Inspection on 08/06/06 for Riverside Care Centre

This inspection was carried out on 8th June 2006.

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. 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 07/03/07

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 Unannounced Inspection 8th June 2006 09:30 Riverside Care Centre DS0000041321.V299316.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.V299316.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.V299316.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 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 Care Home 24 Category(ies) of Learning disability (24), Physical disability (24) registration, with number of places Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 7 November 2005 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.V299316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors between the hours of 09:30 and 19:30. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the acting temporary manager, new manager and five staff. Feedback was received from two health care professionals and seven relatives via comment cards. Some residents were on their annual holiday but a number of service users were at home during various stages of the inspection. Formal interviews were not appropriate. Therefore the inspectors relied upon brief chats, observations of body language, eye contact, gestures, responses and other observations of interaction between staff and service users. Questionnaires were sent to service users prior to the visit. Twenty one were completed. All residents required help with completing these forms, some more than others. Staff assisted and as a result this produced some anomalies between their responses and the real life experiences of residents. Therefore where possible judgements have only been formed following discussion with the individual residents with regard to their responses on the questionnaire. Three residents’ care was case tracked by reading and assessing care documents, observing interactions and by talking to staff and chatting to residents. Two meal times were observed and two drug rounds. A tour of the premises was undertaken to assess the standard of the environment. Staff personnel files were accessed and a sample of maintenance and service records were examined. Other documentation was reviewed including a preinspection questionnaire completed by the manager and action plan sent by the provider, plus copies of visits undertaken by senior managers and other relevant information. Previous requirements which have been met have been deleted from this report. Since the last inspection the Registered manager has left the home. A new manager has been appointed who had commenced employment a few days prior to this visit being undertaken. What the service does well: Staff strive to assist residents with flexible daily routines based on their own preferences with regard to how they are supported. For instance residents can choose when to go to bed and when to get up. Residents were dressed in clean and modern style clothing with accessories and grooming which reflected their individual personalities. Residents are supported to undertake Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 6 independent living tasks and can access the kitchen areas to make drinks and assist with other household chores. They have unrestricted access to all communal areas. Residents’ rights to privacy are respected and staff recognise their cultural differences and needs. Bedrooms are decorated and furnished to a very good standard and residents have chosen their own colour schemes and décor. All communal areas were comfortably furnished, brightly lit and homely. During interviews residents indicated that they were happy living at Riverside and there was largely very positive feedback from relatives and health care professionals. What has improved since the last inspection? What they could do better: The service has experienced considerable upheavals in the past with changes in ownership, large staff turnover and inconsistency in management. During the last six months a temporary acting manager has been in post who has been supported by a team of senior managers from the organisation. This has resulted in positive outcomes for residents and staff. A large number of new staff have been recruited and a new manager has very recently been employed. There are some areas of weakness which need to be focused upon in order for the service to progress further which include: providing residents with more opportunities for stimulating and therapeutic activities which are based upon their individual preferences and needs. Closer monitoring of any residents who are on specialist diets due to health complications. Ensuring that the Local Authority Multi-agency Vulnerable Adult abuse procedures are more closely adhered to, and more frequent structured supervision of staff by management. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 7 Serious concerns were identified at this visit with regard to poor infection control practice and health and safety issues which require immediate action. It is hoped that with a more stable staff team and manager, that improvements made will be sustained and continuing efforts made to address those weakness identified. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Riverside Care Centre DS0000041321.V299316.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.V299316.