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Inspection on 27/06/07 for Riverside Court Nursing Home

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

This inspection was carried out on 27th June 2007.

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

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

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

What the care home does well

Some of the people living at the home and some of their relatives say that they are very satisfied with the service they receive. Visitors to the home say that they are always made welcome. One person said ` they always make you feel welcome as soon as you walk through the door. All the staff speak and have a natter.` Most people also said that they receive enough information about the home to help them decide if it is the right place for them to live. Healthcare professionals who visit the home indicate that the manager `usually seeks advice` and `usually responds appropriately to concerns`. This helps to make sure that people receive the care and treatment they need.

What has improved since the last inspection?

Some of the issues identified at the last assessment of this service have been actioned. Medication records have improved. This helps to ensure that the information relating to the treatment received by people living at the home is clear. Improvements to the physical environment at the home have been made. New carpets and floor coverings have been replaced in various parts of the home. A storeroom that was in a dangerous condition has been repaired. There are further plans to convert this room into a therapy room. An office on the first floor has been converted into an activities room and is equipped with various games, books and art materials. These improvements will help to ensure people live in pleasant and stimulating surroundings.

What the care home could do better:

Although some work has been carried out to improve the care planning system at the home, this has not been undertaken in a consistent manner. There are gaps in care plans, which potentially puts people at risk of receiving inappropriate care and support. Improvements to staff training and development need to be made. This will help ensure that skilled, experienced staff that understand their individual care needs and illnesses supports people living at the home. Some visitors to the home and staff at the home think that staffing levels should be improved as `there are not enough staff on at times`. The service must ensure that residents receive medication as prescribed by the doctor so that their conditions are managed safely and effectively, and this must be recorded properly. It must ensure that staff follow individual care plans for "when required" sedating medicines so that they are given only when needed, and as prescribed, to protect residents from the effects of unnecessary treatment. The manager at the home should monitor and assess the progress of changes introduced to the home. This will help ensure that staff are working safely and to the aims and objectives of the home.

