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Inspection on 24/05/05 for Riverside Care Centre

Also see our care home review for Riverside Care Centre for more information

This inspection was carried out on 24th May 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Statement of Purpose and Service User Guide are very good in providing residents with lots of information about the service they receive. Residents are encouraged by staff to treat Riverside as their own home and to be as independent as they wish. Through out the inspection day they were seen making drinks, preparing food and tidying their bedrooms. Residents are able to make their own choices and are not forced to do things against their own wishes. For example, one resident wanted to have lunch in their own bedroom. One resident stated "I like being able to help". Another resident spoke about their forthcoming birthday plans and that they were going to a local pub for a meal with other residents. There were fresh flowers in their bedroom which had been brought by other residents as a birthday present. One resident said "I like to go food shopping and clothes shopping every week". Staff encourage residents to maintain links with their relatives. Residents stated that they could see their families in their own bedrooms if they wished. Each unit has displayed photographs of the residents who live there and the staff who work for them. There are notice boards containing information for residents in pictures and photographs. During interviews staff reported that they were able to approach the manager if they had any issues and felt listened to. The new Manager is making a positive difference. There are good recruitment and selection procedures in place for new staff with appropriate checks undertaken before staff start work. Complaints are dealt with appropriately.

What has improved since the last inspection?

There was lots more positive interaction seen between staff and residents and there was a friendly atmosphere in the home. For example, staff were seen to be helping one service user write a letter to their relative. Staff can now eat their meals with residents and help them with eating their own meals if needed. Residents are now encouraged to raise any issues through regular meetings and are consulted about how they want their home run. For example one resident proudly showed their new curtains and bed which they had chosen for themselves. All bedrooms are individually decorated and furnished according to residents` own tastes and preferences. Residents stated that staff respect their privacy and knock their bedroom doors before they enter. The manager has introduced meetings for relatives to visit and give feedback about the service. The premises is greatly improved with new and more comfortable furniture. All areas of the home were clean and tidy. A new specialist bath has been purchased for one of the units. Since the last inspection the staff group has been more consistent. resident said "I like all the staff here. We have had some new ones." OneStaff are introducing care plans and pictorial care plans with the help of residents. This helps residents in recognising the support and care they are receiving and identify what they like and don`t like. There is also now a comprehensive statement of purpose and service user guide which gives lots of information to residents about the service provided by the home.

What the care home could do better:

Although care plans are improved there are still areas where further progress is necessary, particularly in approaches to help residents make their aspirations and wishes known. Improved recording and monitoring of health care appointments is also needed in order to ensure that residents needs are fully met. Outings in the community have become reduced for a number of reasons. There needs to be an assessment of residents` needs to ensure that there are enough staff on duty to take them out individually or in groups if they so wish. In particular some residents now need more assistance and therefore extra staff are required. One resident stated "It`s O.K. (here), but I would like to go out more". At meetings residents have asked to go on different outings and said that they would like to go out for more meals. Residents still have to pay for their own holidays. An annual holiday for residents has not yet been organised because of issues relating to staff payand changes made by the new owner. It is hoped that this is sorted out soon as residents clearly enjoy going on their holiday. Staff need to receive more training in order for them to carry out their duties and meet residents` needs. The home could do with some new transport. The current mini-buses are old, unreliable and compromise residents` dignity.

CARE HOME ADULTS 18-65 Riverside Care Centre Wolverhampton Road, Wall Heath,Kingswinford West Midlands DY6 7DA Lead Inspector Jayne Fisher Unannounced 24th May 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Riverside Care Centre Address Wolverhampton Road, Wall Heath, Kingswinford, West Mids, DY67DA 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) 01384 404652 01384 404797 Highfield Healthcare Centres Ltd Dee Edwins (Acting) Care Home 24 Category(ies) of Learning disability (24), Physical disability (24) registration, with number of places Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: To ensure that there is a dedicated staff group for each unit. This condition is met. Date of last inspection 12th October 2004 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 the 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. The turfed area of the bottom of each garden is bordered by a brook. The Home provides accommodation for twenty-four service users who have a learning disability and may also have a physical disability. User’s 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 all three houses. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted between the hours of 8.30 a.m. and 7.30 p.m. by two inspectors. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: formal interviews with the manager and support staff who were on duty. There was a tour of the premises. All residents were at home during varying parts of the inspection process. Some residents were happy to chat with the inspectors although open dialogue was not possible with all residents. A number of records and documents were examined. Other information was gathered prior to the inspection from previous inspection reports, Regulation 37 notifications (notification to CSCI by the home of any incident which affects the health, welfare or safety of residents) and an action plan submitted by the home after the previous inspection. What the service does well: Statement of Purpose and Service User Guide are very good in providing residents with lots of information about the service they receive. Residents are encouraged by staff to treat Riverside as their own home and to be as independent as they wish. Through out the inspection day they were seen making drinks, preparing food and tidying their bedrooms. Residents are able to make their own choices and are not forced to do things against their own wishes. For example, one resident wanted to have lunch in their own bedroom. One resident stated “I like being able to help”. Another resident spoke about their forthcoming birthday plans and that they were going to a local pub for a meal with other residents. There were fresh flowers in their bedroom which had been brought by other residents as a birthday present. One resident said “I like to go food shopping and clothes shopping every week”. Staff encourage residents to maintain links with their relatives. Residents stated that they could see their families in their own bedrooms if they wished. Each unit has displayed photographs of the residents who live there and the staff who work for them. There are notice boards containing information for residents in pictures and photographs. During interviews staff reported that they were able to approach the manager if they had any issues and felt listened to. The new Manager is making a positive difference. There are good recruitment and selection procedures in place for new staff with appropriate checks undertaken before staff start work. Complaints are dealt with appropriately. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 6 What has improved since the last inspection? There was lots more positive interaction seen between staff and residents and there was a friendly atmosphere in the home. For example, staff were seen to be helping one service user write a letter to their relative. Staff can now eat their meals with residents and help them with eating their own meals if needed. Residents are now encouraged to raise any issues through regular meetings and are consulted about how they want their home run. For example one resident proudly showed their new curtains and bed which they had chosen for themselves. All bedrooms are individually decorated and furnished according to residents’ own tastes and preferences. Residents stated that staff respect their privacy and knock their bedroom doors before they enter. The manager has introduced meetings for relatives to visit and give feedback about the service. The premises is greatly improved with new and more comfortable furniture. All areas of the home were clean and tidy. A new specialist bath has been purchased for one of the units. Since the last inspection the staff group has been more consistent. resident said “I like all the staff here. We have had some new ones.” One Staff are introducing care plans and pictorial care plans with the help of residents. This helps residents in recognising the support and care they are receiving and identify what they like and don’t like. There is also now a comprehensive statement of purpose and service user guide which gives lots of information to residents about the service provided by the home. What they could do better: Although care plans are improved there are still areas where further progress is necessary, particularly in approaches to help residents make their aspirations and wishes known. Improved recording and monitoring of health care appointments is also needed in order to ensure that residents needs are fully met. Outings in the community have become reduced for a number of reasons. There needs to be an assessment of residents’ needs to ensure that there are enough staff on duty to take them out individually or in groups if they so wish. In particular some residents now need more assistance and therefore extra staff are required. One resident stated “It’s O.K. (here), but I would like to go out more”. At meetings residents have asked to go on different outings and said that they would like to go out for more meals. Residents still have to pay for their own holidays. An annual holiday for residents has not yet been organised because of issues relating to staff pay Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 7 and changes made by the new owner. It is hoped that this is sorted out soon as residents clearly enjoy going on their holiday. Staff need to receive more training in order for them to carry out their duties and meet residents’ needs. The home could do with some new transport. The current mini-buses are old, unreliable and compromise residents’ dignity. 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 Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 5 The homes Statement of Purpose and Service User Guide are excellent, providing service users and prospective service users with details of the services the home provides enabling an informed decision about admission to be made. EVIDENCE: The Home has now produced a statement of purpose and service user guide that it meets the requirements of the Care Homes Regulations 2001 and National Minimum Standards. The service user guide is a particularly well written document which explains what services are offered in a meaningful manner. The Home has had no new admissions. Examination of the admission policy reveals this to be a comprehensive document so that any prospective service users will be thoroughly assessed prior to their admission to ensure that the home can meet their needs. There is a comprehensive assessment tool and all existing service users have been thoroughly assessed by a care consultant employed by the organisation. All specialist services are offered for persons with complex needs such as psychology and psychiatry. The home still needs to progress plans to ensure that all staff have the training necessary to ensure that they can meet the needs of service users (see further comment in standard 42). Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 10 On examination each service user has a contract/terms and conditions of occupancy. Only slight improvements are necessary for example with regard to specifying the room number occupied and any additional charges such as the annual holiday. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 and 9 Care plans require some expansion, updating and review as they do not all cover aspects of personal, social and health care in sufficient detail; this has the potential to place service users at risk. More efforts are now being made to consult service users about the running of the home and as a result they are able to influence decisions. EVIDENCE: A sample of care plans and risk assessments were examined. There has been a marked improvement in the quality of care plans. Each unit has made progress, some more than others. It was particularly pleasing to see that much effort has been made in producing communication passports and developing care plans in pictorial formats. Some staff have received training in care planning which has assisted with the progress made. Person centred planning is taking place but the home needs to expand approaches in order to assist service users further with making their wishes and aspirations known such as essential life style planning. There was evidence that some care plans had been reviewed with service users, families and professionals. Further progress is necessary as one care Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 12 plan examined had not been reviewed with family and other professionals since 2000. A review meeting had taken place for one service user on 5 April 2005 however on perusal of the minutes the care plan had not been updated with the agreed changes; some action identified had not taken place. Some care plans need to be more individualized to reflect the needs of the specific service user for example with regard to social inclusion. Care plans need to be produced for service users who are epileptic and who need assistance with pressure area care. For example, one service user has been assessed as high risk of developing pressure sores but there was no care plan in place. One care plan seen for pressure area care needed expansion as there was no mention of pressure relieving equipment. All care plans seen contained excellent daily reports completed by staff. Monthly key worker reports are also being introduced. Formal systems for recording and monitoring challenging behaviour are now being used. The home has good risk assessments in place which cover a range of topics. The home uses a professional risk assessment tool to identify the risk of pressure sores (the Waterlow score). Only slight improvements are required. For example risk assessments with regard to hoist transfers need to specify the exact level of maintenance and service checks required and sling size used. Information was supplied to the home to update risk assessments with regard to wheelchair users. There is evidence through discussion with service users and examination of records that they are being offered opportunities to participate in the running of the home. Service users are able to raise issues at meetings but the home needs to document what action is taken to address items raised during these forums. Further progress is necessary in order to demonstrate that service users have opportunities to participate in all aspects such as the development of policies and procedures, recruitment and selection of staff. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Staff support service users to learn and use practical life skills thereby encouraging independence which enriches their lives. Access to the community has been restricted and as a result service users are not always able to enjoy social stimulation and follow their own hobbies and interests. EVIDENCE: Service users in all three units were observed in undertaking a variety of independent living skills tasks through out the inspection day. Care plans contained goals with regard to this aspect of their care. Examination of comprehensive daily reports confirmed what activities service users undertake during the day and evening. Service users were seen making drinks, helping prepare meals, washing up, tidying their bedrooms etc. The majority of service users attend day centres, hobby clubs and local colleges during the week. Although service users do have access to the community and enjoy some trips and outings this is not at a frequency they would like. During interviews Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 14 service users stated that they would like to go out more. This had also been raised during service user meetings with residents identifying that they would like to go out for more meals and on various day trips. Care plans need to be more specific and related to service users’ individual preferences rather than just stating that staff need to ‘encourage’ community activities. Not all service users’ individual activity programmes identified community based activities. Records examined confirmed that activities are not taking place as regularly as they should be according to programmes. For example, during a ten day period one service user had only been out on one community based activity (other than attending their day centre). There were a number of reasons given for the restriction in outings. For example the three mini-buses are not always road worthy and because of their age have to keep undergoing repairs. On occasions the home does not have enough qualified staff to drive the mini-buses. As a consequence service users have to be driven to their day centres in relays which can mean long waiting times. There were complaints from staff that they did not have sufficient funds to arrange service user outings. For example, 2 units recently went to visit a circus, the third unit was unable to go as they had lent money to one of the other units for purchasing food! Another reason given is insufficient staffing levels particularly at weekends and increased dependency of service users. This was discussed with the manager who stated that reviews of staffing levels had already been undertaken due to increased needs of service users and outcomes were being discussed with the service provider (see further comment in standard 33). The manager confirmed that there were funds available for recreation but that a separate budget had yet to be allocated due to changes in the ownership of the organisation. In the interim the home can use petty cash to fund community activities and outings. The manager stated that she was in the process of centralizing the petty cash systems to simplify and improve procedures. It was suggested that in the interim written protocols are devised for staff guidance with regard to funding outings and activities. Each unit has an activity wall planner. It was pleasing to note that these are now accurate and are being followed. The quality of wall planners varied in each unit. For example in one unit there was a colourful detailed pictorial/photograph daily wall planner and also individual service user weekly activity programmes