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The outcome of this group of standards is judged to be good. The home has a good assessment tool. This ensures that any prospective service users can be assured that all of their needs will be fully assessed in order to ensure that Riverside is a suitable placement. EVIDENCE: There have been no new admissions to the home since the last inspection. There is currently one vacancy. Examination of case files confirms that there is an assessment tool which can be used to assess prospective service users’ needs. This is also used to review existing service users’ needs and support levels as is good practice. There is an outstanding requirement with regard to ensuring service users are issued with contracts/terms and conditions of occupancy which contain all of the information stipulated in the National Minimum Standards 5.2. It is pleasing to see that on examination of case files new contracts have been issued following the change in ownership last year. All of these have not yet been signed by the manager, service user (and/or advocate). Additional charges should also be included such as the cost of the annual holiday. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The overall outcome for this group of standards is judged to be adequate. Overall care planning, risk assessments and strategies for enabling residents in decision making are improving and at present are adequate although further progress is necessary. EVIDENCE: A sample of case files were examined, staff and service users were also interviewed as part of case tracking and in order to determine progress to meeting outstanding requirements. It was pleasing to see that much improvement has taken place with regard to care plans and risk assessments, case files were efficiently organised which made auditing easier. All care plans seen had been reviewed on a six monthly basis with evidence that service users, families and social workers had participated in this process. Whilst care plans and risk assessments cover a wide range of topics, some require more detail in order to be effective working tools for staff to follow with regard to care delivery. These must be updated as and when needs change or when reviews have taken place, and recommendations have been made. For example, one resident has a mobility care plan but this does not specify the Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 11 type of mobility equipment utilized by the resident such as handling belt, hoist and wheelchair. There is a separate care plan with regard to use of the hoist but this also needs further details for example with regard to type of transfers. The Occupational Therapist assessment suggests that the resident should be encouraged to walk with the assistance of two staff but this is not reflected in the care plan. There is a care plan in place with regard to continence management but this does not include information regarding incontinence pad sizes and pad changes which according to staff is undertaken up to six times daily. Care plans with regard to tissue viability should include types of pressure relieving mattresses, when these were purchased and detail regarding changes of position. Another resident had a review in February 2006 but recommendations made had not been transferred into care plans, for example, swimming sessions, staff receiving Makaton training and more vigilant monitoring of a weight reducing diet. Care plans regarding challenging behaviour also require more detail. For example, one resident’s plan referred to nursing staff, states that staff are to use de-escalation techniques but does not adequately describe what these entail, and fails to describe all of the types of challenging behaviour that the resident may exhibit. Staff also need to familiarise themselves with the content of care plans and risk assessments. It was pleasing to see communication passports and other details of communication needs in care plans. There are on-going attempts at person centred planning but different approaches need to be explored in order to assist service users further with making their wishes and aspirations known such as essential life style planning, life story books, MAPS and PATHS. Not all service users have care plans in place with regard to how they are supported to manage their finances as previously required. As with care plans, risk assessments are improved and cover a wide selection of subjects. Some however require more detail and expansion. Some risk assessments are slightly confusing as staff have used different tools to assess the same risk and there is conflicting scoring and outcomes. For example, a nutritional screening tool for one resident states that there is cause for concern whilst another nutritional risk assessment identifies ‘medium’ risk. Although there are risk assessments in place for moving and handling, there are no specific assessments in place for use of wheelchairs and the associated risks with regard to posture belts and other seating accessories. Requirements from previous inspections were also monitored. Where applicable, these have been either met or will remain outstanding until fully met. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 The overall outcome for this group of standards is judged to be adequate. Life style outcomes for residents are adequate, however more opportunities are required for residents to participate in stimulating and therapeutic activities as well as social inclusion based upon their personal preferences. EVIDENCE: Progress is slow towards providing activities which are based more upon resident’s personal choices. A new system is currently being introduced which is more person centred however this has not yet been fully implemented. A new proposed activity programme was examined for one resident however this failed to address the outstanding recommendation from the last review meeting to include swimming sessions. During interviews staff stated that the resident enjoyed going swimming but had not been for some time. There were no independent living skills identified in the new activity programme (and neither was the resident included in the ‘household chore’ list displayed in the kitchen). During interviews a staff member gave excellent examples of how they encouraged the resident to participate in living skills tasks but this was not recorded or included in any care plan. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 13 During a one week period the resident’s activity plan identified five community based outings none of which had taken place. Another service user had five outings identified in their activity plan but again these had not taken place. The activity monitoring sheets were not consistently completed by staff and did not always include evaluation of the activity undertaken, or whether or not the resident had refused to participate. The temporary manager acknowledged that some activities which were identified were inappropriate for the resident due to their physical disability. During the visit residents were seen to participate in independent living tasks for example making drinks, helping with bringing in the shopping and sweeping the floor. One resident stated “there isn’t anything I don’t like about living here”, another commented “we do go out but only if staff aren’t too busy”. A third resident said that they had been out to the garden centre in the morning but didn’t get out of the mini-bus commenting that “nobody did”. Another resident said that they liked cooking and enjoyed making ‘victoria sandwiches’. Feedback gathered from staff was that they felt they were making progress with regard to activities and outings but still needed to make further improvements. Improvements have taken place with regard to ensuring that all residents are offered an annual holiday. Some residents were currently on holiday. During interviews residents spoke excitedly about their forthcoming holidays, and others commented on how much that they had enjoyed theirs. Interviews with residents and staff confirmed that residents are supported to maintain important links with their families and friends. During interviews one resident confirmed that they were visited by a former carer and could also go and visit their carer at home. There were records of contact made with families as is good practice. Feedback received from seven relatives confirmed that they were made to feel welcome by staff when visiting the home. Daily routines are flexible and residents’ right to privacy are respected. For example, during interviews residents confirmed that they could access a bedroom door key if they wished. Bathroom doors are fitted with appropriate privacy locks. All seven relatives who completed comment cards confirmed that they could see their family member in the privacy of their own bedroom if they wished. Staff must ensure that they use residents’ preferred forms of address rather than generic terms such as ‘darling’ or ‘sweetheart’. A variety of meals and mealtimes were observed during the day of the visit; it was pleasing to see that staff had taken time to ensure that meals were well presented and sat with residents to promote a congenial atmosphere. There were large and small portions of food served to residents according to their individual preferences and alternative options were seen. A number of Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 14 improvements have taken place including ensuring that residents are consulted about menu planning. During interviews residents confirmed that they were given choices and that if they didn’t like something they would ask staff who would change it. There are a couple of outstanding issues: there is improved record keeping with regard to residents’ food intake, however staff are failing to record residents’ chosen options at breakfast time. A resident in one of the units is on a specialist diet: gluten free and weight reducing due to identified health complications. The review meeting held in January 2006 states that the service user should be on a weight reducing diet due to ‘significant’ weight gain. The nutritional care plan needs more clarification as to how staff support and monitor weight increase. Examination of food intake charts reveal that the resident is on a diet that is high in fat. In addition weight monitoring demonstrates that the resident is continuing to gain weight. For example, in April 2006 the resident weighed 12.1 kg. and in May 2006: 12.12 kg. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The overall outcome for this group of standards is judged to be adequate. Overall personal support and healthcare arrangements adequately meet needs of residents. Residents’ preferences regarding how they are supported is largely adhered to, there are systems in place to identify any potential health care complications and arrangements for medication only need slight attention to ensure systems are compatible with good practice. EVIDENCE: There are care plans and monitoring charts in place with regard to how residents’ personal support needs are meet. It was pleasing to see that care plans identified whether the resident preferred male or female staff with regard to personal care tasks. The home now has a full complement of male and female staff to more adequately reflect the gender composition of the service user group. As previously required suitable aids and adaptations have been obtained to enable residents to have the choice of whether to shower or bathe. During interviews one resident stated “it’s alright living here” when asked if staff offer them appropriate support. During interviews a staff member gave excellent responses to how they supported a service user with their personal preferences and cultural needs. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 16 Improvements have been made with regard to healthcare. For example, there is consistent checking and recording of residents’ weights. There are good systems now in place for monitoring residents’ health care appointments with a health check sheet contained in case files for such purpose. One resident’s health check sheet was seen to be blank in some areas. Staff reported that family take responsibility for escorting the resident to dental and ophthalmology appointments. Information must therefore be obtained from the family to complete the record and ensure that the resident is accessing the required health care appointments. Feedback from two visiting healthcare professionals was positive with regard to staff communication and their management of residents’ needs. Where residents’ lack capacity to consent to invasive screening tests, this has been discussed with the General Practitioner as required and outcomes recorded in the residents’ care plan. As discussed, whilst there is evidence of residents’ attending well person clinics, care plans must be established as to how varying types of monitoring supplement these annual tests (for example, staff observing any physical abnormalities and residents’ encouraged to self examine where appropriate). It is pleasing to see that residents’ have annual health care checks and regular medication reviews. As required, management have discussed the frequency of night time checks with residents and their advocates with outcomes documented in care plans. However, one resident had requested two checks during the night time but according to night staff monitoring charts was receiving checks every two hours and this must be reviewed. Care plans need to accurately describe why and how staff carry out any checks during the night. There was one area of concern relating to continence management. For example one service user is incontinent (mainly at night) although the ‘initial health check’ assessment states there are no problems with continence. The resident’s care plans give staff no practical guidance for managing incontinence or toileting programme. There are no continence aids and staff were unsure as to whether advice had been sought from the continence advisor. (See further comment in standard 30). Arrangements for the control and administration of medication are good. There are regular visits from the local pharmacist who has identified no serious issues at recent visits. All medication received into the home is checked and recorded as is all returns to the pharmacy. Medication administration record (MAR) sheets are being completed accurately. A number of improvements have taken place to meet outstanding requirements from previous inspections. Observation of a drug round was undertaken and staff followed appropriate procedures with only one slight exception which was discussed with management. Only a few minor amendments are required as identified in the Requirements section of this report. For example, more detailed guidelines are required for the administration of ‘as and when’ (PRN) medication. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The overall outcome for this group of standards is judged to be adequate. Complaints are adequately managed although further improvement is needed to ensure vulnerable adult abuse procedures are robust and offer suitable safeguards to residents. EVIDENCE: The home has a comprehensive complaints system. During interviews residents were clear about who they should speak to if they are unhappy. One complaint has been received about the service since the last inspection. This was thoroughly investigated by the service provider with action taken to rectify practice issues that had been raised by the complainant. As previously identified, a complaints procedure must also be produced in a range of formats to suit residents’ needs. Six out of seven relatives who completed feedback comment cards stated that they were not aware of the home’s complaints procedures. There have been two adult protection allegations made since the last inspection. Both were investigated and found to be unsubstantiated. The acting manager acknowledges that more proactive reporting to the Commission for Social Care Inspection should have taken place with regard to the last allegation. In addition the Local Authority Multi-agency vulnerable adult procedures should have been more rigorously adhered to. A further allegation of potential vulnerable adult abuse was made by a member of staff to the inspector during this inspection visit. The member of staff had already raised the issue with the acting manager on the previous day, although Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 18 there was no record of the conversation completed. The incident had allegedly occurred on the 4 June 2006 but had not been reported to management until 7 June 2006. The manager stated that they were in the process of completing a complaints form but that the member of staff was reluctant to complete a written statement. The concerns raised by the staff member are of neglect and therefore potentially fall within the remit of vulnerable adult abuse. Instructions and advice were given to implement the Local Authority multiagency vulnerable adult abuse procedures, to report the incident accordingly, and seek further guidance from the Local Authority in how to progress further. Not all staff have yet received training in vulnerable adult abuse awareness. During interviews the majority of staff gave appropriate responses to how they would deal with an incident of abuse. During examination of staff personnel