CARE HOMES FOR OLDER PEOPLE
Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport, Cumbria CA15 8AZ Lead Inspector
Lorraine Frost Unannounced 21 June 2005 10:00 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 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 F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Riverside Court Nursing Home Address 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ 01900 815323 01900 815033 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tamaris Healthcare (England) Ltd, (wholly owned subsidiary of Four Seasons Health Care) Vacant Care Home 60 Category(ies) of Dementia - over 65 years of age (45), registration, with number Old age, not falling within any other category of places (15) Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1) To include two named persons under 65 years of age. Total not to exceed 60. The Commission for Social Care Inspection are to be notified by an application for variation to the conditions of registration should any of the two named people reach 65 years of age or leave Riverside Court 2) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 04/05/05 Brief Description of the Service: Riverside Court is a purpose built two storey care home providing nursing care to service users within four units. Each of these units can accomodate up to fifteen people. Three of the units are for service users who have been diagnosed as being mentally infirm and the other unit is for older people who do not fall within any other registration category and who require nursing care. Riverside Court is close to Maryport harbour and local amentities. There is a large car park within the grounds of the home and there is 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 acting manager of the home. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection commenced at 10.00 and concluded at 16.20. Another Regulatory Inspector, Nancy Saich, accompanied the lead inspector for this visit. The inspection included talking with residents, visitors, staff and the acting manager. It included reading resident files, staff recruitment files, and other relevant documentation. A tour of the home of the home was also conducted. What the service does well: What has improved since the last inspection?
There have been many improvements since the last inspection when the inspectors had serious concerns about the home. Since then there has been a concerted effort by the management and the staff of the home to work together and with others to promote the health and welfare of the residents. Input from other professionals has greatly contributed to the improvements seen. For example residents receive regular planned visits from specialists and changes to routines and procedures have been successfully implemented. Staff have received training from specialists from the mental health teams to make them more aware of the resident as an individual. Documentation such as care plans, risk assessments, and medication records are regularly audited and this has led to further improvements in the quality of record keeping and in the monitoring of residents. Staff morale and attitudes have changed since the last visit and those spoken with were very supportive of the acting manager as she was of them. They were more positive about their work and demonstrated a better awareness of the resident as an individual, and this was reflected in the way that they worked together and the way they approached the residents. Residents were well presented and one person said, “My nails have never looked better.”
Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 6 Residents were clearly more relaxed and said, “I like living here.” There were other positive comments throughout the day about the staff and the home itself. Activities were improving with residents saying that they had been to see the Bounty when it came into the harbour. A number of residents from each of the units had been out to see it. Other residents commented on the bingo sessions and the singing and dancing they had enjoyed. One unit was closed whilst being completely refurbished and the manager had made her office more welcoming for visitors. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The pre admission assessment form is detailed ensuring that the information required to determine whether the home can meet the needs of the resident is obtained, and the assessment process helps to assist the resident to make a choice of where to live. EVIDENCE: Pre admission assessments are carried out and the process including a meeting with other professionals who are involved in the care of the resident. This benefits staff, residents, and their relatives. A visitor and a resident, who said that they liked Riverside Court, confirmed this. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Most residents are benefiting from the improved planning and monitoring systems that identify their health and personal care needs. However much work is to be done to ensure consistency throughout the home. Good quality dementia care based on current good practice is not provided throughout the home leaving many residents with unmet needs and staff unsure of appropriate strategies to utilise to benefit the resident and others in the home. Auditing and better communication has improved the standard of administration, record keeping, and stock control of medication, ensuring that residents are now more likely to get their medication as prescribed. EVIDENCE: Care plans and risk assessments had improved. Some care plans identified strategies to be deployed at key times, but not all staff were aware of them and it was not properly documented for all residents. The timescale for compliance relating to this standard has been extended, as there has been an improvement in the quality and content of the documentation. The management auditing systems have improved the practices around medication in the home and staff have been made aware of their
Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 10 responsibilities. However, staff were washing their hands using a treatment prescribed for a resident. This was highlighted at a previous inspection and a requirement made for the practice to stop. The charts showed that medication had not gone out of stock recently and that medication had been given as prescribed. New systems have been implemented following consultation with the local practices and the pharmacist to ensure that residents receive prescribed medication and treatments promptly. Communication and joint working with other professionals has improved with regular planned visits taking place. This has led to internal and external procedures being reviewed to minimize the risk of delay in residents receiving consultations and treatment. Staff spoke to residents in a kindly manner and a good rapport was seen between staff, residents, and the visitors. The privacy and dignity of residents was respected throughout the day. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Although there were improvements to arrangements for daily life and social activities the home continues to fail to meet the needs of people with dementia, as there are no planned activities or approaches being used to counteract the difficulties encountered by these people. EVIDENCE: A number of residents were still in bed or having breakfast when the inspection started. Residents said they got up and went to bed as they wished. Staff said that those residents with dementia were checked on but no longer routinely dressed by the night staff in the early morning. Residents said they had been out into town the day before the inspection and staff said they tried to take people out when the weather was fine. The activities organiser described the one-to-one work she did with residents and a number of people said they enjoyed these and group activities and entertainments. Very few activities are provided that are designed to meet the needs of people with dementia. Staff are not aware of some of the more common approaches to helping people with memory problems. There had been improvements to the way food and drinks are provided in the home. However there were still some matters that showed that residents – especially those with dementia- were not being helped to make choices or to be as independent as possible.
