Key inspection report CARE HOMES FOR OLDER PEOPLE
Riverslie 79 Crosby Road South Waterloo Liverpool Merseyside L21 1EW Lead Inspector
Mike Perry Key Unannounced Inspection 09:00 18 and 19th August 2009
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DS0000059055.V376925.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Riverslie Address 79 Crosby Road South Waterloo Liverpool Merseyside L21 1EW 0151 928 3243 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) Innocare Limited None registered. Current acting manager – Yvonne Dempsey Care Home 30 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (30) of places Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Learning disability - Code LD (Maximum number of places: 1) The maximum number of service users who may be accommodated is 30. Date of last inspection 31st July 2008 Brief Description of the Service: Riverslie is a Care Home with nursing and personal care only. In total the Home can provide care for 30 residents. There are 22 single rooms and four double rooms, some of these with ensuites. Bedrooms are situated on all floors. There is a single lounge located on the ground floor and a dining area that has two separate sittings for lunch and dinner also located on the ground floor. Riverslie is a converted building on three storeys and provides a small passenger lift to all floors. There are gardens to the rear of the Home that are accessible from the ground floor. All areas of the Home are accessible to the residents and there are handrails and ramps provided throughout Riverslie for this purpose. Riverslie is situated in the Bootle area near to the local parks and the docks. The surrounding area is mainly residential. The Home is set back from a dual carriageway. Parking is available to the front of the building and there are main travel routes that provide easy access to the Home. Mike Dempsey is the Responsible Person and the current acting manager is Yvonne Dempsey. The service is advertising for a permanent manager. The manager has provided details for fees for the home which are from £440 to £593 per week. Riverslie DS0000059055.V376925.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 the people who use this service experience adequate quality outcomes.
The inspection was unannounced and was conducted over a period of 2 days 11 hours]. All day areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. Residents in the home were spoken to along with members of staff and the Manager. Relatives were interviewed. Comments have been used in the report. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and update about the home and assists in focussing the inspection. During the visit we were able to speak to a visiting care professional. What the service does well:
Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. The assessments were consistent in detail and quality and clearly identified care needs so that a good idea of the care needs were apparent. All relatives and residents spoken with did generally feel that they are kept informed about the care and that any medical or care appointments or reviews are fully reported. There are clear records of health professionals visiting. We spoke to visiting health care professional who reported that the person she was reviewing was well placed in the home and had generally improved since being admitted. Similarly, relatives and residents were pleased with how staff approached the personal care of residents. Residents were observed to be clean and appropriately dressed. One person commented; ‘I am enjoying life. Everything is very well taken care of. Staff are friendly and helpful and there is a nice atmosphere’.
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 6 At the time of the inspection we found the home to be very warm and welcoming. Residents were happy to chat and to tell about life in the home. Staff were seen to actively interacting and supporting people including domestic staff. This means that the social life of people in the home is given some priority. Residents surveyed and spoken with were all pleased with the meals. The dining room was observed to be pleasant with tables laid and menus displayed. Residents have a choice of where they have meals. Those people spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. This helps ensure that residents are kept safe in the home. At the time of the inspection we found the home to be warm and welcoming. Residents were clearly settled and found the surroundings comfortable. The improvements were commented on by some of those spoken with. All areas seen were clean and generally well maintained. Training is ongoing in the home. Staff spoken with said that they felt supported through the training programme. Currently 15 of the care staff have a National Vocational Qualification [NVQ] which is over 50 so that the home can evidence a core of staff who are competent to carry out care. The residents and their relatives gave good feedback about all staff and the manager. Comments included: ‘Staff are lovely and very helpful’ ‘I like the home and the staff are very nice’ Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. What has improved since the last inspection?