displayed. Another unit had a written wall planner and still needs to develop a pictorial/symbol type activity programme. The home has continued to make improvements to meals and mealtimes. For example staff were seen to be assisting service users with eating in a professional manner. There was a more congenial atmosphere with staff eating meals with residents. There is improved record keeping with regard to service users’ choices from the daily menu. There are currently no service users on specialised diets. Not all units were able to demonstrate that they had carried out a documented consultation with service users regarding the Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 15 menu. This was said to have been discussed during service users’ meetings Food supplies and stock but no minutes were available to evidence this. rotation varied in each unit. Two units were extremely well stocked and one unit had good stock records maintained. However another unit had limited supplies and did not have sufficient stock to follow the next day’s menu plan despite carrying out a weekly ‘big’ shop which was also supplemented by daily food shopping. Although it is recognised as good practice that service users are now being encouraged to undertake shopping duties, adequate food supplies must be maintained in order to follow the weekly menu and provide choice with regard to alternatives. There were no stock records maintained in this unit. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The health needs of service users are well met however, slight improvements are necessary in order for closer monitoring and recording with regard to certain potential health care complications to further enhance and ensure healthcare needs are met. There are good procedures relating to the control and administration of medication although further improvement is necessary in some areas to ensure service users’ needs are met. EVIDENCE: There were good records maintained with regard to service users’ preferred daily routines however there was still some conflicting information in respect of care plans and procedures relating to night time checks. For example a couple of service users had chosen to not have night time checks or only receive one check during the night. According to records however, night staff were still carrying out more regular checks. The Home is currently completing a ‘priority screening for healthcare’ booklet for all service users along with the primary care team and community learning disability nurse which is a good initiative. However, some of the information needs to be updated with more accurate details. For example there was no mention of one service user’s skin condition and one tool stated that the service user had epilepsy which staff said was not the case. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 17 The home is now undertaking regular (and recorded) weight checks. All nutritional screening tools examined were up to date and fully completed. One of the units had completed a detailed health care summary tool which allows for easy monitoring of all health care appointments. Two of the units had the same tool but the quality of information was variable. For example in one unit it was not possible to determine from either the health care summary sheet or daily reports that a service user had received an up to date ophthalmic check. There were also no details of a dental check. The Home is trying to make referrals for health screening with regard to potential complications such as testicular, breast and cervical cancer. However, care plans still need to be devised with regard to these particular aspects of health care. Guidelines need to be established for staff in individual care plans with regard to observation of any physical abnormalities whilst carrying out personal care tasks. Staff were said to be awaiting training before this is completed. There were improvements with regard to diabetic care plans and monitoring. Any deficiencies identified were corrected on the day of the inspection. In general there are good procedures relating to the administration and control of medication although some improvements are necessary as identified in the Requirements section of this report. For example, the home had returned one service user’s PRN ‘as and when required’ medication but had not obtained a new supply before disposing of the out of date stock. Staff had signed one medication administration record (MAR) sheet on four occasions in error, to signify medication was administered when it was not given as per instructions. As discussed with the manager where service users are unable to give verbal consent to medication, consent must be addressed via review meetings with advocates. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Complaints are handled objectively and action is taken to look into concerns raised. Some improvements have been made with regard to vulnerable adult abuse policies and procedures; although more progress is necessary in order to offer service users with more safeguards from abuse. EVIDENCE: The home has a comprehensive complaints policy and keeps an up to date complaints log. Records and interviews confirmed that the manager has a proactive approach to dealing with complaints in a thorough and fair manner. The complaints procedure is openly displayed. An audio format is still required. During interviews staff gave competent responses to how they would deal with any issues relating to vulnerable adult abuse. However, not all staff have yet signed the vulnerable adult abuse policy. This requires updating as requested at the previous inspection and to reflect legislative changes. The home needs to obtain a copy of the Local Authority vulnerable adult abuse procedures. The home still needs to provide all staff with training in vulnerable adult abuse. The home has a whistle blowing procedure which is openly displayed. However, the names and contact numbers of senior staff within the organisation need to be identified for whom staff can contact rather than just stipulating ‘the director’. An evaluation of financial procedures and policies will be undertaken at the next inspection. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30 The standard of the decor, quality of furniture and furnishings has greatly improved thereby providing service users with a more comfortable and homely environment. Only slight improvements are necessary with regard to providing a safer and more accessible premises for service users with disabilities. EVIDENCE: An inspection of the home confirmed that much improvement has been made since the last inspection. For example, the premises were clean and tidy through out. Shabby and old furniture has been replaced and there is new carpeting. As a result the general appearance of the home is much enhanced, and is comfortable and practical for service users. Service users were happy to show the inspectors their individual bedrooms. These were all clean and comfortable with lots of personal touches. Service users spoke about how they had chosen their own furnishings and furniture. There was also documented evidence that residents had been consulted about redecoration and lighting in their bedrooms. The quality of bedding and linen is much improved; there were only a couple worn pillows noted. The manager stated that there were sufficient stocks to replace these immediately. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 20 The home still needs to provide more suitable storage space for wheelchairs (or to specify that this is not a facility in the statement of purpose). The lawns and gardens also still need to be made more accessible for wheelchair users. Since the last inspection a new Parker bath has been purchased for one of the units. Catesby House also now requires a specialist bath as at least one of the residents cannot access the current facility. The home has been experiencing difficulties in water temperatures with regard to two ground floor showers in Littleton House. Staff report that when water is being run off the system elsewhere the shower temperatures fluctuate and become excessively hot. As a result they were not using the showers and were awaiting contractors to visit. Apparently this was an issue which they thought had been rectified a couple of weeks earlier but which had returned. The manager was asked to carry out an immediate written risk assessment which staff must sign to ensure that the showers are not used and that control measures are established to minimize risk should temperatures start to fluctuate when the showers are repaired once more. Some slight improvements are necessary with regard to infection control and in particular staff wearing appropriate protective clothing whilst carrying out food preparation. Any additional items are identified in the Requirements section of this report. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 After a period of considerable instability in staffing there is now a more stable staff group in order to provide consistency of care for service users. However, more improvements are needed providing staff with the necessary training in order to meet service users’ needs. Staffing levels are having an impact upon the quality of life for some service users. EVIDENCE: Last year the home had a 100 staff turnover. It was pleasing to see that only five staff members have left employment since the last inspection in October 2004. Unfortunately only 3 out of the current 31 care staff are qualified to NVQ II or above. There is evidence of some specialist training for example some staff have undergone training in dementia awareness and epilepsy awareness. However, both specialist and mandatory training requires improvement (see further comment in standard 42). As already stated in this report staffing levels have been impacting upon service users’ community outings. In addition due to decreased dependency of some service users, staff state that they are struggling some mornings to get service users ready for their day centres and attend to their personal care needs. There is an outstanding requirement for the home to send in staffing proposals to the Commission for Social Care Inspection (CSCI) using an appropriate staffing assessment tool. The manager has carried out an Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 22 assessment of dependency levels which shows a deficiency of some 85 hours per week. The manager states that this is currently being discussed with the service provider. In view of changes in service users’ dependencies the home must review this assessment and forward staffing proposals by the timescale identified in the action plan. On examination the duty rota requires updating. For example, the manager’s hours must be included; one unit does not identify the full name of the staff who are on duty. Not all units are conducting regular staff meetings. On examination the home has robust recruitment and selection procedures. Only slight minor improvements are necessary as identified in the Requirements section of this report. The home has started to implement an induction and foundation training programme for staff which meets the Sector Skills Council’s specifications. Seven staff have begun this training but unfortunately there has been problems with the accredited training agency. On further exploration it was ascertained that no staff have yet had their training modules assessed or verified. A new training facilitator has been identified. The home is now making progress with regard to ensuring that staff receive structured supervision although the frequency still needs to be improved upon. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 41, 42 and 43 Progress has been made in clarifying the lines of responsibility and accountability and to provide formal professional managerial support and supervision. As a result there is clear leadership with staff demonstrating an awareness of their roles and responsibilities thereby providing service users with enhanced care. Some improvements are necessary with regard to mandatory training in order to promote service users’ health, safety and welfare. EVIDENCE: The management of the home has stabilized with the current manager now being in post for nearly a year. During interviews staff demonstrated an awareness of their role and the needs of the service user group. There was a much improved atmosphere within the home and staff were observed in positive interaction with service users through out the day. The Home is currently developing the quality assurance system as required. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 24 Some improvements have taken place with health and safety, and food hygiene practice. For example all substances hazardous to health were found to be secure. There is now more regular testing of the fire alarm system and bi-annual fire safety evacuations. The home has had a fixed electrical wiring check and the manager states that works have been identified. A copy of the report was not available and this needs to be obtained in order to determine if any works need urgent action. The home does not keep a record of the annual servicing of wheelchairs and this needs to be addressed. There are some outstanding items identified at previous inspections. For example, risk assessments for substances hazardous to health (COSHH) still require updating. Although staff are aware of the procedure for manually disabling the passenger lift in the event of an emergency, a written procedure is still required. A full inspection of maintenance and service checks will be undertaken at the next inspection. As already stated mandatory training requires improvement. Fire safety and moving and handling has been undertaken by the majority of staff (although not all). The majority of staff have not undertaken training in first aid awareness, infection control or health and safety. There is a training plan in place which hopefully will address these shortfalls in the near future. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 x 2 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 2 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 1 2 2 2 Standard No 11 12 13 14 15 16 17 3 3 1 2 3 2 2 Standard No 31 32 33 34 35 36 Score x 1 1 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Riverside Care Centre Score 2 2 2 2 Standard No 37 38 39 40 41 42 43 Score x x 2 2 2 2 2 E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 26 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 5 Regulation 5(1)(b) Requirement To ensure that service user contracts/ statement and terms of conditions are issued to all users and contain specific information with regard to rooms to be occupied and all information as required by Standard 5.2 (Previous timescale of 1/11/03 is partly met. 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. To introduce a person centred planning (or essential life style and life story) approach. (Previous timescale of 1/10/03 is partly met). To ensure care plans are reviewed with the service user (involving significant professionals, family and advocates) at least every six months. (Previous timescale of Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 27 Timescale for action 1/9/05 2. 6 15 1/10/05 1/10/04 is partly met). To ensure that care plans are updated as and when needs change or new needs are identified following review meetings. 3. 8 12(3) To ensure that service user questionnaires are produced in a format suitable for users, and that these are completed and included in the service users’ guide. (Previous timescale of 1/11/03 is partly met). To offer more opportunities for service users to participate in the day to day running of the Home through joining staff meetings, representation in management structures, recruitment and selection of staff. (Previous timescale of 1/10/04 is partly met). To demonstrate how issues raised by service users during their meetings are actioned with written records maintained. To review and expand written risk assessments with regard to the use of bed rails, moving and handling and hoist transfers. To ensure that risk assessments are reviewed annually, or more frequently if required. (Previous timecale of 1/1/04 is partly met). To review and expand risk assessments for wheelchair users identifying risk associated with using posture belts and manufacturers specifications with regard to maintenance checks and frequency of servicing. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 28 1/10/05 4. 9 13(4)(c) 1/7/05 5. 12 12(3) 16(2)(n) To ensure that all activities are monitored and fully evaluated with written records maintained. (Previous timescale of 1/9/03 is partly met). To continue to develop pictorial activity wall planners. 1/9/05 6. 13 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 is not met). To ensure community inclusion is included in the care planning system. (Previous timescale of 1/2/04 is partly met). 1/9/05 7. 14 16(2)(n) 8. 16 17(1)(a) 9. 17 16(2)(i) To establish a written procedure/proctocol with regard to the financing and budgeting of service users recreational activities (including social inclusion). To ensure that staff are made fully aware of and follow this procedure. To provide an annual seven day 1/10/05 minimum holiday for service users which is included as part of the basic contract price. (Previous timescale of 1/8/03 is not met). To ensure that restrictions on 1/7/05 residents’ choices be negotiated, included in service user plans and reviewed regularly: decision not to provide bedroom door keys, certain items of furniture, personal care given by opposite gender staff, opening of users’ mail preferred bed times etc. (Previous timescale of 1/9/03 is partly met). To carry out a documented 1/7/05 Version 1.30 Page 29 Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc consultation with service users regarding increasing the variety of meals provided on the weekly menu plan. (Previous timescale of 1/9/03 is partly met). To ensure that records of food supplies and stock rotation is maintained. (Previous timescale of 1/1/05 is partly met). To ensure that the food temperature probe is regularly calibrated with records maintained. (Previous timescale of 1/1/05 is not met). To ensure that there is an adequate supply of food stuffs on the premises in order to be able to follow the weekly menu plan in all units. To obtain heated place mat for service user in Catesby House as identified at review meeting of 5/4/05. The Home should introduce a procedure for the monitoring of service users’ health with regard to potential complications such as breast screening, testicular screening etc. (Previous timescale of 1/8/03 is partly met). To improve systems for the recording and monitoring of all health care appointments. (Previous timescale of 1/7/04 is partly met). To review the practice of two hourly checks for all service users by night staff. To accordingly update ‘night management’ care plans for all individual service users. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 30 10. 19 12(1)(a) 1/8/05 (Previous timescale of 1/12/04 is partly met). To arrange ophthalmic, dental, audiology and chiropody appointments for all service users. (Previous timescale of 1/12/04 is partly met). To ensure care plans/ Priority Health Screening Tools contain accurate details with regard to service users health needs and conditions. To make the following improvements to the control and administration of medication: 1) To ensure that any changes to medication (including discontinuation) is recorded on the MAR sheet and written authorization is obtained from the prescriber with a record maintained in the care plan. (Previous timescale of 1/2/04 is partly met). 2) To ensure that consent is obtained to medication from each service user and recorded in the care plan. (Previous timescale of 1/10/04 is partly met). 