Inspection on 04/06/08 for Riverside Court

This inspection was carried out on 4th June 2008.

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

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 21/11/07

Riverside Court 20/08/07

Riverside Court 27/02/07

Riverside Court 15/05/06

Riverside Court 09/12/05

Riverside Court 22/08/05

Riverside Court 26/11/04

Riverside Court 01/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Riverside Court The Croft Knottingley West Yorks WF11 9BL Lead Inspector Gillian Walsh Key Unannounced Inspection 12:50 4th June 2008 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.V366857.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.V366857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Court Address The Croft Knottingley West Yorks WF11 9BL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01977 673233 01977 673066 riverside.court@craegmoor.co.uk Speciality Care (UK Lease Homes) Limited Care Home 61 Category(ies) of Dementia (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.V366857.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 June 2008, fees ranged from £367 to £635 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 Commission for Social Care Inspection are included within the Service User Guide. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. Riverside Court has a history of unsatisfactory care standards. Previous inspections identified a number of areas of serious concern. In view of this and within the Commission’s regional improvement strategy, a number of meetings with the company’s Responsible Individual and managers have been held. These meetings focused upon the breaches in regulation, outstanding requirements and sought information from the company regarding progress in these matters, and to obtain an agreement from the company in relation to any outstanding matters. Additional contact has been made with the responsible individual and regional manager by telephone and at multi agency safeguarding meetings. Since the registered manager resigned in the spring of 2007 there have been several changes of acting managers, three of whom were suspended or dismissed by the company following issues of concern. Since the visit in November 2007 there has been a further change in the management of the home and a change in the regional manager. Since the last key inspection in November 2007, six unannounced inspection visits have been made to the home and the Commission served a Statutory Requirement Notice in May 2008, which required the home to make improvements in specific areas. The outstanding requirements relating to Regulation 12 Health and Welfare and Regulation 13 Medication are now subject to further enforcement action and the deadline requirement dates are not included in the requirements section at the end of this report. This report relates to the key Inspection, which was undertaken over four days, 4, 12,13 and 17 June 2008 by three inspectors and a pharmacist inspector. During this inspection, the inspectors spoke to some of the people living at the home, some of the staff and the home’s management. The inspectors read care records, looked at some staff records, walked around all areas of the home and observed meals being served. The pharmacist inspector checked a sample of medications and related documentation On this occasion surveys were not sent out to gain the views of people involved with the home. However there were discussions with people and observations of their care throughout the visits. The Commission had also received information about the home from some healthcare professionals involved in the care of people living at the home. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 6 Other information used in the inspection process included notifications from the provider to the Commission about deaths, illnesses, accidents and incidents at the home and copies of the monthly management visits to the home. During this visit, the inspectors identified poor standards of care, unsafe systems relating to medication, lack of social activities, risks to people’s health and wellbeing and a failure to respect people’s privacy and dignity. The inspectors would like to thank all of the people who gave their time in assisting this inspection. What the service does well: What has improved since the last inspection? What they could do better: Management processes need to be put in place to make sure that people living at the home receive they care they need and are safe. To do this, improvements must be made in: • • • • • • • • • Care planning and delivery Systems relating to medications Accessing medical help for people when they need it Maintaining people’s privacy and dignity Making sure people receive the nutrition they need to promote and maintain their health and well-being. Keeping people safe from harm and abuse Making sure the environment is safe Making sure that staff receive the induction, training and supervision they need to provide good care to people. The introduction and sustained use of audit and review systems. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 7 Following this visit and the findings that required improvements have not been addressed the Commission is taking further enforcement action to ensure the outcomes for people living there are improved. 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.V366857.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.V366857.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Standard 3 could not be fully assessed at this visit as since serious concerns have been identified about the standard of care provided, Craegmoor has voluntarily stopped admissions to the home. Wakefield Metropolitan District Council has also suspended placements at the home. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use services experience Poor quality outcomes in this area. Staff are not always working to care plans, and poor practice in relation to meeting healthcare needs and managing medication puts people at risk. People’s privacy and dignity needs are not always considered or met. This judgement has been made using a range of available evidence including a visit to this service. EVIDENCE: The home’s acting manager and area manager said that care-planning documentation used at the home had been reviewed and that new care plans for all of the people at the home were in the process of being developed. As part of this inspection a selection of people’s care plans were looked at in detail. Some of the care plans gave quite good detail about the individual’s needs but others were confusing and inaccurate. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 11 Prior to the visits, the Commission had received concerns from a district nurse about the care of someone suffering from pressure sores. The care plan for this person was looked at and was found to be difficult to follow and did not inform the reader of the processes needed to change the dressings or to evaluate the presentation of the wound. This had resulted in staff simply recording “dressings changed” rather than recording an evaluation of any healing or deterioration which may have occurred. The nurse in charge of the unit told the inspectors said that they thought the various care plan sheets had become mixed up and agreed that the information on the care plans was confusing. Despite this staff have clearly worked well with the tissue viability nurse, as the persons pressure sores have almost healed. Another health care professional had shared concerns with the Commission over the adequacy of pain relief for someone who developed advanced skin sores. Medical instruction was given to provide palliative management and pain control in April 2008. However the inspectors confirmed from this person’s care records that pain control had been poorly managed, had not been sufficient and had led to this person experiencing significant pain particularly when their dressings were being changed. Another person had a care plan for a very specific area of need. The care plan said that the person required daily nursing interventions and procedures to promote health and to treat an ongoing infection. No evidence could be found in daily records to show that the care prescribed was being given or that medical attention had been sought in relation to the infection. The clinical manager said that the nurses were giving the required interventions once or twice each week but again no written evidence could be found of this and none of the staff spoken with had any knowledge of the procedure ever having been undertaken. The home’s acting manager later told the inspectors that none of the nursing staff working in the home knew how to carry out the required procedure. The clinical manager also said that they had not sought medical attention regarding the infection, as they did not know who was the correct healthcare professional to contact. As inspectors were aware that this infection had gone untreated for at least two weeks, it was brought to the immediate attention of a member of the management team who made a referral to the GP (General Practitioner) straight away. It is of great concern that staff working at the home can develop a care plan which includes performing a procedure, on a daily basis, that none of the staff are trained or skilled to carry out and, when asked about the care being given, gave incorrect information to the inspectors. It is of further concern that medical attention was not sought for an obvious infection, which could cause the person discomfort and irritation. Other examples of staff not following care plans were seen. The care plan for one person said that they were able to mobilise independently with the aid of a Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 12 stick. However staff were observed telling this person on several occasions during the inspection visits that they must not walk and needed a wheelchair. Another person’s care plan stated that the person “requires feeding by one staff and a small spoon” and to “make sure” that due to a risk of choking, the person should be given thickened fluids. The inspectors observed that this person was left alone for a period of twenty minutes with bowl of soup and a large spoon. The person was trying to eat the soup but was continuously putting an empty spoon to their mouth. They had also been provided with a drink, which had not been thickened. Staff who are not following care plans, who do not having the necessary skills to meet a persons identified needs and failing to seek medical attention when it is required, are putting people at risk. In May 2008 the Commission issued a statutory requirement notice that made very specific requirements relating to the home’s failure to promote and maintain the health and wellbeing of people living at the home. A significant part of this was the failure to make sure that people received adequate nutrition to maintain and promote health. In response to this the registered person had supplied the Commission with information that procedures had been put in place to make sure that people’s nutritional needs would be fully met. As part of this inspection a dietician accompanied inspectors to look specifically at nutrition. The dietician identified poor recording of nutritional intake, inconsistencies in relation to care planning and a lack of understanding amongst staff of the need for fortified and high energy protein diets for people with poor appetites. The dietician advised, after discussion with catering