Inspection on 20/08/07 for Riverside Court

This inspection was carried out on 20th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Riverside Court 25/08/09

Riverside Court 04/06/08

Riverside Court 21/11/07

Riverside Court 27/02/07

Riverside Court 15/05/06

Riverside Court 09/12/05

Riverside Court 22/08/05

Riverside Court 26/11/04

Riverside Court 01/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Riverside Court The Croft Knottingley West Yorks WF11 9BL Lead Inspector Elizabeth Hendry Key Unannounced Inspection 20th August 2007 09:55a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Court Address The Croft Knottingley West Yorks WF11 9BL 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) 01977 673233 01977 673066 riverside.court@craegmoor.co.uk Speciality Care (UK Lease Homes) Limited Care Home 61 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30), Old age, not falling within any other category (31) Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One place DE for named person Date of last inspection 27th February 2007 Brief Description of the Service: Riverside Court is a purpose built home which provides nursing care for up to 61 older people. The home is divided into two separate nursing units: a 31bedded unit providing general nursing care and a 30-bedded unit providing nursing care for the elderly mentally ill [dementia care]. Accommodation in each unit is located on two floors consisting of single en-suite bedrooms, communal sitting rooms and dining facilities for each unit. There is level access at the main entrance and a passenger lift allows easy access to the first floor accommodation. Riverside Court is situated in the Knottingley district of Wakefield. It is served by local rail and bus routes and has off-street car parking facilities at the front of the premises. As of 20 August 2007, fees ranged from £367 to £635 per week, dependent upon the assessed individual need. The home has a Service User Guide that provides information about their service for current and prospective residents. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit was made to the home by two inspectors on 20 August 2007. The inspectors arrived at the home at 09:55 hours and left the home at 20:00 hours. The last full inspection, carried out in February 2007, identified a number of areas of serious concern. Within the CSCI regional improvement strategy, three meetings with the company’s Responsible Individual and managers have been held. These meetings focused upon the breaches in regulation, outstanding requirements and sought information from the company regarding progress in these matters, and to obtain an agreement from the company in relation to any outstanding matters. It was, therefore, of concern to find that many of these matters had not been resolved and the Commission will formally address these with the company. During this visit, the inspectors spoke to some of the people living in the home, two visiting relatives, some of the staff and the home’s management. The inspectors read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a detailed tour of the building and observed lunch and tea being served. Prior to the inspection, twenty service user questionnaires were sent to Riverside Court to obtain individual views from those living in the home. At the time of writing this report, five surveys had been returned to the Commission. Some of the people living in the home are very frail and may have difficulty completing a questionnaire. Relatives’ surveys were sent out to twenty of the individuals’ relatives/friends. Four health care professional questionnaires were sent out. At the time of writing this report, no responses had been received from health care professionals; and five had been returned from relatives. Other information used in the inspection process included notifications from the provider to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, adult protection safeguarding meetings, copies of the monthly management visit reports produced by the provider, minutes of residents’ meetings and an annual quality assurance assessment completed by the provider and manager. Since the last key inspection, the registered manager has left and a new manager has been appointed. At the time of the visit to the home, the manager had only been in post for six weeks. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 6 The inspector would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The people running the home need to make sure that they have safe ways of working that make sure that people who live in the home get the care that they need. Care plan and risk assessment documentation needs to be more detailed and provide staff with full details of individual needs and clearly explain how those needs are to be safely met in the home. This must be evidenced within daily records. Daily records need to be improved as they do not contain sufficient information to determine the general health and welfare of people living in the home or what activities they have taken part in throughout the day. The privacy and dignity of those living in the home must be maintained and staff need to take care to ensure that comments made to people who live in the home could not be misunderstood or possibly offensive. Care must be taken to provide assistance and encouragement to those individuals who need help with their meals and accurate records must be kept to show what has been offered and what the individual has managed to eat. Unpleasant odours within the home must be eliminated to enhance the comfort of those people living at the home. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 7 Moving and handling risk assessments must contain more information to enable staff to safely assist in the transfer of individuals. Training records identified that all staff have attended recent moving and handling training, however observations made on the day of the visit identified that good practices learnt on the training course are not being consistently adhered to. The manager must monitor the day to day running of each of the units to ensure that the staff team are adhering to the company’s policies and procedures of the home and all of the people living in the home are protected by the working practices of the staff team. Activities should be individualised and all of the people living at the home must have access to activities to suit their needs. Information relating to these activities should also be clearly documented within each individual care plan. There are a number of improvements that should be made that would enhance the living environment for residents. The hall carpet within Shannon and Clyde Units should be replaced. People’s bedrooms should be kept clean at all times and, where identified, should be redecorated to ensure a pleasing and welcoming environment. Several of these present serious issues to the standards of care must be addressed to ensure at all times people living at the home receive appropriate care and treatment. The registered provider and manager must, at all times, ensure that the staff on duty have the experience and skills needed to care for the people within the home. 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 Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People move into the home following an assessment of their health, personal and social care needs. EVIDENCE: This home does not provide intermediate care. The home’s terms and conditions of residence, and resident contract seen, identify what is and what is not included in the weekly bed fee. Information regarding the trial period, notice of termination of contract and services available within the home is also included within the contract and Service User Guide. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 10 The home’s pre-admission assessment for one individual was viewed and found to determine the level of need in the following areas: personal care, mobility, communication, family involvement, medication and medical treatment. Care management assessments were present within some people’s care files; these assessments clearly identified what level of care the individual should be receiving. Despite this, one person is currently residing on the residential unit despite being assessed as needing, and paying for, nursing care. When asked why this person was in the residential unit, the manager was unable to give an explanation. All of the four care plans viewed contained basic information relating to the personal care needs and abilities of each person, some care plans contained ways in which staff could meet those needs. The manager and staff spoken to during the site visit confirmed that care plans are developed based on the preadmission assessment, which is undertaken by a senior member of staff. The home has admitted people with a diverse range of needs and from a variety of cultural backgrounds, mainly from the local area. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use this service experience POOR quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The health care needs of those who use the service may not always be met due to lack of detail, omissions in care plans and errors within medication procedures. EVIDENCE: At the last key inspection in February 2007, care records were found to be of a poor standard and requirements were issued as a result of this. Following this, the responsible individual confirmed that this work had been carried out. However, when these care records were reassessed during the visit to the home, the standard had not improved. Care plans once again failed to identify all of the individuals’ needs and provide an individual perspective on how care should be provided. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 12 All four care plans examined were found to lack detail. For example, when a need is identified in the care plan, such as the individual’s care needs, it identifies what the needs are but then fails to advise staff how those needs are to be met in the home. On the day of the visit, one person was in need of barrier nursing, their care plan did not detail how the staff could meet this individual’s needs, instead the care plan stated that staff should discourage family contact, which has lead to the person becoming socially isolated. Similarly, moving and handling risk assessments are in place; however they lack detail and do not address all the risks. Of the four viewed, all were found to lack detail and provide unclear, conflicting advice for staff. Care plans do not identify all an individual’s health and welfare needs. Neither are they individualised to reflect the person’s likes, preferences and wishes. During the February visit, one of the care plans examined contained details of how a person should be “restrained “ whilst in their wheelchair. This care plan contained no evidence, other than that of next of kin and staff authorisation, that this had been risk assessed and agreed through the correct channels as part of a multi disciplinary review with social workers, health care professionals or occupational therapists. The inspectors spoke at length with the manager about the importance of holding interagency reviews to ensure the safety and welfare of people who live in the home is maintained, and that simply gaining next of kin consent does not protect people who live in the home from inappropriate restraint. Despite this, the statement still remains within the individual’s care plan. Risk assessments were not thorough or detailed. They did not identify all risks to an individual and how those risks are to be managed, minimised and, where possible, eliminated. Daily records examined remained poor and lacked detail about how the individual has spent their day. The management of medications in the home was identified as poor during the inspections in May 2006, October 2006, and February 2007. When reassessed at this visit, standards had slightly improved. The majority of staff have now attended safe handling of medication training. There still remains room for improvement as some medication administration records sampled did not tally with the quantities of drugs stored within the home. During a tour of the home prescribed creams, ointments and nutritional build up drinks were found stored within sluice and linen storage areas, some found did not contain the name of a person it had been prescribed for. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 13 During the last visit, it was identified that the home inappropriately holds a large stock of communal use net knickers. The inspectors were pleased to see that these have now been replaced with named net knickers for each of the people living at the home who require them. Within the Clyde unit, a number of people were once again seen with no stockings, tights, socks or slippers on their feet, which could impact on both their comfort and dignity. A number of care assistants were observed failing to explain or reassure people when undertaking moving and handling tasks. This has the potential to cause a great deal of anxiety, particularly for those people who live in the home who are unable to verbally communicate. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People living in the home are not always supported to maintain contacts, and more needs to be done to ensure the home supports daily and social activity. Those that use the service are not always enabled to make choices in relation to their meals. EVIDENCE: Observations made on the day identified that the activities available within the home continue to be limited, with little provision for more dependent people to participate. The manager spoke of two activities co-ordinators organising weekly activities, however no evidence of individual preferences being sought could be found on files or through observation on the day. Within those care plans sampled, individual interests had been recorded but within daily records there was no reference made to what activities had been undertaken or how care staff had supported the individual. On the day of the Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 15 visit, some people living in the home were seen to be sitting in the lounges without any stimulation or involvement from the staff team. The inspector sat within the Clyde unit lounge for 25 minutes without any member of staff coming to check on people or offer any interaction. Within the Shannon Unit music was playing, one member of staff was present within this lounge, however they were not making any effort to engage with people. When asked what they had planned for the afternoon, the member of staff replied “The activity organiser has taken a resident for a cigarette, then they will have a cup of tea mid afternoon and the evening meal after that”. Some people were sitting alone in their bedrooms with little or no stimulation. On the day of the visit one person who was being barrier nursed was sitting on their chair in the middle of their bedroom facing the door, with no visual stimulation despite the care plan saying how the person enjoyed watching television. This person was isolated from other people living in the home due to a medical condition, however this has also resulted in the individual experiencing long periods of time without any interaction or comfort from members of staff. As on previous visits, it was once again observed that those people requiring a greater level of care or who had speech difficulties were not offered the same choices as those more able, for example, where they would prefer to sit and what they would like to eat. Lunch was observed, the menu clearly stated choices of meals available however staff were observed not asking each person which they would prefer, instead their meals were placed in front of them. On one unit no salt or pepper was present on the table, and were only made available when the inspector asked. One relative spoken with said that the home have said that they are unable to help them get their relative into their car, this has prevented this individual going out socially, something that they used to enjoy. No alternatives were offered to the relative or risk assessments conducted regarding why staff within the home couldn’t provide assistance. The inspectors raised this with the management of the home on the day of the visit, who have confirmed that they will look into it as a matter of urgency. Since the last inspection the home has altered the meal times, a hot meal is now served at lunchtime with a choice of a light meal or sandwiches in the evening. Lunch was observed within Clyde Unit, those people who were able to eat with minimal assistance were escorted to the dining room, while those who required assistance were given their meal within the lounge. Due to the low staffing numbers, only one person at a time could be given their meal which meant that some people would wait up to half an hour for their lunch. The manager was asked why didn’t everyone go to the dining room for lunch, She replied that it had been agreed that those requiring feeding would have their lunch half an hour earlier which would give staff enough time to feed everyone before those who needed less support had their lunch. On the day of Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 16 the visit this had clearly not happened, feedback received from those people within the home and visitors identified that this happens daily and causes many problems and anxieties. It also does not explain why people who need assistance with their meals are not assisted to the dining room to eat. One inspector visited the dining room at 1pm and found a number of people eating their meals unsupervised. The presentation of the dining rooms could be improved by replacing worn tables and chairs, and making sure that the whole room is kept clean and accessible to those living in the home at all times. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience poor quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The home has a complaints policy in place, however complaints are not always appropriately investigated and outcomes recorded are unclear. Those people living in the home are not being fully protected from abuse and poor care because staff are not appropriately supervised and do not consistently follow good practices that they have been taught. EVIDENCE: The manager keeps a record of complaints made, and the outcome of the complaint. Documentation was available of three complaints made since the last inspection. All three complaints were regarding a lack of staff in the lounge on Shannon Unit. Clearly this demonstrates a staffing issue due to the number of complaints made within such a short period of time, the inspectors could find no evidence that staffing levels or deployment had been investigated. All responses to these complainants were “not substantiated, enough staff on duty”. This demonstrates that, despite the home having a clear complaints policy and procedure, it is not always followed. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 18 Of the five service users’ surveys returned to the Commission, three indicated that they were aware of how to make a complaint and two stated that they didn’t know. Since the last inspection, all staff have received training in relation to safeguarding vulnerable adults. Despite this, there continues to be safeguarding referrals being made due to poor practices undertaken by staff, lack of observation and respect for individuals. The manager identified that the management team have started to challenge poor practices and, since the last inspection, a member of staff has been dismissed. Despite this, there still remains a clear lack of supervision of staff to stamp out poor work practices and attitudes. Observations made within the home during the visit indicated that staff interaction and observation of people within the home was inadequate. Staff were observed rushing people, treating people like children and treating people as though they were an object. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience poor quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The decoration and furnishing of the home was, on the whole, of a reasonable standard and some improvements have been made, however there still remains a number of areas that need to be addressed to make the lives of those living in the home safe and more comfortable. Infection control systems currently in place do not protect or promote the wellbeing of those living in the home. EVIDENCE: The home’s premises were found to be suitable for its stated purpose. The premises are in keeping with the local community and have a style that reflects the home’s purpose. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 20 Many of the people living in the home spoken to said that their bedrooms were comfortable and that they had everything they needed. There was evidence that the home has had some redecoration since the last inspection, however communal rooms, and bedrooms, continue to show wear and tear. Holes in the corridor walls were present within all four units. One person’s bedroom that has been newly decorated did not have any curtains at the windows despite the person having slept in that room for a number of nights before it was inspected. Many of the bedrooms inspected had been cleaned when the inspectors toured the home. During the last inspection, inspectors discovered that some people’s beds had been remade over wet sheets and soiled pillowcases, unfortunately three instances of this were found during this visit. A discussion took place with the manager regarding cleanliness within the home, poor practices in relation to infection control and the lack of respect some people are shown by these practices. Plastic coated bowls, cups and beakers within the first floor kitchen were once again found to be very badly stained, and this has been highlighted on the past four inspections. This poses a cross infection risk to people living in the home and, aside from this, is unattractive and unappealing. Offensive odours were not present within living and dining rooms, however they were present within some bedrooms and communal hallways, in particular the hallway of Clyde Unit, and the main entrance hall. One member of staff within Clyde Unit was observed dragging bags of dirty laundry along the hall carpet which will not aide the home in trying to eliminate unpleasant odours. During the tour of the home, the inspectors were asked not to go into one bedroom because the individual was being barrier nursed, no protective equipment such as gloves and aprons or alcohol gel was present outside the room and there was no indication on the door that the person living in the room was to be barrier nursed. While the inspectors appreciate that the individual’s condition should be confidential, other means of highlighting the risk could have been put into place. The inspectors asked to enter the room and asked the nurse on duty where the gloves and aprons were, the nurse replied that they were inside the room. This negates any infection control controls. The nurse was then asked to get some gloves and aprons so the inspectors could enter the room, it took the nurse on duty a considerable amount of time to return with some gloves. On entering the room, the individual was found to be sitting in dried faecal matter, with their cup and beaker lying split on the floor. On leaving the room, the inspectors had to ask for alcohol gel, which was located in the communal bathroom opposite the room. The manager of the home was alerted to the conditions found within Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 21 the room, and then requested that the room be cleaned and the individual made more comfortable. The manager spoke of refurbishment plans having been submitted to redecorate a number of bedrooms and replacing flooring in the corridors, kitchen and dining rooms, and a copy of the schedule of works was seen. However, at the time of the inspection, the manager was unable to give a definite start date for these works. The manager was informed that it is not acceptable for people to live in areas with such unpleasant odours and lie in soiled beds. Several areas of the home, both communal areas and bedrooms, felt cold during the visit and people who were unable to move around independently felt to have cold hands and feet. This was due mainly to windows being opened without staff considering how this would affect people with little or no mobility sitting in the rooms. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use this service experience poor quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. Whilst recruitment processes are in place to protect those people living in the home, they do not always receive the level and safety of care they require from a suitably trained staff group. The needs of the people in the home are not sufficiently met by the numbers and skill mix of staff. EVIDENCE: At the last key inspection in February 2007, there were concerns raised about the number of staff on duty. However, concerns were once again expressed to the manager regarding the competencies, training and numbers of staff available within all of the units within the home. Shannon Unit has been subject to recent changes within the staff team which has, in some instances, caused a deterioration in the standard of care being received for those living within the unit, and a number of complaints have been received in relation to staffing levels. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 23 Observations made during this visit identified a shortfall in staffing, in particular around mealtimes. Those people who require additional support with meals have to wait up to one hour before they can have their meal due to insufficient numbers of staff on duty at key times. Of the five service user surveys returned, one stated that staff are always available when they are needed, one said usually, two said sometimes and one survey said staff are never available when they are needed. General training in infection control, fire awareness and safeguarding of vulnerable adults is provided but serious shortfalls still exist in the work practices of staff. Staff training files indicated that moving and handling training has taken place since the last inspection, however staff were still observed undertaking manoeuvres without communicating to the individual or, when they did communicate, it was in an inappropriate manner. This potentially places both individuals and staff at risk. A discussion took place with the manager about the need to ensure the training staff received is followed and demonstrated in their work practices. It was noted that dementia care training is scheduled to take place for all staff at the end of the month. While it is important for staff to attend this training, the management of the home must ensure it is effective in changing work practices for the better and that the delivery of the training is appropriate. There still remains a need for staff to receive training on maintaining and promoting the privacy and dignity of those in their care. The recruitment and training records of four members of staff were audited. Recruitment records were complete and included references and enhanced criminal records checks. Concerns were raised that a member of staff was employed despite receiving a poor reference from their past employer and no follow up had been undertaken on this prior to their employment. The manager confirmed that this member of staff had recently been dismissed. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use this service experience poor quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People live in a home that is neither run in their best interests nor is effectively managed. The health, safety and welfare of the individuals is not always protected or promoted. EVIDENCE: Since the last inspection a new manager has been appointed, at the time of the visit they had only been in post for approximately six weeks. Since taking on the role, the new manager has begun to challenge poor practices that have been raised by staff and people who live in the home. While the manager is not included as part of the daily nursing team, there still remains a lack of Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 25 awareness as to what is taking place within each unit on a day to day basis. On a number of occasions during the inspection, the manager was unable to account for shortfalls highlighted within the service which means matters affecting the safety, health or quality of life for people living in the home are often not being addressed. No financial records relating to both the home and the residents’ finances were inspected on this occasion, however no incidents surrounding the management of residents’ monies have been reported to CSCI. The manager confirmed that only senior members of staff have access to residents’ monies held within the home. The company provides a quality assurance and quality monitoring system which is based on seeking the views of people who use the service, however no evidence was seen of how this process was being implemented or its effect on standards within the home. When the building was inspected, no fire exits were blocked and the fire extinguishers seen had been serviced. Of those staff files sampled, all had undertaken fire safety training. Information provided to the CSCI identified servicing of the gas installations, central heating system, fire equipment, portable electrical appliances, hoists and call systems. The home has access to a pool of maintenance workers who oversee the day-to-day repairs to the home. Access to the home is via the main entrance, there are appropriate measures in place to ensure the security of the premises and prevent intruders. By the end of the visit to the home, all windows had restrictors in place to ensure the safety and wellbeing of those people living in the