CARE HOMES FOR OLDER PEOPLE Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ Lead Inspector Diane Jinks Unannounced Inspection 27th June 2007 10:00 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.V339536.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.V339536.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) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mr Daniel Cleough Care Home 60 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) Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include two named persons under 65 years of age. Total not to exceed 60. The Commission for Social Care Inspection are to be notified by an application for variation to the conditions of registration should any of the two named people reach 65 years of age or leave Riverside Court. The home is registered for a maximum of 60 service users to include: up to 30 service users in the category of DE(E) (Dementia over 65 years of age) up to 30 service users in the category of OP (Old age, not falling within any other category) 16th March 2007 2. Date of last inspection Brief Description of the Service: Riverside Court is a purpose built two storey care home providing nursing care to service users within four units. Each of these units can accommodate up to fifteen people. Three of the units are for service users who have been diagnosed as being mentally infirm and the other unit is for older people who do not fall within any other registration category and who require nursing care. Riverside Court is close to Maryport harbour and local amenities. There is a large car park within the grounds of the home and an enclosed courtyard style area with outside furniture provided. Full details of the facilities and services offered in the home may be obtained by contacting the manager of the home. The current rate of charges are £373.00 to £696.00 per week, 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.V339536.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The assessment of this service was undertaken over one day by Diane Jinks, Jenny Donnelly and Angela Branch (Pharmacist inspector). A random visit was made in May 2007 and was followed up with this unannounced visit. During this visit the majority of the key standards of the National Minimum Standards were assessed. The pharmacist inspector assessed the handling of medicines to make sure it is carried out safely. This was assessed through the inspection of relevant documents, storage and meeting with the manager and nursing staff. The inspection took five and a quarter hours. The assessment of the service included talking to some of the people who live at the home, some of the staff who work there and the manager of the home. Surveys were also sent to relatives, staff, health and social care professionals. This helps to ensure that a wide range of views regarding this service are obtained and considered. The manager had also submitted an improvement plan and completed an annual quality assurance assessment of the service. These documents assisted in verifying information throughout. What the service does well: What has improved since the last inspection? Some of the issues identified at the last assessment of this service have been actioned. Medication records have improved. This helps to ensure that the information relating to the treatment received by people living at the home is clear. Improvements to the physical environment at the home have been made. New carpets and floor coverings have been replaced in various parts of the home. A storeroom that was in a dangerous condition has been repaired. There are further plans to convert this room into a therapy room. An office on the first floor has been converted into an activities room and is equipped with various games, books and art materials. These improvements will help to ensure people live in pleasant and stimulating surroundings. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service generally have their health and social care needs assessed prior to moving into the home. There are some gaps in the assessment process and this means that people may not always have their needs met appropriately. EVIDENCE: The service has produced a Statement of Purpose and a Service User Guide. These documents provide information about the home and the types of care services it can offer. The documents are available in one standard format, which may not be suitable for some of the people living at the home. The reception area in the home has been improved and there is lots of information displayed on the notice boards in this area. Some of the relatives of the people using this service indicate that they are provided with sufficient information about the home and are aware of the information on the notice boards. People living at Riverside Court generally have their health and social care needs assessed prior to them moving into the home. The assessment process is not consistently followed and this is particularly noticeable where people Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 9 may have dementia illnesses. Evidence of assumptions being made by staff carrying out assessments rather than involving the person’s relatives or friends, was seen on some care records. This means that some people using this service may not always have their individual needs and values recognised or respected. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not consistently record sufficient or accurate information regarding people’s care needs and requirements. This may compromise the well-being of people using this service. EVIDENCE: The manager indicates that all care plans have been reviewed and updated. All nursing and senior care staff have received recent training in care planning. There are still two methods of care planning and filing in place at the home. This is to be evaluated to assess which is the better method. The standard of care planning is still poor and inconsistent. The manager at the home recently developed a plan to help ensure that improvements are made to care plans. This included the manager carrying out monthly spot checks and reviewing care files, but this has not been done. Although all care plans are said to have been updated and reviewed, evidence showed that an original care plan had been copied onto the ‘new’ system. This means that this person’s recorded care needs may not be a true reflection of their current requirements. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 11 The samples of care plans looked at during this visit to the service include some details of the support required to meet the daily living needs of people living at this home. An element of risk assessment, nutritional assessment and nursing needs (where relevant) are also included in the care plans. There are some detailed instructions in some care plans, particularly in relation to behaviour, diet and medication. However, other documents and information recorded in care plans indicate that these instructions are not consistently followed. Some care plans document the personal preferences of people using this service. One of the people spoken to during this visit confirmed that their wishes are respected. Care files show that people using this service usually have access to other health care professional such as their doctor, community nurses (including specialist nurses), chiropodists and community psychiatric nurses. There is also evidence to indicate that some people may not always receive treatment and advice from specialists when necessary. This places people using this service at risk from harm. Medicines are stored properly to maintain their quality. Records for receipt, administration and disposal of medication are adequate. However, there are rare occasions when records are not signed when medicines are given and for some people the dose given was not recorded. For example, for one resident, the dose of a daily blood thinning medicine was consistently not recorded and this places them at risk of serious harm if the wrong dose is given. “When required” sedating medications for the treatment of agitation or aggression are not always managed properly and care plans are not followed. Sedatives for one resident are missing and cannot be accounted for. On many occasions their use cannot be justified. This places the people who use the service at risk of unnecessary treatment and over-sedation that could affect their health and increase their risk of falls. For example, on one occasion a resident received a sedative at teatime but their record said that they “had a quiet afternoon, ate a little tea” and did not show that the sedative was needed. Sometimes changes are made to medication but there are no records to show that doctors have advised these. The manager has recently told CSCI that some sleeping tablets have been lost. The investigation into this was discussed and it is recommended that procedures for investigating discrepancies with medication be reviewed. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some, but not all people living at this home are provided with support and opportunities to make choices and decisions about their lifestyle. This means that some people may be experiencing isolation and are unable to achieve their full potential. EVIDENCE: Some improvements have been made to the activities programme at the home. Office space has been converted to a designated activities room on the first floor. The room is equipped with craft items, books and board games. Two people are responsible for organising activities although some of their work also involves providing direct care and support to people living at the home. Activities and events, including trips out of the home, are posted on notice boards. This may not be displayed in an appropriate format and some of the people who live at the home may not be aware of what is available to them. On the day of this visit to Riverside Court, one of the activities co-ordinators was helping a lady with her hair, as the hairdresser was unable to visit. In the afternoon some people on the first floor took part in a game. The manager has indicated that a survey will be undertaken to establish if social, cultural, religious and recreational needs of the people living at the home are being met. There were no records to confirm that this has taken place yet. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 13 The manager acknowledges that this is something that could be done better by the home. The care files confirm that there is room for further improvements with regard to providing recreational activities to meet the interests and hobbies of people living at the home. Relatives and visitors to the home have differing views about the social activities. Some say that activities are available whilst others would like to see more stimulation provided. Visitors to the home indicate that they are made welcome and are able to visit whenever they want. One of the people spoken to during this visit to the home said that they were ‘quite content here and the staff are very good. I prefer and have only female carers helping me. I have a shower on Tuesdays but would like one more often.’ This person had recently been out with staff from the home for shopping and lunch and really enjoyed it. The menus and meals in place at the home have not improved since the last inspection visit. A survey has been carried out with people living at the home with regard to the food and menus and this subject has been discussed at residents meetings. A limited number of people at this home are able to complete the surveys themselves. Staff and/or relatives had completed the tick boxes and the value and usefulness of this type of survey is questionable. The vegetarian options have not improved and are not included in the daily options, unless people ask for them – most people living at this home are not able to this. Evidence suggests that people requiring a soft diet are not given a choice at mealtimes. One person receiving nursing care did say that alternatives were available if requested. Records show that one person requiring a special diet (diabetic) is given inappropriate food despite advice from a community nurse being recorded in their care plan. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some improvements have been made by the manager to help protect people using this service. There are still gaps and inconsistencies, which potentially leave people at risk from harm. EVIDENCE: There is a complaints process in place at the home. This document in displayed in the home and included in the Statement of Purpose. Most people participating in the inspection process indicate that they know about the complaint process and whom they should complain to if necessary. Details of advocacy services are displayed throughout the home, although the format may not be suitable for some of the people using this service. The manager has started to hold residents and relatives meetings. Dates have been set for the coming year so that people know when they will be held. Minutes are kept of these meetings and some of the topics discussed include inspection reports and planned improvements to the running of the home. Following referrals made under the safeguarding adults procedures, the home is receiving extra support from the Adult Social Care Team, Primary Care Trust and the Mental Health Trust. This will help to ensure that suitable and safe protocols are developed to enable the manager to refer people for specialist services where necessary. This support group are also helping to improve the service provided by the home for people with dementia and some staff training has been arranged. An action plan produced by the manager at Riverside Court, states that staff will receive training in the protection of vulnerable adults. The timescale for this training has not been met. This matter needs urgent attention to ensure Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 15 that all staff at the home are aware of the signs of adult abuse and their responsibilities to protect people living at this home from harm. Where risks of aggression or challenging behaviour by people living at the home have been identified, the management of these risks are not consistently recorded in risk assessments. This means that people living at the home are at risk from harm or from the inappropriate use of sedating medication. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 16 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): Standards19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at the home is generally clean and comfortable. There are some poor practices with regard to cleaning and infection control, which place people using this service at risk from harm. EVIDENCE: The home is generally clean and tidy. General maintenance has improved and there is a programme in place to ensure that further improvements are made and repairs carried out. A linen storeroom that previously posed a hazard has been cleared and repaired. There are plans to convert this room into a therapy room at some stage, but there currently no set timescales for this. On the day of this visit to the home new carpets and bathroom floorings were being laid in various parts of the home. There was some evidence to demonstrate that people living in the home and visitors to the home had been consulted regarding the décor. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 17 New call bells have been delivered to the home. The action plan developed by the manager indicates that risk assessments will be carried out and the new bells will be fitted, but this had not been done at the time of this visit. Shower rooms and bathrooms are dirty and dusty. Some of the equipment in these rooms pose a threat to the control of infection and needs to be replaced. There are several areas in the home where windows do not close properly and are stuffed with tissue to help prevent draughts. This was discussed with the manager during this visit. This matter needs urgent attention to ensure that the rooms used by people living in this home are warm and comfortable. An incident of poor practice with regards to health and safety and the control of infection was seen by the inspectors. This matter was drawn to the attention of the manager for action. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. People using this service do not always have their needs met by skilled and experienced staff. This potentially places them at risk of neglect or harm. EVIDENCE: The information provided by the manager indicates that the majority of people using this service have high dependency levels. The numbers of staff on duty, as per the staff rota, indicates that there may not always be a sufficient number of staff on duty to meet the needs of people living at the home. Some relatives and visitors to the home also indicate that there may not always be enough staff available to provide the level of care expected. The home employs qualified nurses who are supported by health care assistants. Some of the care assistants have gained a National Vocational Qualification (NVQ) at Level 2 or above and four staff are working towards this qualification. Staff training records show that limited training has been provided and that much of it is out of date. Specialist training such as dementia care and caring for people with challenging behaviour has not been undertaken. This means that people living at the home may not always be cared for and supported by appropriately trained and skilled staff. The manager has produced a training plan to cover basic training needs such as health and safety, medication, manual handling, protection of vulnerable adults and first aid. Many of the timescales set have passed and the provision Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 19 of training has not been arranged. Lack of training leaves both staff and people using this service at risk from harm or injury. The manager has not recently recruited any new members of staff. A sample of existing staff personnel files were looked at during this visit. The documents indicated that staff had undergone appropriate checks such as obtaining references and Criminal Record Bureau (CRB) checks. This helps to ensure that only suitable staff are employed to work with this vulnerable adult group. As a matter of good practice, the home is currently updating CRB checks for staff. There have been difficulties with the staff team and the manager is beginning to address these matters. Disciplinary meetings have been held where necessary and staff meetings are now taking place. Some of the staff spoken to during this visit to the home indicated that they are pleased with the action being taken by the manager to improve working conditions. They are confident that their opinions will be listened to and taken seriously by the manager. Comments made by some relatives and visitors to the home indicate that they are aware of some of the difficulties with staff. Comments include; • ‘some of the staff are excellent. They have a very caring nature and show empathy for the residents.’ • ‘they should ensure that the staff they employ want to work with elderly people who may have mental health problems as well as medical conditions’. • ‘I feel that over the last three weeks staff morale has been down a little. Myself I think there needs to be more staff on duty.’ Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 20 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 manager is working towards making improvements to the service. More work is needed in this area to ensure that improvements are made in the best interests of people using this service. EVIDENCE: The manager is trying to make improvements to the service by developing relationships with outside organisations such as the Primary Care Trust, Mental Health Trust and the Adult Social Care Team. This will help ensure that people living at the home are safeguarded and receive the standard of care they require. It will also help raise the manager’s awareness of the special care needs of people with dementia illnesses. Regional and Operations Managers from the organisation continue to visit the home at frequent intervals and offer some support to the home manager. Healthcare professionals and visitors to Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 21 the home have noted some improvements to the management structure at the home. There are some excellent staff employed at the home, but there are difficulties with some staff and this is undermining the improvement of the service. The manager has started to address some of the issues by implementing disciplinary meetings and staff meetings. Staff supervision is minimal at present and staff do not regularly have their practice and career developments assessed. The implementation of a robust staff supervision programme will help the manager identify areas of good and poor care practices. This will also help to make positive improvements to the care service people living at the home receive. The manager has submitted an action plan and improvement plan to the Commission for Social Care Inspection, following recent inspections of this service. Some of the actions have been implemented but many have not and the timescales set by the manager have lapsed. New procedures have not been implemented as described. Where procedures have been changed, the manager has not audited them to ensure staff understand and carry out their tasks and responsibilities effectively. Some of the care practices, records and documentation at the home indicate that the aims, objectives and philosophy of the home are not always followed. This means that the best interests of people using this service may not always be promoted. Accident records are kept and these are monitored and audited. The manager was not sure about what should be reported to CSCI. An explanation was given and the manager was directed to the guidance on such matters. Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 2 Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1) 15 17(1) Requirement Care plans must be developed in consultation with each person living in the home. This will help ensure that the care needs and the outcomes identified for service users are being met properly. (Previous timescales of 31/01/07, 06/02/07 and 26/04/07 not met). People using this service must have access to health care professionals. This will ensure that all aspects of the person’s health care needs are met appropriately. Records for administration of medicines must be accurate to protect residents from medication errors. Timescale for action 31/07/07 2. OP8 13(1)(b) 31/07/07 3. OP9 13(2) 31/07/07 4. OP9 13(2) The registered person must 31/07/07 ensure that medicines are given as the doctor intended. (Previous timescale of 01/04/07 not met). Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 24 5. OP14 12(1) 12(2) 12(3) People living at this home must 31/08/07 be helped and enabled to make decisions and choices within their daily lives. This will help to maximise their autonomy and quality of life. There must be in place, robust policies, procedures and staff training programmes for responding to and reporting suspicions or evidence of abuse or neglect. The policies and procedures must ensure the protection of people living in the home. (Previous timescales of 28/02/07 and 31/05/07 not met). 31/07/07 6. OP18 12(1) 13(4)(c) 13(6) 13(7) 13(8) 7. OP19 16(j) 23(2)(b) The matters identified regarding 31/08/07 the environment must be attended to, in particular the loose fitting windows in bedrooms. The home must provide a warm, comfortable and safe environment for people living there. (Previous timescale of 30/04/07 and 30/06/07 not met). The sluice must be used only for its intended purpose and maintained in a clean, tidy and hygienic manner at all times. This will help to reduce and control the risk of infection for people living at the home and staff working at the home. (The previous timescale of 11/12/06, 06/02/07 and 31/05/07 not met). Bathrooms, showers and toilet facilities must be kept clean, hygienic and free of hazards at all times. This will help to minimize the risks that they present to people living in the DS0000010105.V339536.R01.S.doc 8. OP26 16(j) 23(d) 31/07/07 9. OP26 13(3) 16(2)(j) 23(d) 31/07/07 Riverside Court Nursing Home Version 5.2 Page 25 home. (The previous timescales of 11/12/06, 20/03/07 and 31/05/07 not met). 10. OP27 18(1) Sufficient numbers of suitably 01/10/07 qualified and competent staff must be employed at the home at all times. Consideration must be given to the needs and numbers of people living at the home as well as the physical layout of the home. This will help to ensure the health, safety and welfare of people living at the home. There must be a comprehensive 31/08/07 staff training and development programme in place at the home. This will help ensure that staff are able to fulfil the aims of the home and meet the changing needs of people living in the home. (The previous timescale of 30/05/07 not met). Staff employed at the home must be supervised and have their care practices monitored on a frequent basis. This helps to make sure that staff are working to the policies and procedures in place at the home as well as identifying any training and development needs they may have. Risk assessments must be undertaken by a trained and qualified person. This will help ensure the safety and protection of both care staff and people living in the home. (Previous timescale of 30/05/07 not met). 31/07/07 11. OP30 18(1) 19(5)(b) 12. OP36 18(2) 13. OP38 12(1) 13(4) 13(5) 13(6) 13(7) 14(1)(a) 17(1)(a) 31/07/07 Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc 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 OP1 Good Practice Recommendations It is recommended that consideration is given to producing the Statement of Purpose, Service User Guide and other information that is provided to people using this service, in alternative formats. It is recommended that procedures for investigating discrepancies with medication are reviewed It is recommended that doctors’ instructions regarding medication are accurately recorded. It is recommended that the arrangements for leisure, social and recreational activities are reviewed and updated in consultation with people living at the home, to suit their needs, preferences and capacities. It is recommended that the vegetarian menu is reviewed and clearly included in the daily menu choices. This will help to promote individual choice. 2. 3. 4. OP9 OP9 OP12 5. OP15 Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverside Court Nursing Home DS0000010105.V339536.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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