There have been no particular improvements since the last inspection. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 7 What they could do better:
The dining room is not big enough for all residents but currently not all visit the dining room. The day room is large enough to accommodate extra dining tables if needed. The recommendation has been left at the end of the report for further consideration of dining room space. We looked at two care plans in some detail and found that whilst there was good monitoring and care planned in some areas, others were inconsistent. For example one care plan gave a very clear outline of the care of the person’s leg wounds. On the other hand we looked at a care plan for a person who has diabetes and this was not clear. The person concerned had complex care needs due to a number of underlying medical conditions and although some of these could be followed the diabetic care was confusing and it was evident that the care plan needed updating from its original writing in January 2008. We had some discussion with the nurse in charge and manager and recommended that this is completed. The level of input into the care planning by residents and relatives could be made more evident. Residents and relatives spoken with had also not seen care plans and the manager confirmed that this is something that needs further development. This was a recommendation previously and needs to be addressed so that people feel more involved in their care. We looked at the way medications are managed in the home and found that medication records and practice needs to be reviewed so that records are clearer and administration is made safe. We have made requirements around the way medication is stored and recorded and other good practise recommendations have been also been made. During the inspection we discussed with the manager some observations made of the general environment of the home and these are listed as recommendations at the end of the report. This will ensure that people are living in comfortable surroundings. We had some discussion with the manager about the need to manage the duty rota more effectively in the future to reduce any inconsistencies in staffing numbers. This will help to plan staffing cover more effectively. We looked at the staff files for two new members of staff in order to assess the staff recruitment and selection procedures at the home. The files were incomplete and some key recruitment checks such as references and professional registration checks where not available. We have made a requirement that staff files are audited to ensure that recruitment checks are
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 8 in place. This is important so that the home can evidence that staff employed are fit to work with vulnerable people. We spoke at length with the current acting manager about the need to improve and maintain some key areas of management that have arisen from this inspection. These include medication management and recruitment checks for staff. We also looked at some other key areas such as health and safety and found inconsistencies. Our records show that we have not received any notifications from the service over the past year informing us of key events. We would require the manager to check records and send any outstanding notifications. The pre inspection information required [AQAA] was not completed on time and we had to remind the service to do this. The completion of the AQAA is a legal requirement which helps us to plan the inspection process. We would require that this is completed and submitted on time in the future. There are a lot of inconsistencies at present with some of the management systems. The manager is keen to introduce more complete systems and is aware how care can be affected if issues are not monitored effectively. The Manager needs to be full time in the home while the change over is effected. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 9 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 Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1,3 [standard 6 is not applicable]. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out prior to residents being admitted and these are clear so that a completed picture of care needs can be obtained. EVIDENCE: We saw that each bedroom had a copy of the ‘service user guide’ which is booklet containing information about the home. Those residents spoken with said that they had received a visit from the manager prior to being admitted to the home and that they had been given enough information so that they were aware of the type of home they were coming to. There is also information such as the complaints procedure and a copy of the last inspection report available
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 11 in the foyer of the home. [The new address of the Care Quality Commission [CQC] needs to be included in all information and guidance so that people are can be made aware. Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. The assessments were consistent in detail and quality and clearly identified care needs. The assessments were backed up by information and assessments from both health and social care professionals who had referred the resident so that a good idea of the care needs were apparent. There were also some risk assessments completed which were appropriate. Riverslie DS0000059055.V376925.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some care plans need to be updated with residents and/or relatives so that they can feel involved. Medication administration needs to be improved and audited regularly so that clear and safe practice can be evidenced. EVIDENCE: The AQAA for the service tells us that all of the people in the home have a plan of care and that this is reviewed with the person concerned and/or their relative. We looked at two care plans in some detail and found that whilst there was good monitoring and care planned in some areas, others were inconsistent. For example one care plan gave a very clear outline of the care of the person’s leg wounds. The care plan listed all of the treatment prescribed
