Inspection on 11/09/07 for Riverside Care Centre

This inspection was carried out on 11th 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Riverside Care Centre 09/09/08

Riverside Care Centre 07/03/07

Riverside Care Centre 08/06/06

Riverside Care Centre 07/11/05

Riverside Care Centre 24/05/05

Riverside Care Centre 12/10/04

Riverside Care Centre 25/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

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

CARE HOME ADULTS 18-65 Riverside Care Centre Wolverhampton Road Wall Heath Kingswinford West Mids DY6 7DA Lead Inspector Mrs Jean Edwards Key Unannounced Inspection 11th & 12th September 2007 08:20 Riverside Care Centre DS0000041321.V350538.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 Riverside Care Centre DS0000041321.V350538.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. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Care Centre Address Wolverhampton Road Wall Heath Kingswinford West Mids DY6 7DA 01384 288968 01384 294836 riverside@schealthcare.co.uk 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) Southern Cross Healthcare Centres Limited vacant post Care Home 24 Category(ies) of Learning disability (24), Physical disability (24) registration, with number of places Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 24 LD and 24 PD, all of whom may be accommodated within Catesby, Winter and Littleton Houses, not exceeding the total number registered for. A separate staff group will be identified for each Unit namely Catesby, Winter and Littleton. 7th March 2007 2. Date of last inspection Brief Description of the Service: Riverside consists of three purpose built detached properties: Winter, Catesby and Littleton Houses. The properties were previously registered as separate care establishments but at the request of previous Registered Providers the Home is now Registered as one premise managed by one person. A Condition of Registration has been imposed: that each unit has a dedicated staff team. Riverside is built in the picturesque grounds of Holbeche House situated on the main A449 Wolverhampton to Stourbridge Road and within walking distance of Kingswinford. There is a shared driveway/car parking area at the front of the properties. There is a garden to the rear of the properties, which is separated from the adjoining houses by a panelled fence. A brook borders the turfed area of the bottom of each garden. The Home provides accommodation for twenty-four service users who have a learning disability and may also have a physical disability. Users bedrooms are situated on the first and ground floors. There are shaft lifts for users to access the first floor in each unit. All rooms are spacious and furnished to a high standard. All bedrooms are ensuite with a level access shower. There are communal bathrooms fitted with a hydraulic chair on the first floor of some of the units. A statement of purpose and service user guide is available to inform residents of their entitlements. Information regarding fee levels is contained in the Homes Service User Guide and people may wish to obtain up to date information from the care home. There are additional charges for residents, which include hairdressing, chiropody, toiletries and holidays. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the key inspection visit for 2007 - 8, undertaken by two inspectors from the Commission for Social Care Inspection (CSCI). The inspectors have spent two weekdays at the home. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the new manager, deputy manager and staff on duty during the visits, discussions with residents, observations of residents without verbal communications and examination of a number of records. Other information was gathered before this inspection visit from the homes Annual Quality Assurance Assessment (AQAA), notification of incidents, accidents and events submitted to the CSCI. The CSCI sent out twenty four service user surveys, ten relatives surveys and health care professional surveys. An analysis of the 16 survey forms from service users, and responses from relatives and health care professionals is contained throughout this report. There are currently twenty four residents living at Riverside. Formal interviews are not always appropriate therefore other methods such as informal chats, observations of body language, eye contact, gestures, interactions between staff and residents have been used. What the service does well: The atmosphere within the home is friendly, relaxed and informal. The home is fresh, clean and comfortable. All communal areas have comfortable furniture and are brightly lit. Staff make visitors feel welcome and residents are supported to maintain important links with their families and friends. The staff are caring, friendly and know about the residents needs, using the name preferred by each person, treating them with respect. Residents can move freely around their home and they can make their own drinks and snacks with staff support and supervision where necessary. Residents enjoy their meals, with a generally nutritious diet provided to help them to be healthy. The home is fresh and clean and residents’ bedrooms are attractively decorated with colours chosen by them and with lots of personal possessions arranged to each persons liking. The home has a key worker system, which means that there is a closer relationship between staff and individual residents, whose preferences and needs receive more detailed attention. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 6 There is a range of organised and spontaneous activities for residents, with individual weekly plans in pictures and symbols. A residents relatives say how much she enjoys going to church and the hobby club. The home has its own minibus, which is used for residents’ to go to college, shopping and to visit relatives. Some residents regularly attend day centre placements. The organisation continues to respond to requirements, which are made and is actively trying to improve the quality of care for residents living at the home. This inspection was conducted with full co-operation of the new manager, deputy manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank the management, staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The home has a new manager, recently in post, who is committed to improve standards of care and support and independence of residents wherever possible. She has clear goals and has already made improvements in a number of areas. She has taken action to explore the comments made by some residents and relatives in the homes own quality assurance surveys and residents meetings, relating to minor problems, which are being resolved. She has plans to introduce a relatives committee to support greater resident involvement in the say and running of their home. The way the home plans each persons care has improved with more detail and specific written information providing staff with better guidance about each persons needs and preferences. At this visit additional areas needing fuller detail have been discussed. Health care assessments have improved, with measures in place to minimise risks of falls and risks involved in moving and handling people. There are also records on each persons file, showing that there is generally better access to specialist medical, chiropody and dental care. The results from healthcare professional surveys are generally positive about the improvements this home is making to meet residents healthcare needs, which indicates better relationships between the staff and health care professionals. One person states, communication has improved over the last few months. New care managers appear to have a more skilled approach and I have seen this improve, training offered to staff to look at residents as individuals, more person centred. The homes system for the management and administration of residents medication has been improved in a number of areas, though as a result of this visit there are some additional improvements needed, so that residents are safeguarded as far as possible. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 7 The manager and staff are trying to create an environment, where comments and concerns are welcomed as an opportunity for the home to improve. The managers to introduce a relatives committee, will encourage more involvement. The manager has achieved the first of her goals to recruit additional members of staff and revise the rotas so that staffing levels are more stable, providing the residents with more consistency. The registered manager, as part of the monitoring systems in the home has started to put in place audits of all areas the premises. As a result improvements to the internal décor, fixtures and fittings and the exterior of the home continue to be made. What they could do better: A number of improvements stated to have taken place by the care provider, could not be fully validated during this inspection, for example not all new person centred care records are completed. The homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate information and better detail of the supporting evidence of what the home does well and how the improvements have been made. Information about the services the home provides needs to be revised, updated and produced in easy to read and alternative formats, suited to each persons level of understanding. Improvements must continue to the way residents care is planned to involve them more and to include more detailed information for residents with complex conditions such as diabetes, behavioural difficulties and there must be fuller support for people with the capabilities to be more independent. Health professional surveys include the comment that the way the home could improve, Be more aware of person centred planning approach and retain staff to establish more continuity Improvements are needed to make the homes system of medication administration as safe as possible. There are areas of each of the three houses, which need improvements to the environment, such as the repair of the bath out of use, which limits residents choice, the laundry needing repainting, and screening for kitchen doors to prevent pests entering. There must be enough well trained and skilled staff to meet residents care and social needs at all times, a resident says would like to visit my sister more often. The registered persons and manager needs to make additional improvements to the homes staff training programme. Improvements are also needed to some areas of health and safety, such putting in place approved devices to Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 8 hold open residents bedroom doors and regular analysis of accident and incident records to highlight trends or risks. These actions will make the home a safer place for residents and staff. 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. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 9 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 Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 10 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): 1, 2 Quality in this outcome area is adequate The homes pre admission information (statement of purpose and service user guide) is not up to date or in appropriate formats suited to residents and their supporters meaning information about riverside is not always readily accessible. Residents have their needs assessed by competent persons prior to moving into the home, although it was difficult to determine how the resident or staff participated in this assessment process, due to lack of documentation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA submitted by the service states they incorporate all relevant information about the individual into their care plan and where possible advocacy is involved in this process. Although the home is making progress, from the sample of residents case files examined during the inspection there are some significant gaps and some information, which has not been verified as accurate. For example a resident has been recorded as having brittle bones, information given by family members, which has not been verified with a medical diagnosis or treatment. In addition the Riverside Active Care Learning Disability Services Initial health Check is incomplete and not signed or Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 11 dated. There is no medication listed and information does not correspond with record of assessment information there is no mention of epilepsy, arthritis, and no base line health screening or weight recorded. It is strongly recommended that all assessment information is recorded accurately, with all areas of need assessed and all records are signed and dated by staff completing the documents. The AQAA submitted by the service states they have improved the preadmission documentation and care planning formats have been reviewed and implemented to ensure this is tailored to the needs of the people who use our service. Whist this may be an aspiration the implementation is not complete and is at different stages in the three different houses, with staff demonstrating differing levels of understanding about what is expected of them. The AQAA submitted by the service states they could improve the range of different formats available to produce information relating to the home. There is a statement of purpose and service user guide. However they are out of date, with some information inaccurate and currently only in written formats, which are not the easiest reads. It is strongly recommended the documents are regularly reviewed and updated to provide accurate information in formats, which are meaningful to residents and their supporters The AQAA submitted by the service states they plan to improve purchase and use communication software from widget to enable us to produce a wide range of materials in pictorial formats. It is positive that a number of documents such as activity plans and menus have been produced using widget and are displayed around each of the three houses. During discussions staff generally show that they are aware of residents needs, and there are improved records of each residents preferences such as rising, retiring, likes and dislikes, which reduces risks posed by reliance on verbal communication between staff. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 12 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, 8, 9 Quality in this outcome area is adequate Whilst there is some evidence that care plans have improved they are still not sufficiently developed to ensure that residents and staff have the information needed to know residents assessed, and changing needs and personal goals. The home is improving systems to enable residents to participate in the planning of their care and identify their wishes and aspirations. Support for residents in taking risks is compromised by inconsistent completion of risk assessments meaning that in some instances they are not fully protected in leading an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA submitted by the service states they have improved new person centred care file formats have been introduced all care files have been updated in the last 12 months and reflect greater levels of consultation and participation with the people who use our service, which should demonstrate compliance with a previous requirement to introduce a person centred planning Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 13 approach, for example essential life style and life story books. A random sampled of 3 residents files including care planning and risk management have been examined in depth and another 4 residents file have been assessed in random areas. During discussion staff have stated that all eight residents in one house have updated person centred plans, however the format is in formal written language only and there area significant gaps. In another house the staff state that 2 out of the 8 residents have care plans in the new person centred format and staff at the third house say that none of the care plans have been transferred to the new person centred format. Some efforts are being made to introduce the person centred planning approach so that individual residents can indicate what is important to them and have control over the their care and support. The person centred portfolios in the process of being drawn up by staff include residents’ likes and dislikes, life stories and relationship circles. One resident, whose assessment and care plan are incomplete has a pen picture, which gives a more realistic view of this persons care needs and has guidance for staff, especially for what the GP describes as late stages dementia. For example staff should give simple requests, always saying same thing, in same way, using same words. Give time to absorb request. One staff only to speak at a time. The care plan does contains some useful information relating to behaviours including regarding the making accusations of staff hurting her, which has been determined to be part of escalating dementia. This person has started to scream out when staff are assisting with personal care. The plan contains information about de-escalation techniques and links to risk assessments and behaviour management interventions. It does lack evidence of how staff ensure this resident is still able to make choices as to whether to have a shower or bath and this needs to be improved. This persons record does not have a photograph as required. There is some evidence that key workers review care needs monthly and there are regular formal reviews involving family and other professionals involved in the persons care. It is unclear as to whether all staff have received appropriate person centred care training. Some staff could