files an incident of staff misconduct was seen to be dealt with by a senior member of the management team. As discussed, all incidents of alleged misconduct must be reported to the Commission for Social Care Inspection. One resident has been exhibiting episodes of challenging behaviour. Appropriate support is being accessed from psychologists, however as already stated in this report, more comprehensive details with regard to how strategies are being employed to manage the behaviours is required in care plans and associated risk assessments. Staff are undertaking training in managing challenging behaviour although it is recommended that other training such as non-violent crisis physical intervention (NVCPI) should also be considered in order to supplement this training. A sample of service users’ monies and records were examined in order to ensure that robust systems are in place for managing residents’ finances. On the whole there is good recording and management systems in place. However, one resident’s finance expenditure sheet did not accurately balance with the total sum held on behalf of the resident and there was a discrepancy of £5.00. There was no evidence of regular financial checks being undertaken. Regular audits must be undertaken in order to highlight and rectify any deficiencies. An investigation must be undertaken into the discrepancy highlighted and the resident reimbursed where necessary. Other requirements have been monitored and where appropriate action, has been taken these have been removed from the report. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The overall outcome for this group of standards is judged to be poor. The premises are attractive and homely providing service users with a generally safe and comfortable environment. There is one aspect however which is poorly managed which relates to infection control practice and which requires improvement. EVIDENCE: A tour of the premises was undertaken. A number of improvements have taken place since the last visit. For example the garden area has now been made accessible for wheelchair users with the provision of a ramp. Specialist bathing facilities are currently in the process of being fitted to one of the units and another unit has had appropriate aids purchased to enable residents to have a choice of either a shower or a bath should they so wish. All communal areas are bright and airy and furnished to a good standard. Bedrooms are single occupancy with en-suite facilities provided. They are all individually decorated and furnished with lots of personal touches including some sensory equipment. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 20 A health and safety issue was identified at this visit with regard to the lack of suitable adaptations and aids for one resident who is prone to falls (see further comment in standard 42). Infection control requires improvement as although the majority of the premises were found to be clean and hygienic, there was a very strong malodour present in two bedrooms. According to staff one of the residents suffers from incontinence at night and refuses to wear incontinence pads. The care plan and continence assessment contained no practical guidance for staff with regard to continence management, incontinence aids or toileting programme. Staff were unsure as to whether advice had been sought from the continence advisor. Staff were mopping the carpet on a daily basis with neutraliser and washing the plastic cover on the mattress although there was no cleaning schedule to evidence this. There was no hot water in the laundry area and red disolvo bags were inaccessible. There is a staff group of thirty two but only seven staff have received infection control training according to records maintained. Other infection control issues included: no gloves or aprons in the laundry room or hand washing sign for staff, there was no written laundry procedure displayed, and the kitchen flooring was worn and scuffed. One member of staff was seen holding hands with a service user whilst wearing domestic gloves and a spray cleaner in the other. An Immediate Requirement was issued to address serious concerns raised at the time of this visit. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 The overall outcome for this group of standards is judged to be poor. Standards with regard to the number of staff who are NVQ qualified and who have received the required specialist, induction and foundation training remain poor. Improvements have been made in recruiting staff and reducing agency staff in order to improve consistency of care to service users. The frequency of staff supervision requires improvement in order to ensure that residents benefit from well supported and supervised staff. EVIDENCE: The home has a total of thirty-two support staff, four of whom are qualified to NVQ II or above. The acting manager stated that difficulties have been encountered in obtaining funding from appropriate trainers and that a new trainer has now been identified who will be visiting the home shortly to enrol staff. Specialist training is on-going but is a somewhat slow process. In the past the home has experienced high levels of staff turnover. Since the last inspection in November 2005 ten new support staff have been recruited and it is hoped that the staff group will now remain stable. Only four staff have left employment since the last inspection and there are no agency staff Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 22 currently deployed which is a huge improvement. There was an up to date and accurate duty rota maintained and staff are no longer working excessive hours. All seven relatives who completed feedback cards felt that there were sufficient