Key inspection report CARE HOMES FOR OLDER PEOPLE
Riverside Court The Croft Knottingley West Yorks WF11 9BL Lead Inspector
Tony Railton Key Unannounced Inspection 25th August 2009 08:30
DS0000006212.V377258.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Riverside Court DS0000006212.V377258.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 Polly Downs Care Home 61 Category(ies) of Dementia (30), Mental disorder, excluding registration, with number learning disability or dementia (30), Old age, of places not falling within any other category (31) Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places: 30 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places: 30 Old age, not falling within any other category - Code OP, maximum number of places: 31 The maximum number of service users who can be accommodated is: 61 21st November 2007 2. Date of last inspection 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 and residential care and a 30-bedded unit providing nursing and residential care for elderly people living with dementia. 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 and a garden to the rear. As of August 2009, fees ranged from £396 to £700 per week, dependent upon the assessed individual need. Additional charges are made for hairdressing, private chiropody and any personal newspapers or periodicals. The home has a Service User Guide that provides information about their service for current and prospective residents. Details of the Care Quality Commission are included within the Service User Guide.
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Following this key inspection visit the service has been given a One Star Rating which means people living in the home experience adequate quality outcomes. This visit started at 08:30 and ended at 15:00. During the visit there was the opportunity to meet and speak to most people living in the home. There was also the opportunity to speak to the newly registered Manager, Clinical Manager, Nurses, Senior Carers, Carers, Domestics, Laundry staff, Cook, Kitchen assistant, Administrators, and Handyman. Three peoples records including Assessments, Risk Assessments, Care Plans, Reviews, Daily, Medical and Financial Records. Three staff records were also seen and included, Application Forms, References, Police and POVA (Protection of Vulnerable Adult List) Checks, Supervision and Training records. Other documents considered included the record of Complaints, Minutes of residents and relatives and staff meetings, the Maintenance records and Fire Safety Officer Report. Other information considered included the previous inspection report, report letter, Service Providers Action Plan, Care Quality Commission service history and Annual Quality Assurance Assessment (AQAA) and he homes returned quality assurance surveys. From information received before the visit it was established that all of the Statutory Requirements made following the previous inspection visit had been acted upon. These improvements were looked at and considered as part of this Key Standard Unannounced visit to the home. However the improvements made must be continued and sustainable and the outcomes for people in the home will be reassessed at a future date. It was noted that no enforcement activity is currently being undertaken by the Care Quality Commission. What the service does well:
To make sure the service can meet peoples’ personal care and healthcare needs these are assessed before coming to live in the home. These assessments are very comprehensive and include a “Things that are important to me” assessment showing staff how people prefer to be supported and what they like and don’t like. To make sure peoples’ needs are met these are set out in a plan of care showing staff what they must do. These are looked at regularly and changed if need be to reflect peoples changing care needs. To make sure peoples healthcare needs are met visits by General Practitioners or District Nurses are recorded and their instructions followed. Peoples’ needs are met by staff that is trained and in particular those suffering with mental health problems as staff have training in how to care for those with Dementia. People were observed having their care and support needs met in a relaxed and unhurried manner. People were observed relaxing in clean and pleasant surroundings. People have their own space as they want and people say they like living in the home. One person said they “have everything they need”, another says the “staff are wonderful”. The returned homes satisfaction
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 6 surveys show people are generally happy with the quality of support and services provided. One person said they “have a choice” at mealtimes, another says they “always get plenty to eat”. Some people who need help eating their meals were observed being assisted in a relaxed and unhurried manner. The Certificate displayed shows the home was awarded Five Gold Stars for the kitchen and food preparation following a visit from the Local Authority Environmental Health Department. The Manager, cook and kitchen assistants are to be commended for their efforts in maintaining such high standards for people living in the home. People are protected by the way staff are recruited and selected as records show references, police and POVA (Protection of Vulnerable Adults List) checks are taken up before they are employed. To further protect people living in the home from any kind of abuse all staff has Safeguarding Training provided by the Police and Local Authority. To make sure peoples health, safety and wellbeing is promoted and protected, staff have Health and Safety, Food Hygiene, Moving and Handling, Infection Control and First Aid training. The records also show the emergency equipment including fire prevention systems are checked regularly. What has improved since the last inspection?
