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Inspection on 16/03/07 for Riverside Court Nursing Home

Also see our care home review for Riverside Court Nursing Home for more information

This inspection was carried out on 16th March 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has been very active in re-assessing the provision of their services and care and to look at the actions required to attend to the short falls. An action plan has been provided to the Commission for Social Care Inspection that is progressively being implemented. There are staff that are committed and professional in their work and provide attentive and supportive care in a very positive manner. Mealtimes are undertaken in a relaxed manner and staff are attentive, supportive and encouraging with people. The improvements in the home continue and this provides a more comfortable, fresh and relaxing environment.

What has improved since the last inspection?

The home has progressively attended to the matters raised following the previous inspection to the home. Improved the home`s environment. Initiated the review and development of the care planning used in the home. Constantly monitor the services and care provided in the home. Medicines management and administration is regularly checked and monitored on an ongoing basis.

What the care home could do better:

The manager needs to ensure that the care planning development is completed in the required timescale. This must incorporate appropriate risk assessments for both service users and staff working practices. The necessary work to the linen room must be completed and improvements to the environment continued. An appropriate staff training and development programme that is guided by the needs of service users must be completed to help ensure that the training programme is kept up-to-date and that Safeguarding Adults training is provided as a priority. The manager must ensure that serious concerns relating to nursing practices are referred as appropriate to the Nursing and Midwifery Council. The manager should also review the choices offered for the vegetarian menu and the activities and interests programme offered to people living at the home. Service users should be consulted for their views on these matters to help ensure that appropriate stimulation and choices are provided.

