Inspection on 07/03/07 for Riverside Care Centre

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Riverside Care Centre 09/09/08

Riverside Care Centre 11/09/07

Riverside Care Centre 08/06/06

Riverside Care Centre 07/11/05

Riverside Care Centre 24/05/05

Riverside Care Centre 12/10/04

Riverside Care Centre 25/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

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

CARE HOME ADULTS 18-65 Riverside Care Centre Wolverhampton Road Wall Heath Kingswinford West Mids DY67DA Lead Inspector Jayne Fisher Key Unannounced Inspection 7 and 8 March 2007 08:45 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Care Centre Address Wolverhampton Road Wall Heath Kingswinford West Mids DY67DA 01384 288968 01384 294836 riverside@activecarepartnerships.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Centres Limited *** Post Vacant *** Care Home 24 Category(ies) of Learning disability (24), Physical disability (24) registration, with number of places Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 24 LD and 24 PD, all of whom may be accommodated within Catesby, Winter and Littleton Houses, not exceeding the total number registered for. A separate staff group will be identified for each Unit namely Catesby, Winter and Littleton. 8 June 2006 2. Date of last inspection Brief Description of the Service: Riverside consists of three purpose built detached properties: Winter, Catesby and Littleton Houses. The properties were previously registered as separate care establishments but at the request of previous Registered Providers the Home is now Registered as one premise managed by one person. A Condition of Registration has been imposed: that each unit has a dedicated staff team. Riverside is built in the picturesque grounds of Holbeche House situated on the main A449 Wolverhampton to Stourbridge Road and within walking distance of Kingswinford. There is a shared driveway/car parking area at the front of the properties. There is a garden to the rear of the properties, which is separated from the adjoining houses by a panelled fence. 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. Users bedrooms are situated on the first and ground floors. There are shaft lifts for users to access the first floor in each unit. All rooms are spacious and furnished to a high standard. All bedrooms are ensuite with a level access shower. There are communal bathrooms fitted with a hydraulic chair on the first floor of some of the units. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels have not been provided to the Commission for Social Care Inspection. There are additional charges for residents which include hairdressing, chiropody, toiletries and holidays. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second key inspection for the period 2006 – 2007. As it was a key inspection this means that all core National Minimum Standards were assessed. This inspection was unannounced meaning that no one received prior notification. Two inspectors visited the home over a two day period between the hours of 08:45 a.m. and 7.30 p.m. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the deputy manager and six support staff. Three visiting relatives were also interviewed. There are currently twenty four residents living at Riverside. Formal interviews were not always appropriate therefore we relied upon informal chats, observations of body language, eye contact, gestures, interactions between staff and residents. A number of records and documents were examined, a tour of the building was undertaken, meals were seen being prepared and served, medication was observed being administered and three residents’ care was case tracked through interviews and examination of relevant records. Other documentation was reviewed including action plans sent by the care provider, copies of visits undertaken by senior managers and other relevant information gathered since the last key inspection. The manager has very recently left employment. The deputy manager was supported by an Operations Manager on the first day of the visit, and the Operations Director also made himself available on the second day. What the service does well: The atmosphere within the home is friendly, relaxed and informal. Visitors are warmly welcomed by staff and residents are encouraged to maintain important links with their families and friends whom they can see in the privacy of their own bedrooms. Residents are able to move freely around their home and they can make their own drinks and snacks with supervision from staff if necessary. Residents enjoy a balanced and nutritious diet with their specialist needs well catered for by staff. Residents have chosen their own colour schemes and décor for their bedrooms and these contain lots of their own personal possessions and belongings. All communal areas were comfortably furnished and brightly lit. The care provider always responds promptly to any urgent requirements which are made and is actively trying to improve standards within the home for residents. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There is still a lack of stability within management of the care home and as a result residents do not benefit from a well run home. A number of concerns were identified which demonstrated a weakness in management systems and the day to day running of the home. For example, serious concerns were raised with regard to the failure to ensure that residents have sufficient safeguards to protect them from harm and abuse. Appropriate clearance checks have not been obtained for temporary staff employed at the home. New staff who have been appointed whilst awaiting the return of some of their checks, have not being properly supervised by senior staff. There is a lack of structured induction for new staff before they commence work with residents. Staff were observed using unsafe techniques when assisting a resident with moving and handling. An assessment had not been obtained from a suitable professional and appropriate equipment was not being used. Maintenance and repair works are not being dealt with quickly and thereby jeopardise residents’ safety and well being. Complaints are not always dealt with quickly or to the satisfaction of those who are making complaints on behalf of residents. Medication systems need improvement in order to ensure that residents receive their medicines safely and at the correct times. At present there are not always enough staff on duty Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 7 to meet all of residents’ needs. Some staff need more guidance in order to ensure that they understand how to promote residents’ rights and dignity. It is clear from evidence gained at this and previous visits that the registered provider is keen to improve the standards in the home and to work with the Commission for Social Care Inspection. Any serious concerns which were identified at this visit were being dealt with swiftly in order to ensure residents’ safety. It is acknowledged that some of the shortages in the staff team are as a result of the provider taking responsible action to address poor practice and this has also resulted in some staff turnover. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. No resident moves into the home without having their needs assessed by a competent person such as a social worker. It is difficult to determine how the service user or staff participated in this assessment process, due to lack of documentation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is fully occupied. There has been one vacancy in recent months and since the last key inspection a new resident has been admitted. During interviews staff stated that the resident had visited prior to admission on a couple of occasions, and had an evening meal with the other residents in the house. Upon request, staff could not locate records of these visits or any assessments undertaken by management. Neither could a letter be found from the manager confirming in writing to the service user that the home could meet their needs (as required by the Care Homes Regulations 2001). Examination of the case file revealed that the manager had obtained Care Management assessment from the placing officer. Service users’ contracts/statement of terms and conditions of occupancy have now been issued as required at previous inspections. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 10 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. Care plans do not at present sufficiently guide staff in meeting all of residents’ personal, social and health care needs. However a new system is currently being introduced to remedy this. Efforts are now being made to enable residents to participate in the planning of their care and in order to identify their wishes and aspirations. Risk assessments are in place but not for all of the risks which are posed in delivery of care; an improved system would offer more protection to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random sample of care plans were examined and interviews were held with staff. At present care planning is undergoing a total overhaul. Some units Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 12 were more progressed than others in developing the new systems. Staff cited not having sufficient time in order to make more progress. During interviews staff demonstrated some confusion as to whether they were supposed to be following the old or the new style care plans. They could not explain the new care plan systems stating that they found them difficult to assimilate because of lack of training. On examination deficiencies were noted in both old and new systems. For example, a new care plan was examined which was said to have been completed for one resident. This was not dated or signed. The care plan stated that the resident has dementia which was refuted by the team leader who said there had been no clinical diagnosis. A care plan regarding challenging behaviour was perused. This provided insufficient guidelines for staff. For instance, apart from describing the types of behaviours exhibited, the only instructions for staff were “2 staff should always be around when dealing” and “staff to record any incidents as per policy and procedures”. Another service users’ care plan was examined regarding ‘sexuality and self esteem’. During interviews staff admitted that they were not following the care plan and for example did not have a ‘do not disturb’ sign to place on the bedroom door as specified in the care plan. One resident has a had a broken leg which has been in plaster for the last five months. Upon request staff provided a care plan for examination regarding his mobility. This had not been updated since February 2006 and as a result contained no details of the assistance provided by staff with moving and handling due to fluctuating mobility. Good efforts are now being made to introduce person centred planning approach to enable service users to identify what is important to them and exercise control over the delivery of their care. Person centred portfolios are in the process of being drawn up by support staff which include service users’ likes and dislikes, life stories and relationship circles. Some are more progressed than others. As discussed with the deputy manager, different models of person centred planning may need to be explored depending upon people’s circumstances. To enable decision making there are communication passports and other details of communication needs in care plans. Some policies have been produced in pictorial formats to aid communication. Some improvements are needed with regard to communication strategies particularly as service users have a range of communication needs in each unit. (See further comments in standards 12 and 17). All residents need varying levels of support to manage their finances. Not all service users have care plans in place with regard to how they are supported to manage their finances as previously required. As discussed with the administrator, once appointee details have been finalized Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 13 (see further comment in standard 23), these also need to be included in care plans. Risk assessments still require further development as some residents have a range of assessments in place, however others do not. For example, staff were only able to locate two risk assessments on behalf of one service user (with regard to falls and bathing). There were no risk assessments in place with regard to moving and handling including the use of a hoist. Staff reported that due to behavioural problems the resident would not always co-operate with transfers. There were no risk assessments regarding travel on the minibus, use of the wheelchair and posture belts or incontinence etc. Earlier in the year the resident had sustained a scolding injury when making herself a hot drink. The manager reported this to the Commission for Social Care Inspection (CSCI) and stated that the risk assessment would be reviewed and that the resident would not use the kettle without supervision. This risk assessment also could not be located. Staff were unable to produce a risk assessment with regard to moving and handling for one service user who has decreased mobility and can require two staff on occasions to help him with transfers. A risk assessment for bedrails for one resident had not been reviewed since 15 January 2006. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. There are efforts being made to increase opportunities for service users to lead meaningful lives, further progress is needed however in providing a wider range of stimulating activities and community based outings on a more regular basis. Staff support residents to maintain important links with their families. Residents are offered a healthy and nutritious diet although different strategies could be explored further to encourage some residents to more exercise choice over their diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection activity planning has been reviewed. Riverside Care Centre DS0000041321.V328592.R01.S.doc According to Version 5.2 Page 15 staff this is now carried out weekly. However, staff could not provide any evidence as to how service users are enabled to participate in this planning process. Person centred plans are not yet completed and care plans do not provide information as to how residents are enabled to make choices with regard to activity planning. Two service users’ activity record sheets were examined. These had not been fully completed. On occasions planned activities could be more varied and stimulating. For example, during an afternoon the only activity identified for one service user was to take his plate into the kitchen after a meal. According to another service users’ activity plan their weekend was spent mainly either ‘relaxing’ or watching television. There were no planned outings into the local community, sessions of ‘intensive interaction’ with staff or independent living skills tasks. The deputy manager stated that she had introduced some improvements for example residents are now able to go to church and visit a local sports bar. They can also participate in a hobby club. This was confirmed on examination of records. However, the manager acknowledged “we still need to improve community presence”. During interviews other staff reported that they felt there were improvements upon past performance, but that there were still difficulties in offering residents a range of stimulating activities and community outings due to staffing shortages (see further comment in standard 