Inspection on 09/09/08 for Riverside Care Centre

This inspection was carried out on 9th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Riverside Care Centre 11/09/07

Riverside Care Centre 07/03/07

Riverside Care Centre 08/06/06

Riverside Care Centre 07/11/05

Riverside Care Centre 24/05/05

Riverside Care Centre 12/10/04

Riverside Care Centre 25/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Riverside Care Centre Wolverhampton Road Wall Heath Kingswinford West Mids DY6 7DA Lead Inspector Jean Edwards Key Unannounced Inspection 9 & 11 September 2008 07:50 th th Riverside Care Centre DS0000041321.V371656.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.V371656.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.V371656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Care Centre Address Wolverhampton Road Wall Heath Kingswinford West Mids DY6 7DA 01384 288968 01384 294836 riverside@schealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Centres Limited Mrs Heidi Scott Care Home 24 Category(ies) of Learning disability (24), Physical disability (24) registration, with number of places Riverside Care Centre DS0000041321.V371656.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. 11th September 2007 Date of last inspection Brief Description of the Service: Riverside consists of three purpose built detached properties: Winter, Catesby and Littleton Houses. The properties were previously registered as separate care establishments but at the request of previous Registered Providers the Home is now Registered as one premise managed by one person. A Condition of Registration has been imposed: that each unit has a dedicated staff team. Riverside is built in the picturesque grounds of Holbeche House situated on the main A449 Wolverhampton to Stourbridge Road and within walking distance of Kingswinford. There is a shared driveway/car parking area at the front of the properties. There is a garden to the rear of the properties, which is separated from the adjoining houses by a panelled fence. A brook borders the lawned area of the bottom of each garden. The Home provides accommodation for twenty-four service users who have a learning disability and may also have a physical disability. Users bedrooms are situated on the first and ground floors. There are shaft lifts for users to access the first floor in each unit. All rooms are spacious and furnished to a high standard. All bedrooms are en-suite with a level access shower. There are communal bathrooms fitted with a hydraulic chair on the first floor of some of the units. A statement of purpose and service user guide is available to inform residents of their entitlements. Information regarding the core fee levels of £880 per week was contained in the Homes Service User Guide, however people may wish to obtain up to date information from the care home. There were additional charges for residents, which included hairdressing, chiropody, toiletries and holidays. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission for Social Care Inspection (CSCI), have undertaken an unannounced key inspection visit. This means the home has not been given prior notice of the inspection visit. This inspection was undertaken over two days, with a CSCI Pharmacy Inspector spending part of the first day at the home looking at the arrangements for residents’ medication. All Key National Minimum Standards for adults aged 18 – 65 years were assessed during the visits. The range of inspection methods to obtain evidence and make judgements included: discussions with the registered manager, senior carers and support staff on duty during the visit, discussions with residents, observations of residents without verbal communications and examination of a number of records. Other information was gathered before this key inspection visit including notification of incidents, accidents and events submitted to the CSCI. The home’s Annual Quality Assurance Assessment (AQAA) was submitted to the CSCI on 22 July 2008, prior to this key inspection visit. We sent CSCI survey forms to the home to be distributed to residents, staff and health care professionals, in order that people could give us their views about the home, responses have been included as part of this report. As part of this inspection we also looked in some aspects of an anonymous complaint, which contained some elements of abuse. The Local Authority had held a planning meeting and was taking a lead investigating allegations of abuse, with the organisation investigating specific aspects of the complaint. We took a tour around the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission, where possible. The quality rating for this service is One Star. This means the people who use this service experience adequate quality outcomes. What the service does well: We found that the atmosphere within each house was friendly, relaxed and informal. The houses were fresh, clean and comfortable. The communal areas had generally comfortable furniture and were light and airy. Visitors told us that staff made them feel welcome. Residents were supported to maintain important links with their families and friends. The staff were caring, friendly and generally knew about the residents needs and we saw that people were treated with respect and staff used the name preferred by each person. Residents could move freely around their home and some people made their own drinks and snacks with staff support and supervision where necessary. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 6 Residents told us they enjoyed their meals, and they were generally provided with a nutritious diet to help them to be healthy. The residents’ bedrooms were attractively decorated with colour schemes chosen by each person and with lots of personal possessions arranged to each persons liking. There was a key worker system, which means that there was a closer relationship between staff and individual residents, whose preferences and needs received more detailed attention. A relative commented, “they have had some staffing problems – its better now – more settled.” There was a range of organised and spontaneous activities for residents, with individual weekly plans in pictures and symbols. A residents relative told us “she enjoys going to church and the hobby club”. The home had its own minibus, which was used for residents’ to go to college, shopping, trips and outings, and to visit relatives. Some residents regularly attended day centre placements. The organisation had continued to respond to legal requirements and good practice recommendations, and actively tried to improve the quality of care for residents living at the home. This inspection was conducted with full co-operation of the registered manager, team leader, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspectors would like to thank the management, staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The manager successfully completed the CSCI registration process to become the registered manager at Riverside Care Centre. She demonstrated she continued to be committed to improve standards of care and support and independence of residents wherever possible. She had taken action to explore the comments made by some residents and relatives in the homes own quality assurance surveys and residents meetings, relating to minor problems, which were being resolved. She has held regular relatives and staff surgeries and encouraged resident involvement in the say and running of their home. Information about the services the home provides had been revised, updated and produced in easy to read and alternative formats, suited to each persons level of understanding. The way the home plans each persons care had continued to improve. There was generally fuller detail and specific written information providing staff with better guidance about each persons needs and preferences. At this visit additional areas needing fuller detail were discussed. Health care assessments Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 7 had improved, with measures generally in place to minimise risks of falls and risks involved in moving and handling people. There were also records on each persons file, showing that there is generally better access to specialist medical, chiropody and dental care. The results from healthcare professional surveys were generally positive about the improvements this home had made to meet residents healthcare needs, which indicated positive relationships between the staff and health care professionals. One person stated, communication has improved” “improved training offered to staff to look at residents as individuals, more person centred. The homes system for the management and administration of residents medication had been improved in a number of areas, with only good practice recommendations made as a result of this visit. The additional improvements were needed to make the homes system of medication administration as safe as possible. Referrals to appropriate health care professionals had been made with improved support for some residents with complex physical needs, such as diabetes and challenging behavioural needs, such as aggression or selfharming behaviour. The manager and staff have tried to create an environment, where comments and concerns were welcomed as an opportunity for the home to improve. The complaints procedure had been provided in a number of different formats suited to people’s capabilities. The manager had continued to strive to recruit additional members of staff and maintain the rotas so that staffing levels are more stable, providing the residents with more consistency. The registered manager, as part of the monitoring systems in the home had put in place audits of all areas the premises. As a result improvements to the internal décor, fixtures and fittings and the exterior of the home continued