CARE HOMES FOR OLDER PEOPLE
Riverslie 79 Crosby Road South Waterloo Liverpool Merseyside L21 1EW Lead Inspector
Miss Diane Sharrock Mrs Natalie Charnley Unannounced Inspection 19th May 2006 9:00 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 Riverslie DS0000059055.V295339.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. Riverslie DS0000059055.V295339.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 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.V295339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Where the registered manager is not a 1st Level nurse, the registered provider/responsible individual must at all times employ a suitably qualified and experienced 1st Level nurse who has clinical responsibility for service users at the home who are in need of nursing care. The registered provider/responsible individual must notify the CSCI without delay if this 1st Level nurse gives notice to leave their employment at the home, or ceases to be employed at the home. The registered person/responsible individual must keep the CSCI advised of the progress of their recruitment and selection. Service users to include up to 30 OP and up to 1 LD. Maximum No. Registered - 30, of which a maximum of 18 N (nursing) and up to a maximum of 12 PC (personal Care). Aspects of the environment need to be improved. This was identified at an unannounced inspection in February 2004. A list will be provided to the new owners with timescales. 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Riverslie is a Care Home with nursing and personal care only. In total the Home provides care for 30 service residents over retirement age. There are 22 single rooms, none with en-suite facilities, and 4 double rooms, none with en-suite. 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 3 storeys and provides a 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.
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 5 Mr Vickers is the Responsible Person and currently the home have a new Manager who is yet to be Registered with CSCI. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day with two Inspectors present and was the homes key unannounced inspection measuring all of the core standards. A detailed tour of the premises took place and Resident care plans and various other records were inspected. A selection of comment cards were sent to a sample of named Residents and further comment cards have been left at the home. Interviews took place with both Staff and Service Users and some visitors during the inspection. All areas of the inspection and findings were discussed with the Manager at the end of this visit. What the service does well: What has improved since the last inspection?
Menus at the home have recently been updated to suite the needs of new residents. The home cater for a number of specialist diets including vegetarian
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 7 and diabetic and offer softer diets for those who find chewing or swallowing food difficult. Residents stated that they were happy with the food provided and commented that it was “ok”, “very nice” and “tasty”. Whist staff acknowledged that some improvements to the decoration of the home had been made, most felt that improvements were still needed. The home now has an experienced Manager in place who has a varied amount of experience in care homes. The Manager has acknowledged the issues and concerns that need addressing and is committed in wanting the home to improve on previous standards. The home is a nursing home and the current Manager acknowledges that she is not a Registered nurse and is currently in the process of recruiting a Registered Nurse to assist in the clinical responsibilities at the home. What they could do better:
Full feedback was given to the Manager during and on conclusion of this inspection. Staff also reported that they were positive about the new Manager, however they acknowledged the changes they had encountered over the previous months due to the number of new managers and the new ownership of the home. Areas of concern were noted to need action taken and further evidence to be in place to meet most standards and identified regulations. Some concerns noted were repeated from previous inspections. It is of great concern that the Provider has been unable to meet these regulations. An action plan must be submitted to CSCI giving details of how the company will be meeting these regulations and how they intend to improve the home over the following months. The repeated breaches of Regulations must not continue and the Provider must demonstrate his commitment and responsibilities in achieving compliance with the Care Home Regulations 2001. On receipt of this report the Provider must arrange to meet with Representatives of CSCI to describe what actions will be taken to evidence the regulations will be met. Those areas identified during this inspection that needed action taken to meet the regulations are as follows, A review of all Residents at the home should take place to identify any Resident that may potentially be out of category of the homes current