home. Notifiable incidents are being appropriately reported to CSCI and investigated. Information provided to the CSCI prior to the site visit indicated written assessments of control of substances hazardous to health had been completed and a contract was in place for the disposal of soiled waste and needles. Cleaning products and chemicals hazardous to health were found to be stored in an unlocked cupboard within the Clyde unit. It was identified to the management of the home that, during the visit, staff were observed performing manual handling manoeuvres on a number of individuals, in some instances the manoeuvre undertaken was inappropriate to the individual. Of the staff files sampled, all had attended recent moving and handling training, this brings into question the effectiveness of the training provided within the home and highlights a lack of supervision of staff. Individuals moving and handling plans lacked detail, provided conflicting information and did not contain clear guidelines for staff to follow, which places both the people within the home and staff at great risk. The risk assessments Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 26 viewed were undertaken by a member of staff who had not received appropriate training in conducting moving and handling assessments. Manoeuvres observed by the inspectors did not promote the dignity, safety or wellbeing of people who live in the home, and staff’s interaction and communication of what was happening was found to be severely lacking. Individual care plans did not contain sufficient assessment or instruction for staff to follow to safely move people. Reference was made to “lifting belts” on more than one care plan, which in itself encourages staff to use the equipment inappropriately. This practice puts both people who live in the home and staff at great risk of personal injury. An action plan submitted to the Commission in May 2007 stated that reviews and updates of moving and handling plans had taken place. This inspection was unable to identify that this had taken place in the best interest of the people who require this form of assistance. Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X x 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 12(1)(a) 15(2)(b) Requirement The registered person must ensure that comprehensive and detailed care plans are developed and reviewed to ensure that the people who live in the home receive the level of care that they require, and that staff deliver the care prescribed within the plan and evidence this in the daily records. Previous timescale of 31/01/06, 31-07-06 and 30/11/06, 10/06.07 not met. An accurate record must be maintained of the administration of all medication to people who live in the home to be sure they receive the right medication at the right time. The home must be kept clean throughout. The registered person must ensure that people are protected by effective infection control measures. All carpets in individuals’ bedrooms and communal areas Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 29 Timescale for action 20/10/07 2. OP9 13(2) 20/09/07 3. OP26 12(1a)16( 2j) 23(d) 20/09/07 4. OP10 12(4)(a) 5. OP38 13 6. OP27 18(1)(a) must be kept clean, and free from offensive odours. Staff must undergo training in privacy, dignity and communication to ensure that all of the needs of the individuals who live in the home are respected, fully met, and that their dignity is maintained. The registered person must ensure that all moving and handling risk assessments are appropriate to the needs of the individual and are conducted by a member of staff who has been appropriately trained to do so. All assessments must contain clear guidance for staff to follow. The registered person must ensure that the moving and handling training staff receive is appropriate and that it is adhered to in their daily work practices. Sufficient staff must be on duty within each unit to ensure that all of the individuals’ needs are fully met. Previous timescale of 30/11/06, and 31/05/07 not met. The registered person must ensure that all repair work required within the home is completed, bedrooms should be in a good state of repair with holes in walls repaired and communal areas are decorated and furnished to a good standard, in particular the dining rooms. The registered person must monitor the day-to-day running of the home and take action when required to ensure the health and welfare needs of individuals are met. DS0000006212.V346064.R01.S.doc 20/10/07 20/09/07 20/09/07 7. OP19 23(2)(b) 20/09/07 8. OP31 24 (1)(a)(b) 20/09/07 Riverside Court Version 5.2 Page 30 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. 3. Refer to Standard OP10 OP3 OP12 Good Practice Recommendations Provide staff with training in maintaining residents’ privacy and dignity including communication skills. All pre-admission assessment information should be kept within the individual’s file and used as a basis when developing care plans. The registered person should make arrangements for residents’ social and recreational needs to be assessed and met appropriately. Care plans must clearly identify each individual’s interests and hobbies. Clear instructions and guidelines should be documented to ensure that these interests are accessed and detailed records must be maintained of what activities each service user has taken part in. People who use the service should be given choices of activities they would like to participate in, those individuals who are less able to communicate should be given equal opportunities to take part in activities of their choice. Daily records should evidence that the care plan has been delivered and should contain a detailed account of what each service user has been involved in during the day, and should not just be a generic overview. 4. OP7 Riverside Court DS0000006212.V346064.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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. 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