People living in the home and those caring for them are now supported by a manager registered with the Care Quality Commission. To show peoples healthcare needs are appropriately met any involvement of other healthcare professionals such as General Practitioners, District Nurses and Tissue Viability Nurses are now recorded in their care plans and their instructions followed. To make sure people get enough to eat and drink there are now nutritional assessments and all staff have had training in the nutritional needs of older people. Meetings are now held and staff allocated to those who need assisting with their meals. To make sure people are treated with dignity and their wishes are respected all staff have now had Dignity and Respect training. To make sure people suffering with mental health problems receive the care and support they need staff have received training in how to care for those suffering from Dementia. To protect people who take prescribed medicines these are now checked regularly and those giving people their medicines have now been trained to do so safely. To protect people living in the home from any kind of abuse all staff have now had Safeguarding training provided by the Police and Local Authority. To maintain standards in the home more staff now has a National Vocational Qualification at Level 2 or above. Records show 90 of care staff now has a NVQ qualification. The hot water outlets in peoples bedrooms and toilet areas are now checked regularly to make sure they are not to hot for people to use. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Riverside Court DS0000006212.V377258.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.V377258.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To make sure peoples personal and healthcare needs can be met by the service these are assessed before coming to live in the home. The home does not provide a specialist intermediate care service. EVIDENCE: A sample of three peoples records show they have their personal and healthcare needs assessed before coming to live in the home. The homes manager or a Level 1 Nurse goes to meet people and assess their care needs before they are admitted. The assessments confirmed this. The Assessments are very comprehensive and now include a ‘Things that are important to me’ assessment telling staff what they like and don’t like, and how they like to be supported. The Registered manager confirmed that the home does not provide a specialist intermediate care service. The Registered Manager said the service providers’ embargo on admissions to the home has now been lifted and people choosing to live in the home are now able to do so. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 10 Riverside Court DS0000006212.V377258.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ personal and healthcare needs are set out in their individual plan of care and they are protected by the way medicines are dealt with. EVIDENCE: A sample of peoples records show their personal and healthcare needs are set out in their plan of care. The dates and signatures on the review sheets show these are looked at every month to see if they need amending to reflect peoples changing care needs. The daily records show that peoples care needs are met, but they do not contain many descriptive words to reflect and show peoples choices or any decisions they make about ho they live their daily lives. The records of some, poorly, people nursed in bed include turning charts and fluid input and output charts. The dates and signatures and lack of omissions suggest people are receiving the care and support they need and require. These records also show they are supported by the Tissue Viability Nurse and Palliative Care Nurses. Information regarding other healthcare support is now recorded and instructions followed by staff in the home. On the day of the visit it was noted that there are no patients with pressure sores. The Clinical
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 12 Manager said there are ‘Waterlow’ Assessments and Pressure Area Maps and pressure relieving equipment provided to assist staff when caring for people nursed in bed. The records and a tour of the home confirmed this. The home currently provides care for some very poorly people. However, they appeared to be comfortable and well cared for. Records show that some people have an end of days Request Assessment telling people how they would like to be supported and cared for. Records show people suffering Mental Health problems and in particular Dementia are now cared for and supported by staff that has been trained in how to do this correctly and safely. The staff training records and discussion with care staff confirmed this. People were observed being treated with dignity and having their wishes respected. Positive relationships were observed throughout the visit being fostered between those living the home and those caring for them. People are now protected by the way medicines are dealt with as medicines are checked and audited on a weekly and monthly basis to make sure they are stored, administered and recorded properly. People are further protected as staff that give medicines have been trained to do this correctly and safely. A sample of three peoples medicines were checked and found to be correct. To further protect people living in the home the Medication Policy and Procedure shows there is a policy available for staff to follow showing them how to administer medicines correctly and safely. The improvements to the medicine administration systems in the home are acknowledged, however, to continue to make sure people are safe the manager says the medicine administration system will continue to be monitored and the improvement maintained. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find the lifestyle experienced in the home matches their expectations and they are supported to make decisions about their lives. People also have a choice from a varied and balanced diet. EVIDENCE: Discussion with people living in the home found they are happy with the care and support provided. The homes returned satisfaction surveys show people and their relatives are generally happy with the services provided. The minutes of the residents meetings show they have the opportunity to comment on the running of the home and in particular the activities provided and choice of menu. The Registered Manager confirmed the home has a full time Activities Coordinator that arranges and provides activities on a regular basis. The records confirmed this and also show ‘one to one’ activities with those who cannot join in group activities. The notice board informs people living in the home of planned activities and includes such things as the ‘Knit and Natter’ Club that involves people from the local community coming into the home and socialising. The cards and pictures decorating the lounges show people enjoy Arts and Craft sessions. The photographs displayed around the home show people enjoying birthday parties and seasonal celebrations. The kitchen staff
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 14 confirmed that some people like baking and they regularly produce buns and cakes for people to enjoy. The registered Manager and record of activities confirmed this. One person says they “enjoy the meals” another says they “get plenty to eat” another said they have “a choice of meals”. The menu choice checklist confirmed people are offered a choice of menu every day. The Certificate displayed in the reception shows the home has been Awarded Five Gold Stars for the kitchen and food preparation following a visit from the Local Authority Environmental Health Department. The Registered Manager Cooks and kitchen staff are to be commended for their efforts in maintaining such high standards for people living in the home. To make sure people receive the diet they need and require, the records show they have Nutritional Screening Assessments. Records also show peoples weight is monitored to make sure they are getting enough to eat and drink. Records also show some, poorly people, have their fluid input and output monitored to make sure they have enough to drink. To make sure peoples dietary needs are met the Clinical Manager says there are now daily meetings when staff is allocated to people who need assistance with eating their meals. Staff were observed assisting people with their meals in a relaxed and unhurried manner. To make sure people receive a good diet the training records show that all staff has now had awareness training in the nutritional needs of older people. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that what they say will be taken seriously and acted upon and they are protected from any kind of abuse. EVIDENCE: The complaints policy and procedure displayed in the home shows it is accessible to people living in the home and visitors. The Service User Guide also includes the complaints policy and procedure and everyone coming into the home is provided with a copy. The Care Quality Commission service history shows there have been no complaints received. The homes record of complaints show that what people say is taken seriously and is acted upon. Records show and discussion with the Registered Manager confirmed, the home has appropriately dealt with one complaint received on7th July 2009. The minutes of the residents and relatives meetings show they have the opportunity to comment on the running of the home and the quality of the services provided. People are protected from any kind of abuse as training records show all staff has now had Safeguarding training provided by the Police and Local Authority. To further protect people there is a Safeguarding Policy and Procedure provided for staff to follow that also includes Wakefield Local Authority Protocols. Discussion with nurses and care staff found they have a good understanding of what constitutes abuse and how to report allegations of abuse. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 16 The Registered Manager confirmed that the serious concerns meetings and visits to the home by Social Services ceased a number of months ago as issues relating to these have been appropriately dealt with. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well decorated, well maintained home that is comfortable, clean and safe. EVIDENCE: A tour of the premises found it to be well decorated, well maintained and clean. People were observed throughout the visit relaxing in comfortable homely surroundings. Some people were observed in the lounges, dining rooms and in their own bedrooms relaxing listening to music, watching television or socialising with others. People said they “enjoy living in the home”, one says they are “very comfortable”. All areas of the home are free from unpleasant odours and discussion with the domestics found they have all the equipment they need and require to keep the home clean. Discussion with the Registered Manager found there is a Development Plan for the home and there are plans to redecorate and refurbish large areas of the home. Discussion with the handyman and the maintenance records show that to keep the environment safe regular Health and Safety checks are undertaken.