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 8 registered status. The manager must inform CSCI of the outcome’s of these reviews. A completed managers application must be submitted to CSCI An updated and accurate Statement of Purpose should be submitted to CSCI and made openly accessible to everyone at the home. The complaints policy must be accessible to everyone at the home. Staffing levels should be displayed in the homes statement of purpose. A review of Staffing levels should take place and the Registered person must demonstrate that the home has sufficient staff in place to provide the appropriate care and support for all Residents at the home. Recruitment and selection of staff must be reviewed and all practices must be in line with the care home regulations to ensure the safety of Residents to the home. Evidence of updated professional registration for trained nurses must be in place and checked as per the national midwifery councils guidelines. Quality assurance tools should be developed further and implemented including utilising questionnaires to all parties to elicit their views and carry out regular minuted Residents meetings. The home should have access to updated and appropriate policies and procedures as a matter of priority. Health and safety records should be up to date including reviews of accidents. Risk assessments must be up to date and all necessary maintenance checks must be in place with evidence of contractors maintenance checks, Risk assessments must be completed with appropriate action taken to minimise risk of those Residents that currently smoke at the home. Risk assessment must be applied regarding the storage of products in bathrooms and prescribed creams must be removed from these ares and appropriate storage maintained . Care plans should be completely reviewed and developed to show evidence that they can eventually meet all parts of the standards including the proviosn of social care plans. Pre assessments and admission records must be clear and able to demonstrate that the home can meet the needs of those Residents admitted to the home. All Residents must have a contract /terms and conditions in place. Care issues around Privacy should be reviewed included the use of communal toiletries and displaying of personal information in communal areas. Medications should be reviewed and immediate actions taken to ensure all requirements are met and that systems are in place to evidence that a consistent standard can be maintained in the administration and recording of medications. Activities should be developed and utilised so that all parts of this standard can be met. Supervision of Staff should be developed further to evidence that all parts of this standard will eventually be met, Records should be developed further to show that Staff have individual training records including 3 paid days for training and an overall training development plan for the home, All staff must have all necessary training to assist them in their role and all mandatory training must be up to date for all
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 9 Staff. The development plan should identify what actions will be taken to ensure the home’ has 50 of staff with nvq qualifications. A planned maintenance and decorating plan should be produced for all areas of the home. All rooms should be provided with a lockable door or storage area for the use of Residents living at the home. All Residents must have access to a nurse call cord and appropriate supervision must be provided for communal areas, especially were there is no access to a nurse call system. The kitchen area needs deep cleaning and appropriate cleaning schedules in place to ensure a consistent standard of cleanliness at the home at all times. The management of malodorous smells must be reviewed and appropriate action carried out to eradicate malodorous smells at the home. Previous regulation 26 reports should be submitted to CSCI and must be submitted monthly thereafter. A complete review of how Residents finances are managed must take place and be fully accessible to the homes manager. Action must be taken to ensure that any procedures for managing finances are in line with the care home regulations 2001 and national minimum standards. 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. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 10 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.V295339.R01.S.doc Version 5.2 Page 11 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): 1/3 The required documents- Statement of Purpose and Service User Guide still needing to be updated and supplied to all Parties, Pre assessments still need further developments to ensure the home can meet Residents needs. Quality in this outcome area is poor. This judgment has been made using available evidence including a site visit to the service. EVIDENCE: The Statement of Purpose, has a number of topics that are not included in the file and it also needs updating regarding details of the manager/ Responsible Person and the training qualifications of staff, numbers of staff on duty each day and the homes admission criteria. This document was located in the office and not really on show for access to all parties Staff could not find a Service User guide. This would mean that all parties do not have easy access regarding information needed about the home. Both Staff and Residents had no knowledge of what a Statement of Purpose or Service Users guide was or were they could locate the homes current inspection report. These documents are necessary for informing everyone about the home and its facilities and procedures.
