Inspection on 24/07/07 for Riverside House

This inspection was carried out on 24th July 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 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 House 26/04/06

Riverside House 18/10/05

Riverside House 18/05/05

Riverside House 01/02/05

Riverside House 31/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Riverside House Wattsfield Road Kendal Cumbria LA9 5JL Lead Inspector Mrs Margaret Drury Unannounced Inspection 24th July 2007 10:45 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 House DS0000036514.V341084.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 House DS0000036514.V341084.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside House Address Wattsfield Road Kendal Cumbria LA9 5JL 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) 01539 773090 01539 773512 www.cumbriacare.org.uk Cumbria Care Care Home 34 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (11), Old age, not falling within any other of places category (23) Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. A maximum of twenty-three older people (OP23) may be accommodated to include eleven 11 older people with dementia (DE(E)11). The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004. When a single room of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users. To accommodate one named younger adult with dementia (DE1). Date of last inspection 26th April 2006 Brief Description of the Service: Riverside House is a purpose built home registered to provide care and accommodation for up to 34 older people, 11of whom may have various forms of dementia. The home is situated in a residential area on the outskirts of Kendal approximately a mile from the town centre and general amenities. It is set back from the road overlooking the river and has its own private gardens and lawns. Riverside House is made up of four units, over three floors, served by a passenger lift. The units are named; Kentmere, Howgill, Farleton and Romney. All the bedrooms are for single occupancy. The Romney unit provides shortterm intermediate care, in partnership with Social Services and the local NHS Trust, to help people return to their own homes as soon as possible after their discharge from hospital. The home provides a statement of purpose and terms and conditions that give any prospective resident and/or their families details of the facilities on offer. There is also a copy on display in the hall. The fees in this service range from £373.00 - £442.00 per week as at the date of the visit. There are extra charges for Chiropody, hairdressing, newspapers, toiletries and taxi fares. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit, which forms part of the key inspection, took place over one day in July during which time all of the key National Minimum Standards were assessed. Survey questionnaire forms had been sent to some residents and three had been returned to The Commission for Social Care Inspection. Prior to the visit the acting manager had completed an Annual Quality Assurance Assessment (AQAA) that outlined the services and facilities provided and the home’s plan for the future. This information, together with that received from residents, visitors and staff during the visit confirm the findings of this report. The inspector was able to speak with residents, all of whom said how much they enjoyed living in Riverside House. Comments received included, “ the girls are so kind”, “you could not find any better place to live” and “I like living here because I can spend time in my own room if I wish”. Later in the visit, time was spent speaking to staff and visitors to the home. Comments from visitors confirmed that the staff provided an extremely high level of care. “They are wonderful” and “they are so caring, nothing is too much trouble” were comments received about the staff and “ I am always made very welcome and can enjoy a cup of tea with my mum” were comments made about the home in general. During the visit the inspector spent time with the acting manager discussing the operation of the home and looking at the administrative procedures. A tour of the building was undertaken looking at the environmental standards. The home manager has recently left after a long period of sickness. During this time there has been an acting manager in place who has been responsible for the running of the home. What the service does well: Residents and visitors spoke very highly of the staff and praised the level of care and support provided. The inspector observed warm interaction between staff and residents and visitors said they were “always made welcome and Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 6 offered tea and biscuits”. The home provides a warm and homely atmosphere with staff supporting residents in their daily life and ensuring the routines within the home are applicable to the needs of those living there. Care plans are in place and well kept with all the monthly reviews up to date. Information on them was relevant and provided sufficient detail for the care staff to meet the assessed needs. Medication records were up to date and correctly completed, with details of all prescribed medication recoded. What has improved since the last inspection? What they could do better: Environmental standards need improving as parts of the home are now in need of redecoration. The new care plan format has yet to be introduced. This will provide a more person-centred plan of care for each resident and will further enhance the level of care provided. Please contact the provider for advice of actions taken in response to this Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 7 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 House DS0000036514.V341084.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 House DS0000036514.V341084.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): Standards 1, 2, 3, 4, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service, together with their representatives have sufficient information to make an informed decision about moving in. EVIDENCE: The home provides a statement of purpose that is specific to the home. This, together with the resident guide, gives clear information about the home and resident group cared for. There was a copy of these documents plus the last inspection report on display in the hall. Copies of these documents can be supplied in different format such as large print or audio if required. Admissions to Riverside House are not made until a full needs assessment has been carried out. The assessment is completed by the manager or a member of the senior team in a sensitive manner and involves family members or advocates should the resident request this. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 10 Prospective residents and/or their families are invited to visit the home prior to admission, to view the available rooms and meet other people living there. This also gives opportunity to meet the staff and discuss the level of care needed to meet the assessed needs. The home provides intermediate care in a small 5-bed unit and the inspector was able to spend time speaking with staff and the residents who were staying the unit. The staff interviewed agreed that the type of care given to the residents was different, in that they were “enablers” rather than “carers” as this ensured that residents became sufficiently confident to return home. Members of the multi-disciplinary team visit the home every week to discuss the needs of the residents and to ensure progress is being maintained. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs and ensures their privacy and dignity are maintained at all times. EVIDENCE: A sample of residents’ care plans was examined during the visit. Each resident has a plan of care that is based on the original assessment of needs. The home uses the corporate format that is detailed and provides details of the tasks the resident needs assistance with and also what they are able to do themselves. Healthcare needs are detailed and a record of doctor and district nurse visits was available. All the care plans are reviewed monthly using a “tick-box” system. This system does not always reflect any changes required to the level of care provided. The organisation is introducing a new format for the care plans that is due to be “rolled out” shortly. This will improve the quality of the information recorded on the care plans, which will assist the staff in the provision of care. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 12 The manager now ensures that nutritional needs are kept under review with a member of staff having responsibility for weighing residents and recording the details. Risk assessments are completed to ensure the residents are provided with the necessary aids to maintain their independence. The home works to the corporate medication policy that allows for an extra member of staff to act as a “checker” when the supervisors are giving out medicines. Internal training is provided for all staff that are responsible for handling medication. Systems for the recording of controlled drugs are in place and a record is kept of all medication returned to the pharmacy. If, for any reason, a medication record has to be hand written a second member of staff checks the details before the medication is handed to the resident. This is an added safeguard for the residents. A check of the medication records evidenced that they were neatly and correctly completed. Records also show that the residents receive attention from other healthcare professionals such as chiropodists, opticians and dentists. Observation during the visit evidenced that staff interacted well with the residents and attended to them in a pleasant and courteous manner. Visitors remarked on the attitudes of the staff commenting,” the staff are so kind and always so polite” and “the girls cannot do enough for our mum” Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 13 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. People who use this service are encouraged to make choices about their daily lives. Some activities are available to help to meet the social and cultural needs of the residents. EVIDENCE: Activities are arranged for residents in each of the units and there is now a record of the activities that have taken place. This is in the form of a photographic record and illustrated the various types of activities that have taken place so far this year. One member of staff organises outings or community activities and one of the supervisors looks at what the residents enjoy in the home. Residents’ outings are limited at the moment due to staff shortages although the manager has requested permission to advertise for staff. Residents are encouraged to remain as active as possible but can choose not to join in if they prefer to spend time in their room. Residents are able to follow their religious beliefs through regular Communion services and visiting ministers. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 14 Visitors are welcome at any time and comments made included;” We are always made very welcome and offered tea and biscuits”. The home is currently using agency staff to cook the meals as the resident cook is on sick leave following an accident. The residents generally enjoy meals but one remarked, “It’s not quite the same without our own cook”. Special diets are catered for and staff are mindful of the need for good nutrition. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 15 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. Residents are able to express their concerns knowing they will be listened to and acted upon at all times. EVIDENCE: There are policies and procedures in place regarding the protection and mistreatment of vulnerable adults. These are available for staff to read and give clear guidance about what action should be taken if necessary. The manager has just received copies of the latest practice guideline and procedure issued by Cumbria County Council. Information is passed on to the staff through supervision, staff meetings and in-house training. The guidelines also provide information about the “Mental Capacity Act”. The home does not currently have a complaints register/log and this was included in the Quality document as an issue to be addressed in the future. Any complaints or concerns are passed from the staff to the supervisor or manager and are dealt with immediately. A requirement was made concerning the introduction of a written record of complaints. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enable residents to live in a safe and comfortable environment. EVIDENCE: Riverside House is a purpose built home with accommodation over three floors. There is a passenger lift serving the two upper floors. There are four selfcontained units over the three floors, one of which specialises in the care of residents suffering from various forms of dementia. The intermediate care/rehabilitation unit is situated on the ground floor. Each unit has it’s own lounge/dining and kitchen facilities as well as residents’ rooms. There has been no redecoration or refurbishment undertaken since the last inspection due to financial constraints within the organisation. This has meant Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 17 that parts of the home are now looking in need of some attention. The organisation’s estates manager is aware of the situation and the manager understands that some work is to be carried out later in the year. Work has, however, been completed on replacing the metal window frames. All the bedrooms are for single occupation and although many of them are a little small those residents who spoke with the inspector were pleased with their accommodation. One resident said,” I am very lucky as my room has a lovely view over the river”. The bedrooms were all personal to each resident with photographs, ornaments and pictures. There are bathing and toilet facilities on each floor, all of which are suitable for residents who may have a disability. Hoists and other aids are provided to help residents maintain their independence and assist movement around the home. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. People living in the home are generally satisfied with the standard of care they receive but staffing levels may not always be sufficient. This means that the residents may not always have their needs met in a timely manner. EVIDENCE: The home follows the corporate recruitment procedure that meets the regulations and National Minimum Standards. There is accurate recording at all stages of the process and no member of staff starts work before all the legal checks ( Protection of Vulnerable Adults and Criminal Records Bureau) are completed. There are currently staff vacancies in the home, which puts pressure on the existing staff team and necessitates the use of agency staff. The manager has passed a request to her line manager for these to be filled as soon as possible. The staff rota was checked and showed one member of staff on the first and third floors and two members of staff on the second floor. There is also one member of staff working in the rehabilitation unit. On the day of the visit there was, because of staff shortages, no extra member of staff to assist with the Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 19 medication. This also meant that there was the minimum of care staff working on the units and there were times, during break periods, when the frail elderly units were left without staff. The design and layout of the home causes further problems for the effective and efficient deployment of staff particularly at night. The organisation should look to the staffing levels within the home in order to maintain the provision of care to meet the needs of those living there. Staff training is up to date as far as possible although the manager did explain that it is difficult to accommodate all the staff who request training, as places are on “a first come, first served” basis. This can sometimes mean an unfair distribution of training places throughout the organisation. Distances to the training venues and transport problems can also create difficulties. There are currently 14 care staff that have completed the NVQ level 2. This means that the home has met the target of at least 50 staff trained to this level. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect and is operated in the best interest of the residents. EVIDENCE: Riverside House has operated with an acting manager since the registered manager went on sick leave over 12 months ago. She has worked extremely hard to ensure the home has run efficiently and in the best interests of the residents and their families. She has worked for Cumbria Care for a number of years and has a sound knowledge of the organisation’s values and financial planning. She supports the staff team ensuring they are aware of the importance of providing the highest level of care possible. Comments made by Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 21 staff include, “I really appreciate the help and support I have received” and she is available to give advice and can always find the answer to your question”. One staff member also remarked, “she has really pulled the home round the corner”. The management system is open and centred on the care of those who live in the home. She keeps up to date with current developments in social care using internal and external means. Cumbria Care have recently appointed a new manager to start in August who will need to apply for registration with The Commission for Social Care Inspection”. The acting manager at Riverside is moving to another home within Cumbria Care. The home holds personal monies for some residents and there are detailed records kept. All purchases are covered by receipts with income and expenditure detailed and signed by two members of staff. Staff supervision is now up to date with a record kept on each individual staff file. During these meetings opportunity is given to look at selected policies and procedures and to discuss training needs. Staff maintain their own personal development files. The home uses the corporate Health and Safety manual and the Health and Safety manager completes an annual audit of the home. Any issues arising from the audit are dealt with as soon as possible. All risk assessments are in place and fire training and records were completed satisfactorily. All equipment is maintained under annual service level agreements. There is an infection control policy in place and the manager has obtained a training pack, which will act as a training tool to ensure staff are kept up to date with infection control and cross infection issues. Annual quality audit questionnaire are sent to residents and visitors as a means of obtaining comments and opinions about the home from the people using the service. When they are received back the manager prepares a report and acts on any suggestions that will improve the care provided. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 3 2 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP16 Regulation 22(8) Requirement A written records of complaints received must be introduced to evidence any complaints or concerns have been dealt with in accordance with the timescale set down in the procedure and in the best interest of the residents. All staff vacancies must be filled as soon as possible in order to meet the assessed needs of those living in the home. (Outstanding from 30/07/06) Timescale for action 31/10/07 2 OP27 18 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations It is recommended that consideration be given to staffing numbers throughout the home, particularly during the night. This would ensure a better deployment of staff taking into consideration the size and layout of the DS0000036514.V341084.R01.S.doc Version 5.2 Page 24 Riverside House building and ensure all the residents’ needs are met with the minimum delay. Riverside House DS0000036514.V341084.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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