CARE HOMES FOR OLDER PEOPLE
Riverside Mews Ancholme Court Market Place Brigg North Lincolnshire DN20 8LD Lead Inspector
Sarah Urding Unannounced Inspection 1st August 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverside Mews DS0000002906.V306761.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 Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Riverside Mews Address Ancholme Court Market Place Brigg North Lincolnshire DN20 8LD 01652 653414 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) North Lincolnshire Care Limited Mrs Jan Pursey Care Home 25 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (25) of places Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Condition of Registration is that the home only uses designated beds for the DE (E) category of service user. To admit 1 Service User under the age of 65 years Date of last inspection 8th December 2005 Brief Description of the Service: Riverside Mews is a care home providing personal care and accommodation for 25 older people. North Lincolnshire Care Limited owns and manages the home. The home is a converted 18th century warehouse extending to three floors with a conservatory on the ground floor. All the homes bedrooms are single and there is a shaft lift connecting all three floors. Riverside Mews is a wellestablished care home in the market town of Brigg. It is set in the middle of the town overlooking the river Ancholme. There is easy access to all of the town facilities and events, including the weekly market. There are ample toilets and bathroom areas in the home. The dining room and several bedrooms overlook the river, with very pleasant views. The home caters for predominately low to medium dependency service users, with problems of old age and other associated medical problems. Five of the bedrooms are registered for EMI care. Staff have received appropriate training in relation to Peg feeds for service users. The home has a relatively stable work force, that appears to be very committed to the home and promoting service users independence as much as they are able to, and for as long as is possible. The current scale of charges are £327-£377 per week. Additional charges include hairdressing, chiropody, newspapers/magazines and holidays. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection and the visit to the home was unannounced, taking place over a period of six and a half hours. CSCI received comments prior to the inspection from five care managers, one member of staff and twelve service users. This information was used in the inspection and will be reflected in this report. On arrival at the home the building was looked around and a number of records and policies were inspected. The manager and three members of staff were spoken to. Sixteen service users were also spoken to. What the service does well:
There is a sense of belonging created by the atmosphere in the home. Staff refer to feeling part of a family when they come to work. Service users also say that they are comfortable and included in the decision making in the home. The home is run in such a way that it consults and keeps service users informed of occurrences and changes. Some care managers say that staff respect and take pride in their work and that they are made to feel welcome and comfortable when visiting. Staff are positive about the support they receive from the management and feel able to contribute and approach them when things need to be addressed. Staff demonstrate a good understanding of policies and are aware of how to protect vulnerable people. Service users commented that they receive lots of support prior to moving in to the home and are invited for tea to help them make their mind up about whether the home is suitable for them. Service users say that staff may be busy but they always respond to their needs. They feel that the staff do the best they can. The home ensures that service users are occupied throughout the week with regular activities. One to one time spent with service users takes place regularly and is recorded. Service users are encouraged to follow a lifestyle of their choosing. Some service users say that the meals in the home are very good and that they can choose what they like to eat. The home caters well for a variety of diets. One service user said that Riverside Mews is an excellent home and would highly recommend it. The home is clean, tidy and well maintained. One service user said that the cleaner does a good job and their bedroom is always clean. Another service user said that she does not know how staff get the sheets so white and crisp. The home has a good complaints system in place and service users feel confident that concerns raised will be listened to and dealt with. The home recruits and trains staff safely which means that it does its best to ensure that service users are looked after by safe and competent people.
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 6 The home is well managed and a safe place to live. 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. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are able to make informed choices about the home and can be confident that the home can meet their needs owing to a thorough assessment on admission. EVIDENCE: The statement of purpose and service user guide are appropriate and describe the facilities and services available to service users. One service user made a comment in their questionnaire that they did not know that the home catered for people who are “mentally impaired”. In reading the guides to the home, they do refer to looking after people with dementia but this is not explained in a language that most people would understand. The home should make it clearer to service users that people with dementia are looked after. There have been some concerns raised about the owners’ dogs that are often located in the courtyard outside the home and are known to go in to the home on occasions. Some people find this intimidating. The manager acknowledged
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 9 that this could be the case although she says that the dogs are safe and will not attack. The manager has been asked to let people know of the existence of the dogs in the guides to the home so that they can make a more informed choice about where to live. The manager has recently moved to an adjacent building to the home and a gate has been erected to prevent the dogs from roaming freely in the courtyard. The manager also intends to strengthen the fence between the service users garden and the land next to this. This should ensure that the dogs’ presence is minimal. The manager should consult with existing service users about the dogs and act accordingly. The standard relating to service users contracts was looked at during the inspection because one service user said that she was not sure whether she had been issued with a contract and terms and conditions of the home. Three service users records were assessed during the inspection and it was found that the home has issued clear contracts. Pre-admission assessments are carried out prior to all service users entering the home so that the manager is able to see if service users needs can be met. The assessments are detailed and clearly set out covering all aspects of standard 3.3. The assessments are linked to the care plans of the home. Service users, their relatives and health professionals are consulted with and contribute to the assessments. This is good practice as it enables the home to glean full information about service users lives. The home does not offer intermediate care. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users health and personal care needs are well met by staff that understand the importance of treating service users with dignity and respect. EVIDENCE: Clear and detailed care plans are held for service users. Four service users care plans were looked at and assessed as appropriate to meet the standard. They inform staff how to meet the needs of service user on a daily basis. The care plans reflect the pre-admission assessment carried out prior to service users entering the home. Service users health care needs are being well met by the staff in the home. Service users say that they can see a GP of their choice when they request. One service user said that she has had the same dentist for years and continues to see this dentist despite the distance. Good records are kept of all health appointments and the home ensures that appointments are kept. Service users medication is safely administered and is stored appropriately. The records of the administration of medication were looked at for four service
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 11 users. These are accurately documented and the amounts of tablets held in the home are accountable. Service users spoken to said that they are always given the correct medication on time. One service user self-administers and the medication is safely stored. A record is kept of the disposal of medication and controlled drugs are safely kept. Service users spoken to said that staff treat them with respect and are polite. Positive relationships were observed between staff and service users. A number of service users said that they can “have a laugh” with the staff. Service users said that staff call them by their preferred name. Staff were observed to talk to service users appropriately on the day of inspection. One service user made a comment that sometimes staff spoke sharply to her and she did not like it when staff spoke to her like a child. This was fed back to the manager. In discussion with staff about respecting people’s privacy, staff were able to demonstrate that they understand the need for sensitivity when carrying out personal care tasks. Staff were observed to knock on people’s doors prior to entering and service users say that their privacy is respected. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Good facilities are provided for service users to experience activities, community and religious involvement of their choosing and maintain contact with their relatives. Meals are nutritious and balanced, offering a healthy and varied diet for service users. EVIDENCE: Service users lifestyle in the home satisfies their social, cultural religious and recreational needs. This was evidenced in care plans and in talking to service users and staff. A range of weekly activities is offered in the home including bingo, reminiscence, board games and arts and craft. Activities diaries are kept to record one to one time spent with service users. These are completed on a regular basis and are a good way of evidencing that a range of activities are carried out on an individual basis. Religious services are regularly held in the home and service users are able to attend church services in the community. Staff receive equality and diversity training, which they say, is useful and enables them to understand the individual needs of service users. The home is part of a group of homes owned
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 13 by North Lincolnshire care Limited. One of the other homes has an equality and diversity management plan in place, which positively addresses these issues. It would be good practice if this is introduced in to Riverside Mews and looked at on an individual basis for all service users. This would demonstrate that the home actively promotes needs and wishes in this area. Contact with family and friends is promoted by the home. Service users are positive about being able to see their friends and family when they wish. Visitors to the home say that they are made to feel comfortable and that the atmosphere is welcoming. Within the home’s review of care the manager assesses the home’s ability to make visitors feel welcome. She had recently picked up on the fact that at times visitors are not being offered refreshments. This has been raised in the staff meeting and evidences that the home has a good self-audit system in place. This ensures that standards are appraised and maintained. Service users are encouraged to maintain choice and control over their lives on a daily basis. Advocacy services are made available to service users. Staff spoken to described how they ensure that service users are consulted with and empowered to make their own decisions. This ensures that service users maintain their independence for as long as possible and that staff are aware of treating people in a positive and inclusive manner. The home is run in such a way that service users are consulted with and kept informed about changes and events. Newsletters and service users’ meetings are regular occurrences and demonstrate that practice is good in this area. The most recent newsletter informed service users and their relatives of the plans to improve the garden. A number of service users say that the food is very good. Menus were found to be well balanced and varied. Service users spoken to say that they have a choice of food at mealtimes. In discussion with the manager, the likes and dislikes of service users are recorded and the cook is aware of these. She says that alternatives are always available at every mealtime should people not like the menu choice. The lunchtime meal was observed to be well organised and relaxed. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for complaints and protection are handled well and practice ensures that service users are consulted with and listened to. EVIDENCE: The home has a clear complaints procedure in place. Service users spoken to said that they have no complaints about the home and feel confident to raise issues of concern if they arise. The relationships between staff and service users were observed to be open and inclusive. This is encouraging and evidences that service users concerns will be dealt with appropriately. Complaints are recorded in a complaints log and addressed by the manager. There have been a number of complaints since the last inspection, which demonstrate a swift and appropriate response by the manager. The complaints also demonstrate that people’s concerns are taken seriously and that they are listened to. The system in place is rigorous and protects people. A minor addition should be made to the recording of complaints. The complainant’s level of satisfaction with the outcome should be assessed. The home has an appropriate policy in place for the protection of vulnerable adults. Staff spoken to are clear about reporting procedures should a service user make an allegation and around the indicators of abuse. Service users spoken to say that they feel safe when being looked after by staff. All staff receive training in this area.