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 18 The records show there are regular weekly fire alarm tests, and emergency lighting checks. Records show the passenger lift and hoists are serviced regularly to keep them in good working order. Records also show other specialist equipment such as pressure relieving mattresses are also checked to make sure they are working effectively. The Fire Safety Officers report shows the home has been checked and records show the remedial work recommended and in particular the new self closures on the fire doors have been fitted. To further protect people records also show the hot water outlets in peoples’ bedrooms and communal areas are checked regularly. The water outlet temperature of some bedrooms and toilet areas was taken and did not exceed those recommended. To protect people living in the home staff training records show they Have Health and Safety and Fire Prevention Awareness training. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ personal and healthcare needs are met by the numbers and skill mix of staff that are trained and qualified. People are also protected by the way staff are recruited and selected. EVIDENCE: People are protected by the way staff are recruited and selected as a sample of peoples records seen show references, police and POVA (Protection of Vulnerable Adults) list checks are taken up before they are employed. To further protect people records also show application forms, employment history, interview notes, contracts and induction training. Records show that Nurses qualifications and registration details are also checked before they are employed. The Registered Manager says there is enough staff planned to be on duty to meet the current care and support needs of those living in the home. The staff rotas confirmed this. On the day of the visit there was enough staff available to meet peoples care and support needs in a relaxed and unhurried manner. This particularly noted on the unit caring for those with Dementia as there was a quiet atmosphere created and people were relaxed and not agitated in any way. The staff training records show staff have now received training in how to care for and support those suffering with Dementia. The carers are to be commended for their skill and efforts in maintaining a relaxed and positive environment in this part of the home.
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 20 To protect people living in the home staff training records show they have Moving and Handling, First Aid, Infection Control, Fire Safety, Safeguarding, Food Hygiene and Privacy and Dignity training. Training records also show Nurses have specialist training in the use of equipment and in particular the use of pressure relieving equipment and syringe drivers for pain relief. The minutes of the staff meetings and supervision notes show they have the opportunity to comment on the running of the home. Discussion with the care staff found they have a good insight into the care and support needs of older people and they spoke positively about their work and those living in the home. Discussion with the Nurses found they feel supported in their work and have the opportunity for training to maintain their registration with the Nursing and Midwifery Council. The inspector was impressed with the positive attitude of all staff and throughout the visit good relationships were observed being fostered between those living in the home and those caring for them. To make sure peoples personal and healthcare needs continue to be met the manager says they will continue to monitor the staffing levels in the home to make sure they reflect the current and changing service user population. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home that is run in their best interests and where their health, safety and well-being is promoted and protected. EVIDENCE: People benefit from the home now having a Registered Manager. Since coming to the home there have been improvements to the care management systems and in particular the assessment and care planning. The recording of other healthcare professionals’ involvement with people living in the home has also improved. The staff management has also improved and in particular staff training and supervision. People are now safer and protected from abuse as all staff have received Safeguarding training. People are treated with dignity and their wishes are respected and all staff has received Privacy and Dignity training. The way medicines are dealt with has improved. The way people are
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DS0000006212.V377258.R01.S.doc Version 5.2 Page 22 assisted with their meals has improved and nutritional training offered to carers. The minutes of the residents and relative meetings show they have the opportunity to comment on the running of the home and the quality of services provided. The homes returned quality assurance surveys show people and their relatives are generally happy with the support and services provided. However, the information gathered through satisfaction surveys has yet to be collated and a report provided reflecting what people say about the home. The registered manager says the satisfaction surveys are collated centrally and the organisation provides a regional report. People are protected by the way their finances are dealt with as a sample was checked and records found to be appropriately kept. The monthly providers visit reports show Health and Safety forms part of the monthly audit. The maintenance records and staff training records show peoples health, safety and welfare is promoted and protected. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP14 Good Practice Recommendations The daily records would benefit from an increase in the use of descriptive words to show and reflect people’s choices and preferences or when they make a decision about how they live their day to day lives. To make sure service users continue to be protected the home should continue to monitor and maintain safe medicine administration systems. To make sure peoples personal and healthcare needs continue to be met, staffing levels provided in the home should be continually monitored and adjusted to reflect needs of the homes current service user population. The information gathered through service users , relatives and other visiting professionals satisfaction surveys should be collated and a report provided showing what people say about the home and quality of services provided, plus any changes to the way the home runs as a result of their comments.
DS0000006212.V377258.R01.S.doc Version 5.2 Page 25 2 3 OP9 OP27 4 OP33 Riverside Court Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission Yorkshire and Humber Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Riverside Court DS0000006212.V377258.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