and care staff, that they would benefit from training in nutrition and catering for therapeutic diets for people suffering from dementia. Inspectors found a number of other issues relating to nutrition. Documentation stated that people who require a soft diet are given vegetable soup on an almost daily basis at lunchtime. The dietician was concerned that this soup was lacking in protein and not being fortified appropriately to meet people’s dietary needs. Other problems with soft diets were found. Documentation showed that on three occasions, people needing a soft diet had been served the same meal for both lunch and tea. There was also very little variety in peoples diets. One person’s charts show that they have almost the same meals every day. Little consideration is given to how meals could be adapted to be suitable for people needing a soft diet, for instance one persons chart records that they were served liquidised fish and chips. This could have been adapted to poached fish with mashed potatoes or similar to provide a much more appetising and appropriate meal. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 13 One of the cooks had said that they provided fortified milk shakes for people who needed extra nutrients. However, when questioned about this, care staff said that the milk shake was served to anybody who wanted it and did not appear to be aware of who it should be served to or why. As identified on previous inspections, recordings made on people’s food charts do not always give sufficient information and can be misleading. For example lists, but not amounts, are made of the food offered to a person and staff are then supposed to record how much was eaten. Recordings such as “full” or “half” are frequently made but do not give accurate details of a person’s actual intake. One person, whose records indicated that they had lost over a stone in weight between April and May, was seen lying on their bed at 2.30 in the afternoon. Their chart indicated that they had taken a bowl of cornflakes and 150 mls of fluid since 06.00 that day. This person did appear quite sleepy but when asked by the inspector, said they were hungry and asked for a sandwich. The recording of weights and actions taken in response to body weight changes is poor. One very frail person’s charts said that they had lost over a stone in two months and then gained almost a stone and a half in fifteen days. No response had been made to either of these apparent dramatic weight changes. It was also noted that the weights, recorded by the acting manager to be submitted to the company on a monthly basis, differed in some cases to the weights recorded in people’s own care records. Lack of attention to detail and action with regard to people’s nutrition and weight loss puts people at risk of ill health. Further issues relating to dietary intake and mealtimes are recorded in the section entitled “Daily life and Social Activities” of this report. The statutory requirement notice issued in May 2008 included requirements relating to poor and unsafe management of medication. The registered person had supplied the Commission with information that procedures had been put in place for senior staff to regularly audit medications to make sure that the systems were safe. A pharmacist inspector again attended on one day of this inspection and conducted an audit of the systems in place for managing medications at the home. This was not a full audit but the pharmacist inspector chose a number of people’s medications at random to check and again found evidence of poor practice. A check of the records of administration against the quantities received was made, particularly for antibiotics. It was found that the records of Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 14 administration did not always match the quantity supplied. For example one person was prescribed 200ml of antibiotic liquid at a dose of 10ml three times a day. Eighteen signatures of administration were recorded on the Medication Administration Record (MAR) between 2 June 2008 and 8 June 2008 when zero was recorded as the quantity remaining. This means that only 180ml was administered and that this person had not received their full course of antibiotic treatment that had been prescribed to ensure their infection was properly treated. Concerns still remain with the administration of Trimethoprim suspension for one person. This is prescribed as an ongoing treatment to prevent urinary tract infections. Evidence has been found at previous inspections of medication not being given due to medicines being out of stock. Also, where records of administration have been made when the medication has not been given. The pharmacist inspector found that the quantity remaining in the Trimethoprim bottle and recorded on the MAR was less than the records of administration. A supply of 280ml was made on 23 May 2008 and the first dose recorded at bedtime on 23 May 2008. Twenty signatures of administration for a dose of 10ml daily were recorded form 23 May until 11 June 2008. This means that a total of 200ml was administered and that 80ml should be left to cover the remaining 7 days of the monthly cycle to 19 June 2008. However the quantity remaining recorded on the MAR was 40ml. This means that there would not be enough stock for the remainder of the monthly cycle. If a dose has not been given due to refusal or spillage this must be clearly recorded on the MAR rather than using a staff signature which refers to administration. In this way information is available to check the quantity remaining and a supply ordered if required. One MAR had Latanoprost eye drops with a dose of ‘use as directed’. This instruction has been discussed with staff on previous visits as the usual dose for theses drops is at