved type, enabling residents to key-lock their bedroom doors for privacy, when they temporarily leave the room. Resident’s bedrooms contain a variety of personal belongings; many residents provide items of their own furniture. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 20 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, 28 & 29 The home employs enough staff to meet the needs of residents and to ensure their safety and comfort. Recruitment practices are not sufficiently reliable to ensure the protection of residents from potentially unsuitable staff. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents. The inspector spoke to a number of staff, including trained nurses, care workers and household staff. Without exception all expressed unreserved support of management and all aspects of the home, indicating effective team working, provision of good care and encouragement for training. The records of 2 recently employed staff members were examined. One of these persons had commenced work in the home prior to any references being obtained; for the other person the home had not obtained a reference from the care home in which the applicant was at that time employed. Mrs Maidment stated that a POVA check had been carried out in advance of the employment of both persons but was unable to supply documentary evidence to support this assertion. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 21 An Immediate Requirement for the improvement of recruitment practices was issued during the inspection. On 4 July 2005 the manager wrote to the Commission confirming that this Immediate Requirement would thereafter be properly met. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 22 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) These standards were not assessed during this inspection. EVIDENCE: Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement Medicine administration must be in accordance with the instructions written on the medication administration record. There must be evidence that the home operates a robust recruitment system including obtaining at least two written references and evidence of POVA/CRB disclosure before new staff commence work in the home. Timescale for action 28/06/05 2. 29 19 & Schedule 2 28/06/05 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. 2. 3. Riverside Refer to Standard 9 9 9 Good Practice Recommendations When a medicine is prescribed for administration as required the administration record should clearly state the reason for which it is required. The medicine administration records for each resident should clearly state any allergy to medicines, or none known. Handwritten amendments and additions to medicine admnistration records should be signed and dated by the D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 25 writer, and countersigned by someone who has checked the entry for accuracy. 4. Riverside D55 S20488 RIVERSIDE V233818 240605 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole, Dorset BH17 0NF 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. 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