Inspection on 28/01/08 for Riverside Grange

This inspection was carried out on 28th January 2008.

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

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

Other inspections for this house

Riverside Grange 16/01/09

Riverside Grange 23/01/07

Riverside Grange 22/02/06

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Riverside Grange 2052a Hessle High Road Kingston upon Hull East Yorkshire HU13 9NN Lead Inspector Beverly Hill Key Unannounced Inspection 25th January 2008 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.V358322.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.V358322.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 647446 administrator.riversidegrange@hica-uk.com Humberside Independent Care Association Limited Mrs Gillian Johnson 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.V358322.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 23rd January 2007 Brief Description of the Service: Riverside Grange is a purpose built home owned by the Humberside Independent Care Association (HICA), which is a not for profit organisation. The building is on Hessle High Road, near to a Sainsbury superstore and about one mile from the centre of Hessle. The local area has a good variety of shops, pubs, banks and other facilities. The home is on a bus route between Hessle and Hull. The home provides a service for older people who may have a mental disorder or suffer from dementia. The home has thirty-three single rooms, on two floors, all with an en-suite sink and 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. According to information received from the manager the fees are dependent on the assessed needs of the service users up to a maximum of £490 per week. The local authority block-purchase all the beds in the home so any admission has to go through their assessment process as well as the homes. Items not included in the fee are hairdressing, chiropody and personal clothes and toiletries. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 23rd January 2007 and thematic inspection in September 2007, including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to one person and several relatives to gain a picture of what life was like at Riverside Grange. We also had discussions with the registered manager, the cook and care staff members. Information was also obtained from surveys received from staff members, two service users and several relatives. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. What the service does well: Prior to admission the home makes sure people have their needs assessed so they are able to say whether they can be met in the home. They also make sure everyone has a contract of the terms and conditions of residing in the home. Care is provided to people in a clean and tidy home. People have access to a pleasant outdoor area that they can walk around in or sit and enjoy the day, weather permitting. The layout of the home lets people walk around freely without coming up against too many barriers. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 6 People really liked the meals provided. When serving meals to people at lunchtime staff took two meal choices for people to look at so they could choose what they wanted to eat. Relatives said the staff were very kind and caring and made sure people always looked clean and smartly dressed. One relative stated in a survey, ‘they really care for people, show love for them’. Visitors could come at any time and could and did make suggestions about how the home was managed. The manager made sure that any complaints the home received were sorted out straight away and contacted the local authority to advise them of any changes in peoples behaviour that may need more monitoring. There is a good induction and training system to ensure staff have the right skills to care for people with dementia. The home managed peoples’ finances appropriately and kept good records of this. The home had been awarded part 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place. The home had good policies and procedures and staff were aware of how to protect people from harm. What has improved since the last inspection? What they could do better: There have been some updates to the homes statement of purpose and service user guide but there is still some information missing. Prospective users of the service and their families need to have full information about the home so they can make decisions about whether the home is right for them. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 7 The home produces care support plans that state how peoples’ needs are to be met by staff. These need to make sure they include the full range of needs and have clear tasks for staff. Also some risk assessments did not give a full explanation on how to manage the risk and they were not always updated with changes in need. It’s important that staff members have clear guidance in how to support people or care could be missed. There have been some improvements in how the home gathers information about people in order to ensure staff members can provide them with activities and things to keep them occupied. However the home has not got this quite right for everyone and they need to keep improving what is offered to people. Although there had been some improvements generally in the environment some of the bedrooms we visited were quite sparse with little stimulation in them for people. The way the home completes checks on new staff coming to work at the home is usually good. However it was noticed that staff started work after an initial check but before the police check came back. When this happens, which should only in exceptional circumstances, the staff must be closely supervised. This appeared to be happening as routine rather than as an exception. There have been some staff turnover and shortages recently so the home has had to rely on agency staff. The manager needs to make sure the home is fully staffed with permanent staff to improve consistency of care. Formal staff supervision had slipped recently due to management changes. Staff must receive supervision at least six times a year so their practice can be monitored and they can discuss any development needs. 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.V358322.