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Inspection on 06/06/06 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 6th June 2006.

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

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

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

What the care home does well

The home provides a comfortable homely environment and the residents spoken with told the inspectors that the staff were very friendly and helpful. The food provided is varied and nicely presented, and meal times are relaxed and a pleasant experience for the residents. The home has a robust recruitment policy and is gradually building a constant staff group to provide continuity of care for the residents.

What has improved since the last inspection?

The activity programme has been improved to offer more choice for the residents and individual activities are benefiting residents who are unable or do not wish to join in the group activities. Staff training for the care team continues to be developed and the staff are finding benefit from this. Decoration of the home continues on a rolling programme to maintain a pleasant environment for the residents. Residents care plans have been developed further with risk assessments in place but still need to be expanded and more actions and interventions documented.

What the care home could do better:

All members of staff must be included within the training and supervision programme within the home. Care plans need to be developed further on the upstairs units to provide clear lines of guidance and action for staff to follow. Some of the residents` rooms on the upstairs units need to be made more personalised. The home needs to look at Health and Safety and Infection control training for staff to reduce risks of hazard and improve the safety of the residents within the home Emergency call bells must be within easy reach of the residents and staff at all times.

CARE HOMES FOR OLDER PEOPLE Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ Lead Inspector Colette Hibbert Unannounced Inspection 6th June 2006 09:00 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.V291290.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.V291290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Court Nursing Home Address 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ 01900 815323 01900 815033 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Jean Walker Care Home 60 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (15) of places Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include two named persons under 65 years of age. Total not to exceed 60. The Commission for Social Care Inspection are to be notified by an application for variation to the conditions of registration should any of the two named people reach 65 years of age or leave Riverside Court. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 60 service users to include: up to 45 service users in the category of DE(E) (Dementia over 65 years of age) up to 15 service users in the category of OP (Old age, not falling within any other category) 10/02/06 2. 3. Date of last inspection Brief Description of the Service: Riverside Court is a purpose built two storey care home providing nursing care to service users within four units. Each of these units can accommodate up to fifteen people. Three of the units are for service users who have been diagnosed as being mentally infirm and the other unit is for older people who do not fall within any other registration category and who require nursing care. Riverside Court is close to Maryport harbour and local amenities. There is a large car park within the grounds of the home and there is an enclosed courtyard style area with outside furniture provided. The fees for this service range from £385 -£525 dependant on the care and social needs of the resident. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the home and took place over a day; the deputy manager was present throughout. During the inspection the three inspectors, Cath Wilson, Diane Jinks and Colette Hibbert spent time talking with residents and staff in private and in small groups. A selection of records relating to care of the residents and the day to day running of the home were looked at, and a tour of the building was conducted. A pre-inspection questionnaire had been completed and returned and information from residents and relatives had also been returned prior to the inspection. This information will be included within the context of this report. What the service does well: What has improved since the last inspection? The activity programme has been improved to offer more choice for the residents and individual activities are benefiting residents who are unable or do not wish to join in the group activities. Staff training for the care team continues to be developed and the staff are finding benefit from this. Decoration of the home continues on a rolling programme to maintain a pleasant environment for the residents. Residents care plans have been developed further with risk assessments in place but still need to be expanded and more actions and interventions documented. Riverside Court Nursing Home DS0000010105.V291290.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. Riverside Court Nursing Home DS0000010105.V291290.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.V291290.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,and 5 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Residents felt that due to visits to the home and staff assessing their needs prior to admission that the home would be able to provide the care that they required. EVIDENCE: The home gives prospective residents comprehensive information prior to admission. The manager or senior member of staff assess the residents and find out their care and social needs, which the residents spoken with said was very reassuring. One resident said that it ‘made it feel as if the home would be able to prepared to provide the care that they needed’ One resident said she had looked around the home several times before moving in and had been made ‘very welcome’ on each visit with their family. Each resident has a written contract given to them and it states the terms and conditions of the home, and the home also retains a copy. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 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 the following standard(s): 7,8,and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The standard of care plans vary throughout the units.Some were detailed but others did not identify the care needs of the residents. This puts the residents at risk from receiving inappropriate care or their care needs not being met. Residents are treated with respect and their rights’ to privacy is upheld. EVIDENCE: Requirements made by the pharmacy inspector against Standards 9 will be inspected at the next visit and a report will be available from the CSCI. Each resident has an individual care plan, these have been developed and some improvement has been made especially on the nursing unit. On the upstairs units improvements could also be noted but the staff need to look to extending the information within these documents. On one unit in particular the inspectors felt that there was not enough information in the care plans for the care staff to follow. There also needs to be clearly defined strategies for the staff to follow. Although risk assessments are carried out on some of the Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 10 care plans no action or intervention has been documented to enable the staff to have guidance for the care the resident required. Residents were treated with respect, dignity and were spoken to in a polite manner by the staff. Residents spoken with said that they felt the staff made a big effort to maintain their privacy and that their care needs were met. One resident said that she only had to ask and the staff would help, and that they did not have to wait for attention and during the inspection call bells were answered promptly. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 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 the following standard(s): 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. Residents benefit from a well balanced diet and meal times are relaxed and enjoyable in pleasant surroundings. Residents maintain contact with family and friends. Social activities have been improved for some of the residents but some residents would benefit from more communication and stimulation. EVIDENCE: The staff within the home have improved some aspects of the social interaction within the home. There is an activity programme with notices on display to let the residents know what is planned. The residents and staff had spent time putting flags up in the entrance hall to celebrate the start of the world cup which some were looking forward to watching on the television. During the morning of the inspection it was very warm and sunny and some staff took residents out for a local walk, which they all enjoyed. Residents on the upstairs units were less involved in the activities and appeared to be left for periods of time to walk up and down the corridors without staff contact. Staff must try to engage more with these residents and provide communication and stimulation to improve the quality of their lives. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 12 Residents families are encouraged to visit and to maintain contact, one resident said that their visitors were always made to feel welcome by the staff and they always ‘passed the time of day with them’. Residents are encouraged to remain as independent as they are able; staff support them and help them to make decisions. They are able to choice what time they get up, go to bed and they have the opportunity which area of the home they spend time in, either communal or their private rooms. Meal times were seen to be calm and pleasant experience for the residents, they are able to make a choice in the meals they eat. One resident said that the food was ‘very good and that they were given the choice of what they would like to eat’ Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families felt that any concerns would be taken seriously and acted upon. EVIDENCE: The home has a complaints procedure and is included in the service user guide which is given to resident upon admission. Residents spoken with were aware of how to make a complaint, they would talk to head of care and if not happy they would take it to the manager, who ‘would sort it out’. Links with external agencies are used to provide the home with support and guidance for staff on adult protection issues. All relevant staff demonstrated an awareness of the homes policies and procedures and knew what immediate action to take. Residents felt confident that the staff would support them and they felt safe. Questionnaire that had been returned to the inspector by relatives felt that the home would take any concern seriously. Residents are supported as much as they are able to lead an independant life, and the home is aware of the advocacy services and acessess advocates on residents behalf. Residents are able to vote in elections if they wish. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 19,20,21,24,25 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 has a rolling programme inplace to improve and maintain the general décor of the building to provide a homely environment but this needs to be extended to include all residents bedrooms. EVIDENCE: The home is generally clean, tidy and comfortable. There is a rolling programme for repairs and issues raised at the last inspection have been attended to. There were adequate bathing and toileting facilities but the showerhead in one of the upstairs bathrooms was very dirty. None of the rubbish and clinical waste bins had lids on them; this is a health hazard and a possible source of infection and needs to be addressed to protect the residents in this home The taps were not working in one of the bathroom upstairs and many of the towel holders were empty. One of the shower seats was corroded and is in need of being replaced. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 15 Bell pull cords on the upper unit were still being put out of reach, this practice had been identified at a previous inspection and the manager had spoken to the staff. The call bells must be within easy reach of the staff and residents at all times. The bedrooms downstairs were all personalised bright and clean, and one of the residents told me how she had ‘been allowed to bring some furniture from her own home and had also had Sky TV installed as they liked watching the sport’ In contrast to this some of the residents bedrooms on the upper floor were very bare and impersonal, no pictures or photographs or ornaments it was hard to identify whose residents’ rooms they were. The home must look at improving and making each residents room pleasant and personal. The laundry was very noisy and the area around the washers / dryers was covered in spillage of soap powder. This area must be kept clean to reduce the risk of infection. There were no gloves or aprons in this area for the staff to use when dealing with soiled linen. Staff should make sure that they have the correct equipment as provide by the home for performing tasks. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,and 30 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number and skill mix of care staff on duty are adequate to meet the resident’s needs. The home has a robust recruitment procedure in place to protect the residents who live here. EVIDENCE: The staff files showed that the home has a recruitment procedure in place which complies with regulations. Training is provided for staff that meets the statutory requirements.The home has a rolling training programme with NVQ II and III, wound care, dementia care, adult protection, moving and hanling and fire safety training. Residents felt that there needs were met and they did not have to wait for attention. One resident said that they rang the bell and the staff would ‘come quickly to see what she wanted, if they were busy they still anwsered and said they would be a minute. They always come back’ Staff spoken to felt that they could provide the care that they residents required, but they were rather worried as they believed that the company were looking to decrease staffing levels on the evening shift and felt this would affect the standard of care that they could deliver. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 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 has an understanding of the day to day running of the home and is aware of the areas which need improving to provide a safe environment for the residents. Health and Safety training needs to be provide to all staff to promote a safe environment for the residents within this home. EVIDENCE: The Manager is now registered with CSCI. The home generally works in partnership with residents, family representatives and professionals. The home has a statement of purpose that sets out the aims and objectives of the service. There are policies and systems in place to monitor the homes practices. The home has adequate insurance cover. The Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 18 home has a self audit system which is in place and seeks consultation from residents and families as to ways to improve the service it provides. Residents have the opportunity to manage own finances if they wish and the home has systems in place to record transactions and accounts for those who wish the home to provide this service. Service checks are done on a regular basis and documentation is kept. There was a hazard observed with the hosepipe running from the rear of the building through a resident’s room across the corridor and through another resident’s room to the front of the building for the maintenance person to water the garden. Staff were seen to have difficulty moving wheel chairs over the hosepipe and it was a hazard for residents walking along. There was a hazard sign in place but this remained like this for most of the visit, until the deputy manager asked for it to be removed. Health and Safety training is provided for the care team and should be given to the ancillary staff as well. Staff must wear the appropriate uniform to protect themselves and comply with the homes own health and safety policy. There has been some improvement in the delivery of staff supervision but it must be extended to provide support and guidance for all staff working within the home. Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X X 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 3 2 Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 20 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 15 Requirement All service user documentation must be fully updated, reviewed, contain all relevant assessments and care plans to ensure the specific needs of service users with dementia can be met. (The time scale for compliance with this requirement was 01/09/05,and extended to 30/04/06) The registered person should ensure the accuracy of all receipt, administration and disposal records. Timescale extended The registered person must ensure that the fridge is maintained at an appropriate temperature. It must be defrosted regularly and medicines must be stored at temperatures required by the manufacturer. This requirement is unmet Timescale extended. Timescale for action 31/08/06 2 OP9 13(2) 31/08/06 3 OP9 13(2) 31/08/06 Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 21 4 OP9 13(2) The registered person must ensure that hand-written MARs are accurate for strength and name and signed by both author and checker. This requirement is unmet. (Timescale extended) The registered person must ensure that there are complete and accurate care plans in respect of health including the use of when required or as directed medication. This requirement was mostly met. (Timescale extended) 31/08/06 5 OP9 1513(2) 31/08/06 6 OP12 16(2mn) 7 8 OP19 OP20 13(4) 23(b, d) The residents on the upper units 31/10/06 need to have more staff involvement to provide stimulation and orientation. The hose pipe should not be 31/08/06 placed through the home causing risk to residents and staff All areas of the home must be in 31/10/06 good decorative order and clean (This is an outstanding requirement from 30/04/06 timescale has been extended) All residents rooms should be personalised and homely Emergency call bells must be within easy reach of the residents and staff The laundry must be clean and hygienic Staff must have health and safety training and monitor practices within the home. Ancillary staff must also receive training appropriate to their role. All staff must receive supervision 6 times a year. DS0000010105.V291290.R01.S.doc 9 10 11 12 13 14 OP24 OP25 OP26 OP30 OP30 OP36 16(2c,d) 12.1(a) 16(2j) 18 18(1c) 18(2) 31/08/06 31/07/06 31/07/06 31/07/06 31/07/06 31/07/06 Riverside Court Nursing Home Version 5.2 Page 22 15 OP38 12 (1a) Staff must wear appropriate protective clothing whilst at work. 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Riverside Court Nursing Home DS0000010105.V291290.R01.S.doc Version 5.2 Page 23 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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