Inspection on 26/07/06 for Riverview

This inspection was carried out on 26th July 2006.

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

Riverview 05/05/10

Riverview 02/02/10

Riverview 04/02/09

Riverview 07/02/07

Riverview 27/10/05

Riverview 02/11/04

Riverview 09/09/04

Riverview 27/04/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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

CARE HOMES FOR OLDER PEOPLE Riverview Stourton Road Ilkley West Yorkshire LS29 9BG Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 26th July 2006 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 Riverview DS0000019902.V301973.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. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverview Address Stourton Road Ilkley West Yorkshire LS29 9BG 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) 01943 602352 01943 602352 Ilkley Healthcare Limited Mrs Christine Rickerby Care Home 61 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (61), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (6), Physical disability over 65 years of age (1) Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: Riverview is a large, detached property in Ilkley with car parking at the front of the home. Public transport routes and local amenities are nearby. The accommodation is on four floors with two lifts accessing all areas. There are five lounges, two of which are used as dining rooms and activity areas. There are extensive gardens including a small enclosed area accessible to residents. The home provides nursing care for up to 61 older people with dementia. A charge of £495 is made for one week’s stay. The pre inspection questionnaire states there are no extra charges. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk A pre-inspection questionnaire was completed by the home and this information has been used as part of the inspection process. Information from surveys which were sent to residents and health care professionals have also been included. Two inspectors carried out a site visit. Each inspector spent ten hours at the home. During the visit the inspectors looked around the home, and spoke to residents, staff, and two visitors. Records were looked at including; residents’ care plans, risk assessments, admission assessments, food records, staff recruitment and training records, and financial records. The registered provider or registered manager were not present at the site visit. Both inspectors returned several days after the visit and gave an in-depth feedback to them. What the service does well: What has improved since the last inspection? Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 6 Some areas of the home have been decorated and new carpets and flooring have been purchased. The environment was generally pleasant and it was clean and tidy. A new communal area has been created and residents can now access a quiet, therapeutic room. The management team have identified that some important information was missing from staff files. This information should have been obtained at the time staff were recruited. They have spent some considerable time obtaining the relevant information and updating files. This process is nearly complete. 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. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are appropriately assessed before they move into the home. However, they do not receive information about the terms and conditions of their stay before they move in. EVIDENCE: Records for the admission process of three residents were looked at. Someone from the home had carried out a pre admission assessment before they decided if the home could meet the needs of the residents. Key areas of need were assessed and the information was satisfactory. Two residents also had additional assessments that had been completed by health/social care professionals. This practice is good because staff and management make sure the home is suitable before a place is offered. During the tour of the building it was evident that some residents had changed rooms. One resident had changed from a double room to a single room and staff were clear why this move had been initiated. However, it was not a Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 9 satisfactory process because the resident’s family had not been consulted and a new contract had not been agreed. Another resident had moved, this time from a single room to a double room. Staff did not know why the move had taken place and a contract had not been issued. Once a move has been agreed, the resident contract should be amended and signed by the resident or their representative. The majority of residents had a contract that outlines the terms and conditions of their stay at the home. Details of room numbers are included on the contract but all did not correspond with the rooms allocated. The cost of the placement is £495 per week and this should be included in the contract so the resident and their representative are aware of the fees payable and by whom. Currently only the resident contribution is recorded, i.e. £94.45. Contracts are not issued until a few weeks after the resident has been admitted to the home, therefore they do not have details of the term and conditions that apply until after they have moved in. Intermediate care is not provided at Riverview. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were good and they identified how residents’ needs should be met but some additional information should be included in relation to challenging behaviour and how it should be managed. Management now need to look at how the care plans can be implemented. Residents’ health care needs are met. Very poor practices were observed on the day of the inspection and it was evident that some of the basic values (choice, independence and dignity) which underpin ‘quality of life’ are not generally practiced in the home, therefore residents are not receiving a satisfactory level of care. EVIDENCE: Care plans and risk assessments contained information that specified how residents’ needs should be met. There was sufficient guidance for anyone reading the plans to understand how individual needs should be met. For example ‘can do simple tasks herself, can wash her hands and face- encourage this’, chooses own bedtime, becomes anxious if meals/pills not given promptly’. One resident confirmed the contents of their care plan accurately Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 11 reflected their needs. Qualified staff are responsible for writing the care plans and they review them monthly. Care staff said they do read the plans but don’t spend a lot of time reading them. Daily records described two of the residents as becoming agitated or aggressive. Their care plans did not contain sufficient information about the type of agitation or aggression, the level of risk or how it should be managed. Several residents wear incontinence pads. Care plans do not contain information about the type of incontinence pad that is required. Staff said they know which to use but it is not recorded in their plan of care. Daily records were looked at. Entries were generally made twice a day and there was information about medication, food and fluid intake and some events, for example hairdressing, health or behavioural problems but generally bathing was not recorded. Each resident has a list of GP and significant events sheet. Contacts with health care professional are recorded. There was evidence that residents have a health check when they arrive, this includes weight, blood pressure and general observation. The home’s medication system is a Monitored Dosage System. An inspector observed administration of medication at lunchtime. Only four people required medication. This was administered appropriately and the staff explained to residents what they were doing. This is good practice. Medication records were looked at and they had been completed correctly, there was a clear record when medication was refused. A tour of the building was carried out before lunch and this included visiting the majority of residents’ rooms, it was noted that most residents did not have their own toiletries. At the time of the visit forty-six residents were staying at the home. Only one comb and one hairbrush were seen in any of the rooms, most did not have toothbrushes or denture equipment. Staff confirmed they carried a comb with them and use it when getting residents ready. In one double room there were two toothbrushes but it was not known which toothbrush belonged to which resident. It is unacceptable to have communal toiletries and this demonstrates that residents’ dignity is not preserved. An electric shaver was on charge in the office. Staff confirmed that the resident is shaved in the downstairs bathroom rather than his bedroom. This is done for the convenience of staff rather than what is best for the resident. In one area of the home, staff had hung a full set of clothing for each resident on the front of each wardrobe for the following morning. The person in charge at the time of the visit said he had tried to address this practice with care staff because it was institutionalised and does not enable residents to choose what to wear. There was a half set of dentures in one room but the resident staying in the room had their own teeth. Many items of clothing were in the wrong rooms. Underwear, trousers, shirts and nightwear belonged to other residents. Items that had been put out for the following day did not always belong to the Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 12 person. Staff said they did not check the names on the clothing before they put them on, they also said there had been a long standing problem with the laundry system. One member of staff said they thought it was ok to wear other people’s clothes. Two residents were observed to have buttons missing from their clothing. One resident said she didn’t like having buttons missing from her clothes. Several bedrooms had clocks on the walls, although nearly all of them were the incorrect time. This is confusing and is not helpful to people with dementia. Staff said that there is a problem with a lot of residents not having enough clothing, and as relatives are responsible for their finances it is difficult to obtain clothing, therefore the clothing of residents that die at the home is passed on to other residents. Staff said this was one reason why clothing was incorrectly labelled. If there are occasions when residents have to wear donated clothing it should still be appropriately labelled. If relatives, who are responsible for finances, refuse to purchase clothing, a copy of any relevant correspondence and a record of discussions should be maintained. As detailed under the previous section, it was evident that some residents had moved rooms. The process for moving residents is not satisfactory because there was no evidence to demonstrate that the moves had been carried out in the best interest of the residents. When a resident moves rooms it is very important to clearly record when and why the decision has been made and this should be done through a consultation process. Although care plans contained guidance on how residents’ needs should be met, there were a lot of examples seen during the inspection that confirmed care plans were not being implemented on an individual basis, therefore they are not effective working documents. Riverview DS0000019902.V301973.