to be made, with new large attractive planters and small greenhouses in the gardens and redecoration of some corridors. The homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI contained accurate information and better detail of the supporting evidence of what the home does well and how the improvements have been made. Comments from healthcare professionals included, “At the moment they are working well to support an individual I work with to improve the quality of his life – he now has access to more choices, which I feel suits him well.” Improvements had been made to some areas of health and safety, such putting in place approved devices to hold open residents bedroom doors and an improved regular analysis of accident and incident records to highlight Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 8 trends or risks. These actions will make the home a safer place for residents and staff. What they could do better: We noted that some of the information recorded about a new resident recently admitted to the home was not accurate, this meant that this persons needs for care and support may have been misunderstood or care not appropriately provided. There must be improved accuracy of assessment and review information recorded. Although improvements had been made to the way residents care is planned especially for residents with complex conditions such as diabetes, behavioural difficulties, more care must be taken with the accuracy, review and monitoring of the information recorded. There must be more rigorous monitoring and additional safeguards put in place when staff help resident’s with their financial transactions. This was especially important for people who were not capable of make their own decisions and other professionals and independent advocates must be involved to help them. There must also be fuller support for people with the capabilities to be more independent. . At this inspection there were areas of each of the three houses, which needed further improvements to the environment, such as the completion of the redecoration programme, and replacement of some carpets and furniture. Comments were received as part of the inspection process, such as retain staff to establish more continuity, and “the concern I have is with the fast turnover of staff, however I do appreciate this may be difficult”. The registered persons must make sure that staff recruitment continues to be conducted rigorously and that at all times well trained, competent, skilled staff are deployed in sufficient numbers to support and care for all residents’ needs. The homes staff training programme needed additional improvements to make sure all staff received training to understand their role and responsibilities and residents needs. We have strongly recommended all staff receive additional training to safeguard all aspects of residents lives, including their emotional needs, their capacity to make decisions and their finances. Action must also be taken to provide all staff with safe food handling training. The registered persons must make sure that suitable and stable management arrangements are maintained for the running of the home in the registered manager’s planned extended absence. A healthcare professional commented “I feel having a clear plan of action with identified outcomes would keep things moving in the right direction.” This is to make sure residents’ health, well being, independence and safety is promoted. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 9 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.V371656.R01.S.doc Version 5.2 Page 10 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.V371656.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate. The home has an up to date statement of purpose and service user guide and can be provided in appropriate formats suited to residents and their supporters. This means information about Riverside is readily accessible. Residents generally have their needs assessed by competent persons prior to moving into the home. The supporting documentation is not always accurate, which could result in resident’s needs not being understood or met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July stated, “What we do well: Riverside has a statement of purpose and service user’s guide, which has recently been up-dated to reflect service operations. All potential new service users are given copies of this. We have this in a written and pictorial format. Service users have a survey sent to them yearly, which is in a pictorial format. This is completed by service users and advocates where possible. Riverside has not admitted any new service users for the past 2 years but we are currently marketing as we have 2 vacancies. All national minimum standards and best practices will be followed when introducing a new service user to Riverside.” The home’s AQAA also stated, “How we have improved in the last 12 months: The Service User Guide has been developed into a pictorial Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 12 format with the use of the Communicate In Print resource system we have in place at Riverside.” We asked the registered manager about progress to meet the previous recommendations to revise and update the information given to people about the home. She gave us copies of the information available to people interested in the home. We looked at copies of the home’s Statement of Purpose and Service User Guide; these were displayed in the reception area and had been updated in August 2008. We also saw the formats suitable for people living in the home to understand. The core level of fees charged for this service was published in the service user guide and individual fees were recorded as part of each person’s contract of residence. There was clear information regarding additional charges should anyone have additional one to one care, which was charged at £12.50 per hour. Since the home’s AQAA was submitted there had been a new admission to the home, with another new resident due to be admitted on the second day of the inspection visit. We noted that a resident had been transferred from another home within the organisation on 22 August 2008, initially for a respite stay to recover from surgery. The resident’s permanent home was not suited to provide appropriate access for this person’s physical disabilities. We looked at the information transferred to Riverside, together with on-going assessment information. We looked at how the person’s care was being provided and spoke to the staff about how the resident was responding to the temporary move. We discussed some discrepancies with the information with the registered manager for example we were told that the resident had a ‘below knee plaster’ following a total knee replacement, information recorded after admission. However hospital discharge information on file indicated that the date of the knee surgery was 24 June 2008 and there was additional hospital discharge documentation dated 21 August 2008 resident indicating ‘had open reduction and internal fixation to fractured left ankle’. We established this was the result of a fall following the knee surgery. We saw that the falls risk assessment from the previous home had not been updated since 29/6/08, at which time the review recorded “no change.” There were positive aspects to this person’s admission to a ground floor bedroom at Riverside, which was spacious enough to use the hoist for transfers and where there was good access to communal areas. We were told that the resident’s relatives were pleased with the services provided and the good communication from the staff. The registered manager also acknowledged that some resident’s care information transferred to the improved person centred care plan’s had not been carefully and accurately transferred. She was undertaking monitoring of a sample of care records on a regular basis. The registered manager was due to take extended leave and inaccurate information could result in residents’ needs and support being misunderstood or left unmet. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 13 There was evidence that referrals to appropriate health care professionals have been made since the last inspection. There was improved support for some residents with complex physical needs, such as diabetes and challenging behavioural needs, such as aggression or self-harming. During discussions staff could generally tell us about residents preferences such as rising, retiring, and food likes and dislikes. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 14 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): 7, 8, 9, 10 Quality in this outcome area is adequate. There are systems to support residents and their supporters to participate with planning their care and identifying their wishes and aspirations. The person centred care plans are in development to ensure that staff have the information needed to understand residents’ assessed and changing needs and personal goals. There is support for residents in taking risks but this is not always consistently applied, meaning that in some instances people are not fully protected to reach their potential for independence. The systems for safeguarding resident’s finances are not sufficiently robust, which poses risks of financial abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: Each service user has had an individual person centred plan and care and support plan created for them. This has been created in conjunction with the Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 15 service user, family members and other healthcare professionals. These care and support plans cover all aspects of the service users assessed and changing needs and personal goals. They are user friendly and realistic and give service user and staff clear goals, boundaries and guidelines to work along side. The care and support plans are reviewed monthly and a multi-disciplinary review is held a least once a year, therefore any changes or decisions made can be reflected in the care and support they receive. Whenever possible or needed advocacy services are also involved or best interest meetings are held especially in regards to medical decisions, expenditure and placement reviews. All service users are encouraged to attend a monthly service user meeting, assist in recruitment and are regularly consulted and asked to participate in all aspects of the running of the service. Service user meetings are conducted using a variety of communication methods. Service user’s annual quality surveys are in picture/written format so that they are more user friendly. The results from surveys are compiled into an action plan and the results will be discussed with the service users in an appropriate way. We also do well in supporting service users to take risks and promoting independence. We have detailed and regularly reviewed risk assessments. These are written in-house but for the more high risks, these are written in conjunction with either a learning disability nurse or a social worker. This has allowed people to access the community independently, use kitchen areas and have safe relationships with others.” The home’s AQAA stated, how we have improved in the last 12 months: “Our care and support plans have been fully reviewed; they are more users friendly for the staff and service users. We have built good relationships with health care professional and are receiving full support from GP’s and the Intensive Support Team at Ridge Hill.” We looked at a sample of three resident’s care and support in depth and a sample of aspects of other resident’s support and care. We noted that there were positive changes since the previous inspection. The registered manager had introduced night care plans to ensure that residents requiring frequent support were regularly checked, whilst the residents who were more independent and able to indicate their choices were not routinely and unduly disturbed. We found improved care plans, which were more person centered and more meaningful risk assessments for the management of challenging behaviours. We saw referrals for speech and language support for two people without good verbal communication skills and we spoke to staff who told us they had received Makaton training, which they were using to communicate with a resident who had used this type of signing previously. They told us they felt it helped greatly in understanding this resident’s choices and wishes. A previous recommendation had been made to review, update and expand written risk assessments to ensure that any unnecessary risks to the health Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 16 and safety of residents were identified and so far as possible eliminated. Although not all information was entirely accurate the risk assessments in place gave improved support and guidance to identify and minimise risks. There were improved moving & handling risk assessments, with scores identified and the name of hoist and size of sling to be used recorded, which meant staff had good information move and transfer resident’s safely. We noted that there were also copies of moving and handling assessments in the sampled of resident’s bedrooms we viewed. We examined the accident records, and ABC Incident records, which were also improved and there were regular analysis to highlight trends and identify areas where remedial action was required to reduce the likelihood of further occurrences. We saw that care planning also included a financial risk assessment and financial plan, identifying who would take responsibility for resident’s finances, if they were not able to manage their own money. The information did not contain details of any assessment of individual resident’s capacity as defined by The Mental Capacity Act 2005. We noted improvements to the finance systems for managing the resident’s finances held in temporary safekeeping at the home. The registered manager had introduced an improved system for recording full details of all transactions made on behalf of residents. We looked at a sample of financial transaction records in August 2008 and we noted a small number of transactions where the Deputy manager and some senior staff had not diligently followed the system. There were some examples where there were no receipts for purchases and a handwritten receipt had been completed with a total but no items recorded. We spoke to a senior staff who told us that some related to drinks or other items purchased at The Grand Theatre but could not recall the detail 2 months later. We also discussed our finding of a handwritten receipt for the ‘sale’ of a skirt belonging to the deputy manager to a resident. We held a discussion with the team leader who had signed the receipt and she acknowledged to the registered manager and us, that this transaction had taken place. We also noted that hand written receipts for residents who had attended Weight Watchers meetings were for varying amounts with no detail of transactions and the registered manager told us not all resident’s had the capacity to make financial decisions. We asked to see the cards with official receipts for residents who attended Weight watchers meetings, the senior carer told us they were kept at her home. She produced 4 cards in the afternoon of the second day. There appeared to be areas of discrepancies and we were not able to audit the validity of the records. A safeguarding referral was made to Dudley Directorate of Adult and Housing Services and the Police Vulnerable Persons Officer for further investigation. The organisation was co-operative and agreed to undertake an independent audit of the resident’s temporary safekeeping accounts. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. There are increased opportunities for some residents to lead meaningful lives with a wider range and more frequent stimulating community based outings and activities. Residents are supported to maintain important links with their families, wherever possible. Residents are offered nutritious choices for meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: For those service users who are capable we do in-house training with them on fire awareness, food hygiene and Makaton. We have also begun to work with Dudley’s Volunteer Services as some service users are interested in offering their time to others. One service user that has undertaken an interview with the WRVS to work with them at the lunch club and in their library area. Some of our service users attend local day centres or colleges where they undertake academic course or personal development courses such as confidence building and health education. We ensure that educational needs Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 18 and activities are age appropriate for example, younger clients are encouraged to attend colleges or adult education centres, and service users aged 60 plus use Age Concerns as a means of ensuring that their needs and opportunities are met. We have developed in house activities and access to local community facilities such as The Crystal Leisure Centre, local hairdressers, Wall health and Kingswinford library, local pubs, Wombourn Methodist Church and weight watchers. We have good community relationships. Activities are organised and arranged in conjunction with people interests and financial arrangements. We also have training police constables that spend placement days at Riverside. We have built up strong links with the local police station which has enabled us to work on security matters and community presence in Kingswinford.” The home’s AQAA stated, how we have improved in the last 12 months: “The environments of the homes have been redecorated and arranged to suit service users physical needs better. The homes now have a much more userfriendly feel to them and the health and safety of staff and service user has been improved. Through the new care and support plans and monthly resident’s meetings, service users now appear to express their interests better. We have improved the way in which activities and leisure pursuits are organised and arranged. Each house has a dedicated activities coordinator to ensure that all service users’ interests are fulfilled. We have started to seek involvement from other local services to assist service users to have better opportunities outside Riverside.” We saw that daily routines at the home were flexible and promoted independence, wherever possible for example on both days of this inspection visit residents were at various stages of rising, dressing and having breakfast, according to their preferences and activities for the day. People who needed to be up early to go out were prompted and supported, whilst others were allowed to proceed at a more leisurely pace, as they wished, having breakfast as late as 10:15 am. From the sample of care records we examined we noted progress with person centred plans, which provided fuller information about residents’ preferences and how they were supported to make choices. There was improved evidence to show how residents were supported to participate in the planning process for their individual activity programmes. There were care records, which included “map of people important to X”, “map of places important to X” and “my yearly person centred planner, which included things that work and things that don’t work. There were also weekly pictorial activities programmes, which were meant to reflect each person’s needs for any therapeutic activities and their preferred activities. The records also had daily sections for activities chosen as alternatives, which was very positive. One person with complex needs including dementia, and close family involvement had well completed activity records, which included “hand & foot massages”. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 19 We spoke to a number of visitors who told us that they felt warmly welcomed to the home and could be involved as they wished to be in taking care of their family member. We saw evidence in records and we heard from some residents that they go to visit their family at their home. We were told that the majority of residents have good family contact. We observed one young male resident who appeared to be moving about the house in an apparently aimless manner on several occasions during the inspection visits. We attempted to talk to him about how he liked to spend his time but he was disinclined to tell us. We looked at his activity records and discussed the entries with staff. There were no records after week ending 24 August 2008. The records were incomplete and mainly recorded daily living tasks. Examples were Monday – activities were recorded, Tuesday - “put laundry away”, no further entries, Wednesday – “change bedding – listen to music”, Thursday – no activities recorded, Friday – “shopping, laundry”, there were no activities recorded for Saturday or Sunday. The activity record for the resident admitted on 22 August 2008 had nothing entered. We noted from discussions and observations that in practice there were some improvements, with a resident accessing the local library independently, supported with a written assessment of any associated risks. We heard about residents being welcomed at the local Methodist church and they go on visits to a local community bar and hobby club. We were told that all residents have been on holiday this year, in small groups supported by staff. We saw photographs displayed in each house and a resident told us that they had lovely weather on their holiday. The organisation funded staffing arrangements and the registered manager told us that the organisation had continued to make a £250 annual contribution towards the cost of a holiday for each resident. The registered manager acknowledged that there was still an issue that there were only a small number of staff qualified to drive the minibus, which limited the frequency of outings available for all residents and on occasions compromises had to be reached. There was evidence of trips to local beauty spots and places of interest such as Bridgnorth, where residents said there was a favourite café to have a snack. We also saw evidence from receipts that residents had visited The Grand Theatre. An anonymous complaint to the CSCI alleged that some residents were ‘forced’ to go out on occasions, in particular to attend Weight Watchers. We looked at records and spoke to a large number of staff about the arrangements for outings. We received a variety of responses, which will be considered as part of a wider investigation. We found evidence that the escorts for Weight Watchers meetings were the Deputy Manager and a senior carer, who also attended Weight Watchers meetings. We discussed our concern with the registered manager that records were insufficient to demonstrate all residents were Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 20 capable and made a positive choice to attend Weight Watchers meetings. There were undoubted health and social benefits for residents wishing to attend the meetings and be supported to achieve a healthy weight. However as highlighted at the previous section of this report Weight Watcher records appeared inconsistent. Furthermore there was no clear evidence of sustained weight loss for a considerable cost to each resident. We looked at food records for residents attending Weight Watchers meetings, there were no recent ‘food trackers’ in place and the foods did not show that they were being encouraged to follow healthy choices. This raised the issue of whether these residents’ were receiving value in care support in relation to the large proportion of their personal allowance spent in this way. The AQAA stated what the home does well about meals, “Riverside has made meal times a more relaxed and much more of a social event. We have redecorated and re arranged dining areas to ensure that all service users can access tables and eat together if they wish. Service users always accompany staff when purchasing food from local suppliers. We have begun to hold themed dinner parties so that service users can be introduced to new types of food. This has meant that new foods can then be incorporated into the weekly menus. We have also reviewed the morning procedures, now service users enjoy a relaxed start to the day.” We chatted to residents at meal times, most people told us they that they liked the food. We saw evidence that some residents help with food shopping and preparation. A resident was keen to make drinks for us during our visits. The menus are now in pictorial and / or widget form and displayed in each house. We observed staff asking people what meal choices they wanted and staff were sensitive in the way they assisted people to eat. Staff were able to explain the resident’s special dietary needs, such as gluten free and diabetic options. The food intake records showed some improvement but there were still entries, such as packed lunch or sandwiches with no details, which did not demonstrate the nutritional value of the food consumed. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 21 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is adequate. There is an understanding of the concept of valuing people and as a result staff support residents’ rights to dignity and privacy. Generally residents health care needs are supported. There are some specific and significant areas where staff lack knowledge or understanding, which may lead to residents needs not being met. There are corporate procedures for the management and administration of resident’s medication. There some practices, which do not fully adhere to procedures, which mean that some residents may not receive their medication as prescribed by their doctor, posing potential risks to their health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: “Care and support plans and medical records. Residents meetings and care plan management reviews. Multi-disciplinary involvement. Pharmacy audits”. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 22 The registered manager acknowledged that the home still had improvements to implement. An example was, further improvements with documentation of health needs. We were told the home was working with the Health Facilitation Team to ensure that all residents had an up to date Healthcare Passport. We were told that some aging residents with Downs Syndrome were beginning to develop Dementia and that the home was receiving some support from Dudley PCT, however this was still in the development stages and would hopefully continue. The home’s AQAA indicated the improvements already made in the past 12 months, such as accessing training and support from healthcare professionals to make sure that staff and residents have full confidence in managing each person’s healthcare and medical needs. Continuing with the development of ideas and clear policies and procedures for managing health care for people with learning disabilities and dementia. Having a focus on working towards resident’s managing their own medication as appropriate. The registered manager recognised this as an important development for some residents who may move to a more independent supported living arrangement. Additional improvements were that the registered manager had introduced a procedure for the monitoring of residents’ health with regard to potential complications such as breast screening, testicular screening. She had also introduced an improved system for the recording of routine health care appointments, which allowed easier monitoring. The previous recommendation to establish each residents capacity to understand risks and make their own decisions regarding their health care and diet was not fully implemented as highlighted at the Individual Needs and Choices; and Lifestyles sections of this report. There were improved records of regular and recorded weight checks for residents. However the weight records for the residents attending Weight Watchers meetings were not used as part of their healthcare records. There was also a lack of clarity as to whether the residents with a BMI (Body Mass Index) of 30 had been referred to Dudley PCT for 12 weeks free vouchers for weight watchers meetings. We were told that the district nurses continued to administer insulin injections for the resident with diabetes and staff at the home perform the blood sugar monitoring, an invasive body procedure. There was evidence that the previous requirement to formalise and document the parameters for blood sugar monitoring and the protocol for when this procedure needs to be performed had been put into place. There was also evidence of a written invasive body protocol for blood sugar monitoring agreed with the GP practice nurse, signed by staff undertaking the procedure. The registered manager had introduced night care plans for residents needing care and support during the nighttime. The practice of night staff conducting two hourly checks for all residents had been reviewed and revised. The level of monitoring deemed necessary had been discussed and agreed with the multiRiverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 23 disciplinary team, on a risk assessed basis. Some people able to make decisions were not being disturbed, whilst another resident who needed more frequent monitoring, had hourly checks recorded throughout the night. We, the Commission used a Pharmacist Inspector to assess the home’s medication system. We saw a list of staff signatures and staff initials available, which identified members of the care staff team who could administer