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 12 The homes Manager explained that she plans to ensure all documents are accesiblie to everyone at the home including open access in the reception area. In case tracking care plans it was noted that the homes staff may have admitted Residents outside the current homes registrered categories. The Manager agreed to arrange an immediate review with the local authority and to take appropriate action if it was found that any persons was outside the homes current registered category. One other care plan had no evidence of an assessmnet or admission details that could evidence if the home could meet the persons needs. The care records case tracked had no evidence of a contract or terms and condition. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 13 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): 7/8/9/10 Although progress has been made with careplans it has still been identified that the Health and Personal care needs are not always being met according to individuals Resident’s needs. Residents are treated with respect by the staff, who understand how to maintain individual dignity and privacy. Quality in this outcome area is poor. This judgment has been made using available evidence including a site visit to the service. EVIDENCE: The care plans case tracked were detailed and have records in place to eventually meet the standards however during case tracking of 4 care Residents care records various areas were in need of review and improvement. One care plan identified one Resident with specific Mental Health needs. There was limited detail in the care plan to address this persons “mental health needs” and there was no evidence of any specified external specialist in Mental Health. As pointed out to the homes Manager the home is not registered for this category of Resident. This is potentially a serious breach of the care home Regulations 2001. The homes manager agreed to arrange reviews with the
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 14 local authority to ensure updated information has been obtained regarding the placement of this Resident and update in their care needs. Care plans generally showed no evidence of social care needs being met, some care plans had different formats thought to have occurred due the number of managers that had worked at the home over the last 18 months. One Resident was noted to have a head wound however in reviewing their notes it was identified that this need had not been documented in the Residents care plan. The homes Manager acknowledged the need for all care plans to have complete review and work to be carried out to ensure the homes care records meet all parts of the national minimum standards. There has been limited progress in medications, a separate pharmacy inspection on the 3/5/06 identified a number of requirements to be met. A separate pharmacy report detailing the findings of the pharmacy inspection has been sent to the Home. The requirements made during that visit are included and repeated in this report. Internal auditing of medications must be developed so that actions can be taken to improve on the present standards. All Staff must receive appropriate training as a matter of urgency to ensure they have appropriate knowledge base to safely administer medications. Boots pharmacy recently carried out a pharmacy audit in May 15th 06 and left 5 recommendations. The manager acknowledged that she would be arranging for further training and regular reviews and audits of the homes medications. The staff observed during the inspection were attentive and polite to the residents at all times. Residents spoken with said that “staff are lovely here”, Relatives visiting stated that “the home is lovely and the staff could not do enough to help their relative settle in.” Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/14/15 Residents have contact with family, friends and the community and this is appropriately supported by the staff. A number of decisions are made by the care staff on behalf of the residents based on what the staff think is in the best interests of the residents. Unfortunately there is no written record of resident’s choices or preferences. Quality in this outcome area is adequate. This judgment has been made using available evidence including a site visit to the service. EVIDENCE: Activities records are held at the home, however they were found to not be Recording the activities of individuals. The home manager stated that this was done in the past and it is recommended that this be re introduced to allow the home to show individualised care. Residents and staff confirmed that activities such as quizzes, bingo and sing-along take place, however some commented that they would enjoy more trips outside the home. There was no display of any organised events, this should be developed and Residents should have their opinions and requests taken into account so that this programme is reflective of their needs.
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 16 Residents also stated that visitors can “come and go as they please”; this was noted during the inspection. One visitor to the home commented “ I am always made to feel welcome at the home, staff are warm and caring”. Currently the home have no regular minuted Residents meetings, this is something the new Manager plans to develop to evidence how Residents views will be obtained `regarding developments in their home. Staff informed the inspectors that they “always try and offer choices” where they can. Examples were given of offering choices on meals, bathing routines and activities. Residents confirmed that they were able to make some decisions for themselves and that staff supported this process. Three residents were noted to be resting on their beds during the inspection, one resident in particular, was shouting for staff to attend to him. On closer inspection, none of these residents had access to nurse call bells and only one bedroom throughout the entire building had a call bell lead in place. This must be urgently addressed by the manager to ensure residents have control over and access to calling for help from staff. It was also noted that a bath list was displayed in the communal area, this should be removed to enhance a homely atmosphere and reflective of the Residents own home. Communal toiletries were also noted in bathroom areas. This practice should be reviewed so that Residents are given opportunities to have their own chosen toiletries similar to what they would have used prior to admission. Menus at the home have recently been updated to suite the needs of new residents. The home cater for a number of specialist diets including vegetarian and diabetic and offer softer diets for those who find chewing or swallowing food difficult. Discussions with the cook, highlighted that she does not have a budget to follow when ordering and that ordering is often variable. Infrequent records were being kept on fridge and freezer temperature records and no records that detailed what cleaning is done in the kitchen, this is important to maintain good food hygiene. A recommendation was made to the Manager to obtain a copy of ‘ Safer Food, Better