Inspection on 27/02/07 for Riverside Court

This inspection was carried out on 27th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 20/08/07

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 27th February 2007 10:15 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.V318383.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.V318383.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 riversidecourt@craegmoor.co.uk Speciality Care (Rest Homes) Limited Ms Julie Douce 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.V318383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One place DE for named person Date of last inspection 15th May 2006 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 27 February 2007, fees ranged from £359 to £558.80 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.V318383.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 27 February 2007. The inspectors arrived at the home at 10.15 am and left the home at 7.00 pm. A third inspector spent two hours within the home observing the care being given to a small group of service users, all of whom were suffering from dementia. The last full inspection, carried out in May 2006, identified some areas of serious concern and, since then, the Commission has carried out a further additional random visit. This visit took place on 31 October 2006 and was carried out to check progress following the May 2006 inspection. Both the random visit carried out in October 2006 and this visit found the home has made little progress in addressing some of the issues previously identified. Within the CSCI regional improvement strategy, two meetings with the company’s Responsible Individual and managers have been held. These occurred in September 2006 and December 2006 and 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 some 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 service users, a visiting relative, 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, ten service user questionnaires were sent to Riverside Court to obtain service users’ views about living at the home. At the time of writing this report, no surveys had been returned to the Commission. Some service users in the home are very frail and may have difficulty completing a questionnaire. Relatives’ surveys were sent out to ten of the service users’ relatives/friends. Two GP practices attend the home and questionnaires were sent to them and other health care professionals who visit the home. At the time of writing this report, one response had been received from a health care professional; none had been returned from relatives, service users or general practitioners. 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 strategy Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 6 meetings, copies of the monthly management visit reports produced by the provider, minutes of residents’ meetings and a pre inspection questionnaire completed by the provider and manager. 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 service users 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 service users’ needs and clearly explain how those needs are to be safely met in the home. This must be evidenced within daily records. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 7 Daily records need to be improved as they do not contain sufficient information to determine the general health and welfare of a service user or what activities they have taken part in throughout the day. The standard of medication management, administration and records must be improved to ensure service users receive the correct medications at all times. Staff must be trained and competent to administer medications. Service users’ privacy and dignity must be maintained and staff need to take care to ensure that comments made to service users could not be misunderstood or possibly offensive. Care must be taken to provide assistance and encouragement to those service users who need help with their meals and accurate records must be kept to show what has been offered and what the service user has managed to eat. Unpleasant odours within the home must be eliminated to enhance service users’ comfort. Moving and handling slings must be kept clean and in good condition. An immediate requirement was issued following this inspection to replace frayed, stained and worn hoist slings to protect service users. Moving and handling risk assessments must contain more information to enable staff to safely assist in the transfer of service users. Care should be taken to ensure correct movement and handling practice is used in the home and that movement and handling training includes a practical session in which staff can practice the techniques. The Registered 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 service users are protected by the working practices of the staff team. Activities should be individualised and all service users 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. Service users’ 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 service users receive appropriate care and treatment. The registered provider and manager must, at all times, ensure Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 8 that the staff on duty have the experience and skills needed to care for the service users. 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.V318383.R01.S.doc Version 5.2 Page 9 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.V318383.