33). During interviews there was a mixed response from residents with regard to whether they were offered opportunities to pursue their own interests and hobbies. One resident talked about her favourite interests such as going bowling, visiting the cinema and poetry writing. Another resident stated “we can go out but it depends on the mini-bus”. One resident stated “I’d like to go food shopping more”. Pictorial activity programmes or boards are no longer used. Some staff reported that they felt these were not necessary and another staff member said that she had been told by the manager to read out the activity programmes to residents on a daily basis. However, it is clear that some residents require communication aids such as pictures and symbols. During interviews one resident stated that as she could not read she would prefer to use pictures. Staff were seen to warmly welcome visitors to the home. Residents are not discouraged by staff from maintaining intimate personal relationships if they so wish. Records demonstrated that residents visit their former family homes and during interviews residents confirmed that they had contact with their families. Daily routines promote independence for example upon arrival at 8.45 a.m. not all residents were up and dressed, some had chosen to have a lie-in according to their wishes. During interviews one resident stated “I can go to bed when I want to, staff don’t tell me when to go”. When asked if she had a key to her bedroom she stated “no don’t have a key, I don’t want one”. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 16 Residents were observed to have unrestricted access around the home. Some staff were overhead not using the residents’ preferred forms of address as stated in care plans (see comment in standard 18). Mealtimes were observed and residents were seen to have a range of choices. Staff were seen to respond promptly to requests made by residents. Not all units used tablecloths; staff reported that these were going to be purchased. During interviews residents confirmed that they liked the range of food which was offered. One unit has a four weekly written menu plan. On examination there are two choices for the main meal but these were seen to be lacking in variety. For example, chicken casserole or chicken curry, sausage casserole or toad in the hole. Residents’ individual food records demonstrated that they invariably chose the same item. Another unit was seen to have a menu plan which according to staff was chosen with residents on a weekly basis although there were no records to confirm how residents participated in this process, and no pictorial aids are used. Care plans did not contain information as to how residents are supported to make choices from the menu, although there was some information regarding their preferences. In another unit staff stated that they relied on their knowledge of residents’ preferences to plan the menu. It is recommended that a variety of strategies are used to enable residents to make their choices known on a daily basis and in order to plan menus. Since the last inspection food records are more consistently completed and menus identify the specialist dietary needs of residents. Nutritional screening tools are used (see further comment in standard 19). However it is suggested that a more comprehensive tool may be beneficial as recommended by community dieticians and which utilizes a Body Mass Index scoring system to identify obesity or malnutrition. Any other items discussed during inspection of these standards are contained within the Requirements and recommendations section of this report. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. Some people who work in the service do not understand the concept of valuing people and as a result residents’ dignity and privacy can at times be compromised. Some elements of health care are well managed, but others require improvement. Whilst the home is actively trying to improve their procedures for administering medication thereby reducing the risk to residents, there are still some failures in current practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some aspects of personal support provided to residents by staff demonstrated sensitivity with regards to their privacy and dignity however there are some practices which need to reviewed. For example, there has been an outstanding requirement to review two hourly night checks for all residents. As a result staff had began obtaining service users’ preferences with regard to night checks and where their choices needed to be overridden because of medical or behaviourial reasons, this was being discussed within a multi-disciplinary team Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 18 including the service user (or if residents lacked capacity to consent). Consequently some residents had chosen to have less checks and care plans had been established. Staff now report that there has been a directive from senior management for all service users to receive two hourly night time checks irrespective of their preferences or needs. This is not in the spirit of a person centred approach and can deprive people of their privacy and dignity. This was discussed with the Responsible Individual. Other aspects of poor practice included: • a staff member stating in the presence of the resident that they are ‘non verbal’. • a staff member overhead saying “eat your dinner all up for Judy and she will give you a big kiss I’m sure”. • staff using phrases such as “good girl”, “mate” and “darling”. • referring to residents’ allowances as ‘pocket money’. • residents’ laundry being hung outside their bedroom doors. • written instructions for staff displayed in residents’ bedrooms with regard to laundry and personal support needs. • unnecessary signage on residents’ ensuite bathrooms. • a resident overhead having to ask a member on two occasions for toilet roll for his ensuite bathroom. There was a serious concern raised regarding one service user who had broken his leg five months ago and who was being assisted with mobilizing by staff using unsafe techniques. No assessment had been obtained from a competent person such as an Occupational Therapist (O.T.) and no equipment was being utilized to assist with transfers. There has been an outstanding requirement to ensure that all residents receive support to access routine health checks with regard to dentists, chiropody, ophthalmology etc. Despite records being disseminated it was possible to confirm these are taking place. For example, staff were requested to locate details of one resident’s most recent dental appointment. This could not be found on the ‘yearly record of health checks’ sheet, the monthly appointment sheets or the ‘contacts’ record. Eventually details were found by examining daily reports. An improved system for monitoring and recording of routine health checks would be beneficial. Upon sampling records, a procedure or care plan for health care screening with regard to potential complications from breast, testicular or cervical cancer could not be located. An informative ‘initial health check’ booklet was found in a service user’s case file however, this had not been fully completed (nor was dated or signed). Staff could only locate two weight check records for one service user who was admitted in September 2006 both of which were undertaken in December 2006. