Inspection on 09/11/05 for Riverslie

This inspection was carried out on 9th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Riverslie 23/03/10

Riverslie 18/08/09

Riverslie 31/07/08

Riverslie 28/08/07

Riverslie 15/03/07

Riverslie 19/05/06

Riverslie 06/07/05

Riverslie 02/02/05

Riverslie 13/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Riverslie 79 Crosby Road South Waterloo Liverpool Merseyside L21 1EW Lead Inspector Mrs Julie Garrity Unannounced Inspection 9th November 2005 10:00 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.V267807.R01.S.doc Version 5.0 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.V267807.R01.S.doc Version 5.0 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 Mrs Marie Elaine Williams 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.V267807.R01.S.doc Version 5.0 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 inpection 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.V267807.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 1 day and was a total of 7 hours. It was a routine unannounced inspection. A tour of the premises took place, seven staff were spoken with and care records reviewed such as care plans, medications, daily records and accident records. Interviews were held with the acting manager, quality manager, two senior members of staff and five other staff. Twelve residents were spoken with and two family members were involved in the discussions. What the service does well: What has improved since the last inspection? What they could do better: The previous manager has left the Home and an acting manager who was in post for six weeks has also left. A further acting manager is due to start in the Home in a few weeks. The lack of consistent management team has resulted in a lack of appropriate leadership which has lead to inconsistency in approach from staff. This has resulted in a need to address that all staff are appropriately checked prior to commencing in the Home, receive training suitable to their job role and the needs of the residents, receive supervision and a review of competency for their job role and the maintenance of appropriate documentation such as care plans. This inconsistent management has also resulted in none of the requirements on the previous report being addressed and a number of quality areas have not been progressed. A separate pharmacy inspection was undertaken after this report and a number of requirements are made separately from that report. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 6 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.V267807.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this area were reviewed. EVIDENCE: Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents are treated with respect by the staff, who understand how to maintain individual dignity and privacy. Limited progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. These shortfalls have a potential to place residents at risk. EVIDENCE: The staff observed during the inspection were attentive and polite to the residents at all times. Residents spoken with said “staff are kind”, “they are always very nice to me” and “staff are polite and aware of how to look after me well”. A relative spoken with supported this point of view and said “staff are pleasant, always ready to help, supportive of my mum and treat her very well with lots of dignity”. The registered manager has recently left the Home and the acting manager is reviewing all of the care plans. Care plans do not detail all of the residents needs, do not involve the residents or their relevant family members in developing the care plans, are not regularly reviewed and of the care plans viewed four contained inaccurate and out of date information. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 10 There has been no progress in medications, a separate pharmacy inspection on the 18/11/05 identified an number of areas to be addressed, these included an out of date policy on the administration of medications, that did not clearly detail to staff the correct way to manage medications and staff not following best practice and managing medications in accordance with legislation. A separate pharmacy report detailing the findings of the pharmacy inspection will be sent to the Home. The pharmacy inspection report is available on request. The inspection identified that a two of the residents required care of a pressure ulcer. The staff had been utilising dressings that were not prescribed, that details of the pressure ulcer such as size, shape, medical grade and records of dressings used were not detailed in the care plans. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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. Without this information care staff are likely to make decisions for the residents based on inaccurate information and as such the decisions made will be inappropriate. EVIDENCE: Several visitors were in the home on the day of the visit and they were observed interacting freely with their relatives. The atmosphere between staff, residents and visitors was relaxed and warm. All resident’s files seen held clear family and contact details. The majority of residents and relatives in the Home spoken with commented positively on the food that was provided. Two residents said, “the food is really nice” and “I enjoy the food available”. Not all of the residents felt that the food was suitable one resident said it was “ not what I would choose to eat regularly”. The menus available were not written from residents expressed choices. In general staff made selections for residents less able to detail a choice based on what they thought that they would like. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 12 A daily menu board that is meant to tell residents what food is available was completed and detailed different choices. Unfortunately it is written in very small handwriting and not easily readable by residents with any sight issues. The staff have conflicting opinions as to what a diabetic diet should be. A lack of monitoring residents weight or inclusion of a dietician in general and special diets does not allow the manager to determine if the residents receive a health diet specific to meet their dietary needs. There are two sittings for lunch and there is a tendency for these to be arranged in accordance with the needs of the residents, as determined by the staff rather than the residents expressed choice. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 13 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): The majority of staff have received training in making sure that the residents are suitably protected. However senior staff lack specific knowledge and rely on the manager to address concerns. The manager in place at inspection needed further training in this area. The lack of staff and the managers understanding of Protection of Vulnerable Adults places residents at risk. EVIDENCE: Records in the Home detail not all staff have received training in Protection of Vulnerable Adults. Discussion with staff detail that staff including senior staff did not have a clear understanding of Protection of Vulnerable Adults and a copy of the guidelines from Social Services was not available for staff to refer to should they need to. When staff records were viewed it was identified that one member of staff has not had suitable checks in place prior to commencing working in the Home. Residents and relatives spoken with said, “staff would address any concerns I have and make sure it was fixed”, “I have every confidence in the staff to make sure that all of the residents are well cared for and protected” and “the staff here are very caring they’d make sure that any problems would be seen to”. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 14 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 The appearance of the Home continues to improve. It is clean, hygienic and pleasant. EVIDENCE: The owner has made sure that the appearance of the Home continues to improve, this has included redecorating the outside of the Home, the dinning room and some of the bedrooms. The top floor bathroom has now been redecorated and is available to the residents. On the day of inspection a ground floor room was being redecorated. The owner had decided on the colours to be used and the residents whose room it was were not consulted, nor where their relatives approached. It is a condition of registration that the Home produces a detailed breakdown of maintenance in the Home and this has been outstanding on the last 4 reports. 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. This should also include general on-going maintenance that would as an example detail to a resident when their bedroom was to be redecorated or refurbished. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 15 A number of areas remain in need of addressing including, dining room furniture, worn and damaged bedroom furniture, stained and worn carpets in several bedrooms and the main corridors, damaged paintwork and chairs in the day room. Several residents said that their bedrooms have been measured for new carpets. However they had not been consulted as to when the carpets would be replaced or what colour they would be. Staff are aware of how to maintain good hygiene levels in the Home and soap and towels were available in all bedrooms. Staff detailed that there is sufficient plastic aprons and gloves available. It was noted that staff serving food in the dinning room did not all have food and hygiene certificates and one was not wearing protective clothing such as an apron. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 16 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): 28, 29, 30 Staff have a caring attitude and are confident that they take care of the residents properly. There are areas of care within the Home such as special diets, management of medications and care of wounds that staff did not demonstrate competency in the care that they delivered. EVIDENCE: Residents were complimentary about the care that they received from the staff one resident said “lovely, kind, caring girls” and another said, “I’m happy with the care that I receive”. Staff demonstrated a genuinely thoughtful and enthusiastic attitude towards the care that they gave residents and were keen to learn new skills. The manager cannot be confident that there is always enough staff to meet the resident’s needs as staffing levels are not monitored on a regular basis. Most staff have the correct checks before they are employed, this includes references, police checks and previous experience. However one long-term member of staff did not have a Criminal Records Bureau check (police check. Staff are aware of a variety of training available and recently several members of staff have undertaken medication training. However there was no assessment that the staff were competent to do this and a lack of supervision of staff prevents the acting manager from identify the gaps in staff training. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 17 Training needs identified included, Protection of Vulnerable Adults, 2 staff in need of moving and handling up dating, epilepsy, usage of external preparations, food hygiene, health and safety, wound care, understanding of special diets and the usage of nutritional supplements, All of these areas were identified from the care needs of the residents. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 18 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, 35 and 38 The home is not being consistently managed and there is no regular leadership, guidance and direction to staff to ensure residents receive quality care. This results in some practices that do not promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: There is no registered manager and this has been the case for nearly three months, an acting manager was in post at this inspection who has since left. On the day of an inspection a quality manager was employed for 2 days a week. The quality manager has since been recruited as the next acting manager. When spoken with the residents and the staff were unclear as to the arrangements for management this was further confused as the acting manager is not a registered nurse and staff were unsure as to how this would impact on the nursing role of staff. Due the changing management none of the outstanding requirements have been addressed. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 19 The owner has not been undertaking regular visits to the Home in order to provide support and leadership to the manager and maintain a quality of service. The Home manages the funds for very few residents, of those residents whose funds are managed by the Home, the acting manager was unsure as to the source of the residents funds, what legal responsibility the home had regarding the funds and suitable arrangements to make sure that the residents received their personal funds when needed. Three of fire doors were wedged open including the kitchen door, which has equipment in place that has not been regularly tested. Records indicated that fire drills and instruction had taken place regularly. The staff members spoken to confirmed this. During the visit wheelchair were noted not to have footrests in place. Regular environmental checks in order to maintain Health and Safety had not been undertaken and Health and safety training has not been undertaken for all staff. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 20 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 X 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X X 2 Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. OP7 Regulation 15 (1) (2) Requirement Timescale for action 23/12/05 2 OP8 12 (1) (a) (b) 3. OP9 13 (2) Residents care plans must 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 the previous report) The healthcare needs of the 09/12/05 residents must be reviewed. Advice on wound care of residents must be sought and only dressings prescribed for the resident utilised. All medications must be given in 09/11/05 accordance with the GPs prescription. All records relating to medications must be recorded in accordance with the Homes policy. (Outstanding from the previous report) A pharmacy inspection has been undertaken to further explore this requirement. Timescales for compliance with this requirements from the pharmacy inspection will be detailed separately to the Home from the pharmacy inspector. DS0000059055.V267807.R01.S.doc Version 5.0 Page 22 Riverslie 4. OP14 16 (2) (m) 5. OP15 16 (2) (i) 6. OP18 18 (1) (c) 7. OP19 23 2 (b) 8. OP30 19 (4) (5) 9. 10. OP31 OP35 CSA 2000 Section 11 17 (1) (a) The manager must make sure that all residents choices, preferences, likes and dislikes are asked for and recorded. This information should be used to determine the daily routine, resident’s activities, the Homes redecoration and the menus. (Outstanding from the previous report) The menu must be developed taken from residents expressed choices and reviewed to make sure that it provides a balanced and nutritious diet. All senior staff must be aware of their role in reporting and investigating allegations or potential incidents of abuse. (This requirement is outstanding from a previous report). A maintenance programme, that details timescales for ongoing maintenance must be produced with timescales for compliance. The maintenance programme must detail for residents the planned dates of individual room decoration and general refurbishment. (This requirement is now outstanding on four previous reports and also a condition of Riverslie’s registration that has not been addressed) All staff must have appropriate checks and training in order for them to care appropriately for residents. (This requirement is outstanding from a previous report). An application for registration must be submitted for the acting manager. The management of resident’s personal allowances must be reviewed and a policy and procedure to guide senior staff and the acting manager in dealing with resident’s finances must be put DS0000059055.V267807.R01.S.doc 23/12/05 09/02/06 23/12/05 09/12/05 09/12/05 23/02/06 09/01/06 Riverslie Version 5.0 Page 23 11. OP33 24 (1) (2) (3) 12. OP38 12 (3) into place. The owner must 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 a previous report). All staff must receive regular Health and Safety training in order for them to comply fully with Health and safety legislation. 09/12/05 23/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. 4. 5. 6. 7. 8. Refer to Standard OP7 OP8 OP15 OP18 OP26 OP27 OP30 OP38 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. Residents should be regularly weighed. The menu board in the dining room should be updated daily. A copy of Seftons Social Services guidelines on protection of vulnerable adults should be made available for all staff to read. Staff should be reminded to utilise protective clothing such as plastic aprons when serving food to residents. The staffing levels should be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. All staff files should be reviewed to make sure that the correct checks on staff have been completed. All wheelchairs should have footrests in place. Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 24 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 © 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 Riverslie DS0000059055.V267807.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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