3) To ensure that each unit has an up to date list of staff who are authorized to administer medication. (Previous timescale of 1/10/04 is not met). 6) To ensure that dates of opening are recorded on creams. 7) To improve stock rotation to ensure that any creams with exceeded expiry dates are disposed of. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 31 11. 20 13(2) 1/9/05 8) To carry out written risk assessments with regard to individual service users who self administer medication such as creams. 9) To ensure that any barrier preparations (such as Sudocrem) are either prescribed or included on the household remedy list. 10) To liaise with the pharmacist to ensure that medicines no longer required are removed from the computerized medication administration record (MAR) sheets. 11) To ensure that all staff responsible for the administration of medication sign and date the new administration policy. 12) To ensure that there is an adequate supply of as and when required PRN medication at all times. (New stock must be ordered and received prior to existing stock becoming out of date). 13) To ensure that medication requiring refrigeration is stored in a drugs fridge or kept in separate tin in the kitchen fridge. It must not be kept in one service users fridge stored in their bedroom which must be expressly used for their own medication. 13) To ensure more accurate recording on the administration of medication (MAR) sheets. Staff must double check the dosage and time before signing to confirm administration has Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 32 taken place. 14) To pursue plans to ensure that all staff receive training in the safe handling of medication from an accredited trainer. 15) To provide staff with training and written procedures regarding blood glucose monitoring and the Acu-check meter. Training must be approved by the primary care team with written records maintained of staff who are responsible and have received training. To ensure that service users 1/10/05 and/or their families’ wishes are ascertained with regard to ageing and death. This to be fully recorded on users’ care plans. (Previous timescale of 1/10/03 is partly met). To ensure that the complaints 1/9/05 procedure is available in a format suitable for service users. (Previous timescale of 1/8/03 is partly met). To provide all staff with training 1/8/05 in vulnerable adult abuse awareness. (Previous timescale of 1/9/03 is not met). To review and expand the adult protection policy. (Previous timescale of 1/10/03 is partly met). To obtain a copy of the Local Authority vulnerable adult abuse procedures. To ensure that the whistle blowing procedure includes the names and contact telephone numbers of senior staff who are to be contacted. 12. 21 12(3) 13. 22 22(8) 14. 23 13(6) Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 33 15. 24, 26, 27, 28 and 29. 23 To make the following improvements to the environment: 1) To identify and provide adequate storage space for wheelchairs (or if this is not possible to include this lack of facility in the statement of purpose and service user guide). (Previous timescale of 1/9/03 is not met). 2) To provide a documented maintenance and renewal programme for the fabric and decoration of the premises. To forward a copy to the CSCI. (Previous timescale of 1/2/04 is partly met). 3) To carry out a programme of external redecoration to make good worn paintwork. (Previous timescale of 1/2/04 is partly met). 4) To provide communal bathrooms with seating and storage for service users’ personal belongings. (Previous timescale of 1/2/04 is partly met). 5) To repair cracked seal around communal bath in Catesby House and repair damaged plasterwork. (Previous timescale of 1/2/04 is not met). 8) To ensure all parts of the garden area are accessible to wheelchair users. (Previous timescale of 1/2/04 is not met). 9) To provide telephone facilities for all service users to receive or make calls in private. (Previous 1/10/05 Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 34 timescale of 1/2/04 is partly met) 10) To provide suitable storage facilities for staff. 11) To ensure that bedroom doors in Catesby House shut suitably into rebate. 12) To remove empty fish tank from kitchen in Catesby House. 13) To repair broken extractor fan to laundry area in Catesby House. 14) To ensure that all swing/bins and other disposal receptacles are fitted with suitable lids. 15) To improve stock control regarding quality of bed linen. For example worn pillows must be immediately replaced. To introduce written procedures and/or check lists to ensure that this is maintained. 16) To progress plans to ensure that a more suitable specialist bath is obtained for Catesby House. 17) To ensure that repairs are progressed with regard to ground floor showers in Littleton House, to ensure that there are no fluctuations in temperature whilst in use (? by the fitting of thermostatic stabilizers). To ensure that there is a supply of liquid soap and disposable paper towels available in all kitchen areas at all items. To ensure that staff at all times Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 35 16. 30 13(3) 1/8/05 wear personal protective clothing whilst carrying out food preparation and cooking tasks. To install a paper towel dispenser in the kitchen area of Catesby House. To provide staff training in: 1) challenging behaviour. (Previous timescale of 1/9/03 is not met). 2) diabetes awareness. (Previous timescale of 1/12/03 is not met). 3) epilepsy awareness. (Previous timescale of 1/12/03 is not met). 4) To ensure that all staff are working to obtain an NVQ II or III by an agreed date; or the Manager must provide evidence to demonstrate that through past work experience staff meet this standard. (Previous timescale of 1/4/04 is not met). 5) To ensure that 50 of the staff team are qualified to NVQ II or above by 2005. 6) To pursue plans to ensure all staff receive training in dementia awareness. To obtain and use the staffing guidance issued by the DoH to reassess staffing levels against the assessed dependency of service users, the results to be forwarded to the CSCI for consideration; together with staffing rotas, which clearly identify care hours, ancillary hours, managerial supernumerary hours and 17. 32 18(1)(c) 1/8/05 18. 