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 13 and how this should be carried out and monitored. It also included reference to external professional support such as district nurse input. The reviews [evaluations] were also clear so that it was easy to follow the progress of the wounds. On the other hand we looked at a care plan for a person who has diabetes and this was not clear. The person concerned had complex care needs due to a number of underlying medical conditions and although some of these could be followed the diabetic care was confusing and it was evident that the care plan needed updating from its original writing in January 2008. The person concerned had stopped one course of treatment some time ago but it was not clear why and the staff were unaware of the reasons. A new plan of care had not been continued. We had some discussion with the nurse in charge and manager and recommended that this is completed. The level of input into the care planning by residents and relatives could be made more evident. The resident discussed said that they had not seen the care plan and would be interested in this; ‘it would be good to see what I am paying for’. Other residents and relatives spoken with had also not seen care plans and the manager confirmed that this is something that needs further development. This was a recommendation previously and needs to be addressed so that people feel more involved in their care. All relatives and residents spoken with did generally feel that they are kept informed about the care and that any medical or care appointments or reviews are reported. There are clear records of health professionals visiting. We spoke to visiting health care professional who reported that the person she was reviewing was well placed in the home and had generally improved since being admitted. Similarly, relatives and residents were pleased with how staff approached the personal care of residents. Residents were observed to be clean and appropriately dressed. One person commented; ‘I am enjoying life. Everything is very well taken care of. Staff are friendly and helpful and there is a nice atmosphere’. Medication was reviewed. Those administration records reviewed were not clear and easy to follow and this could cause confusion and possible errors. For example one person was on a lot of medication and the administration records cover 7 pages and 17 different medications. We found it very difficult to follow as pages were not attached to the folder and so were in danger of falling out. Some medicines were handwritten by staff and dates along the top did not match on each sheet so it was not immediately clear what had been administered each day. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 14 One person was on a medication at night for pain. This had been signed for on 27/7/09 but not since. There was no note on record to say why this had not been given. Both staff were not sure whether or why it has been discontinued. This was evident with some other medicines. Other handwritten medicines had no signature of staff and some had only one signature. We would recommend that any handwritten entry of this kind should be checked and signed by two staff so that the risk of errors can be reduced. One person was on a topical cream [handwritten not double signed] which was Kept in the persons room and applied by care staff. No note of which care staff administered this had been made. We advised that a record needs to be made of the care staff administering the medication and the time of application so that records are accurate. There were 2 complete handwritten sheets. No entries were double signed. This was particularly confusing as two items were written on both sheets and it was confusing to see which should be given. There was a risk of administering medication twice. [This was clarified during the inspection]. Some medication records had staff signatures recorded on the wrong day and corrected with arrow but again this was not clear. The nurse reported having to complete the medicines quickly on that particular day due to staffing shortages. We checked the stock of a ‘controlled’ medicine [controlled under the misuse of drugs act 1971 and misuse of drugs regulations 2001 therefore needing to be specially stored and recorded] and found that in this instance there was an extra days supply of the medication when checked against the existing records. This could not be explained by staff. The medicine was not being kept stored in the controlled medication cupboard as is required but was stored in the medicine trolley. We have issued a requirement for this and also a good practice recommendation that the medicine should also be recorded in the controlled drug register for the home as well as the routine medication administration record [MAR]. This will ensure that the monitoring of this medicine is in line with good practice to ensure safety. There are no residents who are self-medicating. This was discussed with reference to the home’s policies and procedures and good practice. Currently, there is no assessment tool in use for residents if they were to self-medicate to any degree. This was discussed with reference to an example document. The wishes and ability to self-medicate need to be included on all admission and pre-admission assessments so that any independence can be supported. This
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 15 was previously recommended as good practice in promoting independence and autonomy for people. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life and social care for residents continue to be developed so that residents generally are supported to feel relaxed and ‘at home’. EVIDENCE: The AQAA completed by the manager states: ‘A wider range of activities support material will be introduced (already started) so that residents can be tempted to engage in social and personal activity that suits them and their needs more easily, as opposed to mainly being invited to take part of group activities.