CARE HOMES FOR OLDER PEOPLE Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ Lead Inspector Cath Wilson Unannounced Inspection 16th March 2007 09:45 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.V319681.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 Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 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) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Care Home 60 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 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. The home is registered for a maximum of 60 service users to include: up to 30 service users in the category of DE(E) (Dementia over 65 years of age) up to 30 service users in the category of OP (Old age, not falling within any other category) 6th June 2006 2. 3. 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 accommodate 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 an enclosed courtyard style area with outside furniture provided. Full details of the facilities and services offered in the home may be obtained by contacting the manager of the home. The current rate for charges are £396.00p to £434.00p. There are additional charges made for matters such as hairdressing or the purchase of newspapers. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second Key Inspection to this home following two previous random visits and a first Key Inspection. This was in order to follow up the requirements that had been made and to re-assess the overall outcome rating for this service. The Pharmacist Inspector from the Commission for Social Care Inspection has also completed two random visits to the home following the first Key Inspection. Today’s inspection was also undertaken with inspectors Di Jinks and Jenny Donnelly. During this time key standards of the National Minimum Standards were re-examined. We were able to meet with service users, the manager, assistant manager and staff and assess the home’s policies, procedures and staff and service user’s records and documentation. A tour of the premises was also undertaken. Prior to this visit questionnaires had also been sent out to service users, relatives, staff and social and health care personnel. Their responses to these were used to obtain their views of the services and care provided. The manager had completed a pre-inspection questionnaire and this assisted in verifying information throughout this inspection. Inspectors also met with the manager and regional director of the Company responsible for this care home to give feedback from this inspection. What the service does well: What has improved since the last inspection? Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 6 The home has progressively attended to the matters raised following the previous inspection to the home. Improved the home’s environment. Initiated the review and development of the care planning used in the home. Constantly monitor the services and care provided in the home. Medicines management and administration is regularly checked and monitored on an ongoing basis. 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. The summary of this inspection report can be made available in other formats on request. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 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.V319681.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Standard 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures and documents in place to ensure individual need is assessed and people are informed of the services and care. EVIDENCE: Services users had been provided with information that would inform them of the services and care that can be provided. These documents included a Service User Guide and Statement of Purpose. These had been reviewed in February 2007 and the manager continues to review these to ensure the detail included is accurate. Consideration should be given to the format of these documents to help ensure they are accessible to all service users. People are also informed about whom to contact if they are concerned about the services and care provided. Assessments of people’s individual needs had been undertaken prior to the commencement of any care being provided and this included an assessment by the manager. The assessments and the care Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 9 provided are intended to work in conjunction so that the care people need and require is provided in a consistent manner. The care planning used in the home has not consistently provided this and the introduction of a different way to manage this will prove beneficial. There is further information regarding the care planning methods used in the home later in this report. Personal information is confidentially managed and securely stored. Riverside Court Nursing Home DS0000010105.V319681.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, 6, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information contained in the current care plans did not record that people’s individual needs are effectively nor consistently met. EVIDENCE: The care planning used in the home had been identified in previous inspection reports to be in urgent need of review to ensure that people’s assessed needs, wishes and choices are effectively met and planned for. The planning and delivery of care is essential to people’s well being. Throughout the inspection inspectors met with service users, relatives, staff and the managers, observed care practices and assessed people’s care plans. These continue to show inconsistencies in both detail and practices. However, it is noted that the manager had introduced a new method of care planning to care staff. The manager has set a six-week time-scale for their completion including staff training in implementing these. Health care matters are included in the updating of the care plans so that there are rigorous practices and procedures in place to ensure the health, welfare and safety of people in the home. This Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 11 will include appropriate risk assessments that are kept up-to-date with people’s changes and integrated in the overall delivery of care. The manager and senior staff will monitor these actions on an on-going basis and inspectors will check that this requirement has been fully met. Medicines management in the home was generally found to be good on this inspection with systems being monitored daily. Information received from service users, relatives, staff and professional personnel were mixed about the services and care provided. Some relatives stating ‘they were very pleased and confident with the care their relative received’ and ‘the care provided was excellent. Other relatives stated that ‘care my relative needed was not followed through’. Inspectors did see some very positive interaction between service users and staff with good examples of sensitive attention and care being provided. The manager has also identified areas regarding the delivery of care that require urgent attention. The manager was informed by inspectors that the language and wording used in some of the daily notes was not appropriate and is demeaning to people. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 12 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 is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People’s leisure and community interests are known to staff, as are people’s religious and culture wishes. Arrangements are in place for these to be attended to. These details have not always been clearly noted in the care planning used in the home. The new method of care planning being presently implemented will clearly include these matters. The manager has also identified further training for staff in these matters that will be included in the revised training and development programme for staff. On the day of the inspection people were involved in arranged interests and activities. People taking part in these were supported by the activities organiser, one of two employed in the home. These daily activities are also displayed in communal areas so that people can be made aware of the day’s opportunities. Seeking opportunities to further people’s choice and participation in everyday events so that appropriate stimulation is provided has been recommended following this inspection. Family members are encouraged to have and maintain contact. Mealtimes are arranged to meet individual need and staff were observed being supportive and encouraging to people throughout lunchtime. Menus are Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 13 provided and a range of choice is available. Inspectors also recommended that the vegetarian menu offer further choice. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 14 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 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems and practices employed in the home have not promoted the health, safety and welfare of service users. EVIDENCE: There are policies and procedure available to staff regarding safeguarding adults, complaint and health and safety practices. The manager is currently reviewing these and the staff practices required to follow them. Review is currently underway of the training and development programme for staff. This will help to clearly identify specific as well as general training requirements and the necessary updates for these. There have been complaints made, including matters regarding safeguarding adults, and about the services and care in the home. Information showed that when a complaint had been made this had been positively dealt with by the organisation. There is evidence to show that the action needed following one complaint had not been fully addressed. This is currently being attended to by the manager. Clearly identified risks and appropriately recorded risk assessments are not in place and are essential to minimising risk to service users as well as staff. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 15 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, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home environment continues to improve and provided a clean and generally comfortable environment. EVIDENCE: Since the previous random inspection to the home improvements had been made to the environment. The home is clean and there were no mal odours present. There are however, some outstanding matters that are progressively being attended to and inspectors had previously been provided with an action plan to show how these matters will be addressed. The linen cupboard has not been upgraded as previously required and does pose a hazard. Inspectors were informed that a date for the commencement of this work would be provided within one week. The windows that do not close properly in service user’s rooms have also been listed for attention. The manager’s attention was drawn to the lack of call bells in two bedrooms, the Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 16 need to change the shower chair in the upstairs unit, access to sufficient fluids and glasses/cups for service users in communal rooms, damaged chairs on Ellen Unit, and displaying staff notices in service user’s bedrooms. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 17 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. There are staff in the home that are both skilled and experienced in their work and committed in providing very sensitive care. There are, however, some practices that have jeopardised the health, safety and welfare of people in the home. EVIDENCE: The home’s recruitment procedure is well documented and is currently being updated in its practice to ensure that POVA checks [Protection of Vulnerable Adults] and CRB’s [Criminal Records Bureau] are vigorously carried out. The matter of referring nursing practices to the Nursing Midwifery Council is also subject of a review so that guidelines are always followed. There have been matters raised in complaints made about the care provided. The practices of some staff have put service users safety, welfare and personal dignity and integrity at risk. Inspectors observed one person being lifted by their clothing and left in a state of confusion and disarray and staff not using appropriate moving and handling techniques. The training and development programme currently in use shows that training matters in relation to these and other issues are not regularly attended to or updated. Risk needs to be accurately assessed for all concerned to assist in safe care practices and the safe care of service users. A requirement has been made regarding these matters. This said inspectors did observe some positive care being provided throughout the inspection and people were provided with attentive and supportive care. Staff were approachable throughout our visit and assisted throughout the Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 18 inspection. Inspectors were also informed by staff that they would like the allocation of work duties to be reassessed by the manager as some felt these were not always fairly addressed. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 19 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, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is creating a positive and committed approach to the provision of services and care to people in the home. EVIDENCE: A new manager has been in post for three months and is proceeding with his application to be a Registered Manager with the Commission for Social Care Inspection. There have been noticeable improvements to the home in both the environment and care practices. The manager, with the support of his regional director have indicated in their action plan how they will progress these in conjunction with matters identified throughout inspections to the home. Meetings with inspectors and senior managers has clearly indicated the way the home wishes to progress and the positive manner in which they wish to Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 20 achieve this with service users care and needs placed first. The time scale indicated for the completion of developing people’s plans of care, developing the staff training matrix, continuing to monitor the provision of services and care will address the health, safety and welfare matters raised throughout the inspection. Information received from relatives and professional social and health care personnel said that there have been improvements in the home recently and that the new manager has been very positive in his approach. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 1 18 X 2 X 2 2 3 2 2 3 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X X Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 22 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 OP38 Regulation 18 Requirement The registered person must ensure that the linen store is maintained in an orderly fashion and the plaster and electrics are safely maintained. (The previous timescale of 31/12/06 applies) Timescale for action 14/04/07 2. OP7 15 26/04/07 The registered person must ensure that all service user care plans are developed to ensure people’s comprehensive needs and outcomes are met and details recorded. This includes all health care matters. Specialist advice and guidance to be sought as appropriate and records of these maintained. This to be achieved in the prescribed time-scale. The registered person must ensure that as far as practicable, service users are enabled to make decisions regarding the care they receive, their health and welfare and take into account their wishes and feelings. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 23 3. OP21 23 Ensure that all bathrooms and shower facilities are kept clean and free of hazards at all times. Ensure that all toilet seats are made secure. 20/03/07 4. OP38 12 13 14 17 5. OP19 23 6. OP27 18 7. OP30 12 13 18 The registered person must ensure that risk assessments are undertaken by a trained and qualified person. Risk assessments must include safe systems of work for staff to follow to help ensure the protection of both care staff and service users. Ensure that the matters identified regarding the environment are attended to. • Loose fitting windows in service user’s rooms are attended to • Beds are appropriately made and provided with clean linen at all times. • Beds are provided with pillows this is needed by service users • Ensure calls bells are available and accessible • Rusty sink water outlets are upgraded Ensure nursing practices that jeopardise the health, safety and well being of service users are appropriately referred to the NMC [Nursing and Midwifery Council] The registered person must ensure that there is a comprehensive staff training and development programme, that ensures staff fulfil the aims of the home and meet the changing needs of service users. 30/05/07 30/04/07 15/04/07 30/05/07 Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 24 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 OP15 OP12 Good Practice Recommendations Review the vegetarian menu to enhance individual choice. Review the activities and interests provided for service users that enhance appropriate stimulation and choice. Riverside Court Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Nursing Home DS0000010105.V319681.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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