Inspection on 23/01/07 for Riverside Grange

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Riverside Grange 16/01/09

Riverside Grange 28/01/08

Riverside Grange 22/02/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Riverside Grange 2052a Hessle High Road Kingston upon Hull East Yorkshire HU13 9NN Lead Inspector George Skinn Key Unannounced Inspection 23rd January 2007 09:30 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 Grange DS0000065164.V328308.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 Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Grange Address 2052a Hessle High Road Kingston upon Hull East Yorkshire HU13 9NN 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) 01482 581000 Humberside Independent Care Association Limited Position Vacant Care Home 33 Category(ies) of Dementia - over 65 years of age (33), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (33) Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit two service users under pensionable age. Date of last inspection 22nd February 2006 Brief Description of the Service: Orchard Garth is a purpose built home, which has been operating since March 1991 it has recently been purchased by the Humberside Independent Care Association (HICA) who are a not for profit organisation. The building is on Hessle High Road, near to a Sainsbury store and about one mile from the centre of Hessle, which has a good variety of shops, pubs, banks and other facilities. The home is on a bus route and buses run regularly between Hessle and Hull. The home provides a service for elderly people who may have a mental disorder or suffer from dementia. The home has 33 single rooms, on two floors, all with en-suite toilet. There are four bathrooms, one shower room, and two lounge/dining rooms, as well as a large conservatory. Ancillary services include staff room, laundry and kitchen. There is a small garden area by the car park to the front of the house, but service users do not go there because it is not secure. There is a secure garden for service users which is located to the side of the home and can be accessed via the conservatory. Double-locking doors can be found throughout the home to ensure safety of service users who are mobile and wish to walk about the home. Riverside Grange DS0000065164.V328308.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 inspection undertaken over a two-day period. Prior to the inspection questionnaires were sent and the result of these helped to form judgements made about the service. Because of the dependency levels of the service users it was felt appropriate to include an observation undertaken by an inspector trained to use a special observational tool called a Short Observational Framework for Inspection (SOFI) this is to assess the quality of the interaction between the service users and the staff. What the service does well: What has improved since the last inspection? 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 Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 6 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 Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 7 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): 1, 2, 3, 4, 5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to moving into the home, however there is not adequate information provided to prospective service users or their representative to enable them to make an informed choice or that the home can meet the service users needs. EVIDENCE: Those files case tracked had evidence which showed that service users had been assessed prior to moving into the home, the home complete a thorough assessment which identified how individual needs should be met. There was no evidence which would indicate that prospective service users could experience a trial stay or that the admission process may be staggered to meet the needs of the service user and their carers: or that this had been offered to any prospective service users. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 8 The service user surveys indicate that people had not agreed a contract or received enough information about the service prior to moving into the home. Inspection of records indicated that no contract had been agreed with the service users or their representatives. The home have produced a Statement Purpose, however this did not detail the specific way the home meets the needs of those people with dementia. There was no evidence which would indicate that the home had produced a Service user guide. This means that service users or their representatives do not have enough information or the quality of information they need about the service they will receive and how much it will cost or that the service will meet their needs. Riverside Grange DS0000065164.V328308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are recorded in a detailed care plan however there was no indication that therapeutic intervention is based on research or up to date good practise guidelines regarding care of people with dementia. Service users are treated with dignity and their right to privacy is maintained. The homes handling of medication does not put the service users at risk. EVIDENCE: The home keeps records detailing the care the service user should receive, those care plans case tracked as part of the inspection contained evidence of risk assessments; the completion of an agreements with the service users or their representatives was variable. Care plans are regularly updated and reviewed with all those who have an interest in the service users care. Daily records were kept for each service user and these generally reflected what happened with the service user on a daily basis. There was no evidence that any therapeutic interventions undertaken with the service users are based on current good practise guidelines or research concerning care for people with dementia. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 10 The health care needs of the service users are ensured by the home; there is evidence of service users accessing health care professionals when appropriate and records show that the personal hygiene of the service users is maintained. The home handles all of the service users medication. No service users self medicate due to the level of dementia. The home has effective procedures in place for the safe handling of medication and observation during the inspection indicate that staff had good practise when handling medication. The record of the controlled drugs in held in a loose-leaf binder, this does pose a potential risk of losing records. Controlled drugs records should be kept in accordance with the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. Observation made during the inspection indicated that all service users are treated with dignity; staff were seen to be courteous and addressed the service users sensitively and calmly. Those relatives spoken with and surveyed as part of the inspection process were satisfied with the care which is provided at the home. Riverside Grange DS0000065164.V328308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are not adequately stimulated during the day and there are no therapeutic activities undertaken which are based good practise guidelines and current research. The home does acknowledge individual interests, likes and dislikes and these are recorded in care plans. The home provide meals which are wholesome in relaxed surroundings. EVIDENCE: The home acknowledges the service users interests and cultural needs, this is recorded as part of their care plans, however there was very little evidence of activities undertaken with the service users during the inspection. There was no evidence in the service users care plans of any therapeutic activities undertaken which are based on current good practise guidelines for people with dementia; or any working practises or interventions also based on good practise guidelines for people with dementia. The temporary manager stated that the home are advertising for a full time activities co-ordinator. There is very limited consultation with the service users due to the dependency levels so as a consequence this is mainly undertaken with relatives as part of the company’s Quality Assurance system. The relief Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 12 manager stated that the main source of information gathering is by observing service users. It was reported that the service users do go out of the home and undertake activities in the community; this was evidenced in the care plans. The service users received many visitors during the inspection and they stated that they were made to feel welcome and had the choice of seeing their relatives in private or in the communal lounge; the majority choose the later option. As part of the inspection process it was felt pertinent to include an observation undertaken by an inspector who has been trained in using the Short Observational Framework for Inspection (SOFI). This is a detailed observational tool which can be used to assess the quality of interaction between service users and staff. The results of this were that staff interaction with the service users was limited but of a good quality; there were long periods of time during which the service users were sleeping. It was also decided to use the SOFI because of the incidents that have been occurring at the home involving some of the service users which lead to a vulnerable adults investigation; and the dependency levels of the service users. The inspection was undertaken over two days and both lunchtime meals were observed. There are always two alternative meals at lunchtime and tea is choice of sandwiches or hot meals. Due to the dependency levels of the service users at lunchtime the staff show the service users the two meals available and they make a visual choice. The meals are served in a relaxed and informal setting and staff assist the service users sensitively. Riverside Grange DS0000065164.V328308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place and the service users are protected by it. The company do provide vulnerable adults training for staff but not all staff have received this. EVIDENCE: The company have in place a complaint procedure for staff to follow and the complaints procedure is referred to in the homes Statement of Purpose. The relief manager has started to record all complaints received by the home. A vulnerable adults investigation recently undertaken by the Local Authority was instigated by a member of staff’s lack of confidence in the previous relief managers handling of a complaint regarding the conduct of a service user. The member of staff was able to contact HICA’s senior management with the issue and it was dealt with appropriately. This would indicate that there is a clear procedure for staff to follow if they have any concerns and the company responds appropriately. This does ensure the safety of the service users. Those staff interviewed were aware of what to do if they suspected any abuse was taking place within the home or they witnessed any bad practise. It was not possible to ascertain if the service users were aware of a complaint procedure due to the level of dementia, however those relatives spoken with were aware of the complaint procedure and their right to complain. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 14 Staff receive vulnerable adults training during the block induction which is provided by the company for all staff employed, however some staff have not attended any induction training even though they have worked at the home for a number of months. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 15 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): 19, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in an environment which is well maintained and clean, however lacks stimulation for those with dementia. EVIDENCE: The home was found to be well maintained and clean. All areas have been redecorated and all accommodation is provided in single rooms with en-suite toilets. Bathrooms and toilets were designed to meet the needs of the service users and were clean and comfortable. There are grab rails along the corridors and the home provides lifting equipment for the staff to use. All equipment is routinely maintained. The home does not provide a stimulating environment for people with dementia; all the bedroom doors are the same colour giving no indication to Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 16 the service user of which one is theirs. There are some old photographs of locations around Hull on the wall in the up stairs corridor but these are not in the main living area and are inaccessible to the service users independently. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed to meet the meet the needs of the service users, however some lack training in basic and specialist areas, this could put the service users at risk. EVIDENCE: Evidence seen indicated that there is the required amount of staff on duty to meet the needs of the service users. Questionnaires used as part of the inspection process indicate that the respondent were confident that the staff had the skills to deliver care in way which was of the service users choosing. Those staff files looked at during the inspection contained evidence of a robust recruitment and selection procedure and all required checks were undertaken prior to staff starting employment at the home. It is company policy that all staff undergo a block weeks induction training, which covers mandatory training as well as dementia, early in their employment; evidence seen indicated that some staff who had worked at the home for a number of months had not received the induction training, this meant that only in house basic training had been received from senior staff. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 18 The relief manager had identified the training as an issue and acknowledged that there were some staff on duty who had not received any formal induction training or any formal training on dementia; however they were always supervised by more experienced senior staff who had received the appropriate training. This could however have the potential to leave the service user at risk and vulnerable. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by some one who is competent to do so. Service users are not supported by staff that have the necessary skills to meet their needs. The home is run in the best interests of the service user and there is an adequate QA system in place. EVIDENCE: Currently the home is being managed by a relief manager. She has the relevant experience and qualifications to manage a service which is specifically designed for people with dementia. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 20 The company have in place robust policies and procedures which are reviewed regularly including health and safety, however due to the lack of induction training not all staff have been adequately trained in these and there has been an over reliance on in house training. The relief manager has developed an action plan and staff who have been identified as needing training have been prioritised. The company have a quality assurance system in place and an annual performance report is complied and goals set to achieve. Issues were raised as result of the recent vulnerable adults investigation regarding the home sending the required notification by virtue of regulation 37 of the Care Homes Regulations 2001. The relief manager does understand the need to comply with the requirements of regulation 37 and has since taking over ensured that the CSCI is notified of all reportable incident. Regulation 26 visits undertaken by the provider were available for inspection. Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 21 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 2 2 3 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 N/A 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 N/A 18 2 3 N/A N/A 2 N/A N/A N/A 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 N/A 3 N/A N/A N/A N/A 2 Riverside Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 4, 5 & 6 Requirement Timescale for action 30/06/07 2 OP2 3 OP4 4 OP4 The registered person must ensure that there is an up to date Statement of purpose and service user guide available to prospective service users. This will ensure that prospective service users have the required information to make an informed choice. 4, 5 & 6 The registered person must ensure that each service user has a written contract/statement of terms and conditions with the home so they understand their and the providers responsibility regarding their residency at the home. 10, 12, The registered person must 13, 14, 18 ensure that all specialist services & 19 offered are demonstrably based on current good practise and reflect specialist and clinical guidance. This will ensure that the service users receive the most up to date and current care available. 10, 12, The registered person must 13, 14, 18 ensure that staff individually and & 19 collectively have the skills and DS0000065164.V328308.R01.S.doc 30/06/07 30/06/07 30/06/07 Riverside Grange Version 5.2 Page 23 5 OP5 4, 5 & 14 6 OP7 15 7 OP12 5, 12, 16 & 23 8 OP18 5, 13, 17, 18, 19, 20, 22, 37. 23 9 OP22 10 OP30 18 & 19 11 OP38 10, 12, 13, 16, 17, 37 experience to deliver the service and care which the home offers to provide. The registered person must ensure that prospective service users and their relatives and friends have an opportunity to visit and asses the quality, facilities and suitability of the home. The registered person must ensure that the service users plan meets relevant clinical guidelines produced by professional bodies concerned with the care of older people with dementia. The registered person must ensure that service users find the lifestyle experienced in the home matches their recreational interests and needs. The registered person must ensure that the staff trained appropriately to ensure that service users are protected from abuse. The registered person must ensure that the environment is suitably adapted to meet the needs of those people with dementia. The registered person must ensure that the skills of the staff are adequate to meet the needs of elderly people with dementia; and that they receive training which demonstrably based on current good practise and reflect specialist and clinical guidance. The registered person must ensure that all staff receive training to ensure the welfare and safety of the service user which is demonstrably based on current good practise and reflect specialist and clinical guidance. DS0000065164.V328308.R01.S.doc 30/06/07 30/06/07 30/06/07 30/06/07 30/06/07 30/06/07 30/06/07 Riverside Grange Version 5.2 Page 24 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 Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Grange DS0000065164.V328308.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!