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The arrangements for handling complaints is now much improved giving residents the chance to have any issues dealt with appropriately and promptly. The arrangements for protecting vulnerable people from abuse were generally in order but would be improved by some amendments to the procedures. EVIDENCE: The home had received no complaints since the last inspection visit. Residents, visitors and staff were confident that they knew how to complain. No one had any complaints on the day. Staff could access the procedures and said they could support someone who wanted to complain. The acting manager said she tried to respond to any concerns as soon as possible. She had introduced relatives meetings and these provide a venue for discussing issues. Care staff, the acting manager, and a nurse were all asked about the protection of vulnerable adults and all had a good idea of how to report any abusive practices. The policy documents needs to be amended so that staff have clearer guidelines to follow that would help with the investigation of abuse. Residents were asked about this and no one had any problems with the way staff treated them. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 Improvements have been made to the cleanliness and tidiness of the home providing residents with a comfortable and clean place to live. The standard of décor in residents’ bedrooms is good providing them with a room that they can personalise and treat as their own. EVIDENCE: On entering the home it felt cleaner and fresher than on previous inspections. The dining rooms had been tidied and the tables were set with tablecloths and serviettes and on one unit there were table decorations. One nurses’ station had been relocated to the unit office and there were plans to remove the old nurses’ station. Consideration was being given to placing seats in that area for residents and visitors. The sluice fan had been fixed and therefore the unpleasant smells previously noticed were not present at this inspection. Residents liked their rooms and invited the inspectors into them. One resident said how light the room was and showed the inspector the views from the
Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 14 window. They were tastefully decorated and allowed the resident the opportunity to personalise them. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 This home has acceptable staffing levels with enough nurses and care staff available to attend to the health and personal care needs of the service users. Some staff had a qualification in social care. The home fails to deliver the right levels of training for staff development in dementia care and this means that residents’ needs are not being addressed properly. Some recruitment practices do not prevent unsuitable people from working with the residents. EVIDENCE: The rosters for the previous four weeks were seen and the home had been suitably staffed during this time. Trained nurses were on shift by day and night. The residents said there were enough people on duty to care for them. Staff felt that there were enough people on duty to give everyone sufficient care and sometimes to take them out or sit with them. A number of people were having specific one-to-one attention from staff that allowed complex care needs to be monitored. There was a proportion of care staff with N.V.Q qualifications and others who were registered to start this. Staff felt that this award helped them in their care of the residents. Staff training was checked and most staff had received core training that helped them to carry out basic tasks. Some staff had not received the basic dementia awareness training despite the fact that at least thirty people in the home have this diagnosis. This applied to both nurses and care staff. There
Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 16 had been no ongoing training on how to help people with dementia by using specific techniques or approaches. Staff spoken to on the day felt that they relied on ‘common sense’ and by doing what they thought worked for other staff. The inspectors did see inconsistencies in approach that could be lessened by training, team development and good planning for care. Staff talked about how they were recruited and how the home had made sure by interviewing, checking references and criminal records that they were suitable. However, the files for two new recruits were checked, and it was found that two people had started to work in the home but their work references had not been checked thoroughly and this might have compromised residents’ safety. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, and 38 Residents, visitors, and staff are benefiting from the improvements seen as a result of the high level of input by both internal and external management teams of Riverside Court. Through improved management audits and staff training the health, safety, and welfare of residents and staff is being promoted. EVIDENCE: Staff have received training on a number of topics recently and have been formally supervised. The formal supervision needs to be expanded to cover key areas to highlight good practice and to promote the ethos of the home and the service it is registered to provide. Staff have been kept informed of the results of the audits to assist in the continuing improvement of the home and to support them by clearly showing the shortfalls as well as the improvements.
Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 18 Three “Relative” meetings have been held by the acting manger since taking up the post in May 2005 to promote the approachability of the management. Visitors confirmed that they had attended these and had found them useful and informative. The inappropriate storage of items in bathroom cabinets seen at the last inspection has been rectified. Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2
COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x 3 x x x 3 x 3 Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All service user documentation must be fully updated, reviewed, contain all the relevant assessments and care plans to ensure the specific needs of the service user with dementia can be met. (The timescale for complaince with this requirement has been extended.) Medicines prescibed for use by service users must not be used by staff e.g Hibiscrub and paracetemol. Timescale for action 01.09.05 2. OP9 13(2) 04.05.05 3. OP12 16(2)m 4. 5. OP14 OP15 12(4) 16(2)i (This is an outstanding requirement with a timescale for compliance of 04.05.05) Service users with dementia 01.08.05 must have a planned activities programme specific to their needs. Service users must be assisted 01.08.05 to make informed choices and to remain for as long as possible. A review of the menus must be 01.08.05 undertaken to meet the specific needs of those service users with dementia related conditions.
Version 1.30 Page 21 Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc 6. OP18 13.6 7. OP29 19 8. OP30 18 (The timescale for compliance has been extended to allow the acting manager time to research current guidleines relating to dietary needs of those with dementia related conditions.) The policy for the Protection of Vulnerable Adults must be reviewed to prevent investigations from being compromised. The recruitment and selection of staff must be carried out in accordance with written policies and procedures at all times. Staff must receive training and supervision to enable them to deliver good quality dementia care based on good practice guidelines and current research. 01.08.05 21.06.05 01.09.05 9. 10. 11. 12. 13. 14. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard Good Practice Recommendations Riverside Court Nursing Home F58 F10 s10105 riverside court v235502 210605 ui stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park, Gillan Way Penrith Cumbria, CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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