Inspection on 17/12/09 for Riverside Court Nursing Home

This inspection was carried out on 17th December 2009.

CQC 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 Nursing Home 31/03/10

Riverside Court Nursing Home 18/12/08

Riverside Court Nursing Home 12/12/07

Riverside Court Nursing Home 27/06/07

Riverside Court Nursing Home 16/03/07

Riverside Court Nursing Home 06/06/06

Riverside Court Nursing Home 10/02/06

Riverside Court Nursing Home 21/06/05

Riverside Court Nursing Home 28/01/05

Riverside Court Nursing Home 07/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ Lead Inspector Diane Jinks Key Unannounced Inspection 17th December 2009 09:00 DS0000010105.V378217.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Riverside Court Nursing Home DS0000010105.V378217.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 riverside.court@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd 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) Manager post vacant Care Home 60 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (60) of places Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 30) The maximum number of service users who can be accommodated is: 60. Date of last inspection 18th December 2008 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, services and weekly charges at Riverside Court may be obtained by contacting the manager. Riverside Court Nursing Home DS0000010105.V378217.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 0 star. This means the people who use this service experience poor quality outcomes. The inspection of this service took place over several months. As part of the inspection we sent surveys to some of the people that live or work at the home. Some surveys were also received from relatives. This helps us to obtain a variety of views and opinions about the service. The lead inspector for this service, Diane Jinks was assisted by another inspector Margaret Drury, during the visit to this service. We spent eight hours at the home. During this time we looked at a sample of care files, staff recruitment and training records, a sample of general records and some of the policies and procedures of the organisation. We spoke to several people that live at Riverside Court and some of the staff that work there, including the manager. One of our pharmacist inspectors also made a visit to the home to check that medication storage, records and administration are managed safely. This part of the inspection took six hours. We carried out a short random inspection of this service in October 2009 following concerns that had been raised about the way in which staff had been recruited. The temporary manager completed the Annual Quality Assurance Assessment – the AQAA. This document is a self assessment that is completed by the provider. It supplies us with information about the home, including any improvements that have been made. It also provides us with statistical information about the home and helps us to target and plan our inspection. What the service does well: The home provides people who are thinking of moving into Riverside Court with sufficient information to help them make their decisions. The information is produced in a variety of formats, which helps make it more accessible to people. Some of the people that returned surveys or who we spoke to told us that the home keeps them informed if their relative is unwell or they have concerns about them. They told us that the ‘staff are polite and efficient.’ We saw some of the staff working with residents during our visit to the home. They were Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.2 Page 6 generally attentive to the residents and treated them in a kindly and friendly manner. Some of the people we spoke to felt that they were ‘cared for to a good standard,’ and one relative told us, ‘for the short time my relative has lived at Riverside Court she has had all the love and care she needs and seems to be happy there.’ Riverside Court employs two activities co-ordinators. They have worked hard to develop a programme of entertainment and activities for the people that live at the home. Nearly all of the people we spoke to or received surveys from mentioned the activities. Examples of the comments we received included the following: • • • ‘The patient entertainment is excellent and all staff are very helpful.’ ‘Activities are very well done at the home. There are parties, bingo, entertainment and fundraising events.’ There are good activities we are always doing something. Residents get on well with each other, they enjoy going out and chatting with each other.’ What has improved since the last inspection? What they could do better: We found that pre-admission, care needs assessments are not consistently completed. This means that the home may not be appropriate or meeting the needs of some of the people that live there. Care needs assessments should provide the basis of individual care plans. We found that care plans had not been sufficiently completed, nor were they being Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.2 Page 7 consistently followed by care staff. There are gaps in the care planning process which may place people at risk from harm or injury, particularly in relation to nutrition, medication and health and safety. Overall, medication was handled poorly. There were many examples of poor practice that could place the health and well-being of residents at risk. We did not identify any areas of good practice relating to the handling of medication. Many of the people we spoke to or who returned surveys told us that there are problems with the meals. People said that there should be: • • • ‘A better choice of meals’. ‘The food prepared does not look appetising at times and is very bland.’ ‘Too many convenience ingredients are used and meals lack the home made appeal.’ The home has had a long standing problem with poorly fitting windows and this continues. We found that some windows had been stuffed with tissue paper or were taped up to help prevent the draughts. We told the manager about these matters and we have written to the provider, as they need to be dealt with promptly. The home has been without a registered manager since March 2009. Since that time the management arrangements have changed frequently and this has affected the continuity and consistency at the home. Some of the people that use this service have noticed a difference in the quality of the service. Some of the comments we have received include the following: • • ‘The frequent management changes make it difficult to have concerns addressed adequately.’ ‘When mum first went to Riverside in May 2008 the manager and deputy made the home a positive and happy environment. Since they left the new management made changes and the atmosphere in the home changed.’ ‘I would hope that the next manager is willing to drive the home and staff morale back to the level it was.’ ‘I have reported to management on several occasions that the windows in my relative’s room do not fit, after 18 months nothing has been done.’ • • We have made seventeen statutory requirements as a result of this inspection. Four of the requirements are repeated from previous inspections as they have not been actioned by the provider. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 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 Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessment processes are not always followed consistently. This means that people may not always have their care and support needs properly considered and assessed. EVIDENCE: The home has produced and updated their Statement of Purpose to reflect the changes to the management arrangements in place at Riverside Court. There is a large information folder available in the reception area of the home. This contains further information about the home including a Service User Guide, a copy of their last inspection report and a variety of other information about Riverside Court. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 10 The people, who returned surveys to us, indicated that they received enough information about the home to help them decide to live there. The person completing the AQAA on behalf of Riverside Court told us that they usually liaise with social workers and care managers to help ensure a smooth transition for people moving into the home. People move into the home for a trial period of one month, initially. This helps to ensure that the home will be suitable and able to meet their needs and expectations appropriately. During our visit to the home, we looked at a sample of care records. We found that people have assessments of their health and social care needs before they are offered a place at Riverside Court. Where appropriate, assessments have also been obtained from social workers or the hospital. The organisation produces their own assessment document called a ‘Care and Health Assessment Profile.’ This document includes an assessment of all daily living activities. It provides the assessor with points to consider when carrying out assessments, for example potential risks, mental health and wellbeing, care pathways and ability levels. This assessment tool is not used as well as it might be and we found that many areas are left blank or record only brief information about individual needs and requirements. This inconsistency means that people may not always have their needs thoroughly assessed and recorded and therefore may not always receive the most appropriate care and support. During our visit to the home we observed there to be a sufficient number of staff on duty to meet the needs of the people using this service, although staff were kept very busy. One person said in their survey ‘They definitely need more staff. There seems to be too few staff to cover all the rooms, they are so far apart if anyone rings for the toilet etc. it takes quite a while to get the other end of the home.’ A member of staff thought the home could do better by ‘having more staff on during the day so we can spend more time with the people we look after rather than doing lots of paperwork which takes up a lot of our time.’ We spoke to some of the staff during our visit to the home. Some of them told us that they had not had specific training in dementia care and in working with people who may display aggression or challenging behaviour. This means that people may not always be supported by staff that have the skills and experience required to meet their specialist needs. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and assessments are incomplete and medication is poorly managed. This means that people using this service may not always get the treatment, care and support they should, when they need it. EVIDENCE: The person completing the AQAA told us that people living at Riverside Court have their care and support needs recorded in a care plan. They told us that care plans are reviewed monthly and contain an element of risk assessment, nutritional assessment and an assessment of skin and pressure care needs. During our visit to the home we looked at a sample of care files and we spoke to some of the people that live there. We spoke to some of the staff and observed some of their care practices. The people participating in this Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 12 inspection told us that staff were always available to provide the care and support they needed. We saw that care plans have been developed from the initial care needs assessments. The assessments are not completed in a consistent way and many areas have not been completed at all. This means that some people may not have all of their care and support needs recognised and met. However, one relative told us, ‘the care provided by the nursing staff and carers is excellent. My relative is treated with respect and in turn feels very close to her carers. As a family we are also welcomed into the home whenever we call.’ Another said, ‘my relative is so very well cared for and loved. I can’t speak highly enough of the staff who look after her. It doesn’t matter what time you visit everyone of those wonderful people can’t do enough for you. I couldn’t wish for her to be in a better place.’ Most of the care records we looked at showed that people had lost weight in the last few months. Although instructions for staff to follow were generally recorded in the care plans, there was no evidence to confirm that staff followed them. Food and fluid intake charts have not been maintained, people have not had their weight monitored as frequently as they should and where people are unable to have their weight monitored in a conventional way, no alternative methods are used. We did not see any records to account for people’s weight loss nor anything to confirm that professional advice had been sought. Some people were recorded as being at risk from the effects of pressure wounds. The home does ensure that pressure relieving equipment such as mattresses and cushions are available and used. We saw records to confirm that staff regularly monitor and check that people with poor mobility are helped to change their position. However, care plans do not include wound management or treatment plans to help ensure people receive appropriate support and treatment when pressure sores or injuries have developed. One person has recently moved into the home. A care needs assessment has been obtained and some parts of their care plan has started to be completed. This person has very limited mobility, is at risk from pressure sores and requires some assistance from staff with their mobility. Most of their care plan and risk assessments are incomplete, including the parts relating to nutrition, pressure care and mobility. Another person wears a prosthetic to help improve their appearance and maintain their dignity. There is no mention of this in their care plan and this does not demonstrate that people are treated with respect and dignity. We saw that one resident was fitted with a urinary catheter. We saw that the catheter bag was lying on the floor with no catheter stand in use. When a member of staff was questioned about it she told us that the stand was in the Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 13 bathroom and started to walk out of the room. We had to ask her to place the catheter bag onto the stand. This is poor practice, particularly where the care plan clearly states they are at risk of infection. During our visit to the home we noted that a desk diary had been left open and in public view. Personal and confidential information was recorded in the diary. We discussed this with the manager during our visit to help ensure that confidential information is stored properly. Two of the entries in the diary gave us cause for concern. The entries stated that two people needed a swab taken from wounds but that this could not be done as there were no forms for microbiology. This indicates that people living at Riverside Court may not always have access to health care services when necessary. The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the manager and other staff. This part of the inspection took six hours. Feedback was given to the manager at the end of the inspection. Overall, we found that medication was poorly managed and there were a number of areas that needed improvement in order to fully protect the health and well-being of residents. We looked at records for receipt, administration and disposal of medication. We found that some records for administration were inaccurate and leaving residents at risk from errors that could cause harm. For example, some records were not signed, and others did not say why medication was not given. Other records were duplicated suggesting that medication was given twice. We counted a sample of medications and compared them with records to check if they tally and are given in the correct dosage. We found that some medicines were missing and could not be accounted for. Others were in excess showing that they had not been given according to the prescribed instructions. We looked at a sample of residents’ files and checked information relating to changes in medication. Some medication changes were seen but there was no evidence that they were intentional or had been double-checked by staff. This means that residents are at risk of getting the wrong dosage. For example, the dose of a sedative for one resident was reduced by the doctor. However, when the next 4-weekly supply of medication was received the dose was tripled. There was no information to support this dose change. In another case a resident received a sedative morning and night. The night-time dose was increased to manage night-time disturbance. However when the new supply was received the higher dose was given in the morning and lower dose was given at night. Again there was no information to suggest that this change was intentional and this could lead to unnecessary day-time sedation. The