staff on duty however one family member made comments about the large staff turnover and stated that they only see staff a ‘few times’ then they have left which is not good for the residents. Recruitment and selection procedures are good with only one minor shortfall. One member of staff had recently been recruited but upon checking the dates of employment provided by the candidate, did not correlate with those given by the referee. The second reference was not dated or signed by the referee and therefore their identify could not be validated. The home has started to implement an induction and foundation training programme for staff which meets the Sector Skills Council’s specifications. However progress is slow as according to the acting manager there are only four staff allocated per training session. As a result not all new staff are not yet completing induction training within the first six weeks of employment, or foundation training within the first six months of employment, by an accredited learning disability awards framework (LDAF) provider as required. There is a central staff training programme a copy of which was forwarded to the CSCI following the last inspection as requested. This now requires updating to include training which has recently taken place and the former acting manager agreed to send an updated version to the CSCI. Staff have not yet received training in equal opportunities and disability equality. There were individual training and assessment profiles in place for staff. On examination staff personnel files were well organised and therefore easy to audit. The frequency of staff supervision requires improvement as acknowledged by the former acting manager. For example, one support worker has only received two supervision sessions since employment in May 2005. Another member of staff had received their last supervision session in December 2005 although it had previously been identified that increased supervision was essential. It was pleasing to see that annual appraisals had taken place. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The overall outcome for this group of standards is judged to be poor. The temporary acting manager has been receiving ongoing support from the organisation in order to improve standards and shortfalls identified. Quality assurance systems require improvement so that residents and other users can be confident their views underpin the development of the service. There are some areas of health and safety which are poorly managed and practice therefore compromise residents’ safety and wellbeing EVIDENCE: Since 2002 there has been a yearly change in the management of the service. The last registered manager left employment in November 2005. A temporary acting manager was appointed in the interim whom the organisation has supported with a team of senior managers. A new manager commenced employment a few days prior to this visit and as such it is not possible to Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 24 evaluate whether or not they have the competencies and skills to meet the aims and objectives of the service. Feedback was positive from staff during interviews regarding how they have been supported by the temporary management team. Regular staff meetings have been taking place. There is on-going progress towards improving quality assurance systems. Questionnaires have been completed by service users; outcomes are said to be in the process of being analysed by the organisation and results forwarded to the home. Questionnaires for stakeholders and families are in the process of being distributed. There were two serious concerns identified with regard to service users’ health and safety which require immediate action one of which has already been mentioned in this report relating to infection control practice. The second concern is in respect of measures taken to minimize the risks of a service user falling when trying to get out of bed. Management were in the process of trying to obtain a height adjustable bed and suitable adaptations for the bedroom however this was anticipated to take up to six weeks to achieve. In the interim an armchair and rolled up mat were being used to prevent the service user from getting out of bed. A risk assessment had been carried out but on examination this did not include all of the safety measures which were said to be implemented and needed more clarification. An immediate requirement was issued to rectify the situation more expediently. Other areas for improvement included: lack of up to date servicing of hoisting and lifting equipment. For example, the passenger lift in Catesby House has not been serviced on a six monthly basis (in compliance with the Lifting Operations and Lifting Equipment Regulations 1998), the last recorded service being June 2005. The passenger lift in Littleton House has not been serviced since May 2005. The hot water temperatures in staff toilets in all three units exceed safe limits being upwards of 50 oC. There were no warning signs for staff and in addition service users can access these toilets as they are unlockable from the outside. The pantry door in Winter House was left open despite the sign that this should remain locked (as well as food, this contained an almost full bottle of whiskey). Staff were seen to be using wheelchairs to transport shopping from minibuses into one of the units. Mandatory training for staff is ongoing. It was pleasing to see that some outstanding requirements have received action since the last inspection. For example, wheelchairs have been serviced, portable appliance testing has been carried out and accident reporting was improved as demonstrated at the monitoring visit in March 2006. Fire safety is improved as is food hygiene practice. A visit took place in February 2006 from Environmental Services with regard to food hygiene practice. Recommendations made have been carried out with one exception is which to fit a fly screen to the kitchen. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 25 There is an outstanding requirement to review the Legionella risk assessment of February 2003; the home still needs to demonstrate that recommendations made in the assessment have been carried out. Where requirements from previous inspections have been met these have been removed; any new items discussed during this visit are contained with the Requirements section of this report. Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 26 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 x 30 1 STAFFING Standard No Score 31 X 32 1 33 3 34 2 35 2 36 1 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 1 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 1 X Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 27 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 YA5 Regulation 5(1)(b) Requirement To ensure that service user contracts/ statement and terms of conditions are issued to all users and contain specific information with regard to rooms to be occupied and all information as required by Standard 5.2 (Previous timescale of 1/11/03 is partly met). To review and expand care plans, to include detailed daily reports which reflect goals and objectives, to include restrictions on users’ choice, to provide detailed communication methods, to produce care plans in a format suitable for service users and to be signed by users. (Previous timescale of 1/10/03 is partly met). To introduce a person centred planning (or essential life style and life story) approach. (Previous timescale of 1/10/03 is partly met). To ensure that care plans are Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 28 Timescale for action 01/10/06 2. YA6 15 01/10/06 updated as and when needs change or new needs are identified following review meetings. (Previous timescale of 1/10/05 is not met). 3. YA7 15(1) To ensure that care plans contain goals and objectives with regard to service users who require assistance/supervision with managing their own personal allowances and benefits. To accurately identify the exact level of support and assistance they require. (Previous timescale of 1/2/06 is not met). 01/10/06 4. YA8 12(3) To offer more opportunities for 01/10/06 service users to participate in the day to day running of the Home through joining staff meetings, representation in management structures, recruitment and selection of staff. (Previous timescale of 1/10/04 is partly met). To demonstrate how issues raised by service users during their meetings are actioned with written records maintained. (Previous timescale of 1/10/05 is not met). 5. YA9 13(4)(c) To expand the risk management 01/09/06 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). DS0000041321.V299316.R01.S.doc Version 5.2 Page 29 Riverside Care Centre 6. YA12 16(2)(n) To ensure that all activities are monitored and fully evaluated with written records maintained. (Previous timescale of 1/9/03 is partly met). To undertake reviews of weekly activity programmes to ensure that they are wholly reflective of service users’ preferences, needs and recorded interests. Recommendations made during review meetings must also be included. (Previous timescale of 1/2/06 is not met). 01/09/06 7. YA13 16(2)(m) To ensure all service users are facilitated to participate in the community in accordance with preferences and assessed needs. (Previous timescale of 1/2/04 is not met). 01/09/06 8. YA14 16(2)(n) To provide an annual seven day 01/10/06 minimum holiday for service users which is included as part of the basic contract price. (Previous timescale of 1/8/03 is not met). To ensure that service users’ choices from the daily menu are more consistently recorded. (Previous timescale of 1/1/06 is partly met). To ensure that the menu in Catesby House contains information regarding the specialist diet of one of the service users due to digestive problems and that staff follow the requirements of this diet which must be repeated in a nutritional care plan. (Previous 01/09/06 9. YA17 16(2)(i) Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 30 timescale of 1/1/06 is partly met). 10. YA19 12(1)(a) 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 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. (Previous timescale of 1/12/04 is partly met). To arrange ophthalmic, dental, audiology and chiropody appointments for all service users. (Previous timescale of 1/12/04 is partly met). 11. YA20 13(2) To make the following improvements to the control and administration of medication: 1) To pursue plans to ensure that all staff receive training in the safe handling of medication from an accredited trainer. (Previous timescale of 1/9/05 is partly met). 2) 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). 3) To ensure that all prescriptions are held securely Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 31 01/09/06 01/09/06 until collection by pharmacy. 4) To ensure that more detailed guidelines are established for all ‘as and when required’ (PRN) medications – for example when precisely the medication can be administered, what the initial dose to be administered is, what the maximum daily dosage is, how long the treatment should be continued for. 12. YA22 22(8) To ensure that the complaints procedure is available in a format suitable for service users. (Previous timescale of 1/8/03 is partly met). To provide all staff with training in vulnerable adult abuse awareness. (Previous timescale of 1/9/03 is partly met). 