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 19 Staff utilize a range of screening and assessment tools with regard to dependency, tissue viability and nutrition. On closer scrutiny and upon discussion with staff, some were found to be inaccurately scored and wrongly calculated thereby giving a misleading rating. For example, one resident’s ‘monthly nutritional screening tool’ (albeit this was not completed on a monthly basis by staff), was not scored to identify that he had lost weight in the previous month as demonstrated by examination of his weight check records. Another person’s dependency scale did not tally when adding the scores and did not accurately identify that he required two people with mobilizing. A serious concern arose in November 2006 when a blood sample was taken from the wrong service user due to staff negligence (see further comment in standard 23). Since the last key inspection in June 2006 there have been serious failures with regard to medication practice. On one occasion staff administered an incorrect dose of medication to a resident and on another occasion administered medication to the wrong service user. A third incident involved tablets found to be missing from the monitored dosage system (M.D.S.). Management have taken appropriate action with regard to the staff involved. Training has since been undertaken and guidelines have been improved regarding ‘as and when required’ (P.R.N.) medicines (as required at previous inspections). Two medication audits have been completed by the deputy manager: one of these took place in January 2007 and the other presumably in February 2007 (although not dated). Concerns were identified at this fieldwork visit when one member of staff was observed to sign the medication administration record (MAR) sheet prior to witnessing the resident take all of the dispensed medicines. At 10. 45 a.m. the resident had resulted to prompting staff regarding her medication which should have been administered at 8.00 a.m. During interviews the resident stated that sometimes staff were too busy and she had to remind them about her medication. The resident refused to take her Peptac liquid informing the staff member that she preferred to take this with her breakfast. The member of staff was observed to place the tot of liquid back into the trolley stating that she would ‘try’ again later. When it was pointed out that this was not good practice the member of staff said she would therefore pour it back into the bottle. Advice was given regarding correct disposal procedures. The MAR sheet was not corrected to signify that this medication had been refused. Some other issues were raised including: keys to medication left in the medication trolley in an unlocked office and a prescription for Chlorpromazine pinned to a notice board in an unlocked office. Repeat prescriptions were found left on display in another unit where the front door had been left open although the unit had been vacated by staff and residents. Please see the Requirements and Recommendations section of this report for further items discussed. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 20 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. The complaints process needs improvement as at present there are some instances when complaints made on behalf of service users have not received an appropriate response. Vulnerable adult abuse procedures need to be more robust in order to offer suitable safeguards to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was difficult to obtain information regarding complaints due to lack of documentation. The complaints log could not be located on the first day of the field work visit but was produced on the second day. This had only been commenced in November 2006 and failed to include complaints which are known to have been made previously. There is supposed to be a monthly complaints monitoring form completed by the manager but only one form completed in October 2006 could be located by staff. Further information was later retrieved from Head Office by the Responsible Individual. This demonstrated some anomalies. For example, it was noted that the monthly monitoring sheet for December and completed in January 2007 by the manager, failed to contain details of a complaint made in December, and which was included in the complaints log. Complaints are not always quickly dealt with, or to the satisfaction of the complainant resulting in further complaints. For example, it was noted from Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 22 monitoring sheet that a complaint was received in July 2006 about service users’ finances. This was not resolved and a further complaint regarding the same issue was made in January 2007 and is currently now receiving appropriate action. A complaint received on 4 December 2006 did not receive a response until 10th January 2007. During the visit one resident’s relatives who were interviewed had issues regarding the complaints process stating that they had raised concerns to staff on many previous occasions but had not received a satisfactory response. There were no records of the complaints they had raised. Amongst their concerns was the defective heating in their brother’s bedroom which they stated had not been working efficiently for more than three years. This was refuted by staff however it was acknowledged that there had been problems with the heating for at least twelve months (see further comment in standard 24). It was pleasing to see that pictorial complaints procedures were displayed and all residents who were interviewed stated that they would speak to staff if they had a concern. Staff have now received training in vulnerable adult abuse awareness and during interviews gave appropriate responses as to how they would deal with a potential incident of abuse. Since the last key inspection in June 2006 there have been six referrals made to the Local Authority Adult Protection Team. Appropriate action has been taken by management taken following these incidents. Concerns have been recently raised regarding staff failing to follow Whistle Blowing procedures and these will need to be explored following completion of outstanding investigations. Upon request, information could not be provided by management regarding whether or not staff have been referred to Department of Health for consideration as to inclusion on the Protection of Vulnerable Adult (POVA) list. At this fieldwork visit serious concerns were raised following discovery of a recent alleged incident which had been reported to management but had not been referred to the Local Authority Vulnerable Adult abuse team. In addition no notification had been made to the local office of CSCI. Immediate action was taken by management to make the necessary referrals. The management of service users’ finances has been a cause for concern. Improved auditing and monitoring procedures have been established. Upon sampling these are working effectively with only a couple of minor discrepancies. For example, on one occasion a staff member had signed their name twice when making a transaction rather than obtaining second signature from a member of staff as witness. On 24 February 2007, a member of staff had ‘lent’ a service user £1.47 in order to make a purchase when out in the community this was not instantly repaid and there was still a reminder note in the resident’s purse. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 23 As already stated, a complaint has been made regarding service users’ finances. Discussions with staff and the Local Authority complaints manager confirms that appropriate action is being undertaken by management to rectify issues which have been raised. It was noted that occasionally service users pay for their own meals when in the community. As meals are included as part of the resident’s basic contract fee, discussions must be held with the commissioning authority and residents in order to approve a procedure and suitable contribution. The Service User Guide must be updated to include this as an additional charge plus residents’ contracts. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. The premises are generally attractive, decorated and furnished to a good standard. However, there are some maintenance issues which have not been dealt with swiftly and are jeopardising residents’ safety and comfort. Some aspects of infection control have been improved although there a further issues which need to be dealt with in order to ensure that residents live in a clean and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken. During interviews with one resident’s relatives they complained about the lack of effective heating. They also complained about the draught from the patio door which they had tried to rectify by using tissue paper to block the draught. In addition they pointed out that the window fitting was broken which resulted in a further draught and the Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 25 window not being able to be properly closed. During interviews staff reported that the heating had been a source of concern for twelve months in three residents’ bedrooms. Repairs had been attempted but had so far been ineffective. As a result they had obtained portable electric heaters in December 2006. No written risk assessment had been carried out despite ‘hot surface’ warning signs. This was discussed with management who immediately took action to carry out a risk assessment and remedy the draughts. Contractors visited on the second day of the fieldwork visit to repair the heating. Since the last key inspection visit worn kitchen flooring in one of the units has been replaced. Sealant had been used to repair flooring in another unit. Serious concerns were identified. Staff and service users complained that since the sealant was applied in December 2006, the flooring had become dangerously slippery when wet. There was no written risk assessment or control measures to minimize risks to residents and staff. A Immediate Requirement was subsequently issued and action taken. Staff lockers have now been purchased as previously required. This had been placed in the residents’ dining room in one of the units and must be removed to a more suitable area. Serious concerns were raised at the last key inspection with regard to infection control measures in one of the units. These were not improved and resulted in a further random inspection following concerns raised. At this field work visit the affected bedrooms were found to be odour free. Carpet cleaning schedules were in place for February and March 2007 (although staff could not locate schedules for any preceding months). The following items were noted to require attention: • there was a loose tile in one service user’s ensuite bathroom • communal bathrooms contained electric fans, stereos, vacuum cleaner and electric scales (with a sign written by the manager ‘residents must be weighed here!) • mops and buckets were found stored in the kitchen and communal bathroom • a bar of soap was found in one communal bathroom • not all bathrooms, toilets and residents’ ensuites contained supplies of toilet rolls and disposable paper towels. • there was an malodour emitting from a laundry in one of the units – the team leader stated this was because staff were not always prioritising the washing of soiled laundry. In one of the units there was an extremely offensive odour found in the communal toilet and a pool of water as a result of a leaking wash hand basin in the communal bathroom. In addition according to staff water temperatures were also still fluctuating (although this was not apparent on examination of water temperature record checks). Upon this being pointed out to Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 26 management plumbers visited on the following day and undertook the required repairs. The deputy manager stated that she felt the appointment of a new handyperson would help towards addressing issues more promptly in the future. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 37 Quality in this outcome area is poor. Staffing shortages and high levels of sickness are impacting upon the quality of the service provided to residents. Recruitment and selection procedures do not offer sufficient safeguards to service users. New staff would benefit from more structured induction before starting to work with service users. Improvements are needed in the frequency of formal staff supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection there have been improvements in providing staff with opportunities for vocational and specialist training. For example, information provided in November 2006 to CSCI confirmed that 7 support staff have now achieved and NVQ II or above, and at least half of the thirty two support staff who are employed are now undertaking an NVQ qualification. The registered provider is actively trying to improve the quality and competency of the staff group which has inevitably been responsible for some of the high staff turnover. Efforts are being made to recruit more senior staff. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 28 At present however there are staffing shortages and on occasions there has been only two staff members of duty per shift in some of the units during the day time. This was corroborated on examination of the rota. As already mentioned this has had an impact upon activities and community based outings which was acknowledged by staff. One team leader gave an example whereby a recent resident’s review meeting had been cancelled because none of the existing team had worked with the resident for a sufficient period to be able to participate in such a meeting. On the first day of the field work visit a member of staff from one unit was transferred to cover a shortfall in another, depleting the staff team in the unit to two staff (the duty rota was not amended). Agency staff are employed to cover some of the shortfalls. There were other inaccuracies found on the duty rota. For example, one new member of staff reported that she had commenced employment the previous week but there was no evidence on the duty rota. Some shifts had been left blank with no indication as to whether they had been covered by agency or existing staff. Staff could not locate the December 2006 duty rota upon request in one of the units. On occasions staff are seen to be excessive hours over a prolonged period. For example during one week according to the duty rota a member of staff worked 84 hours per week which included 4 consecutive 14 hour shifts. This situation was to be improving on examination of future rotas. Upon request management were unable to provide up to date information regarding staffing levels and dependency ratios of residents to CSCI. As there have been changes in the service user group and dependency levels, management must undertake a review of staffing ratios in order to ensure that there are sufficient staff to meet all residents’ needs. An evaluation of recruitment and selection procedures was undertaken through interviews with staff and examination of documentation. Serious shortfalls were identified. For example, agency staff are employed on a regular basis however management acknowledged that they had failed to obtain written confirmation from the agency to demonstrate that appropriate clearance checks and training had been carried out. An Immediate Requirement was issued to cease this practice. A new member of staff was interviewed who stated that she had started work during the week commencing 26 February 2007 but could not remember the precise date. There were no details on the duty rota. On examination of the staff file the contract stated that employment had commenced on 6 March 2007. There were two written references although one of the references was undated so it was not possible to identify if the reference arrived before employment was commenced. The criminal record declaration on the application form had not been signed by the applicant. There was no recent photograph on file and no evidence of induction. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 29 It was elicited that the member of staff had commenced on a POVAFirst check. She was not supernumerary. There was no risk assessment in place regarding measures to be taken to minimize risks to service users whilst awaiting the return of a full criminal record bureau (CRB) disclosure check. Management had not discussed the appointment of this member of staff with CSCI prior to employment as is good practice. Management were unaware of the conditions of the Care Home Regulations 2001 for staff who are employed on a POVAFirst check. For example, appointing a member of staff who is appropriately qualified and experienced to supervise the new worker pending receipt of a CRB, and so far as is possible ensure that the member of staff is on duty at the same time including accompanying the staff member on escorts with residents. It was concerning to find that this was not taking place and that the new member of staff had been rostered to work as shift leader on 8 March 2007 (thereby having senior worker responsibilities including access to medication). Fortunately this did not take place as a member of staff rang in sick on the morning and the deputy manager arranged for the team leader to cover her duties. Another new member of staff was interviewed and his file examined. This also demonstrated a range of anomalies. For example, he stated that he had been employed for a week in January 2007 and had left employment which was confirmed by management. He had returned on 6 March 2007 following an interview with the deputy manager. There were no records to confirm his original start date in January 2007 or date when he ceased employment. There was no contract in place for either his employment in January or March 2007. There were no records as to why he had left or why he had recommenced work including details of his re-interview. There was no record of his induction in January 2007. He had commenced his duties originally in one unit but had returned to another. He was not supernumerary whilst being inducted onto the new unit. Progress still needs to be made with ensuring that staff undertake an induction and foundation training programme provided by an accredited learning disability awards framework (LDAF) provider. As according to information supplied by management only 2 staff have so far undertaken this training. This was not included on the central staff training matrix. Training certificates were examined for two members of staff. These did not entirely correlate with the information contained on the training matrix. For example, whilst the training matrix showed that both members of staff had completed training in managing challenging behaviour only one member of staff had a training certificate in place to confirm that this had taken place. Therefore outstanding requirements and recommendations regarding training have been judged as met if training certificates correspond with the training matrix from records sampled. For example, there was evidence that staff have received training in diabetes awareness. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 30 Interviews with staff and examination of records confirms that he frequency of staff supervision still needs improvement. For example, one staff file examined demonstrated that only three supervisions had taken place for one member of staff during the last twelve months. This was despite concerns regarding practice culminating in formal disciplinary action on two occasions. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. Poor outcomes detailed throughout this report indicate weaknesses in management systems which the registered provider is actively trying to reverse. The quality assurance systems ensures that residents’ views are taken into account and help to shape the service provided. There are some areas of health and safety which are poorly managed and practice therefore compromise residents’ safety and wellbeing This judgement has been made using available evidence including a visit to this service. EVIDENCE: For a considerable period there has instability in the management of the care home. There has been no registered manager since November 2005. A manager was appointed in June 2006 who failed to complete an application to Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 32 register with CSCI. This manager’s employment ceased in March 2007. The operations director has arranged for senior managers to support the home whilst a new manager is sought. Shortfalls throughout the report indicate that the management arrangements within the home are not robust and lacking in terms of appropriate systems to support the day to day management, for example supervision records were found to be lacking and staff have been employed without the appropriate clearance checks. During interviews staff complained that they had raised issues with the manager on behalf of the residents but had not received a response. One team leader stated that she had been transferred to manage another unit but had received no induction or handover from the existing team leader who had subsequently been moved to manage the vacancy she had left. Since the last inspection clearer evidence has been provided to demonstrate that there is a holistic quality assurance system in place. Unfortunately there was limited information on the premises regarding the quality assurance systems including audits undertaken by the manager. This information however was retrieved from head office by the operations director on the second day of the fieldwork visit. The manager carries out bi-monthly audits which are validated by a senior manager. On examination there were some anomalies found in the audits carried out by the manager for example with regard to complaint monitoring. Feedback has been sought from service users and their relatives. There is regular monitoring conducted by a senior manager. Since the last inspection there has been improved training for staff in the statutory disciplines which was confirmed on sampling training certificates and the central staff training matrix. More staff have now received training in first aid awareness, moving and handling, infection control and fire safety. There is on-going training currently being undertaken in health and safety. There were serious concerns raised regarding some elements of health and safety practice as already mentioned in the report and including: • poor moving and handling techniques and lack of suitable equipment • no risk assessment in place for a service user requiring assistance with transfers and lack of up to date care plan • no risk assessments regarding the use of portable electric heaters or slippery kitchen flooring • no records of maintenance checks for bedrails and wheelchairs since December 2006. (A wheelchair was found with a large split across the seat which staff were instructed to remove). • no records of monthly checks for emergency lighting systems in February 2007 • no records weekly door checks during the last six weeks Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 33 Since the last inspection maintenance and service records for all three units have been amalgamated into one central folder. On examination the service records do not always identify in which unit the equipment is located or which utility has been inspected and serviced for example with regard to fixed electrical wiring, passenger lifts, hoists and gas installation. It was therefore not possible for management to demonstrate that all maintenance and service checks were up to date. Urgent action is required to ensure that there are appropriate systems in place to ensure that all maintenance and service checks are up to date. Accidents forms are completed and are filed in individual resident’s case files. The manager is supposed to carry out a monthly analysis and a copy is sent to head office. Management could not find copies of the monthly analysis sheets. Serious concerns with regard to obtaining a suitable height adjustable bed and bed rails for one service user as identified at the last key inspection have been addressed. Any other items discussed during inspection of these standards are contained within the Requirements and Recommendations of this report. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X 1 X 2 X X 1 X Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 35 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement To review and expand care plans, to include detailed daily reports which reflect goals and objectives, to include restrictions on users’ choice, to provide detailed communication methods, to produce care plans in a format suitable for service users and to be signed by users. (Previous timescale of 1/10/03 is partly met – ongoing progress is being made). To ensure that care plans are updated as and when needs change, or new needs are identified following review meetings. (Previous timescale of 1/10/05 is not met). To ensure that care plans contain goals and objectives with regard to service users who require assistance/supervision with managing their own personal allowances and benefits. To accurately identify the exact level of support and DS0000041321.V328592.R01.S.doc Timescale for action 01/05/07 2. YA7 15(1) 01/05/07 Riverside Care Centre Version 5.2 Page 36 assistance they require. (Previous timescale of 1/2/06 is partly met). 3. YA9 13(4)(c) To expand the risk management 01/05/07 system to ensure that all areas of risk associated with individual service users are clearly documented, such as personal safety within the Home’s environment. For example, use of the passenger lift, bathing and hot water temperatures. (Previous timescale of 1/1/06 is partly met). To provide a wider range of stimulating and therapeutic activities for service users to meet their individual needs and preferences. 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 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. (Service users’ preferences must be obtained and if this level of monitoring is deemed necessary, it must be discussed and agreed as part of a multi-disciplinary team). (Previous timescale of 1/12/04 is partly met). To ensure that systems are in place to respect the dignity of service users’ for example: by using residents’ preferred forms Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 37 4. YA12 16(2)(n) 01/05/07 5. YA13 16(2)(m) 01/05/07 6. YA18 12(4) 01/05/07 7. YA18 13(5) of address (and as recorded in their care plan), to refrain from using ‘reward’ strategies unless they are agreed as part of a management behavioural guidelines, to cease hanging residents’ laundry on overhead door closers in communal corridors, removal of unsuitable signage and bathing guidelines in residents’ bedrooms. To cease unsafe moving and handling techniques when assisting service users to transfer, for example underarm lifting. IMMEDIATE REQUIREMENT AS OF 7 MARCH 2007. To obtain a moving and handling assessment from a suitably qualified person (such as an O.T.) and undertake any required action by 8 March 2007 for the identified service user. To accordingly update the service user’s mobility care plan and risk assessment by 8 March 2007. – Immediate Requirement 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 ensure that there are regular and recorded weight checks for all service users. To ensure that nutritional screening tools, dependency assessments and Waterlow assessments are more accurately scored and completed by staff. 08/03/07 8. YA19 12(1)(a) 01/05/07 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 38 9. YA20 13(2) To make the following improvements to the control and administration of medication: 1) To ensure that where service users’ choose to self medicate that medicines/creams are more securely stored (or written risk assessment is carried out to demonstrate why this is not required). (Previous timescale of 1/9/06 is not met). 2) To ensure that all prescriptions are held securely until collection by pharmacy. (Previous timescale of 1/9/06 is not met). 3) To expand the household remedy policy to identify a maximum dosage before seeking medical advice. 4) All medicines must be kept secure at all times. For example drug trolleys must be kept locked, and keys not left in the locks. 5) To ensure that the keys to medication cabinet are held separately from any other master keys. 6) To ensure that drugs are administered at the times identified by prescriber and as detailed on the MAR sheet. 7) To ensure correct procedures for administration of medication are followed by staff including completion of MAR sheets. These must not be signed until administration/non administration has taken place. 01/05/07 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 39 8) To ensure that staff are aware of the correct procedure to follow for any refusals of medication including the disposals of medicines and completion of MAR sheets. 10. YA22 22(8) To ensure that all concerns or issues raised by service users, (or people on their behalf), receive appropriate action and are fully investigated. To ensure that there is an up to date complaints log maintained which includes all issues raised or complaints made, details of any investigation, action taken and outcome. To ensure that all complaints are responded to within 28 days. 11. YA23 13(6) To introduce a procedure for ensuring that all staff are fully familiar with, and adhere to the Local Authority Multi-agency Vulnerable Adult abuse procedures and Whistle Blowing procedures. (Previous timescale of 1/9/06 is not met- URGENT ACTION required for compliance by 4 April 2007). To ensure that staff who may be unsuitable to work with vulnerable adults are referred in accordance with the Care Standards Act 2000 for consideration for inclusion on the POVA list and to maintain written records of all referrals/decisions made. To review the practice of service Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 40 01/05/07 01/05/07 users paying for their own meals whilst out in the community, and which are in place of meals provided by the Home, (for which the service user is already funded by the Local Authority). If this practice is to continue, it must be negotiated with funding authorities and service users. A formal procedure must be agreed which is contained in individual service users’ plans, the service user guide and contracts. 12. YA24 23(2)(b) To make the following improvements to the environment: 1) To repair (or replace) worn flooring in Winter House. (Previous timescale of 1/10/06 is not fully met). 2) To conduct a risk assessment regarding the kitchen flooring in Winter House. To identify and undertake control measures to minimise risks to service users, staff and visitors – IMMEDIATE REQUIREMENT BY 8/3/07. 3) To remove staff lockers which are currently stored in service users’ communal lounge/dining room and identify a more suitable storage area. 4) To ensure that houses are left secured and locked when vacated by residents and staff. To continue to undertake repairs to the heating system in Winter House in order to ensure this is working efficiently and is maintained to a satisfactory standard through out the unit in DS0000041321.V328592.R01.S.doc 30/04/07 13. YA24 23(2)(p) 30/04/07 Riverside Care Centre Version 5.2 Page 41 14. YA30 13(3) order to provide sufficient warmth to service users at all times. To improve infection control practice by: 1) To replace loose tile in identified service user’s ensuite bathroom in Winter House. 2) To remove extraneous items from bathrooms including: electric fans, stereos, vacuum cleaner and electric scales. 