medication. A medication policy was available, which was produced by Southern Cross healthcare. This means that people who use the service are safeguarded by a working medication policy, however there was no evidence to show if staff had read and agreed to adhere to the policy. The manager informed us that staff who administer medication to residents were currently undertaking a medication training course provided by Boots Pharmacy in order to ensure that they were kept up to date with safe medication management. A household or ‘homely’ remedy list was available for the treatment of minor ailments such as a headache. People had their own homely remedy list to suit their particular healthcare needs. This had also been checked and agreed by a healthcare professional to ensure the safety of the people who use the service. There was evidence to suggest that the service is able to undertake a check on people’s medication. For example, the dates of opening of medication in boxed containers were recorded. Random checks were made which did show evidence that medication had been administered as prescribed. This is seen as good practice, which would help in checking that medication had been given as prescribed by a medical practitioner. The receipt and disposal of medication from the pharmacy was documented which meant that the service ensured that levels of medication were kept at a safe level. Medication seen in all three houses was secure and locked away safely. Only medication that was in current use was stored in the trolleys, which made it easy to locate individual peoples medication. Each house had a new lockable refrigerator for the safe storage of medication. Records of the temperatures were available. The person in charge of each house held the keys for medication, except in Winter House where the medication keys were kept on the same bunch of keys for the rest of the house including the laundry area. This is not good practice and does not ensure that medication is kept separate and secure at all times. In Winter House, we saw internal medication (a liquid medicine) stored next to an external medication (a cream). This is poor practice and increases the risk of contamination between an external and internal medication, which may Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 24 harm a resident. This was disappointing as it had been an issue at the previous inspection. The medicine records seen in all three houses were well documented either with two signatures for administration or with a code to explain why the medication was not administered. Each medicine record also had a covering front sheet with a photograph to identify the person. This means that the medicine records were up to date and people who use the service were safeguarded. Some people were prescribed medication to be given when required. For example, one person was prescribed a medicine to calm and control their behaviour when required with a written procedure as follows, ‘ Only to be administered when X is extremely agitated and other interventions such as – talking, one to one with staff, quite (sic) area for ‘X’ to be supervised by staff’. It was therefore disappointing that there was not always detailed written information available to inform staff under what circumstances some medicines should be administered. For example, one medicine chart had a handwritten note stating ‘See PRN protocol’ (PRN is an abbreviation for ‘when required’), however there was no written protocol available. We asked the manager where it was and we were informed that some of the protocols were available on the computer and were due to be printed off very soon. This means that staff were not always able to follow good practice to ensure that the health and welfare of people were safeguarded. There had been a recent death of one of the older residents. We saw evidence that resources had been put in place to support everyone through this difficult time. The registered manager explained how well the GP, practice nurse and Macmillan nurse advised and supported the resident, staff and family with end of life care. Comments from the family included, “they have always looked after X, passed away May 2008, all staff gave him the care and love to the end,” and “X stayed at the home till he died, with my husband, daughter and myself visited him day and night – all the staff were so caring to us and X. No one could look after him better.” The registered manager told us the home had developed their skills and sourced training in bereavement and end of life care. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 25 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. The home uses the organisation’s complaints procedure, and generally people feel they are listened to and receive an appropriate response. There are procedures in place to provide safeguards for all aspects of residents health well being and safety. Though training has been provided for staff they do not always follow procedures diligently, which means that residents are not entirely protected from risks of abuse or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: We have the Communicate In Print resource system and have adapted policies and procedures into formats that service users can use. Our complaints procedure is in a pictorial format. We accept complaints as a chance to look at and improve the service. All complaints and concerns are dealt with quickly and all involved appear to be pleased with the outcomes. An open culture has been adopted at Riverside and good links have been built with local multidisciplinary agencies, families and advocate services. We have a strict recruitment process which ensures that all staff have the relevant checks to ensure that service users are protected.” The home’s AQAA indicated that the following improvements had been made in the last 12 months: “We have improved on the recruitment process and staff inductions to ensure that service users are protected. The management of POVA related issues are dealt with effectively with clear keep clear documentation and records.” Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 26 We noted that the home’s updated statement of purpose and service user guide contained clear information about how to make a complaint, with up to date contact details of the organisation’s new Operations Director and Responsible Individual. The CSCI survey responses received from residents, relatives and staff indicated that people were aware of how to raise concerns, how to make a complaint and where to direct their concern or complaint. We looked at the home’s complaints log, which recorded full details of the 4 complaints referred to in the home’s AQAA. Prior to this inspection an anonymous complaint had been received at the CSCI office. There were elements, which have been referred to other agencies as part of the safeguarding procedure and the organisation had taken action relating to specific elements agreed in a multi-agency strategy meeting, including the suspension of a member of staff, without prejudice to allow a fair investigation to take place. The home’s AQAA recorded that there had been 3 safeguarding vulnerable adults referrals made and 3 subsequent safeguarding investigations, with the organisation taking a co-operative and proactive stance. As part of this inspection we have discussed with the registered manager and the recently appointed managing director some practices, which have exposed residents to risks of potential abuse, such as lack of detail in residents temporary safekeeping financial records, taking residents to Weight Watchers meetings with adequate discussions and agreements, and the deputy manager’s sale of her personal property, a skirt, to a resident, highlighted at previous sections of this report. We looked at the records for the usage of the home’s minibus’ but the records were not sufficiently detailed to show which staff and residents had used the vehicle or the mileage and purpose for each journey. The registered manager assured us more robust records would be put in place. The home’s recruitment practices also required some further improvements to make sure residents were adequately safeguarded from risks of harm. These are highlighted at the Staffing section of this report. We spoke to a large number of staff throughout this visit who were able explain the procedure for raising concerns, responding to a complaint and dealing with situations relating to allegations of abuse. However some staff indicated that although they had confidence in the registered manager and felt her to be professional and fair were prevented from sharing concerns because of potential repercussions from another member of the management team. We noted that all staff had received safeguarding training; this was provided “in Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 27 house”. The home’s AQAA confirmed this with the statement “Riverside now has 2 internal trainers that can deliver training in POVA.” It is essential all staff attend training with an external training provider, preferably with advice from the Local Authority, the lead agency for dealing with safeguarding referrals. We consider this especially important in view of the number of previous safeguarding referrals, investigations, anonymous complaint and comments from staff to us during this inspection. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 28 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 Quality in this outcome area is adequate. The premises are generally attractive, decorated and furnished to a good standard. There is a maintenance programme but there are some maintenance issues to be dealt with to avoid jeopardising residents’ safety and comfort. Infection control measures are generally adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: The 3 houses at Riverside are very homely; Service users have been fully involved in the decoration of some areas and the rearrangement of furniture. All service users have personalised bedrooms, they have been fully involved in colour schemes, and purchasing personal items. All rooms have en-suite facilities and are fit for their needs and levels of independence. Service users who require aids and adaptations are assessed and equipment is serviced and maintained regularly. The houses have detailed cleaning routines and infection control procedures are in place. The garden areas are very well kept and are user friendly; flower beds are at a level so that wheelchair and able bodied service users can access Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 29 them. The court yard areas are utilised each day and act as an extra space for service users to relax and pursue their interests.” The home’s AQAA stated, how we have improved in the last 12 months: “Riverside has spent a lot of time listening to service users, families and occupational therapists about how to improve the environment. We have removed fire places to give more floor and wall space, we have redecorated many of the communal areas. We have improved the environment for those who have communication difficulties by using pictorial signs and symbols.” We undertook a tour of the premises and grounds, looking a various aspects of the three houses. We looked at a sample of residents bedrooms with their consent wherever possible and some residents were pleased to show us their rooms. Residents able to express an opinion have told us that they really like their bedrooms, which they can have decorated and arranged as they wish. A number of residents had their own new large flat screens TV’s in their bedroom and other ‘hi tech’ electrical items, such as music centres and DVD players. There was ample evidence that residents were encouraged to personalise their bedrooms, which was very positive. There are inventories of residents personal property on the sample of care files viewed, however the not all items of furniture, and valuables such as glasses, hearing aids and jewellery were included. As previously recommended the inventories should be regularly updated, and signed by the resident or family and staff. A resident told us they would like a “proper green house” to grow more vegetables and plans and they would still like a conservatory, to be able sit out in the cooler weather. The majority of the previous recommendations relating to the premises have been met. The registered manager discussed the ongoing strategies being pursued to overcome relating to the risks of flooding. There was evidence that the registered manager encourages a proactive and innovative approach to the environment. Bathrooms and WC’s and laundries in each house were functional and generally well organised and tidy. The kitchens in each house were clean, tidy and generally well organised. The following areas needing improvement have been identified at this inspection visit: Continue work to improve the flood defence system in place Complete redecoration schedule for corridor areas Replace the damaged (iron marked) corridor carpet in Winter House Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 30 Renovate or replace the recliner chair on loan to resident in Winter House Deep clean carpets in Winter House Replace sofas with more comfortable, suitable design for residents Renovate / replace the damaged kitchen work surfaces in Winter House Ensure any opened dried foods are stored in sealed / pest proof containers Reorganise the freezer in Catesby House to ensure foods are stored safely – raw items separated from cooked items Renovate or replace worn recliner in lounge at Catesby House Obtain Safer Food, Better Business for each kitchen Review the ventilation / procedure for use of dryer in laundry – Catesby Review the lack of headboard in ground floor bedroom – Littleton House Replace defective over-bed light and replace missing call point cord in ground floor bedroom – Littleton House Ensure the damaged bath seat is replaced in communal bathroom – Littleton House Take action to eradicate the strong malodour (stated to be spilled fish food) in first floor bedroom – Littleton House – replacing carpet if necessary The organisation should consider the changing needs of older residents with learning disabilities in the early stages of dementia and plan an appropriate environment, taking account of research and best practice guidance. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 31 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, 36 Quality in this outcome area is adequate. The staffing levels are adequate, and there are reduced levels of sickness and vigorous recruitment, but staff do not always work effectively as a team and follow corporate policies & procedures. This means that residents cannot always rely on consistency in meeting their needs for support and care. Recruitment and selection procedures have not always been rigorously followed, which may mean people living at the home are not entirely safeguarded from risks. There is a strong commitment to staff training and development, which gives assurances that staff have the knowledge and skills to understand residents’ needs. There are systems in place to provide formal staff supervision and appraisals. New staff receive comprehensive and structured inductions for before they work with residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: Riverside has clear roles and a structured staffing system. All staff clearly understand their Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 32 roles along with their limitations. Having this detailed structure means that service users benefit from a variety of the staffs’ abilities, experience and qualifications. We have a rolling training plan in place and now have the facility of two in house trainers. 25 of the 35 staff are trained to NVQ 2 and above As mentioned above Riverside follows strict recruitment procedures to ensure that suitable persons are employed. All staff have or are receiving a 12 week Common Skill Induction programme. Staff receive regular supervisions and regular staff meetings are well as having the opportunity to attend weekly manager’s surgeries. This has created a much more organised and motivated staffing team, which has benefited the service users in many ways.” The home’s AQAA stated, how we have improved in the last 12 months: “A master rota has now been put in place, and a senior staff member is always present on duty to ensure that shifts are organised and managed well. Supervision and training planners have now been put in place to ensure that staff receive quality and organised supervisions. Staff now receive monthly house staff meetings and a quarterly large staff meeting. All staff have or are receiving a 12 week common skills induction. Riverside now has 2 internal trainers that can deliver training in POVA, Infection Control, PCP’s, NVCI, Basic health and safety, Basic fire awareness, Basic medication management, Food Hygiene and Equality and Diversity.” At the conclusion of this inspection visit there were 24 residents accommodated, with a variety of dependency levels and diverse needs, with 8 residents living in each of the three houses. From assessment of staffing rotas, observations and discussions indicate that the current staffing levels is generally adequate. The registered manager told us that there were always 3 carers on rota on the early shift, 4 carers in Littleton House, which had the more dependent residents and 3 carers on the late shift. There was one wakeful night carer in each house with a senior, floating, between the houses at night. We were told that the issues about the security and safety of night staff going between houses had been reviewed with improved security arrangements and night staff made aware of the organisations lone working policy and risk assessments had been put in place. The AQAA contained the following staffing Information, numbers of full time carers 23; Part time 9; other staff not care 3. The average care hours were care staff hours provided for personal care were 661.5 hours per week, care staff hours for support but not personal care were 376 per week, with ‘other staff hours provided’ 120 per week for ancillary duties. The staffing structure allowed for a designated team leader, a senior and support worker in each house on all daytime shifts. However two team leader posts were vacant and being covered by senior carers in ‘acting up’ positions. The registered manager informed us that recent recruitment to the vacant posts had been unsuccessful. The deputy manager, on leave of absence at the time of the inspection and registered manager were still needed to cover some of the care hours. We discussed with the registered manager allegations and Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 33 comments from CSCI surveys that at times there were staff shortages. She told us that there were always the agreed staffing levels planned on the rotas. However she acknowledged that there had been instances when there had been staffing shortfalls. She described recent events when seniors and staff had made decisions to leave the houses, without her knowledge or consent to attend to personal ‘crises.’ She told us staff were very resistant when challenged about their behaviour but were willing to complain about being short staffed. She also acknowledged the validity of some comments we received about the lack of teamwork, stating, some staff were not willing to work together as a team. She also acknowledged that the perception that the deputy manager ‘favoured’ some staff could be valid. We noted that 6 full time and 1 part-time care staff have left the home’s employ in the last 12 months. The registered manager told us that the organisation was having difficulty recruiting the calibre of staff to fill vacancies. We looked at a sample of staff files and recruitment processes for 2 recently employed staff. The personnel files were well organised with indexes and dividers and there were recruitment checklists on each of the staff personnel files. We acknowledged that recruitment processes were generally compliant with regulations, policies and procedures there were some areas of weakness. The application form for one person had only a limited work history, with the year employment started / finished rather than month and year. This posed risks that gaps of months in the employment history could be missed. One person had been employed on a POVA First basis, with a documented risk assessment in place, and the named supervisors also recorded on staff rotas as a matter of good practice. From examination of records staff received a basic induction covering, in brief the homes policies and procedures followed by the 12 week skills for care common induction standards. The registered manager demonstrated a strong commitment to staff training and development, together with support measures such as structured supervision. From the sample of staff files examined there was evidence that staff have participated in regular recorded supervision sessions, confirmed in discussions with staff. During discussions with staff all stated that they found the registered manager open and professional but some expressed concerns about the usefulness of supervision sessions with the deputy manager where they stated they felt unable to raise issues without being challenged or blocked in an unhelpful manner. We noted the statement made in the home’s AQAA, that all staff understand their roles. We have discussed this with the registered manager in view of our findings during this inspection, especially relating to the deputy manager, team leader and senior who had not recognised their actions relating to activities and resident’s finances had breached professional standards and could be viewed as breaches of safeguarding procedures. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 34 Staff spoken to had generally shown that on a practical level they were knowledgeable about residents needs and how to meet them. We noted that the home had 17 staff with NVQ Level 2 or above and 8 care staff working toward NVQ Level 2. The registered manager had implemented an annual training plan and individual staff training profiles. There were some gaps in the required training, particularly for food hygiene training, identified as 23 with training in the AQAA submitted. This training must be considered a priority, essential for all staff involved in food preparation and food handling. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 35 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): 38, 39, 41, 42 Quality in this outcome area is adequate. The management arrangements generally indicate improving leadership and better communication in the home, with relatives and with external healthcare professionals. The introduction of quality assurance systems give assurances that residents’ views are taken into account and help to shape the service provided. The management of health and safety generally provides safeguards for residents’ safety and wellbeing This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 22 July 2008 stated, “What we do well: Riverside has made significant steps to ensure that service users with communication and physical difficulties have a much more user friendly environment, and that they Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 36 have equal access to policies and procedures, community facilities and communal areas in the homes. Riverside has better relationships with healthcare professionals and has developed strong links with Dudley PCT, The Intensive Support Team and some local community facilities. This has enabled service users to gain greater access to speech and language therapist, Occupational Therapist and District Nurses. This in turn has provided opportunities to Riverside to have specialist training and to be able access a variety of resources. Giving service users and family members the opportunity to assist with the recruitment process has enhanced our relationships with family members and has also improved service user’s skills and confidence when dealing with people. The new lay out of service user’s care/support plans and files has made service users empowered and staff more aware and confident of service users needs, personalities, goals and aspirations. Riverside has set clear job roles and boundaries for staff. Having internal trainers on site means that staff have taken ownership of their roles and are being invested in which has meant that we are retaining staff and developing staff to a good level. Complaints are dealt with well, Riverside views complaints as an opportunity to improve and monitor where the service is at. The environment has been adapted and decorated with involvement from service users; we have ensured that the homes promote good health and safety practice but also look and feel homely.” We reported following previous inspection visits there had been a considerable period of instability in the management of this care home. There was no registered manager since November 2005 until the current manager appointed in June 2007. There was an acting manager from June 2006 who failed to complete an application to register with CSCI, and ceased employment at the home in March 2007. At the inspection in September 2007 the current manager had only been in post for 10 weeks and had made very good progress with the implementation of improvements improve the quality of life for residents living at the home. Since the last key inspection Heidi Scott successfully applied to the CSCI Regional Registration Team to be the registered manager for Riverside Care Centre. She held the position of registered manager in two registered care homes prior to her appointment at this home. She had considerable experience and had achieved the Registered Managers Award (RMA). She demonstrated a good understanding of the tasks she needed to achieve and how she was going to prioritise them. She had a commendable knowledge of all of the residents and their needs. She told us at this inspection that she had more dedicated managerial hours and the home was less reliant on her having to cover care shifts. However we questioned the level of support she had received from the organisation and from within the home to effectively manage and develop this complex home and to implement and sustain the changes required. Heidi Scott was due to go on extended leave immediately following this key inspection, leaving the home temporarily without a registered manager and deputy manager, and with staffing vacancies including two team leader posts. We expressed our concerns about the stability of the service and the potential Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 37 impact for the residents living at the home, many with conditions needing stability and continuity. On the second day of this inspection we met with the recently appointed managing director who gave us some information about the interim management arrangements for the home. We were told that a project manager, previously a registered manager with the CSCI, would be taking responsibility for Riverside Care Centre during the registered manager’s period of leave. We requested that formal notification, including the person’s details, qualification and experience be forwarded to the CSCI, in compliance with The Care Homes Regulations 2001 - Reg 38. The registered manager had made good progress with the implementation of the home’s quality assurance system, which included feedback from residents and relatives. Staff and residents meetings have taken place regularly, with minutes posted on notice boards. There was an annual development plan and a representative of the registered providers have made the required Regulation 26 visits to the home and reports of monthly unannounced visits relating to the conduct of the home have been made available to the home and the organisation’s Responsible Individual. The registered manager submitted the home’s AQAA on request by the CSCI. This was comprehensively completed and we have been able to verify the majority of information as an accurate reflection of the quality of the service provided. The registered manager acknowledged that the recent safeguarding referrals and complaint revealed that the systems in place to assure resident’s safety and well being had not been followed or appropriately monitored by key members of staff. She told us that she felt disappointed to find that actions she had been assured were completed, were not in fact in place; these included omissions in care plans and records of resident’s financial transactions. She also cited examples of inaccuracies in some care records she had monitored, which left her feeling that some of her confidence had been misplaced. There were improvements for example the efforts with recruitment and deployment of more skilled staff, and plans for a changed ethos in the home to more person centred planning and supported independence for resident’s care and support. We noted that there had been improved Regulation 37 notifications but reminded the registered manager that notifications were also required following serious disciplinary sanctions or dismissals of staff. We looked at a random sample of health and safety and service maintenance records, which were generally satisfactory. The following equipment, as applicable, had been serviced or tested as recommended by the manufacturer or other regulatory body: premises electrical circuits in 2004, Portable electrical equipment, Lifts/stair lifts, Hoists [including portable], Fire detection and fighting equipment, Emergency call equipment, Heating system, Soiled waste disposal, Gas appliances, all serviced in 2008. The home had written assessments on hazardous substances [Control of Substances Hazardous to Health]. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 38 We saw that mandatory training was being provided for the majority of staff commensurate with their roles in a rolling training programme. There were some gaps where some staff did not have all required training and the manager had plans in place to rectify any shortfalls. We highlighted in the Environment section of this report that training in safe handling of food, and food hygiene training was essential for all staff involved in food preparation and food handling. We noted that accidents forms were completed and were filed in individual resident’s case files. The registered manager had made considerable improvements to the way that accident records were centrally collated and analysed with monthly statistics forwarded to the organisation. There were 16 recorded accidents involving residents since April 2008. However there was an accident record dated 9/4/08 indicating “bruise to back” “another service user hit X in back after having an argument”. The manager had written a review indicating more detail required but this was not followed up with a safeguarding referral, details of other resident or ABC record. In May 2008 there was a recorded fall but no review of risk assessment for the resident and another resident with a recorded incident of bruising with no risk assessment. We discussed the improvements needed for monitoring to ensure an effective system for auditing, analysing and evaluating accidents / events involving residents, to highlight risks and trends, with effective measures implemented. The home had a policy for preventing infection and managing infection control. However the home’s AQAA indicated the Department of Health guide ‘Essential Steps’ had not been used to assess current infection control management and the home did not have an action plan for work on infection control management that still needed to be done. We noted that 20 staff had received training on the prevention of infection and management of infection control, which was positive. During the tour of the premises we noted that as people try to leave Littleton House through the fire door to the fire assembly point the access was restricted and people were ‘hit’ by the door. Action must be taken to resolve the impeded access / egress. Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 39 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 3 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 3 3 X 2 X X 2 X Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 40 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 YA7 Regulation 13(6) Requirement The registered persons must ensure that assistance and / or supervision for resident’ s to manage their personal allowances and benefits is clearly documented as part of their care plan, with an accurate record of their capacity to undertake or consent to financial transactions. There registered persons must demonstrate consideration has been given to seeking independent advocacy where residents are unable to give consent, or make decisions to ensure their best interests are protected in compliance with the Mental Capacity Act 2005. This is to safeguard residents from emotional / financial abuse. 2. YA7 13(6) 1) The registered persons must ensure that there are detailed and accurate records of all financial transactions undertaken using the home’s temporary safekeeping system. This is to safeguard residents from DS0000041321.V371656.R01.S.doc Timescale for action 01/10/08 01/11/08 Riverside Care Centre Version 5.2 Page 41 emotional / financial abuse. 2) The registered persons make arrangements for regular documented independent audits of resident’s temporary safekeeping accounts, and notify the CSCI and Dudley DACHS of the results. This is to safeguard residents from financial abuse. 3. YA9 13(4)(c) The registered persons must ensure that risk assessments are in place and regularly reviewed following accidents or incidents of abuse between residents. This is to safeguard residents from risks of abuse or harm The registered persons must make arrangements for all staff to attend safeguarding training from an external training provider to ensure that they understand professional boundaries, and have confidence to report suspected abuse appropriately in accordance with the Safeguard & Protect procedures. This is to safeguard residents from risks of abuse or harm The registered persons must ensure that staff who have been appointed on a POVA First check are subject to the supervisory and induction arrangements stipulated in the Care Homes Regulations 2001, Regulation 18(1)(c)(i) and 19(11), which include two satisfactory written, authenticated references, a written risk assessment, and named, qualified, competent, supervisors. 01/10/08 4. YA23 13(6) 01/11/08 5. YA34 13(6) 01/10/08 Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 42 This is to safeguard residents from abuse. 6. YA37 9(1), 38 The registered persons must 01/10/08 ensure that formal notification of the management arrangements for the registered manager’s extended leave be forwarded to the CSCI, including the person’s details, experience and qualifications in compliance with The Care Homes Regulations 2001 - Reg 38. The registered persons must 01/11/08 take action to resolve the impeded access through the fire door in Littleton House to the fire assembly point. This is to safeguard residents from risks of harm 7. YA42 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA19 Good Practice Recommendations That new person centred care plans / personal profiles should be fully and accurately completed. That all residents have a Riverside Active Care Learning Disability Services Initial health Check records, which is fully completed, signed and dated with all required information such as medication listed and information which accurately reflects assessment information. Staff should read and sign to agree to adhere to the medication policy in order to ensure that residents’ medication is handled safely. External medication (creams and ointments) must be stored according to safe and best practice to ensure that DS0000041321.V371656.R01.S.doc Version 5.2 Page 43 3. YA20 4. YA20 Riverside Care Centre there is no contamination with medication that is taken by mouth. 5. YA20 It is recommended that there is a documented protocol available which describes the care to be given to residents who could become agitated or aggressive. This must include details for the administration of medication prescribed ‘when required’ for behaviour management. Medication keys should be kept separate from any other keys in order to ensure the safe and secure storage of medication. That the environment be improved Continue work to improve the flood defence system in place Complete redecoration schedule for corridor areas Replace the damaged (iron marked) corridor carpet in Winter House Renovate or replace the recliner chair on loan to resident in Winter House Deep clean carpets in Winter House Replace sofas with more comfortable, suitable design for residents Renovate / replace the damaged kitchen work surfaces in Winter House Ensure any opened dried foods are stored in sealed / pest proof containers Reorganise the freezer in Catesby House to ensure foods are stored safely – raw items separated from cooked items Renovate or replace worn recliner in lounge at Catesby House Obtain Safer Food, Better Business for each kitchen Review the ventilation / procedure for use of dryer in laundry – Catesby Review the lack of headboard in ground floor bedroom – Littleton House Replace defective over-bed light and replace missing call point cord in ground floor bedroom – Littleton House Ensure the damaged bath seat is replaced in communal bathroom – Littleton House Take action to eradicate the strong malodour (stated to be spilled fish food) in first floor bedroom – Littleton House – replacing carpet if necessary The organisation should consider the changing needs DS0000041321.V371656.R01.S.doc Version 5.2 Page 44 6. 7. YA20 YA24 Riverside Care Centre of older residents with learning disabilities in the early stages of dementia and plan an appropriate environment, taking account of research and best practice guidance. 8. YA26 That inventories of residents personal property, including furniture, should be regularly complete, updated, and signed To consider providing a sensory garden for service users. Not Met That staffing levels be kept under review and monitored to ensure that at all times suitably qualified, competent and experienced staff are available at the home to promote and make proper provision for the health & welfare of residents That progress is continued to ensure staff achieve the NVQ 2 Care and/ or LDAF Award That progress be continued to provide all staff with - Mandatory training - Challenging behaviour - Epilepsy awareness - Makaton training and any other appropriate aids for communication systems for residents without verbal communication skills That the organisation should take action to ensure that Regulation 37 notifications are made for staff receiving serious disciplinary sanctions or dismissals That the need for appropriate ramped access to the houses is explored, especially in relation to the male resident observed to be in a wheelchair freewheeling from the house and almost colliding 9. 10. YA28 YA33 11. 12. YA35 YA35 13. YA41 14. YA42 Riverside Care Centre DS0000041321.V371656.R01.S.doc Version 5.2 Page 45 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V371656.R01.S.doc Version 5.2 Page 46 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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