night. However on this visit records of administration had been made against the morning dose from 23 May 2008 to 31 May 2008. On 1 June 2008 a handwritten entry had been made to state that the drops should be administered at night and subsequent MAR entries were against the nighttime dose. This means that this person is not getting their eye drops as prescribed and their eye condition may not improve. A number of people did not receive their medication as prescribed because the medication was not available to administer from. For example the home was informed by fax on 4 June 2008 that one person had been prescribed longterm antibiotics by the hospital. A prescription for these antibiotics was requested by the home the following day on 5 June 2008 but the home did not receive a supply until the 11 June 2008 and the first day of administration was 12 June 2008. A system must be in place to make sure that prescriptions are ordered and medication received without delay. This will prevent the risk of people not receiving their medication as intended by the prescriber. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 15 A number of people have Lactulose prescribed for treating constipation. The quantity prescribed is not enough to cover the 28-day cycle, which means there is a risk that the person may not receive any Lactulose towards the end of the cycle. The prescriber and supplying pharmacist should be contacted to ask for the quantity to be changed. A member of the community mental health team who regularly sees a person in the home made a record in their care plan on 19 May 2008 to inform staff that a request would be made to the GP to increase the dose of Citalopram from 20mg to 30mg. An entry was made in the medication change book kept in the home on 4 June 2008 to state that this medication had been increased to 30mg. On the day of this visit the pharmacist inspector was unable to find evidence of the increased dose in stock. The clinical manager on duty was unable to confirm what dose of Citalopram this person was currently on and why the request to the GP had not been followed up. This demonstrates a poor system in the handling of information supplied by healthcare professionals. Medication requiring storage in a fridge was found in one of the cupboards in the medicines room. Two bottles of liquid medicines were found that had an expiry date of 27 May 2008. A tube of antibiotic eye ointment with 28 days use once opened did not have a date of opening on. This means that there is a risk that medicines may be administered that may have deteriorated and become unsafe to use. Over the four visits made to the home as part of this inspection a number of instances of people not having their privacy and dignity needs met were observed. One person was seen sitting in the main lounge area wearing socks that were very wet. Staff, alerted to this by the inspector, then walked the person through the lounge and up the corridor causing the person to leave a trail of wet footprints, which would draw attention to their situation. Other people’s dignity had been compromised by staff who failed to assist them to change their clothing or wipe their faces after food spillages. One person was seen with faeces down their fingernails and another person was seen in bed wearing only net knickers on their lower body and with only a folded up sheet as a cover. The inspectors have made very similar observations at previous, recent inspection visits. Another person was seen sitting in their room who was shouting to go to the toilet. This was pointed out to the clinical manager by the inspector. The clinical manager replied that this person always shouts and said this didn’t necessarily mean they wanted the toilet. The clinical manager added, ‘this is why we “keep them” in their room’. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 16 On five separate occasions, including three on the same day, the inspector had to ask for care charts, which recorded people’s intake and output, to be removed from main lounges. These charts included very personal details such as bowel movements and incontinence and on one occasion one of the people who lives at the home was found reading the charts. In order to protect people’s privacy and dignity these charts should be kept in a secure place where only staff can access them. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use services experience Poor quality outcomes in this area. People are not always supported to make choices or have control over their lives. Not all people receive an appealing balanced diet. This judgement has been made using a range of available evidence including a visit to this service. EVIDENCE: As part of this visit one inspector carried out a structured observation over a period of two hours from 10:25 until 12:25 in the Clyde (dementia care unit) lounge. This observation was carried out using a tool called SOFI (Short Observational Framework for Inspection). This tool was developed with the Commission in conjunction with the Bradford University Dementia Group and is a recognised tool to aid inspection of dementia care. The inspector observed that people were offered some activities by an activities’ organiser. On the whole most people did not engage well with the group activities on offer such as using musical instruments. A game of giant dominoes likewise failed to engage the two people who were involved. Music was put on the CD player at the beginning of this observation and the same CD was put on 3 times. The most positive responses from people were gained Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 18 when staff engaged them on an individual basis, by talking with and smiling at people especially where there was physical contact such as holding