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 17 All staff are to be coached to understand that support for social activity, including contact with families and other interests, is the responsibility of all staff, and not the sole responsibility of an activities organiser. The care planning format is being modified to promote this understanding and process, and there will shortly be training to introduce the new format’. We found this to be change from the previous inspection where the activities planning had been the responsibility of a designated activities person. Staff interviewed said that four of the current staff members were keen to get involved with organising events and activities and this does occur on a daily basis in the afternoon with extra hours being included. During the inspection we saw a staff member engage those in the lounge with a game of bingo and this was enjoyed by those present. One of the residents was also taken out locally to the shops. As yet the training has not taken place and there is a lack of overall planning. Those people spoken with said that the provision was still patchy and that there could be more outings and entertainers for example. Although some residents had been on a recent trip to Southport and had enjoyed this. Other people explained that there is bingo, quizzes and occasionally an entertainer and a movie. Also there are local trips out to do shopping and to the park. At the time of the inspection we found the home to be very warm and welcoming. Residents were happy to chat and to tell about life in the home. Staff were seen to actively interacting and supporting people including domestic staff. The manager plans to develop things further and to include relatives on more occasions. This means that the social life of people in the home are given some priority. Prior to the inspection we had received some concerns from visitors to the home about the provision and quality of meals. Meals have been reviewed by the manager and the menu updated. One resident commented: ‘The meals were a bit repetitive but the manager has asked residents about a new menu and this has improved things.’ Residents surveyed and spoken with were all pleased with the meals. The dining room was observed to be pleasant with tables laid and menus displayed. Residents have a choice of where they have meals. The dining room is not big enough for all residents (previous report findings) but currently not all visit the dining room. The day room is large enough to accommodate extra dining tables if needed. The recommendation has been left at the end of the report for further consideration of dining room space. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 18 Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected EVIDENCE: There is a complaints procedure available for people in the home. This is displayed in the service user guide. Those spoken with were very relaxed around staff and said that generally they were listened to so that any concerns could be addressed. We asked about any complaints made about the service in the last year and there have been three from various people who use the service. We looked at these and found that they had been dealt with appropriately by the manager so that redress was apparent. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 20 spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. We discussed one incident which had been referred through to safeguarding concerning some money going missing belonging to a resident and this had been referred appropriately through the agreed procedures. The manager was able show us copies of the homes policies and procedures. The training ensures that all staff have up to date information regarding current good practice. The manager was knowledgeable and could explain how to contact the local safeguarding team and understood how an investigation would be organized and has experienced this. This helps ensure that residents are kept safe in the service. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There are systems in place to ensure continued monitoring of the home’s environment so that standards can continue to improve and residents can be assured of a clean and comfortable home to live in. EVIDENCE: The AQAA returned by the manager lists further improvements to the general environment of the home over the past year and plans for further improvements: Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 22 ‘We aim to continue to improve the appearance of the home, internally and externally – already ongoing. Review equipment levels to ensure that this is appropriate. Replace all dining furniture, replace all lounge furniture, purchase more aids and hoists, replace ground floor ramps by front door and access to dining area with improved ramps and floor coverings and refurbish the ground floor shower room’. This evidences both listening to residents’ views (some plans the results of surveying residents) and having systems in place to both monitor and improve quality. Prior to the inspection we received some concerns by visitors to the home that standards of cleanliness were failing and that the home was not clean in some areas and there was a general smell of incontinence. We found some evidence that this has been the case with references to poor cleaning and management of infection control in the home identified on management visits [regulation 26 visits]. The evidence from the inspection, however was that standards are generally acceptable and these issues have been addressed. At the time of the inspection we found the home to be warm and welcoming. Residents were clearly settled and found the surroundings comfortable. The improvements were commented on by some of those spoken with. All areas seen were clean and generally well maintained [see below for exceptions]. There was some malodour detectable on entering the home and in the lounge although this was not consistent and did not linger. We spoke to residents who said that the home was generally comfortable and clean. There is currently a vacancy for cleaning staff on one day in the week and this is being addressed. During the inspection we discussed with the manager some observations made and these are listed below to further inform the process of continuous improvement and are listed as recommendations at the end of the report. • The laundry was found to be generally well managed. The flooring in one area was observed to be flaking and in need of a recoat of paint to ensure easy cleaning. [previously recommended] We made previous recommendations around reviewing dining arrangements so that space [perhaps in the main lounge] is made available. The recommendation made previously has therefore been left in this report for the new management to consider. Two bedrooms seen were in need of redecorating and the flooring re covering. The manager is aware and has made plans to this effect. This will ensure that residents are living in comfortable surroundings. • • Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Overall staffing is sufficient to meet care needs but there needs to be full recruitment checks on file to ensure that staff employed are fit to work with vulnerable people and they are protected. EVIDENCE: Over the two days of the inspection the home were experiencing some staffing difficulties due to staff numbers being depleted. A number of staff were on holiday [3 care staff out of a total of 11] and there was also short notice sickness of staff on both days. This meant that for the first part of the morning until the manager arrived there was one nurse and two care staff to meet the needs of 21 residents. Staff reported that it is very difficult to get immediate cover when there is such a small pool of staff. We looked at the duty rota and found that generally staffing was stable and this was supported by staff interviews. There is also ancillary staff support such as domestic staff and laundry staff as well as staff working in the kitchen.