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users 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.V318383.R01.S.doc Version 5.2 Page 11 The home’s pre-admission assessment for a service user 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 service users’ files; these assessments clearly identified what level of care the individual should be receiving. All of the four care plans viewed contained basic information relating to the personal care needs and abilities of each service user, some care plans contained ways in which staff could meet those needs. The Registered Manager and staff spoken to during the site visit confirmed that service users’ care plans are developed based on the pre-admission assessment, which is undertaken by a senior member of staff. The home has admitted service users with a diverse range of needs and from a variety of cultural backgrounds, mainly from the local area. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ health care needs 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 May 2006, care records were found to be of a poor standard and requirements were issued as a result of this. Following this, the registered manager confirmed that work had been carried out. However, when these care records were reassessed in a random visit to the home in October 2006, the standard had not improved. Care plans were reviewed again during this visit to the home, once again they failed to identify all of the service users’ needs and provide an individual perspective on how care should be provided. 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 service user’s care Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 13 needs, it identifies what the service user’s needs are but then fails to advise staff how those needs are to be met in the home. Similarly, risk assessments are in place; however they lack detail and do not address all the risks, eg manual handling, as described more fully within the health and safety section of this report. Care plans do not identify all a service user’s health and welfare needs. Neither are they individualised to reflect the individual service user’s likes, preferences and wishes. One of the care plans examined contained details of how a service user 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 registered manager about the importance of holding interagency reviews to ensure the safety and welfare of service users is maintained, and that simply gaining next of kin consent does not protect service users from inappropriate restraint. Risk assessments were not thorough or detailed. They did not identify all risks to a service user and how those risks are to be managed, minimised and, where possible, eliminated. Daily records examined remained poor and lacked detail about how the service user has spent their day. Alarmingly one service user’s care plan stated, “Does not eat any solid or liquidised food due to choking”. When asked, the registered manager was unable to explain why this had been recorded within the care plan and said that they do eat liquidised foods. During the random visit in October 2006, a service user was found to be suffering with sticky eyes, this was found to be the case again during this visit. However, no care plan was found to be in place regarding how staff should deal with this and what treatment is necessary to stop this happening again. The management of medications in the home was identified as poor during the key inspection in May 2006. When reassessed in October 2006, standards had slightly improved. However, during this visit further related issues were identified. Following the random visit in October 2006, the registered manager confirmed that she would undertake a full medication audit, and thereafter weekly medication audits. However, significant shortfalls in the storage, recording and administration of medication were once again found. When a sample of Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 14 medications was audited, a number of inconsistencies were found in relation to the medication administration records and the drugs stored within the home. For example, one service user’s Omeprazole had been signed as given on 25 occasions which should have left three tablets in stock, however only one tablet was left in stock. Another service user’s MAR sheet indicated that 80 Paracetamol tablets should be in stock but only 74 could be found. Staff spoken to during this audit confirmed that the medications had been given but could not explain why the medication administration records had not been completed. One service user was prescribed sedation to be given “when required”. Records showed that this was being given at regular intervals throughout the day, however there was no written evidence to justify why the medication was being given so frequently or that staff were monitoring possible side effects. This service user was seen to be very sleepy and spent a large proportion of the time asleep during the 2-hour observation. Two emergency medication kits were found to be three years out of date. When questioned, the manager did not know why they had not been returned. When asked to show copies of the weekly medication audits, the registered manager was only able to produce one audit dated December 2006 and a copy of the three monthly audit that is completed as part of the company’s policies and procedures. During a tour of the home prescribed creams, ointments and nutritional build up drinks were found stored within sluice areas, some were seen to be out of date and others did not contain the name of a service user it had been prescribed for. A large number of dressings, inappropriately stored within the sluice room, were found to be out of date and some had been cut in half and replaced despite the need to be sterile if used. When questioned about this, the registered manager replied, “These had been prescribed for a service user who is now deceased”. No explanation was offered as to why these had not been removed. During the last May and October 2006 visits, it was identified that the home inappropriately holds a large stock of communal use net knickers, instead of these being labelled for individual service users. Once again, inspectors discussed at length with the registered manager the importance in maintaining an individual’s dignity and that, should an individual need to use these aids, then they should be named. The registered manager then said that the home has tried in the past to use service user specific garments but it had not worked out but could not explain the reasons for this. Within the nursing EMI unit, a number of service users were seen with no stockings, tights, socks or slippers on their feet, which could impact on both their comfort and dignity. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 15 When the inspectors observed members of staff interacting with service users, they felt that generally staff were kind and well meaning. However, some staff were overheard discussing issues which were private to individual service users in a communal area. A number of care assistants were observed failing to explain or reassure service users when undertaking moving and handling tasks, in particular when using hoists. This has the potential to cause a great deal of anxiety, particularly for those service users who are unable to verbally communicate. One service user’s care plan stated “X is now trying to get out of his chair when left unattended. Now being placed on their bed when not being observed”. This illustrates a lack of understanding on the staff part on the importance of maintaining a service user’s respect and dignity and their right to choose. It appeared that this action could be being carried out as an alternative to increasing staffing levels within the home. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Whilst service users are supported to maintain contacts, more needs to be done to ensure the home supports daily and social activity. Service users are not enabled to make choices in relation to their meals and the standard of cleanliness within dining rooms is poor. EVIDENCE: Observations made on the day identified that the activities available within the home are limited, with little provision for more dependent service users to participate. The Registered Manager spoke of two activities co-ordinators organising weekly activities, however no evidence of service users’ personal 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 visit, some service users were seen to be taking part in singing, card making and watching television. Many residents were sitting alone in their Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 17 bedrooms with little or no stimulation. Staff were not present for long periods within communal areas; as a result, several residents were left unattended for long periods of time without any input from members of the care team. As on previous visits, it was once again observed that those service users 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, choices were available for those service users who did not require a special diet, however for those service users who required a softer diet no choice was given. This was also the case for the evening meal. The inspector asked a member of staff what they would do if the service user did not like the meal being served, their response was “most of them can’t say what they like anyway”. The inspectors then asked “what if they don’t like it?” the member of staff replied, “they will eat it anyway” and staff were heard to refer to service users on a softer diet as “the softs”. Discussion took place surrounding this with the registered manager, however the manager failed to appreciate the importance of addressing these issues. Positively, a relative visiting the new EMI residential unit said that the staff always made them feel very welcome at any time of the day and that they went out of their way to provide additional support and flexibility in order to accommodate visits out of the home. On the day of the visit, service users could choose from a selection of sandwiches or hot dogs for lunch. For those who required a special diet, it was baked beans and pasta; however this had been blended together and did not look appealing. During the tour of the home, it was noted that vegetables planned for the evening meal were seen to be cooking at 14:25hrs although the food would not be served until 16:15hrs and, therefore, would have lost any of their nutritional value. 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. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints made to the home are listened to and acted upon. Service users are not being fully protected from abuse and poor care because some staff have not been trained to meet their needs safely. EVIDENCE: The manager keeps a record of complaints made, the investigation carried out, the outcome of the complaint and any action taken. Documentation was available of four complaints made in the last 12 months. Two have been upheld, one partially upheld and one remains under investigation. This demonstrates that service users, relatives and their friends are aware of the home’s complaints policy and have used it. All staff have received training in relation to safeguarding vulnerable adults. Observations made within the home during the random visit in October 2006 indicated that staff interaction and observation of service users was inadequate. During the visit in October 2006, an argument broke out between two service users. Because no staff were present the inspector intervened, this was immediately mentioned to staff. It became apparent that the staff on Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 19 duty did not fully appreciate what went on as the two service users were sitting next to each other at the dining table causing the argument to continue. Once again, observations made during this visit showed staff interaction to be lacking and in need of improvement. The manager was told on the day that there was some good examples when the staff enhanced the individuality and personhood of some individuals, however there were some examples of staff outpacing service users, treating people like children and treating people as though they were an object. One service user, during a two-hour period, received no staff interaction at all, neither were they able to interact with other service users. During this visit, the inspectors identified that a large proportion of staff had not received satisfactory training in the safe use of moving and handling equipment; this places service users at risk of serious injury. Such poor practice has already resulted in a referral under local interagency safeguarding procedures. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The decoration and furnishing of the home was, on the whole, of a reasonable standard but improvements to the cleanliness and decoration of communal dining rooms is still required to ensure it is well maintained and safe for service users. Infection control systems currently in place do not protect or promote the wellbeing of both service users and staff. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 21 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. Many residents 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 some rooms, in particular bedrooms, are showing wear and tear. A bedroom that was seen to be missing its en suite door at the key inspection in May 2006 and the random visit in October 2006 was visited again and the en suite door was still not in place. This was raised with the registered manager during previous visits and once again at this visit but no explanation was offered. Many of the bedrooms inspected had not yet been cleaned when the inspectors toured the home. However, when the tour began at 11.00 am it was noted that, in one bedroom, faeces was on the carpet and a small pool of blood was on the lounge carpet near to the entrance. Both were still there at 1.30 pm. The blood was brought to the immediate attention of the registered manager who responded, “The cleaner hasn’t got there yet”. The registered manager was asked if incidents like these would be prioritised in case a service user wanted to return to their bedroom, the manager stated that incidents like this would wait until the cleaner reached the room and would not be prioritised. Within the EMI units, a large proportion of bedrooms had clocks that displayed the incorrect time, in one room two separate clocks each displayed different times. Inspectors discussed with the registered manager the need to ensure that this be addressed as a priority in aiding service users’ orientation to time. Plastic coated bowls, cups and beakers within the first floor kitchen were found to be very badly stained, this has been highlighted on the past three inspections with the registered manager and staff on duty. This poses a cross infection risk to service users 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, central staircase leading to the first floor. The overall cleanliness of the home requires attention, sluice rooms were found to be dirty, many of the residents’ en suite facilities, easy chairs, carpets and walking frames were in need of a deep clean. Dining room furniture was found to be stained by “old” food, as were the walls beneath the serving hatches to the first floor dining rooms. The registered manager said that these stains Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 22 were new, however the stains appeared to have been there for some time as they had become ingrained in the wallpaper and paintwork. Broken and badly worn toilet seats in a number of en suites were still in need of replacement despite this being highlighted during the last three inspections. The inspectors noted that improvements had been made to the standards of cleanliness within the main kitchen and food storage areas following requirements issued at the random inspection in October 2006. However, the first floor kitchen was found to be dirty and in need of a deep clean. Pre inspection information provided to the Commission from the registered manager spoke of refurbishment plans having been submitted to redecorate a number of bedrooms and replacing flooring in the corridors, kitchen and dining rooms. However, at the time of the inspection, the manager was unable to give a definite start date for these works. During the random inspection in October 2006 inspectors discovered that a service user’s bed had been remade over wet sheets and soiled pillowcases, this was shown to the nurse in charge at the time and discussed with the deputy manager, unfortunately instances of this were found during this visit. A long discussion took place with the registered manager regarding cleanliness within the home, poor practices in relation to infection control and the lack of respect some service users are shown by these practices. Moving and handling slings being used within Clyde and Trent units were found to be badly stained with faeces and urine. The registered manager was unable to explain why they had not been laundered or why staff who had undertaken infection control training continued to use them. An immediate requirement was issued to address this as a matter or urgency to ensure the safety of service users. The manager was informed that it is not acceptable for service users to live in areas with such unpleasant odours and lie in damp soiled beds. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst recruitment processes are in place to protect service users, they do not always receive the level and safety of care they require from a suitably trained staff group. Service users’ needs were not sufficiently met by the numbers and skill mix of staff. EVIDENCE: At the last key inspection in May 2006, 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 the Trent, Clyde and Avon units of the home. Observations made during this visit, and during the visit in October 2006, identified a shortfall in staffing, in particular around mealtimes. Those service users 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. Some staff spoken to confirmed that they do not have the time to ensure that service users’ needs are fully met at mealtimes. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 24 General training in infection control, fire awareness and safeguarding of vulnerable adults is provided but serious shortfalls in moving and handling training were identified during this and the last two visits. Staff training files indicated that the moving and handling training did not provide staff with the opportunity to practice, using the equipment used within the home which consequently places service users at risk. On the day of the visit, none of the staff files examined held any evidence that they had undertaken first aid training. However the training matrix supplied to the Commission since the visit indicates that one of these people has undertaken a one-day first aid training course. None of the staff on duty during the visit had undertaken the health and safety recommended three-day training course, which would give them certification as a recognised and competent first aider to meet service users needs. Discussion took place with the manager about the need to maintain a trained and skilled staff group to meet service users needs. A lack of training in dementia care, and maintaining service users’ privacy and dignity, was also identified and discussed with manager. One of the four staff files viewed indicated that the member of staff had not received any training in 2006. The recruitment and training records of four members of staff were audited. Recruitment records were complete and included all the required references and checks. This helps to protect service users from staff who might be unsuitable to work with vulnerable adults. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 25 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is neither run in their best interests or is appropriately or effectively managed. The health, safety and welfare of the service users is not always protected or promoted. EVIDENCE: The Registered Manager has worked in the home for many years. While her role is not hands on, this and previous inspections have identified that the manager does not appear to have an awareness of the goings on within the home and how each unit runs on a day-to-day basis. On a number of occasions during the inspection, the manager was unable to account for Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 26 shortfalls highlighted within the service which means matters affecting the safety, health or quality of life for residents are sometimes not being addressed. Inspectors observed staff wearing inappropriate footwear within the home. When this was raised with the registered manager, the manner in which it was dealt with was far from appropriate and did not support the presence of the inspectors or the reason behind their presence in the home. 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 has been reported to CSCI. The Registered Manager confirmed that only the administrator and herself 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 service users, 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, three out of four 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. Window restrictors were in situ within all bedrooms to prevent falls. Notifiable incidents are being appropriately reported to CSCI and fully 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 appropriately within a locked cupboard. It was identified to the manager that, during the visit, staff were observed performing unsafe manual handling manoeuvres on a number of service users. Of the staff files sampled, those who had attended recent moving and handling training had not undertaken practical techniques using equipment found within the home, in particular using hoists and handling belts. Service user moving Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 27 and handling plans lacked detail and clear guidelines for staff to follow, which places them at great risk. Service users of differing abilities and body shapes were seen to be placed in the same sling by staff who made unsafe adjustments to fastenings, in order to make the sling fit. While observing staff interaction with service users, the inspector overheard two members of staff talking with a service user while fitting the hoist sling, the service user asked why they were using the hoist and the care staff replied that “we have to today because of the inspection”. This indicated that the service user is usually moved by other methods. This raises concerns of practice undertaken by staff in the absence of the inspection team. Manoeuvres observed by the inspectors did not promote the dignity, safety or wellbeing of service users, 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 service users. One assessment stated “2 staff trained in moving and handling to assist service user in standing and transferring”, no other instructions were then included. The same assessment also stated “service user is now totally immobile and uses wheelchair to transfer”; no date was present on this assessment and therefore provides staff with conflicting vague instructions. This practice puts both service users and staff at great risk of personal injury. An action plan submitted to the Commission following the random inspection in October 2006 stated that the registered manager would undertake reviews and update moving and handling plans as required. This inspection was unable to identify that this has occurred. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 28 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 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 29 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, 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 not met. An accurate record must be maintained of the administration of all medication to service users to be sure they receive the right medication at the right time. The expiry date of all medication must be checked and all out of date medication must be disposed of appropriately. The registered person must ensure all staff have attended fire protection training, which should be updated annually, and that staff are tested in their understanding of fire procedures within the home to ensure service users safety. DS0000006212.V318383.R01.S.doc Version 5.2 Timescale for action 10/06/07 2. OP9 13(2) 31/05/07 4. OP30 23 (4)(d) 10/06/07 Riverside Court Page 30 5. OP26 12(1a)16( 2j&k) 23(d) The home must be kept clean throughout. A deep clean must take place and be maintained within the first floor kitchen. Previous timescale of 22/08/05 31/07/06, and 31/12/06 not met. The registered person must ensure that service users are protected by effective infection control measures. All carpets in service users’ bedrooms and communal area must be kept clean, free from offensive odours, urine, blood and faecal matter. The registered person must make arrangements to ensure that residents’ privacy and dignity is maintained. Previous timescale of 31/01/06, 31/05/06 and 31/12/06 not met. Staff must undergo training in communication to ensure that inappropriate language is not used and that all of the needs of the service users are respected, fully met, and that their dignity is maintained. The registered person must make arrangements for residents’ social and recreational needs to be assessed and met appropriately. Previous timescale of 31/01/06, 31/07/06 and 31/12/06 not met. Care plans must clearly identify each service users’ interests and hobbies. Clear instructions and guidelines should be documented to ensure that these interests are accessed and detailed 31/05/07 6. OP10 12(4)(a) 31/05/07 7. OP10 12(4)(a) 30/06/07 8. OP12 16 (2)(m)(n) 30/06/07 Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 31 9. OP19 23(2)(b) 10. OP38 OP18 OP30 13 11. OP38 OP18 OP30 13 records must be maintained of what activities each service user has taken part in. The registered person must 31/05/07 ensure that all repair work required within the home, in particular in those service users bedrooms where doors, are broken or missing are replaced and that works carried out within the home are of a good standard. The registered person shall make 31/05/07 suitable arrangements to provide a safe system for moving and handling residents. All staff must undertake practical training in the safe moving and handling of service users, this must include practical training in the use of all equipment used within the home and the importance of risk assessing before undertaking any moving and handling procedure. Detailed moving and handling risk assessments must be in place for each service user. Clearly explaining what equipment, method, and staff should be involved in the transfer. The registered manager must ensure that this training is satisfactory, appropriate and is at all times adhered to. The registered person must 28/02/07 ensure that all moving and handling equipment within the home is safe to use and is kept hygienic and in a good state of repair. Immediate requirement made 28/02/07 Previous timescale of 31/07/06, 30/11/06 not met. Sufficient staff must be on duty DS0000006212.V318383.R01.S.doc Version 5.2 12. OP27 18(1)(a) 31/05/07 Page 32 Riverside Court 13. OP30 13, 18(1) 14. OP31 24 (1)(a)(b) within each unit to ensure that all of the service users needs are fully met. Previous timescale of 30/11/06 not met. The registered person must 30/06/07 ensure that staff receive first aid training, to ensure that there is a first aider on each shift. The registered manager must 31/05/07 monitor the day-to-day running of the home and take action when required to ensure the health and welfare needs of service users are met. 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 OP3 OP10 Good Practice Recommendations All pre-admission assessment information should be kept within the service users file and used as a basis when developing care plans. Provide staff with training in maintaining residents’ privacy and dignity including communication skills. The communal stock of Net underwear should be discarded and be replaced with a named supply for each service user who requires them. Service users should be given choices of activities they would like to participate in, those service users who are less able to communicate should be given equal opportunities to take part in activities of their choice. Clocks in service users bedroom that display the incorrect time should be corrected in order to assist in the orientation of service users. Damaged Plastic plates, bowls, beakers and cups should be replaced. Vegetables should not be cooked hours in advance of the meal in order to preserve their goodness, taste and DS0000006212.V318383.R01.S.doc Version 5.2 Page 33 3. OP12 4. OP19 5. OP15 Riverside Court 6. 7. 8. 9. OP30 OP30 OP9 OP7 appearance. Staff should undertake and maintain certified first aid training. Those involved in the preparation of meals and drinks should undertake Basic Food Hygiene Training. Handwritten entries on medication administration records should be countersigned. 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. Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI Riverside Court DS0000006212.V318383.R01.S.doc Version 5.2 Page 35 - 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. 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