progress report for this resident following administration of the new supply Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 14 contained entries such as “sleepy this morning”, “had lethargic periods throughout the day” and “very lethargic today spending long periods sleeping”. We looked at a sample of care plans for managing ‘when required’ and complex medication. Care plans are needed so that staff have clear guidance on managing medical conditions, when and why medication is needed, and how it must be given and monitored so that residents receive safe and effective treatment. Some of these care plans were inadequate providing little information on managing serious medical and mental conditions and treatments in order to protect both residents and staff. We looked at the management of people on blood-thinning medication who need regular blood tests for managing the dosage. We found that these tests were not always done on time and this could to lead to harm if the person continued on an inappropriate dose. We noted that some medication ran out placing peoples’ health at risk. This included pain-killers, sedatives and medication for angina. We checked medicines liable to misuse, called controlled drugs. Overall the stock of controlled drugs was in order however the register did not record the recent disposal of one medication and this needed updating. The controlled drugs register should be up-to-date at all times. The manager did checks, or audits, of medication however these did not identify all of the concerns raised at this inspection. These audits must be more thorough and frequent so that concerns are identified and managed without delay to keep residents safe and to protect their health and well-being. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with a range of social and leisure activities to choose from. This means that people living at the home are able to enjoy a stimulating lifestyle, if they choose. EVIDENCE: The home employs two activities co-ordinators. They organise and arrange many varied activities both in the home and outside. Some of the people we spoke to told us of the games, entertainers and lunches out that they have enjoyed whilst living at Riverside Court. The people who completed and returned surveys to us said that there are activities for them to take part in, if they choose. One person said, ‘the activities are well done.’ Another person said, ‘we are given the opportunity to join in activities inside and out of the nursing home environment. It provides a change from the nursing home routine.’ Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 16 Relatives told us, ‘The patient entertainment is excellent all staff are very helpful’; and ‘activities are very well done in mums home. Parties, bingo and fundraisers etc.’ One relative did comment that, ‘the activity girls work hard but now home is full and cannot spend much time with each resident.’ We noted that several people at the home were keen to practise their religion. We asked the manager about the arrangements that were in place to help them to do this. She told us that a vicar used to visit the home but had left sometime ago. She thought he had been replaced but ‘thinks’ he has left too. The manager needs to ensure that suitable arrangements are in place at the home for people who wish to practise their religion. The staff taking part in the inspection thought the home did well with providing activities. They said, ‘we have good activities and are always doing something. Our residents get on well with each other; they enjoy going out and chatting with each other.’ Some of the staff thought that further improvements could be made by, ‘having a minibus for our own residents. We would be out a lot more. Our residents often ask if we can go out but we can’t without a bus.’ We noted during this visit that the home had been nicely decorated ready for Christmas and there was a busy programme of activities, Christmas entertainment, lunches and parties. We visited some of the residents at Riverside Court. One person had their own Sky TV. Although there are things for them to join in if they wish, they ‘like to watch sports programmes’ in the privacy of their own room. Another person was reading a magazine and had the TV on, again in the privacy of their own room. She had not dressed ready for the day but told us that she ‘would get dressed when she was ready. The girls are lovely and help me when needed. The food is good and we always get enough.’ We received varied comments about the standard and quality of food provided by the home. The surveys we received indicate that the food is often ‘bland’ and not to the liking or choice of residents. They told us that fresh fruit, vegetables and salads are limited. Some people told us that the home could do better by having a ‘better choice of meals and food.’ One person said, ‘meals have been served cold when I’ve been in bed poorly’, another said, ‘the food prepared does not look appetising at times and is very bland. Too many convenience ingredients are used and meals lack the home made appeal.’ A relative thought that ‘The meals are sometimes sub-standard as older people don’t like pasta etc. They are used to solid food like hotpots, tatie ash and shepherds pie.’ Another relative agreed that meals were sometimes ‘poor’ and added that their relative ‘loves salads. We have had to ask if they can have them. They seem to serve a lot of tinned or frozen Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 17 vegetables. We provide our relative with fruit and tomatoes and often bring fresh salads.’ The person completing the AQAA told us that people living at Riverside Court received nutritional assessments, but that staff have not received any training with regards nutrition. We saw some evidence of assessments in care plans but they were poorly completed and where issues had been identified they were poorly monitored, with little evidence recorded to show that professional help and advice had been sought. We noted that some people had lost a significant amount of weight but again there were no records to indicate why this might be or of what the manager was doing to monitor this. We observed the serving of the lunchtime meal. People were offered a choice of main course and the meals appeared to be of an acceptable standard and sufficient portion size. We looked at a sample of the weekly menus. These indicated that a varied diet was offered and that there were choices at each meal. We saw staff helping residents to the dining room and helping them to eat their meal where needed. Staff explained to residents what was happening and offered them choices. People were assisted with sensitivity and kindness from staff and this helped to reduce any anxieties they may have had. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally understands safeguarding procedures and reports their concerns to appropriate agencies. There are some gaps, which potentially place some of the people using this service at risk of harm. EVIDENCE: There is a compliments and complaints process in place at the home. This document is included in the information given to new and prospective residents and is available in other formats such as large print or audio tape. Most of the residents and their relatives that returned surveys to us said that they know about the complaint process and that they know who to speak to if they are not happy about something. People said that any concerns they had raised had generally been dealt with appropriately. The person completing the AQAA told us that the home had received three complaints since our last visit. We have received two complaints directly. One of the complaints was from a relative, which was passed to social workers for further investigation. The other was from another care provider, which we investigated by carrying out a random inspection visit to the home in November 2009. This complaint was upheld. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 19 The person completing the AQAA told us that four referrals had been made to social workers in respect of safeguarding vulnerable adults. Both CQC and social workers are aware of many more than this. The number of referrals made may be due to several factors at the home. Poorly completed pre-admission assessments, care planning and poorly managed medication may mean that some people are placed at the home inappropriately. This potentially places other residents at risk of harm or abuse. Staff at the home have received training in the safeguarding of vulnerable adults. This training helps staff to understand what constitutes abuse and helps ensure that incidents are properly reported to the relevant agencies. The staff we spoke to have not received specialist training to help them deal with aggression or challenging behaviour and the manager acknowledged that this is an area that could be improved upon. The provider has also recognised that improvements need to be made to the ways in which people using this service are protected from the risks of harm or abuse. During a recent multi-disciplinary meeting with the provider, they told us of their plans for making the improvements, although at the time of this inspection, the manager told us that these had not yet been implemented. The random visit we undertook in October 2009 was in respect of the recruitment practices in place at the home. We found that recruitment checks had not been carried out consistently and that some staff had commenced working at the home before references and checks had been obtained. Some of this information has now been obtained, but there are still some gaps that would benefit from further investigation. At this visit to the home we found that some improvements had been made and the most recently recruited staff had been checked properly before they commenced work at Riverside Court. Robust recruitment procedures help to ensure that people using this service are protected from staff that may be unsuitable to work with vulnerable adults. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 24 and 26. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general condition of the home is not well maintained and there are several areas that provide risks to the health, safety and welfare of people using this service. EVIDENCE: Riverside Court is a purpose built care home. It provides accommodation in single, en-suite bedrooms with additional communal spaces such as lounge areas, dining rooms, showers and bathrooms. The person completing the AQAA told us that some areas of the home had been redecorated and that some bedrooms still needed to be upgraded. They Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 21 told us that some new equipment had been purchased for the home and that the home had an action plan to help best practice with regard to the control of infection. During this visit to Riverside Court, we took the opportunity to walk around all areas of the home to look at the general environment. The home had been decorated ready for Christmas and was generally warm and tidy. Some of the furniture in the lounges and dining rooms has been replaced and some of the bedrooms have been redecorated. We spoke to the maintenance person employed at the home. He told us that bedrooms are usually redecorated when they become