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Inspection on 18/12/08 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 18th December 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Some of the people that live at Riverside Court told us that the staff are very good and that they usually get the care and support they need, when they need it. They told us that the home is always clean and fresh. One person said, `I am very happy and comfortable here, it`s a place I can relax in.` The food and catering staff are also said to be `very good`. One person told us, `the catering staff have always provided alternatives on days when I do not want or like any of the items on the standard menu. Medicines are managed adequately but extra care is needed to ensure records are complete and accurate to fully protect the health of the people who live there. Regular checks or audits of medication are done to monitor the management of medicines and to keep people safe.

What has improved since the last inspection?

CARE HOMES FOR OLDER PEOPLE Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ Lead Inspector Diane Jinks Unannounced Inspection 18th December 2008 10:00a 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.V373567.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.V373567.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) Mr Daniel Stuart Cleough 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.V373567.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 2nd April 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 and services offered in the home may be obtained by contacting the manager of the home. The current minimum charge is £449.00 per week, but this is dependent upon the level and type of care required. There are additional charges made for matters such as hairdressing, personal toiletries or the purchase of newspapers. Riverside Court Nursing Home DS0000010105.V373567.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 1 star. This means the people who use this service experience adequate 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. This helps us to obtain a variety of views and opinions about the service. We made a visit to the home. During this visit 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. One of our pharmacist inspectors also made a visit to the home to check that medication storage, records and administration are managed safely. We carried out a short random inspection of this service in April 2008 to check that the manager continued to make improvements to the service as we had requested. The manager completed an Annual Quality Assurance Assessment – the AQAA for the service and returned it to us when we asked. This information helps us to gather further evidence, which we can check during our visit to the home. What the service does well: What has improved since the last inspection? The improvements to care plans continue. The sample of care records we looked at generally contain detailed information about individual’s care needs and expectations. There are instructions for staff to follow to help ensure those needs are met properly. The manager has employed a new activities co-ordinator. People participating in this inspection spoke of her and the activities with great enthusiasm. Some of the comments included: Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 6 ‘There are always activities. I take part in cooking, dominoes, and all the entertainment and enjoyed the firework show.’ • ‘The activities person has made events and activities a wonderful difference. There are all kinds of activities now – baking cakes and biscuits, making Christmas gifts and calendars, dancing and sing songs.’ We found that people living and working at the home were more willing to speak to us about their experiences than on some of our previous visits. Both the staff and the people living at Riverside Court were very complimentary about the manager and commented on the differences and improvements at the home. Staff recognised that a lot has been done to ‘change the home and make improvements’. One person told us, ‘Everyone is a lot happier. There are more activities, more money is being spent and the home looks cosier. The manager is always helpful and listens to what is said.’ • What they could do better: Whilst further improvements to the service have been made, there are some areas requiring review and improvement. We have made five requirements and three recommendations as a result of our visit. Although most records for the administration of medication are well completed, staff should take care to avoid omissions and ensure that medication is administered as prescribed so that people receive the correct treatment. The management of a high-risk medication should be improved to reduce the risk of errors that could affect health. There are some areas of the environment, which need to be regularly checked and maintained safely. In particular the communal areas. We found that some toilets had loose seats and that some of the grab rails were coming away from the wall. Emergency call bells are not always accessible from floor level. These shortfalls place people using this service at risk of suffering an accident or fall and then being unable to summon help. 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 to help prevent the draughts. We told the manager about these matters, as they need to be dealt with promptly. Staff have started to receive some training to help them with their work. The manager has produced a training matrix and commenced a training plan. The records do not indicate that staff currently receive the recommended amount of training to fulfil the aims and objectives of the home and meet the needs of the people that live there consistently. Staff supervision is also an area that has been neglected, although annual appraisals have just been carried out and the manager is developing a plan to help ensure that all staff are regularly supervised in their work. Please contact the provider for advice of actions taken in response to this Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 7 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.V373567.