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 24 We saw that domestic staff [for example] were keen to support care staff and spend time with residents in the home. Staff described good team work generally. We also saw that due to needs being greater during the evening due to one person needing extra observation the manager had arranged extra staff cover in the short term. People in the home who were spoken with generally felt that staff were responsive and the pace of the care was relaxed and unhurried. Overall, despite the immediate staffing shortages we found evidence that staffing was generally sufficient to meet care needs. We had some discussion with the manager about the need to manage the duty rota more effectively in the future to reduce any inconsistencies. This would include rationing of holidays at peak periods and also ensuring that the managers hours are planned on the duty rota [currently not] so that staff can be aware when she is on duty. This will help to plan staffing cover more effectively. Training is ongoing in the home. Staff spoken with said that they felt supported through the training programme. Currently 15 of the care staff have a National Vocational Qualification [NVQ] which is over 50 so that the home can evidence a core of staff who are competent to carry out care. The manager provided further information on staff training. This shows that the training opportunities and training needs of the staff team have been identified. The manager reported that the staff training programme is developing and records seen showed a progressive ongoing programme and staff interviewed had attended relevant courses. The residents and their relatives gave good feedback about all staff and the manager. Comments included: ‘Staff are lovely and very helpful’ ‘I like the home and the staff are very nice’ Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. We looked at the staff files for two new members of staff in order to assess the staff recruitment and selection procedures at the home. The files were incomplete and it was difficult to get some information such as start dates for people. One file was for a trained nurse who had been recruited but there was only one reference on file [instead of the two required]. We could also not find whether the professional Identification Number [PIN] had been checked to ensure that the nurse was currently eligible to practice. We have made a requirement that this staff file must be updated and all other staff files are audited to ensure that recruitment checks are in place. This is important so Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 25 that the home can evidence that staff employed are fit to work with vulnerable people. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a number of key systems in the home that need to be audited and standardised so that standards can be more consistent. EVIDENCE: Currently the home has an acting manager, Yvonne Dempsey. Yvonne is covering the home and has been briefed to maintain standards and to recruit a
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 27 permanent manager who may then be registered with the Care Quality Commission. Yvonne displayed an open and positive attitude to the inspection process. She reported that some of the management systems in the home are in need of review and she has been working to achieve this. The routine visits by the responsible person on behalf of the provider has also identified some areas over the last few months that have been inconsistent. We saw the reports produced by the responsible person [regulation 26 reports] which indicate inconsistencies in kitchen management and also the medication administration. We spoke at length about the need to improve and maintain some key areas of management that have arisen from this inspection. These include medication management and recruitment checks for staff. We also looked at some other areas such as the management of residents personal allowance and some good practice guidance issued at the previous inspection such as ensuring two signatures for all financial transactions have not been actioned. Other key areas such as maintaining up to date care plans need further input to maintain consistency. We looked at the health and safety checks carried out in the home. Again there are areas of inconsistency currently. For example the fire log book indicated that routine checks on emergency lighting had not been carried out since June and that there were no current routine health and safety checks carried to check environment hazards such as hot water temperatures and safety of windows above ground floor level. These are important to ensure safe environmental standards are being monitored. Our records show that we have not received any notifications from the service over the past year. These notifications tell us about any key events in the home and ensure we are kept informed. We identified some issues that the home should have informed us about and we would require the manager to check records and send any outstanding notifications. The pre inspection information required [AQAA] was not completed on time and we had to remind the service to do this. The completion of the AQAA is a legal requirement which helps us to plan the inspection process. We would require that this is completed and submitted on time in the future. There are a lot of inconsistencies at present with some of the management systems. The manager is keen to introduce more complete systems and is aware how care can be effected [e.g. medication and diabetic care] if issues are not monitored effectively. The Manager needs to be listed on the duty rota so that it is clear when her hours at the home are. Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 28 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 X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement All care plans for people in the home must be maintained up to date and include all of the assessed care needs. This ensures that peoples care needs are effectively monitored. All medication prescribed and written on the medication administration record must be clearly recorded as given and if not the reasons for this. This includes medicines controlled under the Misuse of Drugs Act. This will ensure there is a clear record of all medicines administered for people in the home and that they are given correctly. 3 OP9 13(2) All medicines controlled under the Misuse of Drugs Act must be stored correctly. This is with reference to the medication discussed on inspection. This ensures safe storage and safety.
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 30 Timescale for action 01/10/09 2 OP9 13(2) 10/09/09 10/09/09 4 OP29 19 All staff must receive the appropriate pre employment checks and these must be evidenced in the staff files. This includes two written references and professional identification [PIN] number for trained nurse. All staff files must be audited against the requirements listed in schedule 2 of the care home regulations. This helps ensure that staff employed are fit to work with vulnerable people and they are protected. All incidents relating to regulation 37 notifications must be reported through to the Care Quality Commission [CQC] so that the regulator is fully informed of incidents in the home. The maintenance schedules do not include routine safety checks and risk assessments of the general environment. These must be carried out with reference to specific hazards and risks discussed. This will ensure that any risks to people living in the home are reduced. 01/10/09 5 OP37 37 10/09/09 6 OP38 13 (4) 10/09/09 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 OP1 Good Practice Recommendations The service user guide needs to be updated with the new contact address and number for the Care Quality
DS0000059055.V376925.R01.S.doc Version 5.2 Page 31 Riverslie Commission [CQC]. 2 OP7 The level of input into the care planning by residents and relatives could be made more evident. This is recommended to help ensure that there is full collaboration. Currently there is no assessment tool for use if residents were to self-medicate to any degree. The wishes and ability to self-medicate need to be included on all admission and pre-admission assessments. The medication administration records need to be tidied up and loose pages made secure so that they are easier to follow and the risk of errors is reduced as well as the risk of some records being lost. All handwritten entries should be double checked and signed by staff to reduce risk of error. Topical creams applied by care staff should have the times recorded and by the staff responsible. It is a good practice recommendation for the controlled medication discussed [schedule 3 medicine] to be monitored and recorded in the controlled drug register as well as the medication record [MAR] chart. 4 OP12 We made previous recommendations around reviewing dining arrangements so that space [perhaps in the main lounge] is made available. The recommendation made previously has therefore been left in this report for the new management to consider. Two bedrooms seen were in need of redecorating and the flooring re covering. The manager is aware and has made plans to this effect. This will ensure that residents are living in comfortable surroundings. The laundry was found to be generally well managed. The flooring in one area was observed to be flaking and in need of a recoat of paint to ensure easy cleaning. [previously recommended] There needs to be a permanent manager who can be registered with CQC. We would recommend that the current acting manager is
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DS0000059055.V376925.R01.S.doc Version 5.2 Page 32 3 OP9 5 OP19 6 OP26 7. OP31 listed on the duty rota. 8. OP35 The financial records for some residents were seen and it was observed that two signatures are not always witnessing individual transactions. [Recommended last inspection] Riverslie DS0000059055.V376925.R01.S.doc Version 5.2 Page 33 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
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