not recall the training; others could and some state they have had training but need further training before they feel they can develop use the new format. During discussions the new manager acknowledges that the process is not satisfactory and further development work is needed to improve the person centred concept, format and staff awareness and competence. She states she has set herself a target of reviewing all care plans and risk assessments, at a rate of 4 each week, with a date for completion by the end of October 2007. All residents need varying levels of support to manage their finances. However as previously reported not all residents have care plans in place to show how they are supported to manage their finances as previously required. Some Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 14 information contained in files is confusing with records for one person stating finances are managed by the Local Authority and in another section stating finances are managed by family. There are further details of some concerns relating the homes management of small amounts of temporary safekeeping and personal allowances on behalf of residents at standard 23 of this report. Risk assessments still require further development as not all residents have a comprehensive range of risk assessments in place. Not all residents with behaviours, which challenge the service, have a risk assessment and risk management strategy. A resident observed to be chewing her hands, causing a lesion and broken skin, and during the morning of the first day of the inspection, she exhibited signs of distress and staff tried various strategies, including offering food and drinks, without success and her key worker eventually took her to her bedroom for a session with sensory lights which, staff state are used as intervention techniques to calm her if she becomes very agitated. Discussions with key worker showed that she has a good awareness of this residents needs on a practical level, however examination of her records show that there are no recorded to strategies on file for her behaviour or selfharm and no action has been taken to seek medical assistance for her broken skin, which may become a source of infection. In another house members of staff state that a resident can exhibit aggressive behaviours. From examination of his records there is insufficient information regarding behaviours, there are no identified hot spots, cues, or triggers and no risk management strategies. Furthermore daily Records contain entries such as been in a bit of a mood he is hyper, he is agitated today, which are subjective, judgemental and do not contain any context. There are now risk assessments in place on files sampled with regard to moving and handling including the use of a hoist. However there are no scores recorded and the details of hoist or size of sling are not detailed, which would be good practice. A resident who used public transport to travel to college unaccompanied has no risk assessment for this activity. Similarly there are no risk assessments for the two residents who walk to the library and return using the bus unaccompanied by staff. There are risk assessments in place for the 3 residents requiring bedrails. One has been reviewed regularly on a monthly basis up to August 2007. The records of checks for the other risk assessments are out of date and staff state that the handyman undertakes the checks and records are held in the main office, however these have not been produced at this inspection. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 15 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, 14, 15, 16, 17 Quality in this outcome area is adequate Efforts to increase opportunities for some residents to lead meaningful lives are continuing with a wider range and more frequent stimulating activities (including community based outings) available. Staff support residents to maintain important links with their families, wherever possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence that generally there is daily routines at the home are flexible and promote independence for example upon arrival at 8.20 a.m. on both days of this inspection visit residents have been at various stages of rising, dressing and having breakfast, according to their preferences and activities for the day. There is still not sufficient evidence to show how residents are enabled and supported to participate in the planning process for their individual activity Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 16 programmes. Person centred plans are not yet completed and do not provide information as to how residents are enabled and supported to make choices. On the first day of this inspection an incident occurred where a member of staff came to the house, asking if someone could drive a resident to college at 1:30 but because another member of staff had been borrowed from the house to drive the minibus there was no one to take the resident to college. The deputy manager intervened and stated that the resident could go by herself to college by bus, with further discussion indicating that the resident had some months previously used public transport and in the deputy’s judgement was safe to travel independently. During separate discussions the manager had stated that the home was devising a development plan for this resident to use public transport unaccompanied. On the second day of this inspection visit inspectors established that the resident had used public transport the previous day to go to college unaccompanied. Examination of her records shows that there is no risk assessment for this activity and no evidence that the development plan to use public transport unaccompanied had been implemented. The manager had been unaware of the situation and has acknowledged that there is no risk assessment and a development plan had not yet been put in place. She states she will be taking action to ensure omissions are rectified. It is positive that activity sheets are now produced using symbols and pictures, most are in colour, however it recognised that this is not appropriate for everyone and on one of residents files sampled there are weekly activity sheets on file in black & white widget. From discussions and observations there are some improvements for example residents are now able to go to church and visit a local community bar. They can also participate in a hobby club. A visitor spoken to says his sister has been at the home for about eight years, she is happy and settled here, staff are very friendly and generally helpful. He says the home could improve activities and would like to see more therapeutic activities put in, though his sister goes to church and the hobbies club and helps around the home. From the sample of records of a young female resident with complex needs, it has been noted that her records shows her religion as Roman Catholic, however there are no indications that her spiritual needs have been discussed with her or her next of kin (mother). Staff spoken to state that some residents have been taken to the local church in Wombourn but do not appear to appreciate the differences in practices and rites between the denominations of Christian religions. During discussions with residents, who are able to speak for themselves they say they can follow their own interests and hobbies. One resident chatted about her favourite interests such as going out to the local library with another resident, these trips are unescorted and supported independence is positive Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 17 but needs to be risk assessed. The resident spent some time sitting in the lounge practising writing skills. She explained she goes to Stourbridge College, and knows time of day that she needs to be there; she does a variety of courses including computer studies. She has her own personal allowance each week and is supported by staff to budget and not spend it all at once. Some residents have been on holiday this year, some to Butlins in Skegness in small groups supported by staff, one resident commented that they had lovely weather. The Southern Cross operations manager confirms that the organisation makes a £250. 