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service receive sufficient information about the home to help them make a decision about moving into Riverside Court. EVIDENCE: The people who participated in the inspection of this service told us that either they or their relative, were given enough information about the home and the services it can provide. This information helped them when making a decision about coming to live at Riverside Court Nursing Home. The home has a Statement of Purpose and a Service User Guide. Both these documents are given to prospective residents and copies of them are kept at the home for further reference. Printed copies of our latest inspection report for the home are also made available to enquirers and there is a copy kept in the reception area at the home. People thinking of moving into the home are able to visit for the day and trial periods of residency are offered. This helps to make sure that the home is Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 10 suitable and will be able to meet the needs and expectations of prospective residents. There is an admission procedure in place at the home, including arrangements for emergency admissions and respite care. We saw that people do have their health and social care needs assessed prior to moving into the home. The home manager carries out the assessments and where appropriate, copies of assessments and care plans undertaken by social workers or hospital staff are obtained. This information also helps to make sure that the home will be able to meet care needs properly and in the most appropriate way. Where people are admitted to the home for respite care, assessments have been reviewed and up dated to make sure that any changes to needs Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some care plan and medication records need to be reviewed and updated to make sure people’s changing needs are safely managed. This will help to ensure that people are respected, treated as an individual and are supported appropriately. EVIDENCE: During our visit we looked at a sample of five care records. We found that further improvements have been made to the way in which people’s care and support needs are recorded. Care plans are reviewed monthly and usually updated if people’s needs change. The manager regularly audits care plans to help make sure they are up to date and accurately reflect what is required by people using this service. Personal care needs are recorded together with the actions that staff should take in order to meet these needs. Records indicate and we observed, that people are encouraged and supported to be as independent as possible. In circumstances where people may sometime behave inappropriately, care plans Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 12 provide information for staff to help ensure that privacy, dignity and respect are protected. The nutritional needs of people using this service are assessed and included in the care planning process. Staff are provided with information about people’s preferences and the level of support they require with eating and drinking. Where specialist advice is needed, for example from the dietician or speech therapist, records show that this is obtained and followed. We found that care plans also contain an element of risk assessment. Risks relating to challenging behaviour, mobility and pressure care are generally identified with strategies put in place to help minimise the risks to people living and working at Riverside Court. There are some gaps in the risk assessment process. For example, where people have been identified at risk of falling there are no clear plans to help care staff manage this safely. Furthermore, where people have suffered a fall, assessments and care plans have not consistently been reviewed and updated to reflect any changes in needs or level of support provided. We brought this to the attention of the manager for further action. Daily records are kept and show that people have access to health care professionals such as the doctor, community nurses, dietician, opticians, podiatrist and dentists. People living at the home are also supported to attend hospital and clinic appointments if necessary. One professional organisation has provided comprehensive assessments and care plans for one person. The manager explained how these care plans have been integrated into the person’s care file at the home. They are detailed and clear about the support this person needs and provide intervention strategies that staff should use if necessary. We spoke to some of the people that use this service. Some of the comments they made include; ‘Staff are always available, but sometimes I have to wait if they are busy,’ another person said; I always receive the medical support I need.’ Someone else told us; ‘I get all the care and support I need and an excellent service all the time.’ We saw medication records that were mostly well maintained however on occasions signatures were missing and it was not possible to tell if people had received their medication of not. We saw a number of medicines administration records being signed in one go after the medication round. This is poor practice that could lead to errors as staff rely on memory when completing the records. We also counted a sample of medicines and checked them against records and these were mostly in order with only occasional discrepancies. Occasionally medicines were not given in the prescribed dose. For example, we saw an eardrop prescribed four times a day that was only signed for administration three times a day for a month. We also saw a course of antibiotics prescribed four times a day. This was dispensed as four blister packs, one each for morning, lunchtime, teatime and bedtime doses. However, when we checked the medication there were only three packs for morning, lunchtime and teatime and this person had missed the fourth dose the day before the inspection. Staff must ensure that medicines are administered correctly. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 13 A sample of care plans relating to ‘when required’ and high-risk medication were checked. These were mostly well completed giving clear instructions for management and review of treatment. The handling of a high-risk medication that required regular blood tests and review of dosage was checked for one person. A care plan for this was seen. However, some test results were not recorded or followed-up. There was little information to show that the dose of medication was confirmed after each test to ensure that it was correct and there was no record of the date of the next test. Staff checked this at the time of the inspection. However, we also saw some good records of changes to other medications that were implemented promptly. Medicines liable to misuse, called Controlled Drugs, were checked and were in order. The manager did regular checks, or audits, of medication to look for discrepancies that could be dealt with promptly to keep people safe. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 14 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): Standards 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. People using this service are provided with social and leisure activities. This helps them to make choices and maintain some control over their lives. EVIDENCE: As part of our inspection of this service we sent surveys to some of the people that live and work at the home. During our visit we also spoke to some of these people. Most of the people we spoke to told us that there has been a marked improvement to the leisure and social activities that are available at the home. One person said; ‘our activities organiser has made a wonderful difference to events and activities. There are all kinds of activities now, baking cakes and biscuits, making Christmas gifts and calendars, dancing and sing songs.’ Another person told us; ‘There are always activities. I take part in cooking, dominoes, and all the entertainment and the firework show.’ One of the people we spoke to has lived at the home for some time. They told us that ‘activities have improved. I join in the one’s I want to. There has been a brass band at the home recently and choirs from local schools singing Christmas songs.’ Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 15 Staff have also noticed a difference. One of them told us ‘the home has changed a lot. Everyone is a lot happier. There are more activities and more money being spent. The home looks cosier.’ One of the units in particular has a designated activities area with games, music and craft equipment for use by the people that live at the home. There is also a pleasant and relaxing sensory room, which has been created through fundraising at the home. People using this service are able to see their visitors whenever they like. Visitors are made welcome by the staff and people may see their relatives and friends in their own room or in one of the communal areas as they please. People are also able to go out with their relatives and receive phone calls from families and friends. One person we spoke to showed us their room. It has been personalised with religious items in accordance with their wishes. This person is visited by the priest and nuns from the local parish. We observed some of the service of the lunchtime meal. Staff were available for support if necessary and encouraged people to eat their meals. Some staff sat with people at the table to help if necessary. Simple equipment such as plate guards and preferred cutlery were in use to help people maintain their independence with eating and drinking. Not everyone was in the dining room as some people prefer to have meals in the privacy of their own room. Some of the people we spoke to mentioned the food at the home and told us that it was good. One person said; ‘the catering staff have always provided alternatives on days when I do not want or like any of the items on the standard menu.’ The meals looked to be of good portion size and people had a choice of main courses and desserts. We looked briefly at the menus. They show that there are two options at lunchtime and teatime. There is a further menu that people living at the home have access to and this includes vegetarian options and snacks, which are available throughout the day. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures in place at the home help to ensure that people using this service are listened to and protected from harm or abuse. EVIDENCE: The home has a process for dealing with complaints and comments. Copies of this are included in the service user guide and a copy is posted in the reception area. We asked the manager to update the copy displayed on the notice board to include the contact addresses and telephone numbers of the other agencies that people may raise concerns with directly. The manager has a system in place for recording and monitoring any comments or complaints that he may receive. The manager told us that he has received two complaints since our last visit to the home, which have been resolved. We found that records have been kept and referrals to other agencies such as social workers have been made where necessary. We have not been alerted to any complaints directly or by other agencies. Some of the people living at the home told us that they are aware of the complaint process and that they know who to speak to if they have any concerns. They said that they are confident staff will listen and act upon what they say. There are safeguarding policies and procedures in place at the home. The manager is aware of the local multi-agency adult protection procedures and notifies us and social workers of any concerns raised. All the staff at the home have received training in the protection of vulnerable adults (abuse). Some of them told us that they know what to do if they have concerns or if someone Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 17 raises a concern with them. Improvements have been made to the way in which staff alert the manager to concerns they may have about people living at the home. During our visit to the service a potential safeguarding issue came to the attention of the manager. He contacted the social worker straight away and made a record of the event. Where people may demonstrate behaviour that can be challenging, this is documented in their care plans. Strategies have been included to help staff deal with these situations as safely as possible. Care plans record instructions for the use of any prescribed sedatives. These are used only occasionally and records show that they are given in accordance with the care plan. This prevents unnecessary treatment that could result in side effects such as oversedation and increased risk of falls and injury for people using this service. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 18 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): Standards 19, 22 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home generally provides a clean, warm and safe environment for the people that live there. EVIDENCE: During our visit to this service we looked at the general environment and accommodation that the home provides. There is a new maintenance person at the home and comments were received from people that live at the home and visitors of the improvements that have been made. There are cleaning schedules in place and the home has a maintenance and improvement plan. The Lavery Unit on the ground floor has started to re-open. Some of the soft furnishings have been replaced in this area and the manager told us of the plans to replace much of the bedroom furniture, refurbish the living room and replace the carpet in the corridor to bring it in line with the rest of the home. The home was warm and generally clean on the day of our visit. Staff had worked hard to ensure that the home was nicely decorated and ready for Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 19 Christmas. Communal areas such as the dining room and lounges were warm, clean and tidy. The housekeepers were in the process of doing the morning cleaning rounds. We spoke to two of them. They told us that they have recently completed National Vocational Qualifications (NVQ) in a subject appropriate to their work. They told us that they had enjoyed the training very much and learned a lot that they had not really realised previously. They told us of the improvements to the domestic systems and processes in place at the home, for example the colour coded cleaning equipment for various areas of the home. This helps to reduce and control the risk of the spread of infection. One of the housekeepers is responsible for the soft furnishings and decorations at the home. We found that many areas have greatly improved with just small touches such as flower arrangements, colour co-ordination, pictures and mirrors. The housekeepers and manager told us of a recent infection outbreak at the home and of the measures that were put in place to help prevent the spread. The manager told us that he had consulted the health protection agency for further advice and guidance. The manager said that there are policies and procedures for the control of infection and that ‘most staff’ had completed training in infection control. The records we saw do not confirm this and the manager did not provide details in the AQAA of the number of staff who have completed this training. We found one or two areas that need to be improved to ensure that people are properly protected from the risks of cross infection. For example some of the clinical waste bins do not have lids to help ensure that such waste is securely contained. We also found that some washbowls had been stored away wet and dirty. The manager needs to make sure that all staff are aware of the infection control procedures. There are several communal bathrooms, shower rooms and toilets throughout the home. We found that these were kept generally clean and tidy. One of the bathrooms was out of use. There had been a problem the previous day resulting in leaking water, causing damage also to a downstairs bathroom. There was no notice on the door, this was discussed with staff, they then ensured that a notice was placed on the door and the faulty bathroom secured. Some of the toilet seats are very loose. This is a long standing problem at the home that needs urgent attention to reduce any risks to the health and safety of people living there. The communal areas are all fitted with aids and adaptations to help people access them independently. We found that some of the handrails in the toilets were unsafe and hanging off the wall, we also found that some of the emergency call bells did not extend to floor level. We found that some of the windows in some of the bedrooms are ill fitting and are stuffed with tissue paper to help prevent draughts. We have highlighted this problem previously. We told the manager of these issues during our visit to the home as they need urgent attention to make sure that people living at Riverside Court are safe. The kitchen appeared clean, tidy and organised. The chef was in the middle of preparing lunch. There are procedures in place for non-kitchen staff entering this kitchen and we saw that these are adhered to. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 20 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff working at the home may not always have the right skills, knowledge and experience to meet the needs of the people they support. This means that people may not always have their needs met in the most appropriate way. EVIDENCE: On the day of our visit to the home, there were sufficient staff on duty to meet the needs of the people that live at Riverside Court. We looked at the staff rota and from this it appears that there are usually enough staff on duty at all times. The staff that participated in the inspection of this service told us that there are usually enough staff on duty. One person said that if there are more residents, more staff are brought into work. Some of the people that live at the home confirmed that there are usually enough staff around to help them. One person said ‘staff are very good but sometimes I have to wait if they are busy.’ We looked at a selection of staff recruitment records during our visit to the home. We found that prospective staff complete application forms and attend for interviews. Checks are made, usually before they start to work in the home. The checks include references from previous employers, Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. The registration status of qualified nurses is also checked to help ensure they are suitable to work at the home. One of the records we looked at show that one person did start to work at the home before the manager had all the relevant Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 21 information and check results. This oversight potentially places the safety of people living at the home at risk. The manager told us that all staff at the home have completed training in the protection of vulnerable adults (abuse). He also told us that staff have received manual handling training, fire training and infection control training. We looked at a selection of staff training records and the staff training matrix at the home. These do not record the duration of the training or who the training provider was. This makes it difficult to assess whether