3) To ensure that mops and buckets are not stored in bathrooms and kitchens (when not in use these must stored elsewhere). 4) To ensure that there are suitable supplies of liquid soap, toilet rolls and disposable paper towels at all times within communal bathrooms, toilets, and residents’ ensuite facilities. 31/05/07 15. YA32 18(1)(c) 5) To establish and display written laundry procedures which identify good infection control practice and ensure that these are adhered to by staff. To provide staff training in: 01/06/07 1) challenging behaviour. (Previous timescale of 1/9/03 is partly met). 2) epilepsy awareness. (Previous timescale of 1/12/03 is partly met). 3) To ensure that 50 of the staff team are qualified to NVQ II or above by 2005. (Previous timescale of 1/8/05 is not met but progress is being Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 42 made). 16. YA33 17(2) To ensure that there is an 30/04/07 accurate duty roster maintained which contains precise details of which staff are covering shifts (including their full names) and any changes made to cover shortfalls. To carry out a review of staffing 31/05/07 ratios and an up to date assessment of the dependency levels of service users and submit staffing proposals to CSCI in order to demonstrate that there sufficient staff on duty to meet all service users’ needs. To carry out the following 01/05/07 improvements to recruitment and selection procedures in order to safeguard service users from abuse: 1) To cease the employment of agency staff without obtaining written confirmation that they have received the necessary clearance checks including a CRB and POVA checks (within the last twelve months), and that they have undertaken suitable training – IMMEDIATE REQUIREMENT AND ONGOING AS FROM 7/3/07. 2) To ensure that staff who have been appointed on a POVAFirst check are only employed subject to the supervisory and induction arrangements stipulated in the Care Homes Regulations 2001, Regulation 18(1)(c)(i) and 19(11). 3) To undertake written risk assessments for any staff who have been appointed on a POVAFirst check to identify and undertake control measures to Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 43 17. YA33 18(1)(a) 18. YA34 13(6) minimise risks to service users. 4) To obtain a recent photograph for staff who are employed. The registered person must ensure that a record of all persons employed are maintained in the care home as in compliance with the Care Homes Regulations 2001, Schedule 4, including: dates of employment and dates of termination of employment, the number of hours for which he is employed each week, a record of all training undertaken including induction training etc. 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 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 partly met). 21. YA36 18(2)(a) To ensure that all staff receive regular recorded supervision sessions (at least six per annum). (Previous timescale of 1/11/03 is not met). 01/06/07 19. YA34 17(2) 01/05/07 20. YA35 18(1)(c) 01/06/07 22. YA42 18(1)(c) To ensure that all staff receive training in: 01/06/07 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 44 1) health and safety. (Previous timescale of 1/9/03 is partly met). 23. YA42 13(4)(c) To undertake the following 01/06/07 health and safety improvements: 1) To undertake a review of the Legionella risk assessment which was carried out on 25 February 2003. (Previous timescale of 1/2/05 is not met). 2) To ensure that there are appropriate systems in place to ensure that equipment provided is maintained in good working order. For example by demonstrating which service and maintenance records relate to which specific unit and ensuring that these are up to date – URGENT ACTION BY 4 APRIL 2007. 4) To ensure that emergency lighting is checked on a monthly basis (or according to the manufacturer’s specifications). 5) To ensure that there are regular health and safety checks undertaken with written records maintained for wheelchairs and bedrails and ensuring that more proactive action is taken to repair or replace any damaged or faulty equipment. Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 45 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA8 Good Practice Recommendations To introduce a person centred planning approach (for example essential life style and life story books) 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. To consider producing activity programmes in a range of formats to meet individual service users’ needs. To provide an annual seven day minimum holiday for service users which is included as part of the basic contract price. To consider introducing a more comprehensive nutritional screening tool such as the ‘Malnutrition Universal Screening Tool’ (‘MUST’) in order to identify issues relating to malnutrition and obesity and which utilizes a Body Mass Index scoring system. Menus could be made available in different formats with pictorial options, photographs etc. to assist service users with menu planning and to make daily choices from the menu plan. Where there are two meals identified on the menu plan, these should be more varied. 6. YA19 To introduce an improved system for the recording of routine health care appointments to allow for easier monitoring and auditing. To ensure that the household remedy policy clearly identifies that Paracetamol pain relief and Lemsip cold treatments are not administered at the same time. To ensure that families and relatives are made fully aware of the home’s complaints procedure to follow. To ensure that the complaints procedure is available in a format suitable for service users (such as audio). Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 46 3. 4. YA12 YA14 5. YA17 7. 8. YA20 YA22 9. YA23 10. YA24 To continue to work towards completing action agreed with the Local Authority complaints manager regarding service users’ finances, for example by auditing accounts, calculating interest accrued and reimbursing service users. It is recommended that the exposed pipe work following installation of new showers in residents’ ensuites is fitted with suitable covering in order to make bathrooms more aesthetically appealing. To consider providing a sensory garden for service users. To provide staff with training in cerebral palsy awareness and tissue viability. To provide training for staff in person centred planning. To provide staff with training in Makaton. To provide staff with training in Bipolar disease in Winter House (as per action plan submitted by manager on 16 October 2006 following medication error). To ensure all references are dated and signed by referee and to check that dates of employment correlate with those given by the applicant on the application form. To ensure that all staff receive statements of terms and conditions of employment. It is good practice to consult and discuss with the CSCI satellite office, Halesowen the potential appointment of any new staff (in exceptional circumstances) on a POVAFirst check. It is recommended that staff are employed on a supernumerary basis until they have completed their induction training. 11. 12. YA28 YA32 13. YA34 14. YA35 To review the central staff training matrix to ensure that it is accurate and up to date and corresponds with training certificates held on the premises to confirm training has taken place. To reinstate weekly fire safety door checks and records. To retain copies of monthly accident monitoring reports on the premises. 15. YA42 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 47 Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 48 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverside Care Centre DS0000041321.V328592.R01.S.doc Version 5.2 Page 49 - 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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