00 annual contribution to the cost of a holiday for each resident who wish to go on holiday, in additional to funding staffing arrangements. Some staff say that residents can go on outings but it depends on the mini-bus and availability of staff to act a drivers. The manager states that there are only 5 staff qualified to drive the minibus and acknowledges that this is an issue, which she intends to resolve. One resident commented on the CSCI service user survey “would like to visit sister more”. There is good evidence that visitors are warmly welcomed to the home and records and observations show that some residents visit their former family homes and the majority have good family contact. During the visit residents have stated that they liked the food, which is provided and some residents help with food shopping and preparation. One resident in particular has been enthusiastic in supplying hot drinks to inspectors throughout the visit. Menus are now in pictorial / widget form and displayed in each house. Staff have been observed to ask residents what meal choice they wish to have and are sensitive in the way they assist people to eat. Recording of food intake is not always satisfactory. Two residents whose care has been looked at in depth have complex needs, including support for a nutritious diet suitable for their needs. In one residents notes it is recorded that staff to provide food and drinks - record all amounts eaten and drunk. Examination of food intake records show that some sheets have no name entered some meals there insufficient information and there is duplication with food and fluids recorded on more than one sheet but with large gaps. Another resident with unstable diabetes has records with entries such as centre or packed lunch or sandwiches with no detail. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 18 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, 20 Quality in this outcome area is adequate There is improved understanding of the concept of valuing people and as a result staff support residents’ rights to dignity and privacy better. Generally residents health care needs are supported; there are some significant areas where needs are not well managed at present. The home has made some improvements to the procedures for administering medication, thereby reducing the risk to residents, but there are still some areas of current practices, which continue to pose some risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA submitted by the service states the evidence for what they do well is in care files, presentation of service users including physical and psychological well being, feed back from the people who use our service, monthly auditing of medication and external pharmacy audits. Regular reviews of medication and health with the service users GP and The AQAA submitted by the service states what they have improved is care files have been up dated in last 12 months to comprehensively express the emotional, physical and social needs of the people who use our service. Systems for monitoring health care needs Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 19 have been reviewed with regards to potential complications such as breast screening, testicular cancer etc. However as identified at the Individual Needs and Choices section of this report the development and implementation of person centred care plans and revised working practices has not been completed. The sample of case files examined show that the Riverside Active Care Learning Disability Services Initial health Checks are incomplete and not signed or dated by staff completing the information, two have no medication listed and one has information, which is not consistent with details held elsewhere on the persons file. One person who has unstable diabetes, and has lived at the home for 6 years, has a completed pen profile completed, stating likes sweet foods, however there is no evidence of discussions about his capacity and level of understanding of the risks. The information recorded by home is not signed or dated by staff, the resident or relatives. Furthermore the care plan summary states continues to eat low fat healthy diet and weight is steady. Weight records show it has fluctuated from 90kg - 81kg - 91kg and no weight checks have been recorded since 8 July 2007. The team leader states that the fluctuations may be due to the fact that he had his leg in plaster but this would not explain the weight decrease during that period or the weight increase when the plaster was removed. There are no explanatory notes relating to the weight records. During discussions it has been identified that the sit on scales have to be pushed from one house to another and there is no evidence of calibration checks to ensure accuracy. The resident has a recorded nutritional risk score of 9, which is indicated as a cause for concern. There are food charts in place, however these are not well completed, with entries such as lunch at centre Staff state that this resident will tell staff at the day centre he has not eaten breakfast and have an additional breakfast there and also choose unsuitable meals there. There is currently no formal method of communication between the home and centre. The district nurses administer insulin injections for the resident with diabetes and staff at the home perform the blood sugar monitoring, an invasive body procedure, in the morning, at 4pm, 7:30pm, with checks at 12mn and 4am only if required. Records show that staff are not following district nurses protocol, which states that the BM check in the night is not required if the reading is 6 at 7:30pm. Over the fist two weeks in September records show BMs in the evening as high as 19.1 and Mon 10/09/07 21.0 at 7:30pm but staff are still disturbing him to do 12mn and 4:am BM checks each night. In addition this residents financial records show that he paid for take out fish & chips supper on Sunday 9/09/07, which is not the low fat, diabetic diet he is recorded has having. Furthermore there are no records available at the inspection visit to show whether all staff, especially night staff undertaking BM procedure have received up to date training from health professionals. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 20 Another resident case file does contain notes relating to leg exercises prescribed by physiotherapy department on 17 August 2007, which is positive, however this record is not signed and dated by staff completing the information. Generally health care professionals seem to believe there are some improvements at the home. Comments from the professional surveys about how well the home meets residents needs are, depending on the amount of staff on duty at the time and usually contact me eventually regarding problems. The home has a Southern Cross medication policy / procedure dated 6/1/06, located in the main office not in the houses and there is no evidence that staff have read or signed to demonstrate their awareness and compliance. The medication policy and procedure displayed in the houses is dated 2003. This needs to be replaced with the up to date policy. The Southern Cross medication policy & procedure regarding medication errors does not guide the staff to notify the CSCI as a Regulation 37 notification. The home uses the BOOTs MDS medication system. The pharmacists quarterly audits were located eventually during the inspection visits and a number of the findings from the CSCI inspectors assessment of the homes management of residents medication had already been highlighted in the BOOTS pharmacist visit to checklist dated 5/9/07. This identifies the following: Winter House try to avoid gaps on the mar sheet (PRN), review homely remedies for R, double sign any handwritten additions /amendments to the MAR sheets, store in internal/external preparations separately and Littleton House store in internal/external preparations separately, handwritten amendments/additions to MAR sheets to be double signed, discussed training requirement. During this inspection visit, 12/09/07 it has been observed that in some houses the actual administration of medication is satisfactory, though 2 out of three staff specimen signature sheets are not up to date. There are a small number of gaps on MAR sheets where there is no signature or code entered for non-administration. In one house the MAR sheet is confusing, where staff have used the monthly MAR sheet to record 3 months of Paracetamol administration. The Calogen liquid medication is stored in the medication trolley not refrigerated or dated according to manufacturers instructions, stating refrigerate and when opened use within 14 days. The medication trolleys contained medication to be taken internally and external preparations stored together. The home had received a supply of Erythromycin, hand written on MAR sheet but no signature or witness, as is good practice. There are a large number of prescribed medicines on the MAR sheets with the instruction as directed, which does not give staff sufficient guidance. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 21 It is positive that a copy of the homes Protocol for administration of PRN medication is located on medication system for each resident requiring medication to be administered in this way. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 22 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, 23 Quality in this outcome area is adequate The complaints process has generally improved and complaints made on behalf of residents usually receive an appropriate response. Improved vulnerable adult abuse procedures are now more robust and offer suitable safeguards to residents. Staff have improved awareness following training in adult protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA submitted by the service states We have a robust and clear complaints and comments procedure for those people who use our service and for those who have any dealings with our service including staff (whistle blowing). Staff and management are approachable and available to listen to comments, compliments or complaints and will always try to take appropriate action. We manage complaints objectively and effectively and have clear timescales in which we provide a response. We also have clear policies and procedures on prevention of abuse and protection of vulnerable adults which can be provided upon request and which we adhere to. These policies and procedures are well advertised within the home and adhere to the guidance in no secrets. During discussion with residents, staff and relatives, they generally confirm that they are aware of the homes complaints procedure, and if there are concerns, there are now responses. It is positive to see that pictorial complaints procedures are displayed and residents who can communicate verbally say that they would speak to staff if they had a concern. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 23 The AQAA information and complaints log at the home show that the home has received 8 complaints in 12 months, which have been upheld. The AQAA submitted by the service states what they have improved Staff have received refresher training in abuse and protection of vulnerable adults. Documentation has been reviewed and improved to evidence that concerns or issues raised have appropriate action. This is confirmed through discussions with staff and examination of staff training records. During discussions staff have responded appropriately, as to how they would deal with a potential incident of abuse. Since the fieldwork visits for this key inspection an allegation of potential physical abuse has been reported to the manager at the home and a safeguarding referral has been made to the Local Authority Adult Protection Team, with appropriate action taken by manager. At the previous inspection visit information could not be provided by the home whether or not staff have been referred to Department of Health for consideration as to inclusion on the Protection of Vulnerable Adult (POVA) list. Inspectors have been given documentary evidence that appropriate action has been taken. Following concerns raised at the previous inspection visit in March 2007 relating to the management of residents’ finances some improvements have been implemented. Residents money held securely at the home in individual receptacles. However a random sample of residents finances identified that only one out of four temporary safekeeping accounts balanced correctly. For example one balance recorded £12.70 is actually £12.80p, another is £1 short, the senior stated that this occurred a few days previously when the deputy manager had given her £1 less than the personal allowance, intending to rectify the discrepancy, which had not happened at the 12/09/07. There are 4 transactions documented but only one signature. There are a small number of missing signatures on other residents financial transactions. At the previous inspection visit in March 2007, it was noted that sometimes residents pay for their own meals when in the community. At this visit all residents financial records sampled had a communal receipt for fish & chips from an outlet in Kingswinford dated 9/9/07, however the record of the transaction indicates that residents not only paid for their own meal, which replaced a meal, which should have been provided by the home, they also paid for staff meals, in that in one house the total price for 10 meals was divided between 8 residents. The organisation has been informed that this practice must cease and residents must be reimbursed. There are issues about the suitability of the meals for some residents, which are discussed at the previous section of this report. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 24 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, 26, 30 Quality in this outcome area is adequate The premises are generally attractive, decorated and furnished to a good standard. Maintenance has generally improved but there are some further maintenance issues to be dealt with to avoid jeopardising residents’ safety and comfort. Mechanisms for infection control have generally been improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises has been undertaken over the two days of this inspection visit, looking a various aspects of the three houses. Residents bedrooms have been viewed with their consent and some residents; have been happy to show inspectors around. The residents have expressed their satisfaction with their bedrooms, which they can have decorated and arranged as they wish. One person has a dark decor in football team colours, together with memorabilia. Another person living in Littleton House would like a blind fitted to bedroom window and another would like a conservatory, to be able sit out in the cooler weather. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 25 The residents are encouraged to personalise their bedrooms which is positive and there are some inventories of residents personal property on their files, however the sample viewed do not include items of furniture, such as a bed and chair purchased by family, these should be regularly updated, and signed by the resident or family and staff. The majority of the previous requirements relating to the premises have been met. The organisational representative and new manager have discussed the difficulties presented by the obstacles the home has to overcome relating to the risks of flooding. It is evident that the manager is proactive and innovative in her approach. Bathrooms, kitchens and laundry are generally well organised and tidy. The following areas needing improvement have been identified at this inspection visit: Bathroom in Littleton has a bath out of use, it is stated the there is a 3 month wait for part and this is in hands of servicing company, which has implications for residents choice for bathing, whilst bath is not available. Laundry needs repainting Wall unit damaged Winter House to be repaired Room 4 loose radiator cover to be rectified Door to room 8 not closing into rebate to be rectified Rectify loose earth cables in en suite shower rooms All bins need lids Room 7 Catesby and kitchen in Littleton Need to risk assess the house in respect of security Need to obtain Safer Food, Better Business Need screening for kitchen doors to prevent pest entry There are some bedrooms that have inadequate lighting. Whilst some residents stated that this was preferred it was not always the case. Provision of such a dimmer switches would allow residents to choose their own preferences in respect of lighting given that the most powerful setting is sufficient to provide expected and safe levels of lighting. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 26 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, 35, 36 Quality in this outcome area is adequate The service continuity and quality has improved due to increased staffing levels, reduced levels of sickness and vigorous recruitment. Recruitment and selection procedures now offer better safeguards to people living at the home. Better staff training is improving the quality of support offered to residents; this assisted by the manager commencing the revision of the frequency of formal staff supervision. More comprehensive and structured inductions for new staff before they work with residents are yet been fully implemented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 24 residents accommodated, with a variety of dependency levels and diverse needs, with 8 residents in each of the three houses. From assessment of staffing rotas, observations and discussions indicate that the current staffing levels is generally adequate. The manager states that there are 3 carers on the early shift, 4 carers in Littleton House, which has the more dependent residents and 3 carers on the late shift and 1 wakeful night carer in each house with a senior, floating, between the houses at night. There are issues about the security and safety of night staff going between houses. There Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 27 is evidence of incidents with intruders around at night, although the area outside the home is well lit, staff do not have personal alarms provided by the home one person spoken to says she has brought her own. There is no risk assessment in place and the staff member is not aware of the organisations lone working policy, though the home has a copy. There is a designated team leader and senior in each house on all daytime shifts. There is a deputy manager and recently