someone’s hand or putting an arm round their shoulders. The three staff who work regularly on the unit demonstrated a good understanding of this and had some very positive interactions with individuals. One staff member got several ladies up dancing which provoked a very positive response. Where staff were relatively unfamiliar with people, such as the nurse on duty and one of the carers who were agency staff, the interactions were much less positive. It was clear from this observation, however, that some people gained a considerable amount of staff attention while others got very little. When musical instruments were being shared out, some people had them just put in their laps without any explanation or encouragement to join in. At 11:25 a drink and some biscuits and fresh fruit were brought to the lounge. The nurse helped one person who needs support to drink and eat. One person was given a drink and a biscuit but was not supported to drink or eat and simply looked at these for a period of half an hour until they were removed by staff, untouched. Another person was given a drink but no table to put it on. This person then tried to put the drink on the floor but couldn’t reach and spilled it, despite being seen by a staff member as she was reaching down. The spillage was cleaned up but no replacement drink was brought. The observation found that there were overall more positive interactions (31) seen than negative ones (22). However there were some major concerns in terms of care practices, which have been discussed in the previous section on health and personal care. People living on other units within the home did not receive much in the way of recreational or social stimulation. On one occasion the television was on in the lounge but without any sound and the radio was playing quite loudly. This can be confusing and irritating for people who want to watch the television. One person who was being nursed in bed had their television tuned in to children’s programmes. This person was unable to change programmes themselves and asked the inspector to change it for them. Relatives and friends of people who live at the home are encouraged to visit but there is little evidence of much contact with the local community. Some people are offered limited choice in their daily lives with regard to meals and activities. However documentation showed that one person was shouting to go to bed for over an hour on one occasion and on another occassion had to wait over six hours before staff assisted them to go for a cigarette. At the end of the observation, the lunch was served and some people took their meal in the lounge. The organisation of this event was haphazard with Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 19 meals being brought at varying times and different staff being in the room at times. This meant that it was unclear to staff who had received their meals and who hadn’t. Also the supervision and support for people when eating their meals was disorganised. One person needed complete support and did get this. Other people were left to manage on their own. Some people were seated without appropriate tables so that their meals were at a low level and tables were too far away for them to manage soup easily. At one point one person took a sandwich from another person’s plate without this being challenged by staff. The same person had ice cream presented to them without being given a spoon, although there was one nearby, whereupon they tried to drink it. Another inspector observed the lunch being served to people in the dining room of the same unit. Three people had to wait over twenty minutes to be served any food with one of these people becoming increasingly restless and agitated. Six different staff came in and out of the room, sometimes serving or helping the people dining and sometimes taking food to people elsewhere on the unit. As a result of this people who were struggling with their meals were going unnoticed. One person only got assistance after spending twenty minutes trying to feed themselves. Another person who did not appear to be interested in the food they had been given was eventually given a bowl of cereal, which they enjoyed. When asked who organised the staff for mealtimes, the care staff said they did this themselves rather than it being led by the nurse in charge. This, they said was due to the nurses being mainly agency workers. Such lack of organisation lead to people not receiving either the help they need or proper nutrition. Over the course of the visits it was observed that there was very little variety in the content of the meals served at lunchtime, particularly the soup and sandwiches. The third option failed to add much to the variety, one day being bacon sandwiches and another hot dog sausages in bread. The acting manager said that the menus were about to be changed to give more variety and be appropriate to the needs of the people at the home. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use services experience Poor quality outcomes in this area. People living in the home are being put at risk through poor management of complaints and abusive situations. This judgement has been made using a range of available evidence including a visit to this service. EVIDENCE: Since the last key inspection the Commission has received one complaint from a person’s relative. The complainant felt it necessary to write both to the Commission and to the local authority as well as the home as they felt that all the verbal complaints they had made to the home previously had been ignored and that as a result their relative had suffered injury. It has not been possible to get a clear picture of how the initial complaints were dealt with due to several changes in management and staffing. However the current management have responded to the complainant appropriately and had made arrangements to meet with the relatives on a regular basis. There have been a number of referrals made to the local authority under safeguarding procedures since the last key inspection. These are being dealt with both on an individual basis and as a collective care setting. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 21 Some of these referrals had appropriately been made by the home, particularly where there had been incidents between people who live at the home or involving staff. However during the inspection a very serious safeguarding issue was discovered by the inspector, which had not been recognised by staff in the home as an abusive situation and had not been reported under local safeguarding procedures. On the visit of 13 June 2008 a care plan was seen in one person’s file stating that the person had taken actions that were abusive toward other people at the home in April 2008. Daily records included other instances of similar behaviour. The acting manager said that she had not been aware of this problem until the day of the inspection when a further incident had occurred early in the morning. The acting manager said she did intend to report this incident but had not done so yet. When asked about other incidents, she advised that she did not consider them all to be reportable. She did make the referral later in the day. During the afternoon of that day the registered person informed the Commission that the person in question was now on one to one care and it would be documented on a daily basis who would be giving this care. However on the next visit on 17 June 2008, it was discovered that there had been further incidents on the evening of 13 June 2008 and again on 15 June 2008. Care staff working on the unit were asked who had been allocated to look after this person, both staff spoken with said no allocation had been made due to it being an agency nurse in charge. One care assistant said that they had been asked a few days ago to “keep an eye on “ the person. Inspectors also saw the person involved sitting in the dining room with a lady who lives at the home with no staff in the vicinity. Staff said that the person was on thirtyminute observations as opposed to one to one care. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 22 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, 23, 25 and 26. People who use services experience Adequate quality outcomes in this area. The home is not always maintained to a level that will ensure people’s safety and comfort. This judgement has been made using a range of available evidence including a visit to this service. EVIDENCE: The home is currently undergoing refurbishment and redecoration. One of the units is closed to allow complete refurbishment and the Commission has been told that this will continue throughout the home. Some bedrooms on units currently being used have already been decorated and new flooring has been fitted in corridors, lounges and dining areas. The newly decorated bedrooms are pleasant and bright and the flooring in the corridors is attractive and easy to clean. Domestic staff appear to have some problems with cleaning the flooring in the dining and lounge areas and need to source the correct equipment to make sure that it looks clean and attractive. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 23 Some people living on Clyde unit do wander in and out of other people’s bedrooms. On two occasions people have managed to lock themselves in their bedrooms and staff have not had access to keys to open the doors. The Commission has been informed that a key has now been found and that new locks have been ordered to ensure that this potentially serious situation does not re-occur. Despite a previous requirement and action taken by management in the home instructing staff to leave them on, mechanical ventilation units were again turned off within en-suites and toilet/bathrooms preventing the required air exchanges from taking place and therefore increasing infection risks. Hot water temperatures in some ensuites and communal toilet hand wash areas were high enough to cause scalding. The temperature at one communal toilet washbasin on Clyde (dementia care unit) was recorded by the inspector at 53.5C, which far exceeds the recommended 43C safety level. The home’s handy man took immediate action to lower these temperatures and the area manager gave her assurances that this would be closely monitored. It was also of concern that the running water temperature for a bath on Clyde unit was only 37C, which is too cool and would not be a pleasant temperature to bathe in. Despite this the bath had been used the day before the inspection. The home was generally clean but some areas, particularly bedrooms, would benefit from care staff making sure that they have left the room clean and tidy after supporting people with their care needs or after people have been given meals and drinks in their rooms. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use services experience poor quality outcomes in this area. Staff in the home are not meeting people’s needs. This judgement has been made using a range of available evidence including a visit to this service. EVIDENCE: Three staff files were looked at as part of this inspection. Generally all recruitment checks have been carried out before people start work at the home. New staff people with just a POVA first check work under supervision before a full Criminal Records Check is obtained. No record of induction training was available in the home for one care assistant who had recently started work. The only evidence of supervision for this person was one record of a session carried out by a manager, which stated they had been given the dignity protocol and raised no issues in relation to it. This staff member, who is a night worker, had only received training in fire safety according to the records. No induction records were found for two other staff whose records were seen. Their training records showed that training has been offered to staff around issues such as food hygiene, protection of vulnerable adults, health and safety, first aid, infection control and dementia care. One of these staff confirmed to the inspectors that they had received this training. Some of the records of Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 25 training are held on an electronic system but the inspectors were told that these were not up to date. Staff spoken to had varying degrees of understanding about nutrition and had not received proper training in this area. From evidence found during this inspection it is clear that staff are in need in updated training in recognising abusive situations and of local, multi agency policies and procedures for the reporting of and dealing with matters relating to safeguarding vulnerable adults. Staff supervision records were seen. The system for keeping these was haphazard and difficult to access and would be extremely difficult to monitor as the records for each individual were not in date order and mixed up with others. The records for two staff showed that one (a nurse) had received supervision on 30 and 31 January 2008. There were then no supervisions recorded until 29 May 08. Then another two sessions were given on 3 June 08. The other person had had two supervisions since the beginning of 2008. One area of concern was that over the course of these inspection visits (4 days), agency nurses were in charge of Clyde dementia care unit on each occasion. There was also agency care staff working alongside permanent staff. Staff confirmed that because of nurse vacancies they were largely working under agency nurses. They said this was difficult at times because agency workers do not know the people living at the home and their particular health and care issues. Continuity of care and safeguarding issues have been identified within this report in previous sections that may relate directly to the fact that agency nurses are covering this unit. Care staff said they tend to organise the shifts between themselves, for example in allocating people to care for individuals, and for mealtimes. Although there appears to be sufficient numbers of staff on duty, the deployment and organisation of staff within the units is poor. The following examples support this observation. The SOFI observation confirmed that the organisation and planning of mealtimes was inadequate and meant that some people did not get the food or support they needed to eat properly or to maintain good nutrition. Observations at other times also noted that one person, who was supposed to be getting one to one support, was left unattended in a situation where they could have posed a risk to others. Daily notes have also recorded that people who have asked for support at times have been left without this. For example, staff recorded in the daily record sheet that one person got up from their chair, asking for the toilet, and was returned to the chair and told to wait but then wet themselves immediately. This is undignified and unacceptable. The lack Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 26 of overall management of the shifts makes it more likely that these types of incidents will occur. Managers told us that they are making every effort to recruit RMN qualified nurses with limited success. However a new clinical manager had been recruited and was due to start the day after our last visit. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use services experience Poor outcomes in this area. There is a lack of consistent and firm management and processes are not in place to promote the health and safety of people in the home. This judgement has been made using a range of available evidence including a visit to this service. EVIDENCE: The home has not had a stable management team for some time with the last registered manager leaving in May 2007. Since then there have been five acting managers. In addition, the home has also had rapid changes in the employment of clinical managers to lead on the care of people living there and this has had a detrimental effect on people’s welfare, which has been evidenced throughout this report. The area manager is likewise new to her post. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 28 A new manager had been recruited and on the last day of our inspection visits, she had taken up her duties and was receiving induction from the acting manager and the area manager for Craegmoor. The financial records for individuals were seen as part of this inspection. Craegmoor use a system where Craegmoor holds all monies centrally but interest on money held is paid to individuals. Any monies to be spent are taken out of petty cash and invoiced back to Craegmoor so that people do not have to wait to access their money. There are electronic records of expenditure and since January 08 there were hard copies of expenditure on file. These records were satisfactory. The new area manager said that she would shortly be completing her regulation 26 quality monitoring report, which she would then forward to the Commission. Previous regulation 26 reports have failed to identify the problems related to the poor standards of care identified during this inspection. There was little evidence found during this inspection that the home is being run in the interests of the people who live there. Evidence throughout this report shows that the health and safety needs of the people living at the home are not being met. Poor standards in relation to care delivery, management of medication and protecting vulnerable people, all have a detrimental affect on the wellbeing of people in the home. Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 29 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 X X X X 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 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X 2 X 2 2 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 30 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 15(1) and (2)(b) Requirement All people using the service must have an up to date, detailed care plan. Care plans must be reviewed to make sure they reflect people’s current and changing needs. The registered person must make sure that all staff are aware of, and work to, individual care plans. This will make sure that people receive the care they need to promote and maintain their health and wellbeing. 2. OP8 13(b) The registered person must make arrangements for people living at the home to receive treatment and advice from healthcare professionals as and when they need it. action in progress”) 28/08/08 Timescale for action 31/08/08 (original timescale: “Enforcement The registered person shall make 28/08/08 suitable arrangements to ensure that the care home is conducted DS0000006212.V366857.R01.S.doc Version 5.2 Page 31 3 OP10 12(4)(a) Riverside Court in a manner which respects the privacy and dignity of service users Requirement not met from statutory requirement notice of 6 May 2008. action in progress”) (original timescale: “Enforcement The registered person shall make 28/08/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To ensure people’s safety, the registered person must make arrangements to: Carry out a full audit and review of the systems used for the recording, handling and safe administration of medicines. Put in place effective arrangements at the home to ensure that any omissions or variations in the administration of prescribed medication and the reasons for these are clearly, legibly and promptly recorded. Put in place effective arrangements to ensure that accurate records of all medicines administered at the home are maintained. Put in place effective arrangements to ensure that accurate administration of medication in accordance with the directions of the prescriber are maintained. Requirement not met from statutory requirement notice of 6 May 2008. 4 OP9 13 (2) Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 32 action in progress”) (original timescale: “Enforcement The registered person must put in place arrangements to ensure that all staff including those who prepare food, are aware of service users’ nutritional needs Ensure staff support and assist all service users with their food intake so that they receive a nutritious diet that is appropriate to their individual needs. Put in place arrangements to ensure that mealtimes are orderly and do not cause confusion and distress to service users Ensure that records of the food provided for service users are maintained and include sufficient detail to demonstrate whether the diet is satisfactory. Requirement not met from statutory requirement notice of 6 May 2008. All people living in the home must have access to daily activities which meet with their individual choice, needs and abilities. The registered person must make sure through staff training and other measures that people living at the home are not being harmed or suffering abuse or being put at risk of harm or abuse. All actual or suspicion of abuse must be reported under local safeguarding procedures. The registered person must make suitable arrangements to DS0000006212.V366857.R01.S.doc 5. OP15 12(1) 31/07/08 6. OP12 16(2)(n)( m) 31/08/08 7. OP18 13(6) 31/07/08 8. OP26 13(3) 31/07/08 Riverside Court Version 5.2 Page 33 prevent infection, toxic conditions and the spread of infection. This must include making sure that mechanical ventilation units within en-suites and toilet areas are switched on to ensure the required air exchanges take place and therefore reducing infection risks. Revised requirement outstanding from 7/4/2008 13(4)(a)(c To prevent the risk of scalding, 31/07/08 ) the registered person must make sure that running water temperatures in areas accessed by people who live at the home, do not exceed 43C 31/07/08 18(1)(a) The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Outstanding requirement from 22/04/08 The registered person must establish and maintain a system for evaluating the quality of the services provided at the care home monitor the day-to-day running of the home and take action when required to ensure the health and welfare needs of individuals are met. Revised requirement outstanding from 31/5/07 To make sure that staff have a good understanding of the people living at the home, the registered person must ensure that staff receive training in dementia care. DS0000006212.V366857.R01.S.doc 9. OP26 OP38 10. OP27 11. OP33 24(1) 31/07/08 12. OP30 18(1)(c) 31/08/08 Riverside Court Version 5.2 Page 34 13. OP36 18(2) The registered person must ensure that staff undertake a proper induction process and are appropriately supervised. 31/08/08 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 OP18 Good Practice Recommendations Staff in the home, particularly senior staff, need to have a better understanding of the local multi agency procedures to ensure that people are fully protected. The organisation and deployment of staff needs to be improved to make sure that people receive the care they need in a timely fashion. 2. OP27 Riverside Court DS0000006212.V366857.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V366857.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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