Business’, which is published by the food standards agency. This will help staff keep the necessary records to protect the residents. Residents stated that they were happy with the food provided and commented that it was “ok”, “very nice” and “tasty”. It was noted that there was no cleaning schedule for the kitchen and some areas were in need of deep cleaning, This should be reviewed by the Manager with appropriate action taken to ensure good standards of hygiene are maintained at all times Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16/18 The home have some staff with updated training however some staff still needed training and not all recruitment checks have been carried out to safequard Residents. Quality in this outcome area is adequate. This judgment has been made using available evidence including a site visit to the service. EVIDENCE: As mentioned previously the Statement of Purpose needs updating and several topics need to be included as listed in the standards and regulations. Staff could not locate a Service User Guide either which should provide an easily accessible complaints procedure and necessary information about the home. The Company must review all complaints procedures within the home to ensure everyone has the opportunity to openly express their views. The manager is currently in the process of investigating a complaint and must submit a regulation 37 report to CSCI following the conclusions and outcomes of her investigation. The investigation notes were noted to have been carried out in an appropriate and detailed manner. The home currently has Sefton LA adult protection policy accessible in the office. Currently 12 Staff have received training on abuse awareness however other staff have not yet received this mandatory training, this was also an outstanding issue noted at the homes last inspection. This must be organised as a mater of priority to ensure all staff are
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 18 updated and have sufficient training to enable them to support all Residents safely. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19/26 Although there are improvements noted to the environment, further actions must be developed to enable the home to fully meet the standards and ensure the safety of the home and Residents. Quality in this outcome area is poor. This judgment has been made using available evidence including a site visit to the service. EVIDENCE: A full tour of the home was undertaken. Many bedrooms were found to be bland and not have a ‘homely’ feel to them. Some bedrooms, mainly on the upper floor, had been redecorated, however the home could not show plans that showed how continuing improvements are going to be made. Many of the homes bedrooms and communal areas had old furniture that needed repairing or replacing. The toilet, bathroom and sluice to the lower floor, near the lounge, had significant malodorous smells. Some residents medications and toiletries were stored in these area, which could be a risk and must be
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 20 removed. Bedroom 6,8, the main entrance and the upstairs bathroom also had a malodorous smells that must be investigated and addressed. Call bells could only be accessed using a cord in one bedroom, which may leave residents at risk. Appropriate facilities and equipment necessary to support Residents at the home must be provided as a matter of priority. Many corridors had scuff marks from wheelchairs on paintwork, visitors interviewed commented on this. One resident, who lives on the top floor, smokes in his bedroom. The home must risk assess this practice and make sure the room has adequate ventilation, such as an expel air, to ensure the safety of residents and staff. Residents bedrooms did not have lockable storage facilities to allow them to store secure items, however all residents spoken to were happy with their accommodation. Outside of the home, four glass panels and general junk such as wooden chairs and wood panels were stored in full view for residents in the car park. This does not create a pleasant atmosphere when coming into the home. The inspector sat with residents in the main lounge for an hour. No call bells were available for residents to use and only two members of staff came into the lounge on one occasion to move a resident to their bedroom. Residents all sit in a circular seating pattern around the room, and 10 out of the 14 residents slept throughout this period. The formation of the chairs does not allow for social interaction between residents and it is recommended that the layout of the room is made more homely. Supervision of large communal areas must be addressed to ensure Residents have access to assistance as needed. Whist staff acknowledged that some improvements to the decoration of the home had been made, most felt that improvements were still needed. A maintenance and decorating programme must be developed to enable a planned approach and investment into the home which allows all Residents to be informed an included into developments of their home, including necessary information as to when their bedroom is planned to be decorated. As stated at the previous inspection, It is anticipated that a maintenance plan should detail weekly maintenance needs such as checking fire alarms, monthly maintenance such as checking call systems and yearly maintenance such as checking fire equipment be produced. Staff went on to confirm that they had access to plenty of stocks of cleaning materials and that the home was usually kept clean and tidy. 3 out of 5 staff had not received training on infection control. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27/28/29/30 There are areas within the Home that need further review and development including appropriately trained staff, appropriate recruitment and selection procedures and review of risk assessments in the home to minimise risks. Staff have a caring attitude and are confident that they take care of the residents properly. Quality in this outcome area is poor. This judgment has been made using available evidence including a site visit to the service. EVIDENCE: In assessing the procedures for the recruitment and selection of staff, four staff files were sampled, including two new members of staff. All files contained just one written reference, and three did not have evidence of Police checks, thus leaving residents at risk and showing clear breaches of the care home regulations 2001. This must be reviewed by the Company and action taken to ensure the recruitment and selection of all staff are in line with the care home regulations and are appropriately carried out to ensure the safety of Residents at the home. Three files were for trained Nurses; none of these Nurses had checks carried out on their professional PIN (personal identification number), which confirms that they are able to practice as nurses. The home Manager was not aware that such checks were needed and of the importance of these checks. The manager was provided with detailed information on how to carry out these checks, which must be done as a matter of urgency, and copies of evidence must be forwarded to the Commission for Social Care Inspection.