appointed manager who are still needed to cover some of the care hours. On the first day of this inspection visit a member of staff from one house has been used to cover to drive the minibus to take a resident from another house to visit her mother, depleting the staff team in the unit to two staff. This issue has been discussed with the manager, she states this should not have happened but is aware of a shortage of designated drivers. The manager states that her priority has been to recruit new staff. The home is now fully staffed on days, though there are still some vacancies on nights, 3 part time posts. She has recruited 2 night carers and is awaiting clearances, which leaves 1 post still to be recruited to. The manager has completely revised the rotas for all three houses to introduce continuity and stability. She has achieved this by reviewing all staff contracts and where needed agreeing a change to contracted working hours. The rotas are planned on a rolling programme, with training and annual leave factored in and she states the rotas are in place up until Christmas, which means she feels confident that there are satisfactory and planned staffing levels in place in each of the houses, though this still requires the co-operation of the staff. The AQAA submitted by the service states what Riverside does well We operate a robust recruitment procedure to ensure that staff have the right experience, qualifications and personal qualities to provide a high standard of care. This is done adhering to our equal opportunities policy. Personnel files are audited on a monthly basis. The rota in the home is managed to ensure that adequate staffing are on shift and a training plan is in place to ensure that all staff are trained for their role and have ongoing development. A sample of staff files and recruitment processes have been examined. The documentation and management of staff personnel files has improved and generally provides better safeguards for residents living at the home. The home has now introduced a checklist for staff files and the inspector has examined four staff files for staff recently employed. Whilst the improvement is acknowledged there are still some areas to be improved. The application form for one person is not signed and two other application forms had only limited work histories, one had only documented 4years employment history and the other 8 years employment history. In addition not all references are from the previous or last employer (in care where possible). One person has been employed on a POVA First basis, notified to CSCI, which is good practice. However there is no completed risk assessment in place, only blank format on Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 28 file, which does not comply with Regulations. Staff need to be aware of the named supervisor for anyone employed on a POVA First basis, which should also be recorded on staff rotas as a matter of good practice. From examination of records staff have a two day basic induction covering, in brief the homes policies and procedures. There are concerns as to whether this sufficient for inexperienced new employees. The skills for care common induction standards are not currently in place and the manager is aware and acknowledges that the LDAF (learning disability awards framework) is not currently part of the induction. She states a more robust induction to include the common induction standards will be put in place. The manager states she has a strong commitment to staff training and development, together with support measures such as structured supervision. From the sample of staff files examined there is limited evidence that staff have participated in regular recorded supervision sessions and this must be improved. During discussions with staff who have had sessions, especially with the new manager, say that they find the sessions useful and helpful. One person says the new manager is more approachable we can phone her up and speak to her. Staff spoken to have generally shown that on a practical level they are knowledgeable about residents needs and how to meet them. The manager is in the process of implementing the homes an annual training plan and individual staff training profiles. There are some gaps in the required training, particularly for some new staff. Discussion with staff member on duty in one of the house has stated that Makaton training is planned, the manager stated that the organisation has not planned this is currently. This decision needs to be reviewed and it is strongly recommended that appropriate training in communication methods be commenced to equip staff to interact with individual residents, such as the person who could communicate using Makaton and is very frustrated when she is not able to make people understand her. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 29 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, 41, 42 Quality in this outcome area is adequate The new management arrangements at the home are at an early stage but indicate improving effective leadership and better communication; this within the home, with relatives and with external healthcare providers. The introduction of quality assurance systems will ensure that residents’ views are taken into account and help to shape the service provided. There are some areas of health and safety which have improved; other areas have yet to be effectively managed and continue to compromise residents’ safety and wellbeing This judgement has been made using available evidence including a visit to this service. EVIDENCE: As identified at the previous inspection visit there has been a considerable period of instability in the management of this care home. There has been no registered manager since November 2005. A manager was appointed in June Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 30 2006 and failed to complete an application to register with CSCI, ceased employment at the home in March 2007. The new manager has only been in post for 10 weeks at the time of this inspection visit and has made very good progress with the implementation of improvements to meet regulations and national minimum standards and improve the quality of life for residents living at the home. The new manager has held the position of registered manager in two registered care homes prior to her appointment at this home. She has considerable experience and has achieved the Registered Managers Award (RMA). Through this inspection visit she has demonstrated a good understanding of the tasks she has to achieve and how she is going to prioritise them. She has a commendable knowledge of all of the residents and most of their needs. Some of this has been gained whilst covering care shifts. Whilst this has been useful, to effectively manage and develop this complex home she must be supported to have sufficient managerial hours to implement and sustain the changes required. Improvements throughout the report indicate that the management arrangements within the home are more effective and rigorous, for example the recruitment and deployment of more skilled staff, and plans for a changed ethos in the home to more person centred planning and supported independence for residents care and support. The manager has started to implement a quality assurance system, which includes feedback from residents and relatives. Staff and residents meetings are starting to take place regularly, with minutes posted on notice boards. The home has an annual development plan and a representative of the registered providers make the required Regulation 26 visits to the home and reports of monthly unannounced visits relating to the conduct of the home are made available to the home, registered proprietors and the CSCI office, Halesowen. Discussions have taken place relating to the new Regulation requiring the home to submit an annual AQAA on request by the CSCI and it is recommended that the registered manager proactively uses this as an additional tool. In addition the evidence to support statements made in the AQAA need to be more detailed and accurate, as the evidence will be tested and verified or not during inspections. The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. However during a tour of the premises it has been noted that a residents bedroom door is wedged open, and on there is a form on her file signed by her sister dated 18/4/07 stating she (the sister) understands and takes responsibility. This is not acceptable and may compromise the fire safety of not only the resident but also others. The West Midland Fire Service should be consulted for advice and an approved devise installed to hold open the bedroom door for this resident and any others wishing to have a similar arrangement. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 31 Mandatory training is being provided for the majority of staff commensurate with their roles in a rolling training programme. There are some gaps where some staff do not have all required training and the manager has plans to rectify any shortfalls. Accidents forms are completed and are filed in individual resident’s case files. Copies of accident records should then be collated and analysed in the main office, with monthly statistics forwarded to Southern Cross Central office. However on one residents case file there is a record of bruising on her back, together with the bruise chart, dated 15/6/07 signed by J. Williams, in trying to collate this with accident records it has become clear that accident records are muddled. There is no accident record dated 15/6/07. There is an accident record dated 5/6/07 showing that she fell on her back but there is no bruise chart and no indication of any injury. Another resident is recorded as cut whilst shaving on two occasions 2 and 28 June 07, even though it is recorded on first accident form to purchase new razor. There are also accidents recorded on holiday and there is insufficient evidence of risk assessments and contingency planning. There are also discrepancies between the numbers of accidents recorded on the Southern Cross audit reports and numbers of copies of accidents held in various files at the home. Therefore it has not been possible to assess accurately how many accidents have occurred involving residents since the last unannounced inspection, especially as the homes own accident analysis is not accurate or clear and does not identify trends or risks and does not record any remedial action. The manager says she has plans to rectify these matter, some having occurred before she commenced employment, this should include an effective system for auditing, analysing and evaluating accidents / events involving residents, to highlight risks and trends, with effective measures implemented. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 32 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 2 2 2 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 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 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X 2 2 X Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 33 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 Requirement 1) To review and expand care plans, to include detailed daily reports which reflect goals and objectives, to include restrictions on users’ choice, to provide detailed communication methods, to produce care plans in a format suitable for service users and to be signed by users. (Previous timescales of 1/10/03 and 01/05/07 is partly met - ongoing progress is being made). It is the home’s responsibility to notify the CSCI when this requirement is met. 2) To ensure that care plans are updated as and when needs change, or new needs are identified following review meetings. (Previous timescale of 1/10/05 and 01/05/07 is partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. Timescale for action 01/12/07 Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 34 2. YA7 15(1) To ensure that care plans contain goals and objectives with regard to service users who require assistance/supervision with managing their own personal allowances and benefits. To accurately identify the exact level of support and assistance they require. (Previous timescale of 1/2/06 and 01/05/07 is partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. 01/12/07 3. YA9 13(4)(c) 1) To expand the risk management system to ensure that all areas of risk associated with individual service users are clearly documented, such as personal safety within the Home’s environment. For example, use of the passenger lift, independent travel on public transport. 2) To devise and implement documented risk assessments and risk management strategies for all residents with behaviours which challenge the service or self harm 3) To ensure risk assessments and ABC charts identify cues and triggers and daily records must be referenced to all other documentation, especially when PRN medication has been used 4) To ensure that where health professionals are involved their instructions, protocols and records are completed diligently It is the home’s responsibility 01/12/07 Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 35 to notify the CSCI when these requirements are met. 4. YA12 16(2)(n) To provide a wider range of stimulating and therapeutic activities for service users to meet their individual needs and preferences. (Previous timescale of 01/05/07 is partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. 5. YA13 16(2)(m) To ensure all service users are facilitated to participate in the community in accordance with preferences and assessed needs. (Previous timescale of 1/2/04 and 01/05/07 is partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. 6. YA18 12(4) To review the practice of two 01/11/07 hourly checks for all service users by night staff. To accordingly update ‘night management’ care plans for all individual service users. (Service users’ preferences must be obtained and if this level of monitoring is deemed necessary, it must be discussed and agreed as part of a multi-disciplinary team). (Previous timescale of 1/12/04 and 01/05/07 is not fully met). It is the home’s responsibility to notify the CSCI when this requirement is met. 7. YA19 12(1)(a) 1) The Home should introduce a procedure for the monitoring of DS0000041321.V350538.R01.S.doc 01/12/07 01/12/07 01/11/07 Riverside Care Centre Version 5.2 Page 36 service users’ health with regard to potential complications such as breast screening, testicular screening etc. (Previous timescale of 1/8/03 and 01/05/07 is partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. 2) To ensure that there are regular and recorded weight checks for all service users. (Previous timescale of 01/05/07 is not fully met). It is the home’s responsibility to notify the CSCI when this requirement is met. 8. YA19 12(1) 1) To establish each residents capacity to understand risks and make their own decisions regarding their health care and diet, especially relating to the resident with diabetes 2) To formalise and document the parameters for blood sugar monitoring and the protocol for when this procedure needs to be performed 3) To ensure there is a written invasive body protocol for blood sugar monitoring agreed with the health professionals (district nurses) and signed by staff undertaking the procedure 4) To ensure that ALL staff performing blood sugar monitoring procedures have documentary evidence of up-todate training from an approved health care professional, competent to deliver the training Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 37 01/12/07 It is the home’s responsibility to notify the CSCI when these requirements are met. 9. YA20 13(2) To make the following improvements to the control and administration of medication: 1) To provide lockable medication fridges, with thermometers, to record minimum and maximum daily temperatures, for the storage of medication requiring refrigeration, such as Calogen, Insulin and liquid antibiotics 2) To ensure Calogen is labelled with date of opening and use by date (14 days) 3) To obtain written clarification of as directed dosages with the prescriber and / or pharmacist 4) To store internal and external medication separately 5) To maintain the MAR sheets without gaps, ensuring a signature or code is entered to indicate administration or reason for non-administration It is the home’s responsibility to notify the CSCI when these requirements are met. To review the practice of service 01/11/07 users paying for their own meals whilst out in the community, and which are in place of meals provided by the Home, (for which the service user is already funded by the Local Authority). If this practice is to continue, it must be negotiated with funding authorities and service users. A DS0000041321.V350538.R01.S.doc Version 5.2 Page 38 01/12/07 10. YA23 13(6) Riverside Care Centre formal procedure must be agreed which is contained in individual service users’ plans, the service user guide and contracts. (Previous timescale of 01/05/07 is not met). The continuation of this practice must cease immediately. It is the home’s responsibility to notify the CSCI when this requirement is met. 11. YA23 13(6) 1) To ensure that the practice of residents paying for staff take out meals ceases immediately and residents are reimbursed for meals paid for on 8/09/07 2) To ensure that individual receipts are issued to each resident for financial transactions 3) To ensure that there are two signatures obtained for each financial transaction, one may be the resident where they have capacity to understand 4) Balances held on behalf of residents must be checked and agreed as accurate, signed and witnessed at each transaction It is the home’s responsibility to notify the CSCI when these requirements are met. 12. YA32 18(1)(c) To provide staff training in: 1) Challenging behaviour. (Previous timescale of 1/2/06 and 01/06/07 remains partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 39 01/11/07 01/12/07 2) Epilepsy awareness. (Previous timescale of 1/2/06 and 01/06/07 is partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. 