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some adjustments to the statement of purpose and service user guide will provide more comprehensive information about the services that are available to people in the home. The home ensured that service users were admitted to the home only after an assessment of their needs had taken place. This supported the decisionmaking about whether they could meet needs. EVIDENCE: The homes statement of purpose and service user guide required further development in parts to ensure the documents provided comprehensive information about the services available in Riverside Grange. The statement of purpose needed information on how the staffing structure was organised to deliver care and the chain of accountability. It also needed to be more specific regarding the complexity of dementia care needs the home is able to meet, the Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 10 physical environment and details of therapeutic interventions. The statement of purpose specifies an admission process based on local authority decisionmaking via a ‘panel process’. The local authority block-purchased all the beds in the home, although the manager stated this did not compromise their decision-making about new admissions, which was based on an assessment of a persons needs, whether the home was able to meet them and their compatibility with other service users. The service user guide needs to include service users views of the home or if this is not possible, the views of their representatives and comments from other stakeholders. It also needs to include information on where the last inspection report can be located if this is not to be included in the guide. Improving the documents will ensure prospective service users and their representatives, and commissioners of services, have full information at hand to decide whether the home is appropriate for their needs. Six surveys were received from relatives and some indicated they did not have enough information about the home in order for them to make a decision about admission. Contracts were provided detailing terms and conditions. The manager confirmed that third party top-ups are not required due to the nature of the block-booking purchasing arrangement with the local authority. We examined five care files during the visit. The manager or other senior personnel had completed the homes pre-admission assessments in all cases. There was evidence the home had obtained assessments and care plans completed by care management in three of the files examined and care plans in all five of them. The assessment information was important to enable the manager and staff team to decide whether the person’s needs could be met in the home. The manager confirmed that it was possible for prospective service users and their families to spend time at the home talking to people who live there, meeting the staff, enjoying a meal or spending the day there. However this was not always possible as some people were admitted as an emergency due to the complexity of their needs and difficulties with their current placement or home situation. The home did provide a respite service for short breaks. The manager confirmed that usually the first six weeks of admission were seen as a trial period and shortly after that a review would be held to decide if the placement was to be permanent. There was scope for the trial period to be extended if required. The home does not provide intermediate care services. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 11 Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 12 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 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments did not fully reflect all the needs the service users had and the tasks staff needed to complete to meet them. This could mean that important care could be missed. EVIDENCE: We examined five care files during the visit and information from assessments had been used to formulate support plans. Some of the support plans were more comprehensive than others and strengths and needs were considered. The assessments indicated specific needs but on occasions these were not planned for consistently. For example one support plan examined gave clear tasks to staff regarding the need to prevent pressure sores yet another had a risk assessment detailing a high risk of pressure sores but no plan to address it. Similarly an assessment indicated the need for one service user to wear protective headgear in the sun but this was not included in the plan. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 13 The support plans did not always have clear tasks for staff in how to support the person or how they would assist someone to maintain their independence. For example an eating and drinking plan stated, ‘fortified meals and drinks offered’ but did not indicate what or when. A continence plan spoke about staff changing pads regularly but not what type or how often or whether it was possible to establish a routine to actually promote continence rather than manage incontinence. A third plan stated, ‘offer reassurance for anxiety’ but did not detail what this was and what works for the individual. Some preferences were detailed in support plans, for example a persons’ preference to a wet shave, and on the whole they referred to promoting privacy and dignity. A relative confirmed they were consulted about support plans, ‘they ask for our approval about what goes in care plans’ and, ‘we look in care plans’. Relatives confirmed that reviews of care were carried out and that they attended. Staff members record daily the care tasks they have completed but when cross-referenced some of the tasks were not indicated in care plans as required for the person, for example the application of barrier creams. Support plans were evaluated but consistency is needed to ensure they reflect the changes noted on evaluation sheets. There was evidence that service users had access to a range of health care professionals for advice and treatment and a consultant held monthly clinics at the home. Risk assessments were completed for areas identified as posing a risk for people. However one person had a risk assessment for the aspiration of food. It was clear on preventative measures but needed more guidance for staff on what to do should this occur. One person had a risk assessment and care plan to manage behaviour that has, in the past been challenging to other service users, but it was observed that it was not followed in practice. The manager confirmed that the risk had been reduced, however the risk assessment and care plan need to be followed or modified to reflect the changes. Similarly after an assessment a physiotherapist had recommended hip protectors for one service user but this had not been followed up. It was difficult to speak to service users about how their personal care and health needs were met due to the nature of their complex needs, however one person was able to tell us that the staff were good and looked after them. Relatives spoken with stated service users were always clean and smart and five of the six surveys received from them stated needs were met always or usually. We observed care staff being attentive to people and respecting privacy and dignity. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 14 Generally medication was well managed and stored and recorded appropriately. There were some issues discussed with the manager regarding realigning the medication administration records so days and dates matched and one recording error when a tablet was not given but the record stated it was. Some senior staff were not fully familiar with specific medication and in one service users support plan it indicated some behaviour was driven by pain but when cross-referenced pain control prescribed, ‘as required’ was being omitted more times than it was being given. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 15 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 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There have been some improvements in the way the home provides a stimulating place for people to live, however more work around promoting choice and occupational/stimulating activities will further enhance the service users lives and wellbeing. The home provides well-presented and well-balanced meals, which meets service users nutritional needs. EVIDENCE: The home completed a fact file for each service user, which detailed information about their life, family, previous interests and hobbies, and likes and dislikes. It was a good source of information to enable the staff to get to know people and help in writing strengths and needs support plans and planning social stimulation. However as some strengths and needs forms do not consistently reflect what the service users can do for themselves, however minimally, staff need to be aware there is a potential for choices not to be proactively promoted. Some risk assessments stated, ‘short term memory’ as Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 16 the reason for the person not having any control over their finances or medication but this is a diagnosis and not the reason. Since the last inspection there had been changes to the communal areas and there were more items of interest for people to pick up and use or look at. Staff were observed assisting people and sitting with them for one to one activities such as reading, playing dominoes, listening to music and chatting. Individual activity records were maintained for each person and there was evidence that some activities were provided such as, visiting entertainers, sensory activities, reminiscing, music quizzes, arts and crafts and nail care. One person spoke of staff taking him shopping locally and it was recorded that visits from families and friends were a regular occurrence in the home. There were some points of information in fact files that could easily be transferred into activities for people, for example one person used to be staunch supporter of Hull City ‘Tigers’ but there was no evidence this had been explored with them. There have been improvements in the stimulation provided for people in the home but this could be improved upon further as records indicated the home had not got it quite right for everyone. A service user and all the relatives spoken with were happy with the provision of meals. They stated there was plenty to eat and drink and choices at each meal. One relative stated, ‘the food cannot be faulted’ and others stated in discussions and surveys, ‘the food is very good’ and ‘excellent food’. The cook explained that senior care staff informed them of the special dietary needs of service users and they used a four weekly rotating menu with healthy options for people. The home received a high score from an environmental health inspection regarding management of the kitchen. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 17 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 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides an environment where people feel able to complain. Staff training and adherence to policies and procedures ensure the protection of service users from harm. EVIDENCE: The home had a complaints policy and procedure that was on display in the home. A complaint form was available for staff and complainants to complete, which detailed the issue, the action taken and the outcome. Those complaints received were of a minor nature and had been resolved. Out of six surveys received from relatives, four stated they knew how to complain, and five stated they felt any issues raised were dealt with ‘always’ or ‘usually’. Staff in surveys confirmed they knew how to action any concerns or complaints. Most service users in the home have complex needs associated with dementia and were reliant on others to act on their behalf. One person spoken with stated they would, ‘tell the boss’, if they had any complaints but that they did not have any at the moment. The home had access to the local authority policies and procedures for the protection of vulnerable adults from abuse. We spoke to several care staff members and a principal care manager throughout the day and all stated they Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 18 had received training in how to safeguard adults from abuse during induction. This covered the different types and symtoms of abuse. However we were not confident that all staff were fully knowledgable about the arrangements for safeguarding vulnerable adults or the principles of third party investigation. This was mentioned to the manager to address. The manager had, in the past, completed the safeguarding training for home managers provided by the local authority and was aware of how to refer any allegations to the lead agency responsible for investigation. They had demonstrated this recently when there had been incidents between service users. When these occurred management followed procedures and alerted local authority care management teams so they could review the persons care or provide extra support when required. The local authority provided one to one support on some occasions until the situation was resolved. There had been one safeguarding investigation involving an agency staff member but there was insufficient evidence for it to progress. However the home decided not to use the agency worker again. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 19 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, 20, 24 and 26 People who use the service experience good quality outcomes in this area. 