Inspection on 30/04/07 for Riverside Care Centre

This inspection was carried out on 30th April 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Riverside Care Centre Sawley Clitheroe Lancashire BB7 4LF Lead Inspector Mrs Christine Mulcahy Unannounced Inspection 10:30 30th April 2007 X10015.doc Version 1.40 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 DS0000068661.V331974.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Care Centre Address Sawley Clitheroe Lancashire BB7 4LF 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) 01200 441205 01200 440130 Canterbury Leased Homes Limited Mrs Gail Linda Ainsworth Care Home 40 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (2) of places Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:*Up to 38 service users in the category of DE (E) (Dementia over 65 years of age). *Up to 2 service users in the category of OP (Old age not falling within any other category). When the named service users in the category of OP leave the home, the registered person shall apply in writing to make all places DE (E) 2. Date of last inspection Brief Description of the Service: Riverside Care Centre is registered with the Commission for Social care Inspection to provide Care and accommodation for up to 40 older people who have dementia. The home is situated in the Village of Sawley near Clitheroe in the Ribble Valley. It is a detached property set in its own grounds. Riverside Care Centre is made up of a one level purpose built unit and a 3 storey Victorian house. Both units give the people who use the service good access to all facilities in the home. Six bedrooms are en suite. The old house provides accommodation on two floors access to the first floor is via a stair lift. Bedrooms are single occupancy and some are en suite and are situated on the ground floor of the home. There are a number of lounge and communal areas throughout and both units provide the resident’s with the opportunity to mix socially or enjoy their privacy. There is a secure courtyard with a sensory garden and ample parking to the front of the building. A village hall and public house are nearby and there is a return bus service that provides transport to Clitheroe once a day. If people want to use this service they should book in advance. Service users receive a copy of the service user guide and have access to the Statement of Purpose. Fees range from £355.50 - £460 per week and service users are billed separately for hairdressing, newspapers, magazines, toiletries and night time incontinence pads. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection included a visit to the home and took place on 30th April 2007. Information was obtained from care plans, staff records, management systems, observations, relative surveys and policies and procedures. The inspector also spoke to 3 resident’s, 2 staff, the visiting hairdresser, and the manager. The Commission for Social Care Inspection have received 2 complaints about the service since the last inspection. and requirements were made under the Homes Refulations 2001. What the service does well: What has improved since the last inspection? Chairs are no longer used to prevent a resident from falling out of bed and there is a safe system in place that has been risk assessed to ensure the safety and wellbeing of the resident. The care plans of the people who use the service are currently under review and residents are being fully assessed to determine the level of risk. All incidents and accidents are now recorded in the homes only official accident book and are not recorded separately in another book. This means that there is a clear and easy to follow audit trail of all accidents and incidents that occur in the home. Therefore the manager is able to measure the frequency of incidents and accidents and ensure mechanisms are in place to protect residents and staff from harm and ensure a safe environment. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 6 A competent handy person has been recruited to carry out regular routine maintenance and repairs in the home and record the findings. This means that the health, safety and welfare of the people who use the service are better promoted and protected. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 2, 3 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all people who use the service and their representatives were given sufficient information on which to base their choice of home. EVIDENCE: The service user guide has been reviewed but needed to include a copy of the homes complaints procedure and information about the number of places provided. A copy of the homes statement of purpose was not available to people who use the service or their representatives. This means that these people might not be clear about the overall care and what is provided in the fee. A new resident admitted on 28/02/07 had not been given a contract and there were no records signed by him or his representative to validate his admission to the home. This means that the resident and his representative would not be Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 9 fully aware of the terms and conditions of his stay at the home including liability and periods of notice. Intermediate care is not provided at the home. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all resident’s care needs were included in a regularly reviewed plan of care that held accurate information. This meant that resident’s personal and health care needs couldnt be met properly. Resident’s were not fully protected by the homes medicine policies and procedures. The principles of respect and privacy were not always observed. EVIDENCE: Case tracking of one resident highlighted that he had a plan of care. However the care plan examined that was in place was poorly developed and did not fully reflect the person. The nutritional assessment relating to the resident’s weight on admission had not been completed and a weight loss or gain could not be fully determined. The admission assessment form didn’t give the GP contact details and there was no information to inform staff about his routine preferences, recreation, sleep and last wishes. This meant that staff did not have enough information about the resident to meet his health care needs. Baseline observations of the resident’s temperature and blood pressure were Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 11 not completed neither was information about the resident’s personal and health