3) To ensure that 50 of the staff team are qualified to NVQ II or above by 2005. (Previous timescale of 1/8/05 is not met some progress is being made). 4) To provide Makaton training and any other appropriate aids for communication systems for residents without verbal communication skills It is the home’s responsibility to notify the CSCI when this requirement is met. 13. YA34 13(6) 01/11/07 To carry out the following improvements to recruitment and selection procedures in order to safeguard service users from abuse: 1) To ensure that staff who have been appointed on a POVA First check are only employed subject to the supervisory and induction arrangements stipulated in the Care Homes Regulations 2001, Regulation 18(1)(c)(i) and 19(11). (Previous timescale of 01/05/07 is not fully evidenced). 2) To undertake written risk assessments for any staff who have been appointed on a POVA First check to identify and Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 40 undertake control measures to minimise risks to service users. (Previous timescale of 01/05/07 is not fully evidenced). It is the home’s responsibility to notify the CSCI when this requirement is met. 14. YA35 18(1)(c) To ensure that new staff receive induction and foundation to Sector Skills Council specification and that this is carried out within the first six weeks and first six months of employment. This must be provided by an accredited learning disability awards framework provider. (Previous timescales of 1/8/03 and 01/06/07 remains partly met). It is the home’s responsibility to notify the CSCI when this requirement is met. 15. YA36 18(2)(a) To ensure that all staff receive regular recorded supervision sessions (at least six per annum). (Previous timescale of 1/11/03 and 01/06/07 is not fully met). To ensure structured supervision and appraisals are prioritised for new staff. It is the home’s responsibility to notify the CSCI when this requirement is met. 16. YA37 18(1) 9(1) To ensure that the manager has sufficient managerial hours, without the need to cover care duties, in order to implement compliance with requirements to improve the service to a level DS0000041321.V350538.R01.S.doc 01/12/07 01/12/07 01/11/07 Riverside Care Centre Version 5.2 Page 41 which safeguards residents, within the specified timescales It is the home’s responsibility to notify the CSCI when this requirement is met. 17. YA42 13(4) 1) To cease using door wedges to prop open residents bedrooms and provide door guards linked to the fire system or other such equipment approved by the West Midland Fire Service, as a matter of priority 2) To ensure the organisation follows its policy in respect of staff lone working and implement risk assessments for senior travelling outside between houses at night It is the home’s responsibility to notify the CSCI when this requirement is met. 01/12/07 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 YA1 Good Practice Recommendations That the homes statement of purpose and service user guide are regularly reviewed and updated to provide accurate information in formats which are meaningful to residents and their supporters That all assessment information is recorded accurately, with all areas of need assessed and all records are signed and dated by staff completing the documents To introduce a person centred planning approach (for example essential life style and life story books) - some DS0000041321.V350538.R01.S.doc Version 5.2 Page 42 2. YA2 3. YA6 Riverside Care Centre progress and ongoing 4. 5. YA6 YA9 That all care plans / personal profiles contain a photo of the resident in the space provided That the Moving & Handling risk assessments are completed with scores and the name of hoist and size of sling to be used That the spiritual needs of residents, especially for the person who is recorded as Roman Catholic be discussed with them and relatives or advocates, with decisions recorded and action taken accordingly That TV programmes and use of the radio, and volume reflect the choices and preferences of the residents living in the house To introduce an improved system for the recording of routine health care appointments to allow for easier monitoring and auditing. - Partly met That the Riverside Active Care Learning Disability Services Initial health Check records are fully completed, signed and dated with all required information such as medication listed and information which accurately reflects assessment information and has base line information such as weight on admission recorded. That staff signature lists are up to date and that staff sign and date the medication policy / procedure to demonstrate their awareness and compliance. That all handwritten entries on MAR sheets are signed and witnessed by two appropriately trained staff That the complaints procedure is available in a format suitable for service users (such as audio, pictorial). In progress That the environment be improved 1. Wall unit damaged Winter House to be repaired 2. Room 4 loose radiator cover to be rectified 3. Door to room 8 not closing into rebate to be rectified 4. Rectify loose earth cables in en suite shower rooms 5. All bins need lids Room 7 Catesby and kitchen in Littleton DS0000041321.V350538.R01.S.doc Version 5.2 Page 43 6. YA13 7. YA14 8. YA19 9. YA19 10. YA20 11. 12. YA20 YA22 13. YA24 Riverside Care Centre 6.Need to risk assess the house in respect of security 7. Need to obtain Safer Food, Better Business 8. Need screening for kitchen doors to prevent pest entry 14. YA26 That inventories of residents personal property, including furniture, should be regularly complete, updated, and signed To consider providing a sensory garden for service users. Not Met That all references are dated and signed by referee and to check that dates of employment correlate with those given by the applicant on the application form. That staff are employed on a supernumerary basis until they have completed their induction training. 17. YA34 That all application forms are fully completed with full employment history, and signed by applicant, with accuracy and any gaps explored and documented That references are obtained from the last social care employer or reasons recorded where this is not possible That risk assessments in place for staff working on a PoVA first basis are fully completed and contain the named supervisor(s), and these are appropriately recorded on staffing rotas That the induction for new staff is developed and implemented to demonstrate evidence of common induction standards Skills for Care That a letter of outcome is provided to conclude the investigation of the member of staff involved in the medication error and that staff disciplinary records are signed by the author To review the central staff training matrix to ensure that it is accurate and up to date and corresponds with training certificates held on the premises to confirm training has taken place. - Progress, partly met That attention should be focussed on the gaps in mandatory training, and prioritised. 15. 16. YA28 YA34 18. 19. YA34 YA34 20. YA34 21. YA34 22. YA35 23. YA35 Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 44 24. YA39 That the homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate, verified information and fuller details of the supporting evidence of what the home does well and the improvements made That the organisation should take action to ensure that all Regulation 37 notifications are received at the correct CSCI office in a timely manner and explore any instructions which may cause deviation from compliance That daily records are reviewed to avoid duplication, especially daily food and fluid intake charts, which should be fully and accurately completed, and monitored That all accident records are collated, with a fully documented monthly accident evaluation and analysis, monitoring trends and identifying control measures to minimise risks That documentary evidence of the previous 3 months accident audit and analysis is forwarded to the CSCI as a priority. 25. YA41 26. YA41 27. YA42 28. YA42 That the need for appropriate ramped access to the houses is explored, especially in relation to the male resident observed to be in a wheelchair freewheeling from the house and almost colliding Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 45 Commission for Social Care Inspection Halesowen Records Management Unit West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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 Riverside Care Centre DS0000041321.V350538.R01.S.doc Version 5.2 Page 46 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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