Inspection on 20/11/07 for Riversway Nursing Home

This inspection was carried out on 20th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Riversway Nursing Home 21/11/08

Riversway Nursing Home 12/02/07

Riversway Nursing Home 07/12/05

Riversway Nursing Home 08/12/04

Riversway Nursing Home 04/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Riversway Nursing Home Crews Hole Road St George Bristol BS5 8GG Lead Inspector Vanessa Carter Key Unannounced Inspection 20th & 21st November 2007 09:30 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 Riversway Nursing Home DS0000020285.V350703.R02.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. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riversway Nursing Home Address Crews Hole Road St George Bristol BS5 8GG 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) 0117 9555758 0117 9540145 riversway@btconnect.com Riversway Care Limited Mrs Angela Glover Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68), Physical disability (6) of places Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 68 people aged 65 years and over requiring personal and/or nursing care. May accommodate up to 6 people with physical disability aged between 40 years and 65 years requiring personal and/or nursing care. Manager must be a RN on parts 1 or 12 of the NMC register Staffing Notice dated 12th June 1998 and CSCI notice of proposal letter effective 7th October 2004 re revised staffing levels apply. 12th February 2007 Date of last inspection Brief Description of the Service: Riversway is registered as a Care Home for a maximum of 68 people requiring nursing care including younger physically disabled people. The Home is situated in the residential area of St George, occupying a riverside site, with easy access to local community facilities and is less than 2 miles to Bristol city centre. It can be accessed by car, or by bus with a short walk. The Home is purpose built, providing mainly single en-suite bedrooms, with five shared rooms with en-suite facilities. The rooms are spaced over two floors and divided into 4 wings. Each floor offers bedrooms, lounge-dining room and bathroom facilities. There are pleasant gardens to the front and side of the property, a conservatory and a balcony accessible from the upper floor. There is a passenger lift providing access to all communal areas. All parts of the home are accessible to wheelchair users. There is plenty of parking to the front of the property with ramped access up to the home and main reception area. The basic fees charged for staying at the Home range from £535 for a shared room to £560 a week for a single room. Fee levels are dependent upon assessed needs and therefore the full costs could be considerably higher than this. The home makes additional charges for a number of other services and these charges are listed in the service user guide. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was unannounced and took place over two days. A total of 15 hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources:• Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Talking with the Home Manager and the Operations Director • Talking with support services staff • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the people who live in the home • A tour of the home • Case Tracking the care of a number of people who live in the home • Talking with a number of the people who live in the home • Talking with a number of visitors to the home, both during the inspection and before and after the visit • Telephone conversations with a number of relatives who had asked to speak to the Inspector • Looking at some of the homes records • Information supplied by people who live in the home (18) and relatives (21) in CSCI survey forms • Information supplied by 3 healthcare professionals and 3 GP’s • Two complaints that have been received by CSCI since the last inspection. What the service does well: Information made available about the home and their pre-admission assessment processes ensure that placement is only offered to those whose needs can be met. People who live in the home can be assured that they will be well looked after and that they will receive the care they need. Medication systems are safe. People who live in the home are able to participate in a wide variety of social activities that are suitable for their needs, and they are very well fed. They have full control over their lives and good relationships are established with families and visitors. They live in a home that is well managed and is run in their best interests. People who live in the home, and their families can be assured that any complaints they may have will be listened to and acted upon and that they will be safeguarded from harm. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 6 People who live in the home do so in a comfortable, well furnished environment that is equipped to meet their needs, and is well maintained. People who live in the home are looked after by staff who are well trained meaning that they skilled and competent to meet individual’s needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and their pre-admission assessment processes ensure that placement is only offered to those whose needs can be met. EVIDENCE: The home’s Statement of Purpose was last reviewed in October 2007 so is therefore up to date. It accurately reflects the current service provision, and contains all the necessary information to enable any prospective person to make an informed decision about moving to the home. Of the 18 survey forms returned to CSCI from people who live in the home, 16 stated that they had been given enough information about the home. One person commented “I visited 10 homes before Riversway and had no hesitation in choosing here”. A copy of the document is kept in the main reception area along with copies of the service users guide and previous inspection reports. A service users guide is provided for all new people, along with a residency agreement and a letter of welcome to the home. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 9 Each person is provided with a statement of terms and conditions regarding their stay. A pre-admission assessment is always undertaken. Either the manager or the deputy manager completes this, before any placement is arranged. This ensures that the home will be able to meet that persons needs and that they have the necessary equipment in place. Where appropriate, assessments and care plans from the local authority and/or primary care trust are obtained, as part of the information gathering process. The documentation completed for two recently admitted people was examined. The information obtained is used to form the basis of that person’s plan of care. Once the person is admitted the care plan is expanded upon with any additional information that is gained. The home offers placement to older people aged 65 years and over who have general nursing care needs. The home is not registered to look after people whose primary care need is dementia, however they do look after many who have memory problems and degrees of confusion. The home is registered to offer placement for a number of people who are younger than 65 years, who are physically disabled. The majority of people who live in the home are admitted from local hospitals, and family members will have previously visited the home, had a look around, found out what the home has to offer and will have had a conversation with the manager. One relative commented “ I came along to look at Riversway and I liked the atmosphere. I knew my relative would be happy here”, whilst a person who lived at the home said “ my daughter chose the home for me. I needed a home with a religious background”. All new admissions are reviewed after a ‘trial period’ of about four weeks, but this may be extended if they have not settled and needs longer to make the decision that the home is the right place for them. One relative spoken to confirmed that a review meeting had been held along with the social worker. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in the completion of care plans and risk assessments will ensure that each person who lives at the home, always receives the care that they need and that safe systems to deal with any risks are devised. Medication systems are safe. EVIDENCE: Each person who lives at the home has a plan of care devised following an assessment of their care needs, and during the inspection visit, six plans were examined in detail. For some of the plans it was difficult to determine what was current information and what was now out of date. Amendments had been made to the plans where changes in needs had occurred, without the aim of the care plan being amended. We (CSCI) felt that this caused a confusing picture to be presented. An example to illustrate this is that for one person it was not easy to determine how their continence was managed, and for another, their mobility plan did not correspond with the outcome of their moving and handling risk assessment. This has the potential to mean a person may not receive the specific care that they need. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 11 On the other hand, there were some good examples of specific person centred care planning for instance in respects of communication where speech is not the primary method of communication, or particular personal care needs. Most of the plans had in general been reviewed on a monthly basis but this was not consistently carried out for all people who live in the home. The home need to look at their recording processes, making their care plans much clearer so that staff are fully informed of the care that they are to provide. Although it is the homes practice to re-assess the care needs of those people who have lived at the home for a length of time, on at least a yearly basis, we found this not to always be the case. This measure would ensure that all plans stay up to date and are clearly written. Wound care planning documentation did not contain enough information, and for a number of people, the records kept only consisted of a running record when dressings were changed. We found that the systems in place to monitor progress of wounds were not used consistently, and therefore may not determine that the treatment is effective. We would expect to see regular photography, wound mapping or tracing and measurements being taken. Basic information about what wound care products were to be used or how often dressings were to be changed were not consistently recorded. For one person it was difficult to determine when the GP or tissue viability nurse had been contacted for advice. Despite these shortfalls in the homes care planning processes, all people who live in the home, and relatives who were spoken with during the inspection, were satisfied with the care provided. “I am very happy. I am well looked after, everyone is so kind”, “I wouldn’t want to live anywhere else” and “I have very good care and support” were examples of comments received. Some people made comments on the CSCI survey forms that on some occasions call bells can take a while to be answered, and one person stated during the inspection “this is only at certain times of the day”. The home are able to monitor the length of time it takes for call bells to be answered and oversee this on a regular basis. Alongside the care plans, a number of risk assessments are completed. Discussion with the manager evidenced that the home use a form developed with the PCT and social services, that has an ‘initial’ screening tool and only leads to a full falls risk assessment if certain criteria are met. The screening tool records if there is a history of falls, any significant health conditions, medications taken and mobility status. We found that the screening tool was not always completed fully, for example parts of the tool were not ticked to indicate a risk or not. This means that a full falls risk assessment is not always completed when it could have been necessary to do so. This risk