care, orientation, memory, thought content, anxiety, mood, awareness and interaction. This meant there was not enough information for staff to fully meet the emotional and psychological needs of the resident and the key worker had signed the incomplete form. The night care profile did not include the resident’s preferred bedtime and the resident’s date of birth on this form was wrong. A general risk assessment was completed but not signed by the staff or resident or their representative and a moving and handling assessment was only part completed along with other health care records. The care plan seen was made up of a list of health care statements and staff ticked a box next to the statement they felt applied to the resident. Although there was room for the staff to include further comments these areas were not completed. The care plan also gave pre written problems and expected outcomes and a list of tasks for staff to do to meet the expected outcome. Although there was space for staff to write further information staff did not include further details from their observations about the resident. It was apparent this method of care planning did not promote a person centred approach to fully meet the needs of older people with dementia. The care plan examined did not have a planned review date and had not been reviewed monthly. People who use the service have access to health care services within and out of the home. Those unable to access local services can have visits to the home by health care professionals. One resident was observed at the home discussing a health issue with his GP in the treatment room while the door was open. This meant that some staff and visiting professionals were unaware of the need to treat people who use the service with respect and dignity. Although medication records examined were up to date a tube of eye cream did not show the date of opening also some prescribed skin creams were being stored in a very warm under stairs cupboard and had melted. The manager was advised to stop using because they might be harmful to the resident’s. All other medication was stored securely and correctly. Six care staff are trained in the safe handling of medication. There is a lack of training for night staff in the safe handling of medication and there is only one night staff trained to administer medication at night. This means that the people who use the service might not have a choice in when they receive their night time medicines and going to bed times would be restricted because they couldn’t stay up later if they wanted to. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of leisure and recreational activities meant that resident’s autonomy and choice in relation to social needs and interests were not maximised and were not being met. EVIDENCE: Case tracking using a resident’s care plan showed that it held information about his activities of living and how these activities affected his health and wellbeing. However some areas of the care plan had not been fully completed and lacked information about recreation and interests. This meant there was not enough information to provide needs led, life-enhancing activities. Observations made throughout the day highlighted the need for activities to be in place to satisfy the social cultural and recreational needs of the people who use the service. One resident was seen reading a newspaper others were seen wandering around the home throughout the day. Although the hairdresser was seen doing peoples hair it was apparent that the resident’s had no meaningful daytime activity and there was nothing in place to suit their needs and preferences. Care staff were very busy keeping up with the work that needed Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 13 to be done and there were not enough staff to offer sufficient recreational activities. The manager said that an activities coordinator was employed for a short time but left so they were again looking to recruit somebody to do this job. Visiting was flexible and relatives of the people who use the service were seen at various times during the day. A comment from a relative who used the CSCI relative survey stated, “More staff and stimulation for resident’s is needed, I’m not aware of events held on a weekly basis”. Menus were changed regularly and there is always a choice of meals. Hot and cold drinks were available throughout the day and these were given out when needed. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 & 17 Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. People who use the service have access to an effective complaints procedure and are protected from abuse. EVIDENCE: There is a complaints procedure that meets the National Minimum Standards and Regulations. The procedure is up to date and is displayed on the notice board in each unit. A number of relatives of the people who use the service commented that they have never needed to complain about the service. Records of complaints made were examined were fully recorded with timescales and outcomes. Policies and procedures for safeguarding people who use the service are in place. The home understands the procedures for safeguarding adults and complies with external agencies and CSCI to provide information when required. Outcomes identified from previous referrals were well managed and issues were resolved to the satisfaction of those involved. Out of 21 care staff 14 have been trained in this area. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables the resident’s to live in a safe and well-maintained environment. EVIDENCE: The home provides a physical environment that is appropriate to the people who live there and is in the process of redecoration. A new kitchen has been fitted in the original building and there is a new clinic area with enough room to store a medicine trolley and related records securely. A planned schedule of work that includes recent purchases made including new furniture, carpet, window blinds and curtains was examined. Throughout the home there is evidence that the change of ownership has made positive improvements to the resident’s living environment to ensure that resident’s are comfortable in their home. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 16 The home is well maintained and provides specialist aids and equipment to meet the resident’s needs. The home allows small groups of people to share communal areas with opportunities to meet relatives and friends in private. Bedrooms are fitted with locks suitable for resident’s capabilities and people who use the service are encouraged to personalise their bedrooms with their own possessions. Bathrooms and toilets are located near to bedrooms. The home is well lit, clean and tidy and smells fresh. A relative who used the CSCI comment card stated, “The home is kept clean and always smells fresh. The bedrooms are very homely”. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of training in health and safety and dementia care might place residents and staff at risk of harm. EVIDENCE: Observation of the care provided and examination of the staff rota showed there were just enough staff to meet the resident’s basic needs but not enough staff to fully meet their needs. There were gaps in the staff rota for day and night duties for the week ahead. The manager said that six care staff had left the home since the new ownership last year and there was a recruitment drive to fill these posts. She said that the staff team were very good and would volunteer to work the duties not covered. The manager said that if agency staff were used the home always used the same agency workers who were familiar with the home and the resident’s. The majority of the staff team were all white British but this reflected the people who currently use the service. The manager recognises the importance of training and tries to support the staff development by following a training plan. Training for staff in health and safety topics was not sufficient and only 4 care staff were trained in dementia care. This meant that the majority of care staff could not fully meet the needs of the residents because they did not have the appropriate knowledge or skill Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 18 to do so. An insufficient number of staff had first aid training and this meant there was not always a person qualified in first aid on duty. Observations of some care staff at work showed they were competent and clear about their role and what was expected of them. One relative stated, “Riverside staff provide the care needed by people with dementia without forgetting the love and respect they also need”. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lack of systems for monitoring the quality of care delivered at the home meant that it could not be shown that the service was being run in the best interests of the people who use the service. EVIDENCE: The manager has the necessary experience to run the home and meet the basic processes of the National Minimum Standards. She is aware of the need to keep up to date with practice and regularly arranges training for herself and the care staff. When asked about the manager care staff said they were confident about her abilities. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 20 There was no annual development plan and there were no mechanisms for auditing and developing the new care plan system to ensure it could properly identify the resident’s needs. Residents’ finances were managed and recorded correctly. The amount held for 1 resident was checked against the records and found to be correct. The money was kept securely. A new maintenance man had been employed to ensure regular checks were done on appliances and fire equipment. The fire alarms were checked weekly and servicing of gas, appliances and the moving and handling equipment had been done. Water temperatures were recorded. Supervision was being done for staff. A record of this was seen in one file that was examined. Staff meetings were being held frequently. New policies and procedures have been introduced to help improve and develop the service and the manager is aware that more work is needed in this area to meet the homes philosophy, aims and objectives. Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation Schedule 1 Requirement To ensure that people who use the service have the information they need to make an informed choice about where to live the registered manager must provide prospective residents and their representatives with up to date copies of the service user guide and statement of purpose. So that people are clear about the overall care provided and the terms and conditions of their stay at the home including liability and periods of notice the registered manager must ensure that people who use the service are provided with a statement of terms and conditions at the point of moving into the home. So that the needs of the people who use the service are fully met the registered manager must ensure that the service user plan is fully completed and provides accurate up to date information about each individual resident. Accurate and up to date records of medication stored in the home must be kept to prevent mis administration to the people who use the service. Timescale of 24/01/07 not met Night care staff must be trained to administer medication at night DS0000068661.V331974.R01.S.doc Timescale for action 30/04/07 2 OP2 5 (1) 30/04/07 3 OP7 15(1)15(2 ) b,c 29/06/07 4 OP9 13(2) 30/04/07 5 OP9 4(c) 18(1,c)(i) 03/08/07 Riverside Care Centre Version 5.2 Page 24 OP14 12(2)(3) 6 OP10 12(4)(a) 7 OP12 16(2)(n) so that that the people who use the service have a choice in when they receive their night time medicines and the time they retire to bed. Timescale of 07/07/06 not met Suitable arrangements to ensure 30/04/07 residents privacy and dignity are maintained must be in place when they need to see their GP at the home. To ensure that the social 03/08/07 interests and needs of the people who use the service are being fully met the registered manager must provide opportunities that meet the preferences and social interests of the resident’s. Timescale of 23/06/06 not met 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 OP8 Good Practice Recommendations Nutritional screening of resident’s should take place on admission to the home to ensure the health care needs of the people who use the service are known and fully met by care staff. Care staff must receive training appropriate to the work they are to perform to ensure that the needs of the people who use the service are fully met. Mechanisms for auditing and developing the new care plan system must be put in place to ensure it can properly identify the resident’s needs. 2 OP30 3 OP33 Riverside Care Centre DS0000068661.V331974.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 DS0000068661.V331974.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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