Riverside Mews DS0000002906.V306761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a clean, hygienic and well-maintained home but the water temperature at baths is not regulated so places service users at risk form scalding. EVIDENCE: The facilities that the home provides for service users are of a high standard. The home is regularly decorated and a planned programme of maintenance is in place. The owners are currently undertaking a project to improve the garden area for service users. Service users said that they have been consulted with about this. Requirements of the fire and environmental health departments are being met. The heating, lighting and water supply meet the relevant environmental health and safety requirements. However, current arrangements to reduce the risk of scalding for service users taking baths require the staff to monitor the water
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 16 temperature prior to service users use. Whilst this reduces the risk of scalding when service users are supervised, there is an ongoing risk of service users running their own baths without supervision. The manager has agreed to fit thermostatic valves to the baths to ensure that the water is of a temperature around 43oC. This will make the environment safer for service users. Policies for the control of infection are in place and followed in practice. Staff were observed to practice appropriately to avoid the risk of cross contamination. Staff are aware of the need to wear protective clothing when undertaking certain tasks. The home has a laundry, which is suitable to meet the needs of service users. Service users are satisfied with the laundry service that the home provides. Riverside Mews DS0000002906.V306761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are looked after by safely recruited and well trained staff. EVIDENCE: The home is staffed appropriately. Three/four staff are on duty throughout the day, which includes a senior member of staff at all times. A further member of staff is being recruited to provide additional cover during the evenings. The home employs a domestic, a cook and a handyman. Two staff are on duty at night. The manager is supernumerary to the rota. Staff are positive about the levels of staffing in the home and feel that numbers are appropriate to meet the needs of service users. The home has previously met the standard relating to training staff to NVQ level 2 but owing to staff leaving employment the numbers of staff presently do not meet the 50 recommended level. Seven out of the eighteen care staff employed by the home are qualified to NVQ level 2 or above in care. Three further staff have applied to undertake this course. On successful completion the home will exceed this standard. Recruitment practice in the home is adequate to ensure that service users are protected. Application forms are fully completed and gaps in employment explored. Written references and POVA First checks are in place prior to staff starting work. This means that the home does its best to ensure that safe people look after service users.
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 18 Staff spoken to feel supported well by colleagues and senior members of staff. They spoke of a family atmosphere and say that they enjoy coming to work. The atmosphere in the home is relaxed and welcoming. A record of training received by staff in the home was available for inspection and appropriate for the work that staff undertake. Training in working with people with dementia is provided and ongoing for all staff. Staff receive a very good induction to the home that covers all aspects of the care task. This is well documented. Riverside Mews DS0000002906.V306761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a well managed home that is safe and inclusive. EVIDENCE: The manager has sixteen years experience in running the care home and has achieved the Registered Manager’s Award. The style of management is inclusive and encouraging. Service users and staff said that the manager is approachable and they feel able to contribute to the running of the home. Staff understand their roles and are given clear direction. This is reflected in their good practice. The home has an excellent system in place for reviewing the quality of care. Regular audits are carried out and service users, relatives and health professionals are consulted with about standards within the home. Views and
Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 20 recommendations are clearly recorded and an improvement schedule is planned where needed. The rigorous monitoring enables the service to continually improve, which can be seen within the records and talking to staff and service users. Service users and staff say that they feel part of the home and are able to contribute to its effectiveness. Service users are protected by the financial procedures of the home. The home does not act as appointee for any service users and looks after monies for service users appropriately. Written records of all transactions are accurately maintained. The home keeps appropriate records and the standard relating to the recording of accidents is now met. Accidents looked at were clearly and fully recorded. The home operates in the best interests of the health and safety of service users and staff. All safety checks are carried out within the specified time frame and policies are in place for safe working practice. The requirement made at the last inspection relating to the gas supply to the home has been met. This is now assessed as safe. Health and safety training is available for staff. Riverside Mews DS0000002906.V306761.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP25 Regulation 12, 23 Requirement Timescale for action 31/08/06 2. OP38 12, 23 The registered person must ensure that risks of service users running baths unsupervised and scalding themselves are reduced. A plan to reduce this risk must be implemented and sent to CSCI for information. The registered manager must 31/08/06 assess, record and act to reduce any presenting risk that the dogs may pose to service users, staff and visitors to the home. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 23 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. 3. 4. 5. Refer to Standard OP1 OP1 OP12 OP16 OP28 Good Practice Recommendations The service user guide to the home should inform people of the dogs on the premises. The service user guide should describe more clearly that it provides services for people with dementia. The company’s equal opportunity and diversity management plan should be completed on an individual basis. Complaints records should demonstrate that the complainant’s level of satisfaction with the outcome has been explored. 50 of care staff should be qualified to NVQ level 2. Riverside Mews DS0000002906.V306761.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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