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 22 Training records at the home need to be updated, which was acknowledged by the Manager. Records showed that staff had received some mandatory training, however some were out of date and some were blank. The Manager must audit the records to show what training individuals need and must be able to evidence how the trained nurses are receiving continual professional development. There was no structured plan to evidence what actions the company was taking to ensure NVQ training would eventually meet the National minimum standards target. Staff thought there were 7 staff in total with their NVQ qualification.There was no training and development plan for the home. Training records were not up to date and there was no evidence of 3 days paid training for staff. Staffing rotas checked were very hard to understand and follow exactly how many staff were on duty each shift. This must be made clearly identifiable. The manager stated that she is currently recruiting a registered nurse to work full time and provide consistency with care. It was clarified that one nurse works on every shift, with 5 care staff in the morning, 4 in the afternoon and 2 at night. The manager confirmed that she sometimes had to use agency staff to cover staff shortages. Staff and relatives spoken to felt the home was sometimes short staffed, commenting “staffing levels could be better”, “we are often short staffed and use a lot of agency” and “we need more staff”. The management of staffing must be reviewed to ensure the home is staffed appropriately according to the ongoing dependencies of Residents. The companies commitment to the basic number of staff on each shift must be displayed in the homes statement of purpose and any changes to the basic levels must show evidence of a clear rationale to link the levels with the residents needs and in consultation with all Residents, relatives and staff. Residents stated that “staff are nice” and “they look after me here”, however some also felt that staffing levels needed increasing. Staff were upset that recently they had been made to work in the laundry and kitchen areas and felt this was a ‘hygiene risk’. The manager must ensure that all areas of the home are fully staffed at all times and that care staff only do the jobs they are employed to do. The management of staffing levels at the home must ensure appropriate staff are in place and that no risks are taken that could increase risks of cross infection. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 23 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): 31/33/35/36/38 The Company must provide appropriate resources and expertise to evidence what actions they will take to demonstrate improvements needed to the ongoing management, health, and safety and welfare arrangements within the home. Quality in this outcome area is poor. This judgment has been made using available evidence including a site visit to the service EVIDENCE: Currently the new Manager has only recently commenced employment at the home however she has worked previously as a registered Manager at another home. The Manager was very helpful and eager to assist and learn during this inspection. Juts one regulation 26 report has been submitted to CSCI, this is legal requirement of the provider and monthly reports Must be submitted to CSCI .
Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 24 All of the homes policies and procedures were noted to be in need of review and updating so that they reflected all relevant regulations and the National Minimum Standards and all necessary information to manage the home safely and appropriately. Samples of finances managed by the Provider were reviewed during this inspection. The Manager currently has monies paid to her on a regular basis from the Provider on behalf of those residents they manage finances for. The Provider is currently an appointee for 6 Residents. The homes Manager had no access to the finance records or bank records for these 6 Residents held by the Provider. It appeared from the homes records that some Residents may not be receiving their “full weekly personal allowance.” One Relative advised that the new contracts recently issued inferred that they should pay a “top up” to current fees from their relatives personal allowance. The management of all Residents finances must be completely reviewed and accessible to the Manager and the Residents. The records must be open and transparent. All Residents must receive their full personal allowance payable into their own personal account or advice taken from them as to were they would like their money stored. If during this review any financial discrepancies are noted then they must be reported to the placing authority to allow them to carry out an updated review. Staff are not being provided with one to one supervision. This is evident in records and through discussions with staff. An action plan must be developed to ensure appropriate action is taken to meet the national minimum standards and to endure all staff have regular 1 to 1 time to discuss their needs and developments. Various maintenance certificates were produced showing some evidence of appropriate checks to facilities at the home. However there was no evidence of an update to water maintenance checks, recommendations were noted to still need to be carried out as advised by the contractor for the homes lift on the 23/2/06, the employers liability insurance appeared to be out of date 14/9/05, an updated certificate could not be found during this visit, the gas certificate was dated 17/11/03 and there was no evidence of any maintenance checks of the homes central heating system. The Manager acknowledged the organisation and management of maintenance certificates needed to be reviewed and improved upon. Evidence of these checks must be produced as a matter of priority to ensure the health safety and well being of everyone at the home and to show an appropriate and responsible approach by the Provider to the ongoing management and safety of the home. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 25 The accident book had recorded accidents, namely 6 recorded for May 06, 6 for April 06, 9 for March 06. Internal audits must take place to ensure that any identified actions are taken to minimise any reoccurrence of accidents. The homes fire book gave details of the fire contactors recommendation-dating march 06 for the fire alarms, call points and door closures. It was of concern that these recommendations had not already been acted upon Prior to this inspection. All aspects of Health and safety and management of the home must be acted upon appropriately to ensure the health and safety of everyone at the home and to evidence that the Provider has fulfilled his legal obligations and to meet all relevant regulations. The shortfalls noted on inspection around the inappropriate management of the home and health and safety has potentially put people at risk. Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 26 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 1 X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 X 1 X X 1 Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) Requirement The Responsible Persons must ensure that Residents care plans, pre assessments and admission records detail the needs of the residents and how the staff are to meet these needs. They must be updated on a monthly basis and include residents, their relatives and care staff as appropriate to the resident. (Outstanding from previous inspection reports) Timescale for action 17/08/06 2. OP27 18 1 a) The Responsible Person is 20/07/06 required to provide evidence that appropriate Staff are provided at the home at all times to meet the needs of all Service Users. 3. OP19 23 2 (b) The Responsible Persons must ensure that the home has a maintenance programme, The maintenance programme must detail for residents the planned dates of individual room decoration and general refurbishment. Environmental
DS0000059055.V295339.R01.S.doc 14/09/06 Riverslie Version 5.2 Page 28 risk assessments must be carried out to all identified risks (This requirement is outstanding on five previous reports.) 4. OP18 18 (1) (c) The Responsible Persons must ensure that all staff have updated abuse awareness training. (This requirement is outstanding from a previous reports). 14/09/06 5 OP29 19 The Responsible Person is required to develop all personnel files in line with this standard and Schedule 2 of the Care Home Regulations 2001. (This requirement is outstanding from a previous report) 14/09/06 6. OP33 26 1)2)3)4) 24 (1) (2) (3) The Responsible Persons must 20/07/06 ensure that they undertake monthly visits to the Home. A report must be submitted to the manager and a copy sent to Commission for Social Care Inspection. . (This requirement is outstanding from previous reports). The Responsible Person is 17/07/06 required to provide an updated risk assessments to all areas of the home including those areas observed at the inspection which are of concern. ie including, residents smoking in rooms, carpets in poor state of repair, prescribed creams and toiletries in bathrooms, access to nurse cords, junk in main car park The Responsible Person must 14/09/06 provide an accurate and accessible Service User guide and Statement of Purpose to Residents and all other parties so
DS0000059055.V295339.R01.S.doc Version 5.2 Page 29 7. OP38 13 4)a)c) 8. OP1 45 6 Riverslie that it is openly accessible. 9. OP31 CSA 2000 The Responsible Persons must Section 11 ensure that a completed application for registration of the new Manager is submitted to CSCI. . 17/08/06 10. OP35 20 1) The Responsible Person is 14/09/06 required to provide evidence that all Service Users finances managed by the company will be reviewed and that their bank account offers an accurate an updated record to reflect Residents current financial balances and demonstrates that the account is solely used for Residents finances. The Responsible Persons must ensure that all staff receive regular Health and Safety training in order for them to comply fully with Health and safety legislation and training on infection control and all necessary training to assist staff in their job role.. The registered person must ensure that medication policies and procedures be reviewed in line with Royal Pharmaceutical Society of Great Britain and Nursing & Midwifery Council guidelines to cover all aspects of medicines management. Previous timescale of 31/03/06 not met The registered person must
DS0000059055.V295339.R01.S.doc 11. OP38 12 (3) 17/08/06 12. OP9 13(2) 17/08/06 13.