empty, in readiness for any new residents. We looked at several bedrooms throughout the home, including the beds and furniture. The rooms were clean and the furniture and beds were of a reasonable standard. Equipment such as pressure mattresses, bed rails and crash mats were in place. Where rooms had oxygen in use, warning notices had been placed on the door. We noted that in some of the bedrooms, call bells were missing leaving people without any means of summoning assistance if needed. We also noticed that some of the cord light switches had been cut off or were missing. The windows in many of the rooms require urgent attention. They have handles and locks missing, have gaps stuffed with paper, and in one case the windows have been taped up to stop the draughts. Some of the people we spoke to or who returned surveys to us commented on the state of the windows. One person said, ‘I have reported to management on several occasions that the windows in mums’ room do not fit, after 18 months nothing has been done.’ Another relative told us that they had taped up windows to prevent draughts. They said that no one at the home had mentioned anything to them about their actions. We have made requirements about the windows at previous inspection visits. We discussed this matter with the manager during our visit and we have written to the provider about the windows at the home. People living at Riverside Court are able to personalise their own rooms to help make them more cosy and homely. We saw that people had brought small items of furniture, photographs, pictures and ornaments and had their own televisions. During our tour of the premises we saw a variety of potential hazards. A vacuum cleaner had been left in the doorway causing a trip hazard, there were wet floors that had not been mopped and there were no slip hazard signs in place. The domestic stores had been left unlocked as had the sluice on Rose Unit. The sluice contained cleaning materials, fluids and used sharps bins. The Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 22 waste bins were overflowing with rubbish and posed a risk of cross contamination. Many of the communal showers, bathrooms and toilets were in a poor condition. Tiling and grouting is very badly stained, dirty or falling out. Two of the communal baths are out of order one has been unusable since October 2008 and had still not been repaired on the day of our visit. There are no suitable waste bins in any of the communal bathrooms or toilets and this also raises the risk of cross infections. In one of the communal bathrooms we found the medicine pots and spoons soaking in the hand basin. Toilet seats are loose in many places and some of the hand rails in assisted toilets have screws missing from the fixings. In one of the bathrooms there was a large basket of communal toiletries and in the dining room a tin of nutritional supplement had been left on the radiator. The pharmacy dispensing label had been partially removed and the name of the person to whom the tin belonged was missing. These items provide potential hazards to people who may have dementia type illnesses. Personal items such as toiletries should be personal to each individual and should be stored safely in their own rooms. Nutritional supplements belong to the person for whom they were prescribed and should be stored safely and securely. We made a short visit to the laundry at the home. This area is kept secure and people using this service are unable to enter this area. The laundry was clean, tidy and well organised on the day of our visit. A new washing machine has recently been purchased and staff working in this area are provided with suitable protective clothing to help minimise the risk of cross infection. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with basic training and support to help them understand and meet the needs of the people that use this service. There are some gaps in the specialised training available for staff and this may mean that there are times when people are not supported as well as they might be. EVIDENCE: On the day of our visit to the home there appeared to be a sufficient number of staff on duty. The home is registered to provide nursing care and the care staff team includes registered nurses as well as care assistants. Housekeepers, cooks and a maintenance person are also employed to help ensure people using this service received the care and support they need. Some of the people we spoke to or who returned surveys to us told us that there was usually enough staff on duty to help them with their daily needs and requirements. Some of the residents told us that staff usually listen and act on what they say. One relative commented, ‘the carers usually are very good but as usual some are more caring than others and will spend time talking and making sure mum is comfortable. The staff go on NVQ courses and previous management tried to help them.’ Another relative told us, ‘Definitely need Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 24 more staff. There seems to be too few staff to cover all the rooms as they are so far apart if anyone rings for the toilet etc it takes quite a while to get the other end of the home, so definitely need more staff on each shift.’ The staff who took part in this inspection felt that there was usually enough staff on duty, although one person thought the home could do better by, ‘having more staff on during the day so we can spend more time with the people we look after rather than doing lots of paperwork which takes up a lot of our time.’ Another thought that the rota could be better organised, fair and flexible. Almost half of the care staff at the home have gained National Vocational Qualifications (NVQ) at least to level 2. Some of the housekeeping staff have also gained this type of qualification in their subject. The manager told us that five more staff were in the process of gaining this qualification. She did not know how staff would access this type of training in the future and did not know how places are allocated to staff. Staff told us that they are provided with training, including induction training when they first start to work at Riverside Court. We looked at a selection of staff training records. They showed that staff receive training in safeguarding adults (abuse), manual handling, COSHH, health and safety, food hygiene, first aid, infection control and some specialist training in wound care, dementia awareness and advanced care planning. We did note that staff had not received training in aggression or dealing with challenging behaviour even though there are some people with very complex needs on the dementia units. When questioned, staff told us that they had never received any training in this discipline and would very much welcome it. The manager told us that staff did need extra training in dementia care, deprivation of liberty safeguards and challenging behaviour. We looked at a selection of recruitment records for staff that had recently been recruited, we also followed up on some requirements we made during our random inspection visit in October 2009. At this visit to the home we found that some improvements had been made and the most recently recruited staff had been checked properly before they commenced work at Riverside Court. We found that the shortfalls identified in our random inspection visit have generally been rectified, but there are still some gaps that would benefit from further investigation. Robust recruitment procedures help to ensure that people using this service are protected from staff that may be unsuitable to work with vulnerable adults. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 36, 37 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of consistent leadership and clear direction means that people living at Riverside Court do not always receive a safe and satisfactory care service. EVIDENCE: Riverside Court has been without a registered manager since March 2009. Since then there have been two periods where the home was run by a peripatetic manager, a short period where a manager was appointed and more recently the appointment of the current manager Ms Pauline Armstrong. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 26 Ms Armstrong has previous experience of managing a care home and tells us that she receives good support from her area manager and is mentored by another manager from a nearby Four Seasons home. She has commenced her manager’s induction training and is in the process of obtaining the documentation to apply for registration as the manager of Riverside Court. At our last key inspection of this service we noted that the home had started to make improvements to the way in which it operated. The lack of clear and consistent management over the last nine months has had a negative effect on the quality of service offered by Riverside Court. Some of the comments we have received from relatives include the following: • ‘When mum first went to Riverside in May 2008 the manager and deputy made the home a positive and happy environment. Since that manager left the new manageress made changes and the atmosphere in the home changed. The deputy left as well as other staff. The new manageress has also left and as yet we have had a temporary manager. I know that the turnover of staff has affected morale and has also had an effect on mum as she does not know people. This must affect her bond with them as they don’t know her history.’ ‘The frequent management changes make it difficult to have concerns addressed adequately.’ ‘I would hope that the next manager is willing to drive the home and staff morale back to the level it was when the last manager left. I know paperwork takes up a lot of time but would like to see someone like a matron who visits each resident with the nurse on duty each morning and checks that all relevant information is exchanged at handover.’ • • Some of the staff completing surveys told us that they usually feel well supported by their manager. We looked at a sample of staff supervision records, but these do not demonstrate that staff are supervised or have their practice monitored on a regular basis. As well as looking at a sample of care and staffing records kept at the home, we also looked at a selection of the maintenance and safety records. The provider ensures that lifts and hoists are serviced regularly and that portable electrical items are tested for safety. Gas appliances have been serviced and checked for safety and so has the fire detection systems and fire fighting equipment. The fire records show that staff have received training in fire prevention and evacuation but they do not confirm that fire drills are carried out very regularly. Care records include an element of risk assessment, but these are not carried out as quickly as they should be nor are they reviewed and kept up to date as required. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 27 One of the records we looked at describes the person as ‘non-weight bearing’ but their handling assessment was not undertaken until seven days after their admission to the home. Another person is also described as ‘non-weight bearing’ and the assessment identifies the use of a hoist for transferring. The records state further on that the person can stand and that a handling belt should be used. This information is inconsistent and confusing for staff. It places both resident and staff at risk from harm or injury. We noted during our visit to Riverside Court that there are several areas that potentially raise the risks of cross infection for staff and residents. There are no clinical waste bins, bathrooms and showers are maintained in a poor condition and some toiletries are used communally. During the visit we spoke to the cook and the kitchen assistant at Riverside Court. We looked at a sample of the records kept in the kitchen. All temperature charts and recordings were up to date. Food in fridges was labelled and all open containers were also labelled with the date when opened. There were weekly and monthly cleaning records in place together with records of a recent food safety and food storage audit that had taken place. Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 2 X n/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 2 1 2 X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X X 1 2 2 Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Staff must ensure that medicines are administered in the correct dosage so that people receive safe and effective treatment. This was to have been met by 01/02/09. Timescale for action 01/02/10 2 OP22 23 31/03/10 Bathrooms, showers, toilet facilities and communal areas must be kept free of hazards at all times and maintained in to a safe and clean standard. This will help to minimize the risks that they present to people living in the home. This was to have been met by 01/02/09. All staff employed at the home 31/03/10 must receive appropriate training in accordance with the aims and objectives of the home and to meet the changing needs of people living at the home. This was to have been met by 31/03/09. Staff employed at the home must be supervised and have DS0000010105.V378217.R01.S.doc 3 OP30 18 4 OP36 18 01/02/10 Riverside Court Nursing Home Version 5.3 Page 30 their care practices monitored on a regular basis. This was to have been met by 31/03/09. 5 OP3 14 People must not move into the home without a full and detailed assessment of their health and social care needs. Regard must be given to the findings of the assessment to help ensure that the home will be suitable and able to meet the needs of the potential service user. Each person using this service must have a plan of their health and social care needs, detailing what those needs are and how those needs will be met. The plan must be kept under regular review and updated as necessary. People using this service must have access to and receive treatment or advice from healthcare services and professionals. This includes access to the dietician and microbiological services. 01/02/10 6 OP7 15 01/02/10 7 OP8 13 01/02/10 8 OP9 13(2) There must be a system for 01/02/10 checking for unexpected changes in medication to reduce the risk of errors. All records for medication must be accurate to prevent mistakes that could result in inappropriate administration of medication. 01/02/10 9 OP9 13(2) 10 11 OP9 OP9 13(2) 15(1) Medicines must not be allowed to 01/02/10 run out. Care plans must be more thorough to provide staff with clear guidance on managing DS0000010105.V378217.R01.S.doc 01/02/10 Riverside Court Nursing Home Version 5.3 Page 31 residents with specific care needs for the administration of complex or when required medication so that they are managed safely and effectively. 12 OP15 16 People must receive a varied, wholesome, appealing and nutritious diet. Individual requirements must be taken into consideration. Where necessary clear and detailed records must be maintained and healthcare professionals contacted for advice and assistance. The matters identified in the report regarding the environment must be attended to, in particular the loose fitting windows in bedrooms, the baths and shower rooms, including the tiling. The home must be maintained to provide a warm, comfortable and safe environment for people living there. 28/02/10 13. OP19 23 01/03/10 14 OP26 13 Suitable arrangements must be 01/02/10 in place for the disposal of soiled waste, particularly in bathroom and toilet areas. People using this service must be properly protected from the risks associated with cross infection. The service must be run and managed by a qualified, competent and experienced person who is registered with the CQC. Records must be maintained in an accurate and up to date manner. Records and confidential information must be stored securely and in line with DS0000010105.V378217.R01.S.doc 15 OP31 9 31/03/10 16 OP37 17 01/02/10 Riverside Court Nursing Home Version 5.3 Page 32 current legislation. 17 OP38 13 The health and safety of people using this service must be protected and promoted. Unnecessary risks to the health and safety of people using this service must be identified and so far as possible, eliminated. 01/02/10 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 OP9 Good Practice Recommendations The manager should undertake more thorough audits of medication so that any issues relating to medication can be highlighted and dealt with quickly to keep residents safe. The register for controlled drugs should be up-to-date at all times. You should ensure that the religious needs of people living at the home are observed and met appropriately. Personal toiletries should be kept in people’s own rooms to help avoid use by others and to minimise the risks of potential cross infection. 2. 3. 4. OP9 OP12 OP26 Riverside Court Nursing Home DS0000010105.V378217.R01.S.doc Version 5.3 Page 33 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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