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. To improve procedures for managing service users’ monies in order to ensure that any discrepancies are quickly identified and service user’s reimbursed if necessary, for example by introducing regular financial checks and audits. To make the following improvements to the environment: 1) To provide suitable storage facilities for staff. (Previous timescale of 1/10/05 is not Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 32 01/10/06 13. YA23 13(6) 01/09/06 14. YA24 23 01/10/06 met). 2) To pursue plans to replace broken compartments in fridge/freezer in Winter House. (Previous timescale of 1/2/06 is not met). 3) To repair worn kitchen flooring in Catesby House and to ensure that that this is made impermeable. (Previous timescale of 1/6/06 is not met). 4) To repair (or replace) worn flooring in Winter House. 15. YA30 13(3) To take appropriate action to remove the source of malodour in all affected bedrooms. To review and improve infection control practice including continence management. To forward written improvement plan to CSCI detailing all action to be taken by 16 June 2006. - Immediate Requirements – 16 June 2006 To provide staff training in: 1) challenging behaviour. (Previous timescale of 1/9/03 is partly met). 2) diabetes awareness. (Previous timescale of 1/12/03 is partly met). 3) epilepsy awareness. (Previous timescale of 1/12/03 is not met). 4) To ensure that all staff are working to obtain an NVQ II or Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 33 16/06/06 16. YA32 18(1)(c) 01/10/06 III by an agreed date; or the Manager must provide evidence to demonstrate that through past work experience staff meet this standard. (Previous timescale of 1/4/04 is not met). 5) To ensure that 50 of the staff team are qualified to NVQ II or above by 2005. (Previous timescale of 1/8/05 is not met). 17. YA35 18(1)(c) 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). 18. 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). The provider must ensure that an application to register a manager in respect of Riverside Care Centre is submitted to CSCI by the date given. To establish and forward an Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 34 01/10/06 01/10/06 19. YA37 9 31/07/06 individual personal development plan for the new manager to CSCI by the date given. 20. YA39 24 To introduce quality assurance and monitoring system which includes active feedback from all users of the service. (Previous timescale of 1/11/03 is partly met). To ensure that all staff receive training in: a) food hygiene awareness (Previous timescale of 1/9/03 is partly met). b) moving and handling including hoist transfers. (Warning letter issued with timescale of 25/11/05 is met but some new staff now need training). c) Infection control. (Previous timescale of 1/9/03 is not met). d) health and safety. (Previous timescale of 1/9/03 is partly met). e) first aid awareness. (Previous Immediate Requirement of 17/11/05 was partly met but 11 staff still require training). f) fire safety training – (Previous Immediate Requirement of 25/11/05 was met but 5 staff still need training). 22. YA42 13(4)(c) To undertake the following 01/09/06 health and safety improvements: DS0000041321.V299316.R01.S.doc Version 5.2 Page 35 01/10/06 21. YA42 18(1)(c) 01/09/06 Riverside Care Centre To ensure compliance with Control of Substances Hazardous to Health Regulations 1988 carry out individual risk assessments on all products used and to update COSHH information. (Previous timescale of 1/8/03 is partly met). To establish a written procedure for the passenger lift escape system to safeguard service users from containment. Staff must be made aware of how to manually operate the lift system. (Previous timescale of 1/1/05 is partly met). To 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). To obtain an appropriate height adjustable bed and suitable safety equipment to meet service user’s needs and promote health and safety – Immediate Requirement to be completed by 15 June 2006. The Manager is required to ensure the health, safety and welfare of service users and staff in relation to safe working practices, and associated routines in the home, in addition to deficiencies noted about the premises as detailed in this report. To ensure that all lifting equipment is serviced and inspected on a regular basis as Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 36 in compliance with the Lifting Operations and Lifting Equipment Regulations 1998 with records/certificates maintained and held on the premises. 23. YA42 23(4) To improve fire safety: To ensure that all staff participate in a fire safety evacuation drill on a bi-annual basis. (Previous timescale of 1/1/06 is not fully met). 01/09/06 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 YA13 Good Practice Recommendations To consider replacing the existing mini-buses with transport which does not compromise dignity or stigmatize disabled persons. To ensure that families and relatives are made fully aware of the home’s complaints procedure to follow. 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 consider alternative forms of training for managing challenging behaviour such as non-violent crisis physical intervention. 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 all staff complete a bi-annual fire safety training refresher. DS0000041321.V299316.R01.S.doc Version 5.2 Page 37 2. 3. 4. YA22 YA28 YA32 5 6. YA34 YA42 Riverside Care Centre 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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverside Care Centre DS0000041321.V299316.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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