Riverslie OP9 13(2) 17/08/06
Version 5.2 Page 30 ensure that self-medication is promoted where appropriate. Risk assessments must be completed (and reviewed) and the resident provided with secure storage facilities within their private room. Previous timescale of 10/03/06 not met 14. OP9 13(2) 17(1)(a) Sch 3 (i) The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. There must be a full record of all medication currently prescribed for each resident. Previous timescale of 10/03/06 not met The registered person must ensure that all medication is stored securely at all times. Medication cupboards and fridges must be kept locked. Previous timescale of 31/01/06 not met The registered person must ensure that all medication is only administered in accordance with the General Practitioners instructions Previous timescale of 28/02/06 not met The registered person must ensure that medicines are only administered to the resident for whom they were prescribed. There must be no sharing of liquids, creams or other preparations. Previous timescale of 28/02/06 not met The registered person must
DS0000059055.V295339.R01.S.doc 17/08/06 15. OP9 13(2) 17/08/06 16. OP9 13(2) 17/08/06 17. OP9 13(2) 17/08/06 18.
Riverslie OP9 13(2) 17/08/06
Version 5.2 Page 31 13(6) ensure that nurses take and record the pulse rate prior to the administration of Digoxin to residents receiving nursing care. Previous timescale of 28/02/06 not met Staff authorised to administer medication must have an assessment of their competence to complete these tasks. 17/08/06 19. OP9 13 (2)18 (1) (c) 20 OP26 16 k) 23 2)d) 17/08/06 The Responsible Person is required to provide evidence that suitable ancillary provision and personnel are supplied to the home on a daily basis to provide an acceptable level of cleanliness and to eliminate all areas of odour noted during the unannounced inspection. The Responsible Person is 20/07/06 required to provide evidence to the Commission that all Service Users admitted to the home have been appropriately assessed and that the care home can evidence that they can meet the Service Users needs in respect of their health and welfare. Those Residents identified following this inspection as out of category must be referred to the placing authority for an updated review. 21 OP3 14 1)a)2)a)b) Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 32 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 OP7 Good Practice Recommendations Care staff should be supported to read care plans and to keep detailed records of the care provided to residents on a daily basis. The menu board in the dining room should be revised to ensure all Residents can see the menu, and developments should take place to ensure Residents are consulted about menus were there views can be acted upon. To continue developing and updating training records and provide evidence of 3 days paid training for all Staff each year. To develop an overall training and development plan for the home based on both the identified staff training needs and Service Users needs including the trained staffs clinical needs. The registered manager should continue with development of NVQ training so as to meet the target of 50 by 2005 The staffing levels should be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. To publish the homes staffing commitment for each day in the statement of purpose. 2. OP15 3. OP30 4. OP27 5. OP12 6. OP32 To continue the developments in the activities programme to meet this standard. To develop regular minuted Resident/Relative meetings. To continue with ongoing Staff meetings and develop the implementation of supervision and appraisals. To ensure all parties are aware of the Companies “whistle blowing” policy.
DS0000059055.V295339.R01.S.doc Version 5.2 Page 33 Riverslie 7. OP33 8. 9. To develop and implement quality assurance audits to the home including the use of questionnaires to all parties to help elicit all parties comments and opinions. To provide a development plan for Riverslei. To provide 2 comfortable chairs for each bedroom and locks to bedroom doors or cupboards. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber A second member of staff should witness all hand written annotations on Medication Administration Record charts. A lock should be fitted to the door of the clinical room. The opening date should be recorded on eye drops and other items with a short shelf-life There should be a formal system for prompting medication reviews in line with National Service Framework for Older People A review of the homes environment to enhance a more homely atmosphere should take place and include the removal of bath lists openly displayed in communal areas. Communal toiletries should stop and encouragement and support given to Residents to be able to purchase their own personal toiletries. Training on privacy and dignity should be developed to review current practices at the home to enhance these areas further. OP24 OP9 10. OP9 11. OP9 12 OP14 13 OP10 Riverslie DS0000059055.V295339.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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