assessment did not lead to a plan of care to prevent further falls. Risk assessments are also completed in respects of moving and handling tasks – a safe system of work is devised for the staff. Some of these needed additional information to be recorded, for example sling sizes, and for one person this had not been Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 12 completed at all. The risk assessments regarding the likelihood of developing pressure sores were in place for all six people however they must be kept under regular review to ensure any increasing level of risk is then acted upon. Records are included in each person’s care plan of contact with healthcare professionals. GP’s visit the home twice weekly on a planned basis and in addition when they are requested. The GP records the outcome of the visit. Records were also seen where community psychiatric nurses visit, physiotherapists, opticians and dentists. This evidences that the people who live in the home receive the healthcare support they need. One person said “the doctor is always asked to visit if I am not well”. Three GP’s and three healthcare professionals returned survey forms to CSCI- their comments included “I have always felt the home offers good care and overcome difficult problems with some residents”, “the home is sensitive to individuals needs and wishes” and “I have always been impressed with the standards of care and communication at Riversway”. The CSCI pharmacist and regulatory inspector made a visit to the home in July 2007, as the home had begun working with a new computerised medication administration and recording system. This system is now being used on both floors of the home and is working well. Medication systems are safe and the staff expressed their satisfaction and confidence in working with it. Those people who were spoken with during the course of the inspection said that the staff are kind and helpful, and that they are treated respectfully. Comments made on many CSCI survey forms included the following “I am very happy with my life here and I wouldn’t want to be any where else” and “my relative is very well looked after and nothing is too much trouble”. Staff were observed during the course of the inspection to be assisting the people who live in the home in a polite and friendly manner. One person commented “I consider the staff to be my friends”. Staff knocked on bedroom doors before entering bedrooms to help to protect their privacy. There are curtains provided in the shared rooms to help ensure the privacy of those who occupy these rooms. The home looks after an increasing number of people who are in the terminal stages of their illnesses. Many thank-you letters had been received from relatives following the loss of their loved one, thanking the staff for their care and support, given at a difficult time. The home will ensure that the person receives the care they want by liaising with them, their family and relevant healthcare professionals. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to participate in a wide variety of social activities that are suitable for their needs, and are very well fed. They have full control over their lives and good relationships are established with families and visitors. EVIDENCE: Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 14 The home employs specific activity co-ordinator staff who arrange group and individual activities. The social activity plan for the week is displayed on the notice boards and also a copy is given to all the people who live in the home. This means that each person will be aware of what is going on. The home have recently purchased new “Reality Boards” and these display the day, date and the weather, and also which members of staff are on duty for that day – these were installed at the request of the “resident committee”. An outside entertainer visited the home on the first day of the inspection and one person reported “it was lovely, I really enjoyed it”. Another person said that the staff had helped them go to a concert in the summertime. One relative wrote in a CSCI survey form “I have been allowed to bring in my relatives dog that I am now looking after, and this meant so much. Also they helped my relative attend my wedding. They pulled out all the stops. It is a home not an institution”. The people who live in the home also have the opportunity to take part in film clubs, karaoke, arts and craft sessions, quizzes and have regular trips out into the local community. The home has its own chapel and Mass is held on a regular basis. “It was important for me to live in a home with a religious background” was a comment made by a person on the CSCI survey form. Other church denominations use the chapel for church services too, and one person said these were held on a regular basis. They already have one mini-bus and are hoping to purchase a second in the near future. A hairdressing service is also provided during the week, and a number of people have their hair attended to on a regular basis. One person said “I like to have my hair done regularly, it is so important to me. The lady is very good”. Monthly “resident meetings” are held, with the home having two “resident representatives” who will play a very active part in raising issues on behalf of the others. One person who was spoken with during the inspection said “If I have any thing that I want discussed I will tell him (referring to the residents representative)”. The minutes of the last meetings were examined and evidenced that the people who live in the home are greatly encouraged in having a say about how the home is run, what meals are served and what activities get arranged. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 15 The Home has a 6-8 week set menu that rotates on a weekly basis. The home displays a copy of the week’s menu choices on the notice boards. Each day there is a choice of two meals at lunchtime however the kitchen will prepare alternatives if neither are acceptable. On the day of inspection there was a choice of a fish pie or a vegetable crumble served with fresh vegetables, but some people had omelettes. One person confirmed that they often have a meal that is different from the advertised meals. Another person said that the kitchen would often prepare them meals that met their cultural needs The home offer a well balanced and varied menu. All of the people who were spoken with during the course of the inspection made positive comments about the quality of meals. When they have a birthday, a ‘Birthday Treats Menu’ is offered – they get a choice of what they want to eat for the whole day and a cake is made for them and any visitors. Meals are either served in one of the two dining rooms, but people can have their meals in their rooms if this is preferred. The dining tables are set out ‘hotel-style’, are covered with linen tablecloths, with place settings and condiments at each table. One person said “I like to go to the dining room normally but if I am not feeling too good, they bring my meal along to me”. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home can be assured that any complaints they may have will be listened to and acted upon and that they will be safeguarded from harm. EVIDENCE: The homes Complaints Procedure is included in their Statement of Purpose and Service Users Guide and is also displayed in the main reception area of the home. All people who live in the home, and relatives who responded via the CSCI survey forms stated that they were aware of how to make a complaint and felt happy about raising any concerns. The home has dealt with two complaints in the last year, both of them having also been raised with CSCI. One of these complaints is still ongoing, whilst for the other complainant; they remain not satisfied with the outcome of the complaints investigation. A lot of dissatisfaction was expressed during the inspection, from both people who live in the home and relatives, regarding recent media coverage, who all felt that “their home” was being unfairly judged. The processes that the home followed in dealing with both of these complaints were examined in detail during the inspection visit. There was a clear audit trail of the actions taken and the measures that they would put in place following their investigation. There is clear evidence that the home responded seriously to both complaints and responded appropriately. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 17 Requirements and recommendations in this report have been made as a result of the complaints, in respects of further improvements with risk assessment and management plans, and maintenance of care records. The manager explained that it is the homes ethos to develop good relationships with each person who lives in the home and their families, right from the day they are admitted to the home. This encourages the opportunity for concerns to be raised before they become serious issues. One relative commented “if something is wrong, I tell someone and it gets sorted out straight away”. The home has a Protection of Vulnerable Adults (POVA) policy. Those staff spoken with during the course of the inspection showed good basic awareness of adult protection issues and of their responsibilities in safeguarding the people who live in the home from harm. Staff referred to the homes whistle blowing policy and would not hesitate in reporting any bad practice. Staff receive POVA training as part of their induction training programme and also on a refresher basis. This will ensure that safeguarding issues remain paramount. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People will live in a home that is comfortably furnished and equipped to meet their needs, and is well maintained. EVIDENCE: Riversway is a purpose built nursing home, designed around the needs of people for whom it is intended. It was opened in 1997 and is currently able to accommodate up to 68 people. Building works will commence in 2008 to provide an additional eight bedrooms with en-suite facilities, a larger management suite, staff areas and a larger chapel complete with stained glass windows. The basement area houses the catering and laundry facilities, staff rooms and training rooms. Entrance to the home is onto the ground floor, with ramps and rails leading up from the car parking area. The home has plenty of car parking spaces, and pleasant gardens surround the side and rear of the home. Some of the bushes have been cut recently to enhance the views of the river. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 19 The Home is located near to private houses, and is a short distance from local shops and the bus service. All parts of the home are wheelchair accessible, with a large passenger lift servicing the upper floor. In the New Year, communal areas of the home will be refurbished. This will include new carpeting and redecoration. The carpet in the main reception area is particularly worn and rucked, but this is being addressed. On each of the floors there is a lounge and dining room. They are well furnished. The lounges are furnished with leather furniture that can be easily cleaned and kept fresh smelling. There is a range of other types of seating for those who need seating that is more appropriate to their specific needs. Leading from the ground floor lounge is a pleasant conservatory area and from the upper lounge a balcony. In addition, there is a ‘quiet room’ and the chapel, currently also used by the film club. Each person’s bedroom has en-suite facilities but there are toilets and assisted bathrooms and shower rooms located throughout the home. Sluice rooms are located on each floor and the home has installed machinery to macerate and dispose of continence products. The home is fully equipped with moving and handling equipment. The corridors are wide, grab rails are fitted in relevant places, and a call system is installed in all rooms. The majority of bedrooms are for single occupancy with just five being shared by two people. The rooms are all nicely appointed and are redecorated in