induction training always takes place for new staff and whether it meets the recommended requirements. From the information available it is unclear whether staff receive at least the recommended three days annual training or whether specialist training such as dementia care or challenging behaviour training is provided. The manager told us that 25 of the care staff have gained National Vocational Qualifications in Care. This qualification helps staff to understand and meet the needs of the people they are supporting. The home has been awarded some funding to enable 12 key staff to receive training in food hygiene and a further 9 staff are scheduled to undertake some training in the administration of medication. The manager recognises that training needs to be improved and told us that over the next twelve months ‘training will be key to improving staffing issues around knowledge, experience and awareness of clinical and individual service users needs and requirements.’ Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by an enthusiastic manager who tries to ensure that the best interests of the people that use this service are protected and promoted. EVIDENCE: The home is regularly visited by senior managers from within the organisation, which helps to ensure that the management and administration of the home is reviewed and audited. There is a quality monitoring system in place at the home and people are able to express their opinions about the home and the care they or their relative receives. The home manager is supported in his day to day duties by a deputy manager and an administrator, as well as qualified nurses who take some responsibility for the various Units at the home. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 23 We have found previously that the home did not always comply with our National Minimum Standards. In April 2007 we carried out a random inspection of this service to make sure that the manager was continuing to implement his plan for the improvement of the service. We found that improvements continued to be made. We asked the manager to complete an Annual Quality Assurance Assessment and to return it to us within a specified timescale. The manager has done this. Throughout the document he has told us about the continued improvements to the service. He has recognised where improvements can still be made and has provided us with some information of how these issues will be addressed over the next year. We spoke to people who live and work at Riverside Court. Most of their comments were very positive. Many people told us of the improvements they had noticed recently, particularly in the leisure activities that are available at the home. During our visit we looked at some of the records that the manager is legally required to keep. The accident book at the home has been completed properly with reports for both staff and resident accidents. The home’s central heating systems have been maintained and serviced regularly. The portable electrical equipment has been tested annually as have the lift, hoists and fire detection system. We asked the manager for the records relating to fire alarm, emergency lighting, door closures and fire fighting equipment checks. These were not available during our visit as the manager told us they were locked in the maintenance office and the manager does not have a key. Staff fire training was discussed with the manager. He told us that some training has been done but acknowledges that it is not done as frequently as it should. He said that ad-hoc training is carried out but there are no records to confirm this. The manager must make sure that this staff training is up to date for all staff at the home. Staff meetings regularly take place and the manager has introduced ‘Made a Difference Awards’. These are designed to acknowledge and recognise staff achievements and improve staff morale. We spoke to the manager about formal staff supervision, which has not yet commenced. Annual appraisals have just been undertaken with all staff. The manager is in the process of developing a plan to ensure that staff receive supervision every 6 to 8 weeks. This will help to ensure that staff have their care practises monitored and will help the manager to identify gaps in staff training needs and further develop the staff training programme. Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 24 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 3 8 2 9 2 10 3 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 3 17 X 18 3 3 X X 2 X X X 3 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 3 X 3 X X 2 X 2 Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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. Bathrooms, showers, toilet facilities and communal areas must be kept free of hazards at all times. In particular the loose fitting toilet seats, grab rails and access to emergency call bells. This will help to minimize the risks that they present to people living in the home. Staff must not commence in post until satisfactory checks have been completed, including references, CRB and POVA checks. You must make sure that all staff employed at the home 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. Staff employed at the home must be supervised and have their care practices monitored on a regular basis. DS0000010105.V373567.R01.S.doc Timescale for action 01/02/09 2. OP22 23 01/02/09 3. OP29 19 01/02/09 4. OP30 18 31/03/09 5. OP36 18 31/03/09 Riverside Court Nursing Home Version 5.2 Page 26 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 It is highly recommended that staff sign records at the same time that medicines are given and take greater care to prevent omissions in medication administration records. You should consider revising the complaints procedure to help make sure that people using this service are fully aware of the agencies and organisations they may contact to raise concerns or issues with about the service. There should be a comprehensive staff training and development plan to help ensure that people using this service receive a high care and from well supported and trained staff. This should be monitored frequently to ensure staff are developing and updating their skills and knowledge. 2. OP16 3. OP30 Riverside Court Nursing Home DS0000010105.V373567.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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