CARE HOMES FOR OLDER PEOPLE
Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ Lead Inspector
Colette Hibbert Unannounced Inspection 10th February 2006 09:15 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 Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 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 Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Riverside Court Nursing Home Address 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ 01900 815323 01900 815033 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) www.fshc.co.uk Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) vacant post Care Home 60 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (15) of places Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To include two named persons under 65 years of age. Total not to exceed 60. The Commission for Social Care Inspection are to be notified by an application for variation to the conditions of registration should any of the two named people reach 65 years of age or leave Riverside Court. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 21st June 2005 2. Date of last inspection Brief Description of the Service: Riverside Court is a purpose built two storey care home providing nursing care to service users within four units. Each of these units can accomodate up to fifteen people. Three of the units are for service users who have been diagnosed as being mentally infirm and the other unit is for older people who do not fall within any other registration category and who require nursing care. Riverside Court is close to Maryport harbour and local amenities. There is a large car park within the grounds of the home and there is an enclosed courtyard style area with outside furniture provided. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection commenced at 09:15 and concluded at 15:00. Regulations Manager Elaine Brayton and Regulatory Inspector Catherine Wilson, accompanied the lead inspector for this visit. Pharmacist Inspector Angela Branch was also present, but will issue a separate report. The inspection included talking with residents, and staff in private and small groups. It included reading residents care files, staff recruitment files and other relevant documents. A tour of the home was conducted and the acting manager was present through out the day. What the service does well: What has improved since the last inspection?
The residents are given the opportunity to make more choices within their life, including when they get up, what activities they take part in and where they like to sit in the home. The manager has done a lot of work to improve mealtimes and make it a more pleasant experience for the residents. Meals are served in a dignified way and residents are encouraged to remain as independent as possible. Those who require assistance have staff to aid them in a quiet and personal manner. Protection of Vulnerable Adults Training has been increased and the manager has linked into the Cumbria Social Services training for the staff. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 7 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 Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, and 5 Prospective residents and their families are given adequate information prior to admission to enable them to make informed choices. EVIDENCE: The home has a thorough service user guide, which provides prospective residents with information about the home. They are encouraged to visit as often as they wish to enable them to discover if the home is able to provide for their needs. Families are welcome to visit and talk to residents and staff. One resident said that he and his daughter had visited and even had been able to choose his room. Each resident has a contract and statement of terms as to what the home will provide for them and it is explained to the residents what they have to do if they wish to terminate this contract. One resident said it was very easy to understand and his family have a copy of it. Residents said that they had met with staff to discuss their care needs so they felt that once they were living in the home the staff would be able to care for them in an appropriate way.
Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, and 11 Care plans were in place for each resident and showed some improvement however there were still some areas that need to be developed to ensure the residents received appropriate care. Residents’ wishes about end of life care had been recorded and people felt that the staff would meet these wishes. EVIDENCE: Care plans on all three units were examined and in general they were found to have improved. There was much more information regarding the residents social history and interests and the daily activities that they had taken part in. Care plans had been updated and reviewed on a regular basis and key worker information was more in-depth. Risk assessments were in place including Moving and Handling, Pressure Area Assessment, Nutritional Assessment. Professional input including GP, Speech Therapy and Chiropody were also documented. In was noted that some of the risk assessments did not reflect the care that was being given and had not been updated to reflect the change in the residents care needs. This must be developed to ensure residents get a continuing and constant level of care from all staff.
Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 10 Some residents had multi-disciplinary consent forms within the care plan for the use of lap straps in chairs where other residents did not, this needs to be formalised across all units within the home to promote good practice by the staff and enable the residents to remain safe. It was difficult to identify from the care plans and other documents what provision the home had made for the residents personal hygiene care. The inspectors could not easily see which staff had delivered the care, and exactly what the care entailed, for example bath, shower, bed bath, wash, hair care, nail care, mouth care. The home needs to develop a better system to ensure and monitor the care the residents are receiving. Those residents who were able, had been asked about end of life care and those who had specific wishes had been documented within the care plan. The residents spoken to were confident that the home would be able to provide them with the care that they needed when that time came. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, and 15 There have been some improvements made within the home for social activities and there are planned activities to meet the residents’ needs. Residents are able to make choices within their lives. Meal times are relaxed and a pleasant experience for the residents. EVIDENCE: The inspection started during breakfast time. The residents had a wide-ranging choice for this meal. Staff were seen asking the residents what they would like to eat and were they would like to sit. Tables were nicely laid out with table cloths and serviettes, there were salt and pepper and sauces on each table. Residents had the choice of juices to drink or tea and coffee. Porridge or a variety of cereals were on offer or a cooked meal of bacon, sausage, eggs, tomatoes and toast. The staff assisted the residents’ in a quiet, dignified manner, and appropriate aids were given to maintain the residents independence. The residents said that they could have ‘ just what they wanted’ Lunchtime was the same, with a nicely presented meal and choices offered. Staff were aware of the residents needs, likes and dis-likes and gave assistance to those who needed it. The home has been working hard on improving the provision of appropriate social activities for those residents with dementia. During the inspection there were 2 activities co-ordinators in the home. One unit had painting activities
Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 12 and another unit had a game of bingo, as that had been requested by one of the residents. There were notices up on the activities board to advertise forthcoming events such as a pamper session and a Valentines Party. The notices for the daily activities need to be written in a more appropriate format. The home needs to look to continue to improve the residents’ day, by building on what they have already started and look at ways to stimulate and provide orientation for the residents within the EMI units. At present there are no clocks, or displays of the day, date for the residents to look at. The residents are given the opportunity to make choices in there daily routine such as what time they get up, or go to bed, what they wear, what they eat, and whether they take part in any organised activities. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 and 18 Residents’ rights are protected by the policies and procedures in place within the home. Residents are protected from abuse and training for the staff is in place in the home. EVIDENCE: The residents’ legal rights are protected by the home. Residents’ spoken to said that they had been given the opportunity to vote in the elections and the home had arranged postal votes for some of the residents. One resident said that he had seen his solicitor not long ago in the privacy of his own room. The home also has an advocacy system in place for a resident who wants to use this facility. Staff were aware of the policies in place for the protection of vulnerable adults and were able to describe the action they would take. Protection of Vulnerable Adults Training is on a rolling programme within the home and staff are updated on a regular basis. The staff training records confirmed this. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 22, 23, 25 and 26 Some areas of the home require attention to provide the residents with a comfortable and clean place to live. Emergency equipment used by staff and residents must be accessible and within easy reach to ensure the safety of the residents. EVIDENCE: The home in general was bright and clean on all units. There was a mal odour in one of the rooms, which the inspector drew to the attention of the manager, and the carpet was cleaned to improve the situation. There were some areas of wear and tear especially in the bathrooms on Ballentine unit. This needs to be included within the future improvement plans for the home. Some of the resident’s rooms on the nursing unit were suffering from wheelchair damage and wallpaper was torn in places. The call bell system on the upstairs units were seen to have been moved out of the reach of the residents, being tied up or placed behind pictures. This must be addressed to improve the safety of the residents. This alarm system must be available for residents, staff or visitors to use if they require assistance.
Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 15 The bedrooms had been personalised with pictures and ornaments for the residents to look at. In some bedrooms’ personal care information was attached to the wardrobe doors for everyone to read. This is not very dignified for the residents and is a breach of residents’ confidentiality. The home should look to find an alternative way to provide staff with information and retain the residents’ privacy and dignity. There are sufficient and adequate toileting and washing facilities for the residents on each unit. Staff where seen to use specialist equipment for the residents at meal times and when moving residents. Hoists had been serviced and were in good working order. This enabled the residents to maintain their independence. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 The home had adequate staff on duty to meet the resident’s needs. Staff training is on going to improve the provision of care within the home. EVIDENCE: On the day of the inspection the home had adequate numbers of staff on duty to meet the residents needs. The rota for the last two weeks also confirmed that the home had been fully staffed. There had been a complaint made to the Commission since the last inspection that the home did at times not have enough staff on duty. This complaint was investigated and was upheld. Since then the home has recruited more staff and have been able to improve staffing levels to provide more care for the residents in the home. The training programme has improved and staff are receiving a variety of job related training, such as Care of People with Dementia, National Vocational Qualifications, and Syringe Driver Training. The Manager is about to commence some Dementia training with a local College and she is looking forward to sharing the knowledge she obtains with other staff. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37and 38 A robust policy is in place to secure the residents finance. Residents’ documentation is stored securely to ensure confidentiality. Health and safety procedures are in place to ensure the residents are safe within the home. EVIDENCE: The acting manager is not as yet registered with the Commission but is working towards the home meeting the National Minimum Standards and requirements made at the last inspection, with the help of the Four Seasons Regional Management team. The home is run in the best interests of the residents with the manager looking at ways to improve the quality of life and adding new activities to the daily programme.
Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 18 The home has a thorough policy in place to safeguard the residents financies with audits every month and copies sent to Head Office. The records kept within the home confirmed this. All care plans are stored within filing cabinets in locked offices on the various units to maintain the resident’s privacy and confidentiality. Staff records are kept locked in the manager’s office. The home has policies and procedure file in the manager’s office, which the staff can use for information at any time. The staff spoken to confirmed this and said that they used it as a ‘reference’ document and it was constantly being up dated. Fire training had improved and the staff spoken to were aware of the procedure for the home and their files confirmed they had attended training sessions recently. This was a requirement made at the last inspection and had been meet. Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 19 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 3 3 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X 2 2 3 2 X 2 X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X 3 3 Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 20 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 Requirement All service user documentation must be fully updated, reviewed, contain all the relevant assessments and care plans to ensure the specific needs of the service user with dementia can be met. (The timescale for compliance with this requirement was 01/09/05 and has been extended.) 2. 3. OP20 OP21 23(b, d) 23(j) All areas of the home must be in good decorative order and clean. Bathroom on Ballentine unit must be made more homely and re decorated. To maintain the residents’ dignity and privacy, personal care information should not be displayed in the resident’s rooms. Emergency call bells must be within easy reach of the residents and staff.
DS0000010105.V281856.R01.S.doc Timescale for action 31/03/06 29/04/06 29/05/06 4. OP23 12.4(a) 28/03/06 5. OP25 12.1(a) 28/03/06 Riverside Court Nursing Home Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Riverside Court Nursing Home DS0000010105.V281856.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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