between being occupied. Some people have personalised their rooms more than others, the home encourages them to make the room their own. All but a few of the bedrooms were seen during the course of the inspection. Each bedroom is furnished with the required amount of furniture, a television, and a telephone line. Many of the beds are divan type with some having been replaced by hospital beds or profiling beds. The home employs two full time maintenance workers for general maintenance work. The environment is maintained to a good standard, and the standard of the fixtures and fittings are also very high. The home also employs a full team of housekeeping and laundry workers. The home was clean and tidy throughout and any bad smells noted, dissipated within a short time. The home have purchased a “revolutionary machine which sanitises and deodorises a room” using ozone, and have had no outbreaks of infection in the last year. Other examples of good infection control procedures include the fact that when one person has had an infection, this has not been spread to others. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are looked after by staff who are well trained meaning that they skilled and competent to meet individual’s needs. EVIDENCE: The home has a full compliment of care staff and qualified staff, supported by a bank of staff, who can be called upon to cover any shifts required. The home do not use agency staff at all - this therefore means that the people who live in the home will be looked after by staff who are familiar with their needs. Several comments were made by both people who live in the home, and relatives, who completed CSCI survey forms, regarding the need for more staff, however the home does staff the home above the agreed staffing notice. Those staff spoken with during the course of the inspection did agree that at certain times of the day and night, it can be extremely busy. Discussion with the manager and the operation manager evidenced that they are looking at how they can use staff hours to cover these busier times. A team of administration staff, housekeeping, laundry, maintenance and catering staff are also employed and provide support in meeting the daily living needs of the people who live in the home. The home currently has some staff who have already obtained an NVQ Level 2 or 3 in care and a number of staff who are working towards the award. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 21 The home employs a senior training co-ordinator who has completed the A1 Assessors Award and they will work with staff towards completing their training. Housekeeping staff are also encouraged to undertake NVQ training. All new recruits to the care team are expected to undertake NVQ training after they have completed their induction training and probationary training. The home has three staff, one who works full time and the other two who have designated part time hours, who are trained up to work as internal training coordinators. The senior co-ordinator explained that all new staff will work with a member of the training team as part of their induction training programme and that this ensures they complete the necessary competences. This means that all new staff will be fully aware of their role and the policies and procedures of Riversway. A training log is kept for each staff member and evidences that they have attended a range of relevant training outside of the Home, as well as that provided by the home. Staff have to attend all mandatory training courses, such as fire awareness, manual handling, protection training, and health & safety as an example. The co-ordinator is putting together a training matrix to identify more clearly the staff who are due for refresher training. Riversway is accredited with the University of the West of England to offer placements for student nurses and the deputy manager is the mentor for this process. This demonstrates the training opportunities available at the home are good and encourage a learning environment In order to determine that the home follows safe recruitment procedures, the files of all staff who have started working at the home this year were examined. For each person there was a written application, two written professional references with at least one from a previous employer, a declaration of medical fitness and CRB checks. There are procedures to monitor that the qualified nurses have maintained their NMC registration and that work permits remain up to date. All the files were in order evidencing that the homes follow safe procedures and ensure that only suitable staff are employed. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People will live in a home that is well managed and is run in their best interests. Recording processes need to be improved to demonstrate that the people who live in this home are safeguarded from falls and accidents, as much as is possible. EVIDENCE: The home manager Mrs Angela Glover has been the registered manager for Riversway since it opened in May 1997. She is responsible for the running of the home, is a registered nurse and has already achieved the NVQ Level 4 in Management. She works all her hours during the week and is supported in the running of the home by reception staff, support services staff and the Operations Manager. There is a deputy manager who has also achieved an Level 4 NVQ, who works shifts and covers alternate weekends. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 23 Regular ‘resident and relative meetings’ are held and theirs views and opinions are welcomed about any matters concerning the running of the home. The minutes of these meetings were examined. The home has a number of ‘resident representatives’ who will speak up on behalf of the others. Staff meetings are held on a regular basis with all staff expected to attend. People who live in the home and staff confirmed during the inspection that their views are sought, listened to and acted upon. This evidences that the home has an open style of management, that will benefit all who live and work there. The home have several different methods of monitoring its own performance. A regular regulation 26 report is written by the Operations Manager after consulting with people who live in the home and staff about home life. Copies of this report are sent to CSCI on a monthly basis. Health & Safety audits are completed in sections throughout a three-month period and a full report written at the end of this period. Staff and resident surveys are carried out on an annual basis, the last one having been completed December 2006. A business and development plan is formulated in respect of the results of these surveys. The home has retained the ‘Investors in People’ award in recognition of the training opportunities available for staff. People who live in the home or their families are encouraged wherever possible to manage their own finances. For some people a local authority finance officer is appointed to manage a their money. Where amounts of money are kept for safe keeping by the home, good administrative systems are in place to show all transactions to and from the accounts. There is a cascade arrangement for staff supervision in place with senior staff supervising a group of junior staff. The three training co-ordinators have attended supervision training to enable them to carry out staff supervision. Any issues that arise during a staff supervision session are fed back to the home manager. The home manager sees all notes kept of meetings and signs them off. Records were seen to conform these arrangements and staff confirmed they have regular supervision. The home generally has good record keeping systems in place and all the records that were required for the inspection were readily produced. However, the home must ensure that all records are properly kept. The night care positional change charts that were seen as part of the examination of how one of the complaints were handled, did not record enough evidence of what actions the night staff had taken to regularly change the position of the person. The home must also ensure that any recordings they make are accurate, reflect what they really mean, and are achievable. One previous persons plan of care said that they “needed supervision at all times”, whereas the manager confirmed that what was meant was close observation. The home is well maintained and in good decorative order, despite being due for decoration in the New Year. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 24 All maintenance records and utility servicing is up to date. The home manager and operations manager both “walk the floor” on a daily basis and regular checks on the environment are made. Any defects that need attention are referred via a “defect sheet” to the maintenance team. The maintenance manager completes regular health and safety audits. All the necessary fire checks were up to date as was staff training and fire drills. The environmental health officer last visited the home in April 2007. Information provided by the manager prior to the inspection stated that all catering staff had completed basic food hygiene training. The home has arrangements in place to dispose of clinical and domestic waste. Improvements are required with the homes risk assessment processes to ensure that any risks are identified and where possible eliminated or reduced:in respects of the management of falls, the home must devise a management plan so that trends can be identified and preventative measures can be taken. where bed rails or lap belts are used to maintain a persons safety, the appropriateness of this course of action should have been determined following a risk assessment, and consent for their use should be obtained from either the person or their representative. Evidence of this must be kept with their care plan. manual handling risk assessments should always result in a safe system of work being devised and indicate what exact equipment is to be used. The assessment should be signed and dated and kept under review. Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 2 3 Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 26 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 Each person must have a plan of care that clearly sets out in detail, what actions the staff are to take. Where changes occur, new instructions should be clearly written, and old information separated, to avoid confusion. Timescale for action 20/04/08 2. OP8 12(1)a Wound care management must 20/04/08 include clear instructions for staff to follow and include effective monitoring of progress and evaluation. Risks to the health and safety of a person must be identified and as far as possible eliminated fall risk assessments and management plans must be in place for all those at risk. Manual handling risk assessments must be carried out for all persons and a safe system of work devised, that details equipment to be used and staff actions. DS0000020285.V350703.R02.S.doc 3. OP8 13(4)c 20/04/08 4. OP8 13(5) 20/04/08 Riversway Nursing Home Version 5.2 Page 27 5. OP8 13(7) Risk assessments should be carried out to determine that the use of bed rails and lap seat belts in wheelchairs is the best means of securing the welfare of that person. Consent for their use must be documented. Records maintained in respect of each person must be accurate, appropriate and kept up to date. For example:Night turn charts should accurately chart positional changes Instructions in care plans should use the correct language and the meaning must be clear. 20/04/08 6. OP37 17 20/04/08 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 The assessed needs of people who have lived in the home longer term, should be regularly reviewed (at least annually) and new care planning documentation then be devised. Waterlow risk assessments must be reviewed for each person on at least a monthly basis 2. OP8 Riversway Nursing Home DS0000020285.V350703.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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