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 some bedrooms lack a personal touch and do not provide any stimulation for people with dementia. EVIDENCE: The home was well maintained and clean. There was a malodour in the entrance when we arrived but this had been addressed later in the day. Since the last inspection when it was highlighted that the home could be developed to provide a more stimulating environment for people with dementia, an area in the main lounge had been decorated and furnished with interesting items and memorabilia. This had proved successful and people were observed sitting in this area with care staff. The area provided people with items to pick up and use to stimulate conversation. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 20 All accommodation was provided in single rooms with en-suite toilets and washbasins. Some bedrooms had been personalised with items from the persons’ home but others were very sparse with very few pictures on the walls, photos or items of interest. All the bedroom doors were the same colour giving no indication to the service user of which one was theirs. Since the last inspection, however, there were new pictorial signs for bedroom doors, bathrooms and toilets. People have access to a pleasant outdoor area that they can walk around in or sit and enjoy the day, weather permitting. The layout of the unit enables people to walk around freely without coming up against too many barriers. Communal areas consist of a main lounge leading into a conservatory and two quiet areas on the ground floor and a further lounge on the upper floor. Both lounges and the conservatory have dining tables and staff confirmed service users could have their meals in any of the rooms. Bathrooms and toilets were designed to meet the needs of the service users with specialised baths and raised seats. All were clean and fresh. There were grab rails along the corridors and the home provided equipment for the staff to use with people that had moving and handling needs. All equipment was routinely maintained. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The homes reliance on agency staff to fill gaps means that care may not be consistent for people. Some gaps in training and recruitment procedures could mean that staff are not fully equipped with the skills required to care for people with dementia and checks are not fully completed prior to them starting shifts. EVIDENCE: Evidence indicated that when shifts were fully staffed there was the required amount of staff meet the needs of the service users. During the day there were usually six care staff and one personal care manager on duty and at night three care staff and one personal care manager. The manager was supernumerary and the deputy manager had three days when they were supernumerary, the others spent completing shifts in the role of a personal care manager. Staff and relatives advised that there had been some staffing issues of late and agency staff had been used to fill gaps. When shifts were not fully staffed and also at busy periods of the day, carers reported they were very stretched and relatives had noticed the difference. We observed periods in the main lounge when there no staff present and the care plan for one person in the lounge during this time indicated they needed to be observed at all times. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 22 Relatives in surveys and discussions on the day highlighted that generally care needs were met. Comments were, ‘they are all very kind and caring and willing to listen’, ‘really care for people and show love for them, all are kept really clean’, ‘they seem to know their job’, ‘oh yes the staff are very nice’, ‘there have been a lot of agency staff and they don’t know people’ and ‘not all staff seem to have the proper skills’. One person also commented that communication could be improved when staff handed over to the next shift. These comments were passed onto the manager to investigate further in meetings with relatives. Staff members stated they worked well as a team and tried hard to produce a relaxed and friendly atmosphere for service users. We observed staff treating people in a respectful and friendly way and one service user told us in a survey, ‘they earn every penny of their wages’. Four staff files examined during the visit evidenced that they started employment after a check against the protection of vulnerable adults register, but prior to the return of the full criminal records bureau check. This is acceptable in exceptional circumstances only and should not be happening routinely. Application forms and references were in place but three of the four files seen required a staff photograph. It was company policy that all staff completed a block induction early in their employment for one week. This covered mandatory training with one of the days as an introduction to dementia care and a half-day devoted to pressure area care and continence promotion. The company also provided access to other training. Records showed some staff had participated in how to manage behaviours that are challenging, social care values, record keeping, risk assessment, communication, sight impairment and how to look after a gastrostomy site. There did not appear to be any recent training on conditions affecting older people such as diabetes, Parkinson’s’ disease, arthritis and strokes. Staff could also access training provided by the local authority. At the last inspection in September 2007, which was a thematic inspection to look specifically at how the needs of people with dementia were met, it was highlighted that care staffs understanding about the different types of dementia, how it affects people, how they can help them and person centred care was limited. In discussion with the manager it was clear that the company had taken this on board and were looking at how they could improve the dementia care training offered to staff. A two-day dementia course they provided had been completed by seven of the care staff team as well as the manager. A further staff member was booked on the course. The manager had completed an audit of staff training and was knowledgeable about who still had to complete mandatory training and when updates were required. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 23 Staff via surveys indicated that they received training that was relevant for their roles, helped them to understand peoples’ needs and kept them up to date. The amount of care staff trained to national vocational qualification level 2 and 3 in care was 32 . A further five care staff were progressing through the courses. The home needs to aim for 50 of care staff trained to this level. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 24 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, 36 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the home is well managed. Full implementation of supervision plans will ensure that all care staff members receive adequate monitoring. EVIDENCE: The new manager had been in post for approximately six months and had completed registration with the Commission. She had completed the Registered Managers Award during her previous position as deputy manager at another home within the company. She has the relevant experience and qualifications to manage a service, which is specifically designed for people with dementia. Staff members and relatives spoken with commented on the managers’ responsiveness and open-door policy. Staff attended meetings and had the opportunity to express their views about how the home was managed. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 25 The company had a system of monitoring the home and the service it provided. This included audits and questionnaires to relevant parties. The quality assurance system was a little behind this year due to management changes but the new manager had started to look at what was required and a relatives survey on communication, the environment and general staff attitude had been completed. There had also been a staff survey last year. Some audits of the service had been completed and there was evidence that an action plan to address some shortfalls, for example in the environment had been produced. Although there was no evidence that the action plans had been carried out to complete the quality assurance loop and professional visitors views had not been collated the manager had made a good start. Relatives generally managed finances although the home held in safe keeping, via a computerised system, a small amount of personal allowance for people as required. This was usually for small purchases, hairdressing and chiropody and was managed by the homes administrator. The company completed regular financial audits. There had been some slippage of staff supervision and records examined highlighted that staff were not receiving the required minimum of six formal one to one sessions per year. A staff supervision plan had been devised now the new deputy manager was in place and this should resolve the issue. When formal supervision had taken place it covered areas such as staff training and development, key worker role, care plans, health and safety and updates of relevant information. Staff members in discussion and in surveys confirmed that supervision has fallen behind. The manager audited accidents and there was evidence that the number of falls one person had been having had been reduced through extra monitoring provided when documentation proved the service user needed more support. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarm tests completed. Staff had policies and procedures to guide their practice and safety posters were on display in the home. The company had a health and safety manager to advise staff and training was provided in mandatory areas of fire safety, health and safety, first aid, basic food hygiene and infection control. There had been some incidents between service users, and when these occurred management followed procedures and alerted local authority care management teams so they could review the persons care or provide extra support when required. A staff member was observed pushing a person in a wheel chair without using the footplates. This was mentioned to them at the time and the manager alerted to remind staff to use them consistently to avoid injury. Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 26 Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 27 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4, 5 & 6 Requirement 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 (previous timescale of 30/06/07 and 15/11/07 not met) The provider must make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. This will make sure that staff have access to information that will help them to provide person centred care and support. The plans should meet relevant clinical guidelines produced by professional bodies concerned with the care of older people with dementia. (Timescale of 30/06/07 from last inspection was not met Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 29 Timescale for action 30/06/08 2 OP7 15 30/06/08 but still within current timescale of 30/01/08). It is acknowledged that this timescale will not be met so has been extended. The registered person must 30/06/08 ensure that all assessed needs are addressed in care support plans with clear guidance for staff on how to meet the needs. Care support plans must be consistently updated as a result of evaluations and changes in peoples’ needs. This will ensure that care staff have the most up to date information in how to care for people. The registered person must 30/04/08 ensure that specific risk assessments are kept up to date, are more comprehensive with clear steps in how to minimise the risks, and provide staff with guidance about what to do should the steps taken not be effective. 30/06/08 The registered person must make sure that people are occupied with appropriate activities that are meaningful to them. This must take into account their needs and preferences and use information that should be in their fact files, support plans and ‘life history’. This will help to promote and maintain peoples’ dignity and social wellbeing. It is acknowledged that some improvements have been made since the last inspection but previous timescale of 30/12/07 is not fully met. The registered person must ensure that stringent supervision arrangements are in place in the DS0000065164.V358322.R01.S.doc 3 OP7 15 4 OP8 13(4) 5 OP12 16 6 OP29 19 31/03/08 Riverside Grange Version 5.2 Page 30 7 OP36 18 exceptional circumstances when staff members start work after the povafirst check but prior to the return of the criminal record bureau check. The registered person must ensure that all care staff members receive at least six formal supervision sessions per year to enable their development. All staff to have had at least one session by timescale for action date. 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP24 OP27 Good Practice Recommendations The registered person should ensure that all service users have personal bedroom space that provides a stimulating environment for them. The registered person should limit the reliance on agency staff by quickly completing the recruitment of more permanent staff. This will ensure continuity of care for people. The home should aim to meet a target of 50 of care staff trained to national vocational qualification level 2 in care. 3 OP28 Riverside Grange DS0000065164.V358322.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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