33 18(1)(a) 30/6/05 Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 36 provide information as to how many hours are spent outside of the premises by service users attending day care provision. (Previous timescale of 1/9/03 has been partly met as the home has previously sent in staffing proposals following an Immediate Requirement however a breakdown of dependency levels and staffing ratios is still required and reviews must be undertaken due to service users increased dependency. To ensure that an accurate and up to date duty rota is maintained at all times which reflects actual shifts worked by staff. (Previous timescale of 25/5/04 is partly met). To improve the frequency of staff meetings and ensure that these take place on a minimum of a bimonthly basis in each unit. 1/8/05 To confirm and obtain written evidence from Agencies providing temporary staff to the Home, that appropriate recruitment and selection procedures are being followed. (Previous timescale of 1/8/03 is partly met). To ensure that health questionnaires in respect of new staff are completed prior to their commencement of duties. To provide staff with training in equality opportunities and disability equality. (Previous timescale of 1/9/03 is not met). To ensure that new staff receive induction and foundation to Sector Skills Council specification Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 37 19. 34 13(6) 19(1)(b) 20. 35 18(1)(c) 1/9/05 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 timescale of 1/8/03 is not met however some progress is now starting to be made). To implement a formal system for the monitoring of timescales for completion of units and assessments of LDAF induction and foundation training. (Previous timescale of 1/10/04 is not met). To forward a written staff training and development programme to the Commission for Social Care Inspection (CSCI). This must identify all vocational, mandatory and specialist training which has been undertaken by individual staff and planned training with dates for completion. (Previous timescale of 1/12/04 is partly met). 21. 36 18(2)(a) To ensure that all staff receive regular recorded supervision sessions (at least six per annum). (Previous timescale of 1/11/03 is partly met). To ensure that all staff receive a recorded annual appraisal. (Previous timescale of 1/11/03 is not met). To introduce quality assurance and monitoring system which includes active feedback from all users of the service. (Previous timescale of 1/11/03 is partly met). E55 S41321 Riverside V228724 240505 Stg4.doc 1/10/05 22. 39 24 1/7/05 Riverside Care Centre Version 1.30 Page 38 23. 40 24 24. 41 17(1)(a) 25. 42 18(1)(c) The Home must provide policies and procedures that comply with current legislation and recognised professional standards (as listed in Appendix III of the NMS). These must be individualized to meet the needs of Riverside, must be dated, monitored and reviewed on a regular basis. (Previous timescale of 1/12/03 is partly met). To obtain and hold information and documents in respect of records to be kept in respect of each service user as listed in Schedule 3 of the Care homes Regulations 2001. (Previous timescale of 1/9/03 is partly met). To ensure that all staff receive training in: a) food hygiene awareness (Previous timescale of 1/9/03 is partly met). b) moving and handling including hoist transfers. (Previous timescale of 1/9/03 is part met). c) Infection control. (Previous timescale of 1/9/03 is not met). d) health and safety. (Previous timescale of 1/9/03 is not met). 1/9/05 1/8/05 1/8/05 26. 42 13(4)(c) e) first aid awareness. (Previous timescale of 1/9/03 is not met). To undertake the following 1/9/05 health and safety improvements: To ensure compliance with Control of Substances Hazardous to Health Regulations 1988 – carry out individual risk Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 39 assessments on all products used and to update COSHH information. (Previous timescale of 1/8/03 is partly met). To ensure the passenger lifts have been fitted with a full height multi-beam non contact safety edge system (or to carry out a written risk assessment if this safety device is not deemed necessary). (Previous timescale of 1/11/03 is not met). To undertake an electrical fixed wiring installation check. (Previous timescale of 1/2/04 is partly met). The home must obtain and use the new style Accident book from the Health and Safety Executive which should have been implemented on 31 December 2003. (Previous timescale of 1/8/04 is partly met). To establish a written procedure for the passenger lift escape system to safeguard service users from containment. Staff must be made aware of how to manually operate the lift system. (Previous timescale of 1/1/05 is partly met). To ensure that a record is maintained (or certificates) to confirm that wheelchairs have received an annual service. To undertake the following improvements to food hygiene practice: To repair broken seal around kitchen sink in Littleton House. (Previous timescale of 1/2/04 is partly met). Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 40 27. 42 13(4)(c) 1/8/05 To ensure that food stuffs requiring refrigeration are stored correctly at all times. To improve stock rotation to ensure any out of date food stuffs are identified and disposed of. (For example bottled sauce). The Home must provide a 1/9/05 business and financial plan which should be held on the premises and available for inspection. (Previous timescale of 1/9/03 is partly met). To ensure that copies of the monthly reports from visits undertaken by the Owners representative are available on the premises and a copy forwarded to the Commission for Social Care Inspection on a regular basis. 29. 30. 31. 32. 33. 28. 43 25 26(4) 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 20 Good Practice Recommendations To review the medication policy and procedures and make the minor amendments as recommended by the Commission for Social Care Inspection, pharmacist inspector. To reduce the excessive level of the ringing tone to the telephone in the Manager’s office, which can be overhead in adjacent service users’ bedrooms. To provide staff with training in cerebral palsy awareness and tissue viability. E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 41 2. 3. 26 32 Riverside Care Centre 4. 5. 13 To provide training for staff in care planning. To consider replacing the existing mini-buses with transport which does not compromise dignity or stimatize disabled persons. Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 42 Commission for Social Care Inspection Mucklow Office Park West Point Halesowen West Midlands National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverside Care Centre E55 S41321 Riverside V228724 240505 Stg4.doc Version 1.30 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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