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The organised activities programme appears to work well and residents do have opportunities to engage in meaningful activities but daily stimulation and general interaction is not satisfactory and must improve. Residents are not helped to exercise choice and decisions tend to be made collectively rather what is best for each individual. Some residents said the food was good and meals are varied and nutritious. However, mealtimes for some residents are very stark and are not enjoyable, social occasions. EVIDENCE: The pre inspection questionnaire stated that a range of activities are provided, this included religious services, bus trips, musical entertainment, art and craft sessions, slide shows and TV, poetry reading, 1:1 with staff and crosswords. The activities record at the home stated that during the month of June an accordionist, a male vocalist, a keyboard player and church fellowship had visited the home and a bus trip to Bolton Abbey was arranged. Every Wednesday a craft session is also held. One staff member has the responsibility for arranging outings and organising entertainers. An activity organiser visits the home one-day a week. The organised activities programme is good. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 14 We received comment cards from four residents, one relative, and two professionals. Inspectors spoke to two of the residents that returned the comment cards and they were generally happy with the care. They spend a lot of time in their rooms and said staff visit them and have a chat. The relative comment card stated they were delighted with the care. Both professional comment cards stated they are satisfied with the overall care at the home, one stated that very occasionally challenging behaviour is not managed well. Some residents living at Riverview do not have the capacity to complete the comment cards. One member of staff brings their dog with them when they are on duty and it was there on the day of the inspection. Residents were fond of the dog and appeared to enjoy it being at the home. One resident brought their cat with them when they moved into the home and another cat that had belonged to the home had recently died. Two residents talked about pets and were pleased pets were allowed to live there. Residents clearly seemed to benefit from having pets at the home. Inspectors spoke to two relatives. One relative said they were happy with the care and they thought it was a well run home. Another felt the home was not meeting the needs of their relative and they were not satisfied with the care. During the inspection staff interaction with residents was observed. The level of interaction was minimal. There were many occasions when staff were seen to sit and chat with each other but there were not many occasions when staff sat with residents. Staff did not generally talk to residents about what they were doing. For example, one staff was observed to approach a resident from behind and pull up their trousers. The resident said ‘who is that? What are you doing?’ The staff member should have explained to the service what they were going to do. When asked about activities, staff talked about the activity organiser and activities that some staff do, but generally staff do not seem to engage in activities with residents. The inspectors arrived at 9.30am and left the home at 7.15pm. Most of this time was spent observing practice and looking around the home. During the day many residents were seen to sit for very long periods of time with little or no stimulation. Some residents appeared to sit in the same place and did not seem to move. Residents go to bed and get up at various times. However, staff did confirm that ‘frail’ residents go to bed at 6.00pm. Care plans should contain information about the time residents wish to go to bed. If residents are unable to make this decision then a preferred routine should be agreed and this Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 15 should be based on experience and knowledge of the resident and what is thought to be their preferred routine. Inspectors observed lunch which was served at 1.00pm. The food looked appetising and residents enjoyed their meal. The food served was the same as what was recorded on the four-week menu plan. The cook records any changes to the menu in a diary. Two residents said the food was generally good. There are four dining areas. Inspectors sat in different dining rooms and observed very different practices. In one area, none of the residents required assistance. Cutlery and serviettes were on the table and staff served the meals and drinks. The lunch was relaxed and residents and the staff member were chatting. In the other area, several residents required assistance. There were no tablecloths, cutlery, serviettes or condiments on the table. Two meals were left on top of a radiator. When staff were giving out drinks and meals, generally, they did not talk to residents. Food and drink was often just put in front of residents. Two staff members were seen sitting on the table in front of residents while they were feeding them. This is poor practice and demonstrates that residents are not treated with respect. One staff said they used to put tablecloths on the tables and couldn’t recall why this had stopped. Riverview DS0000019902.V301973.R01.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about how to make a complaint is made available. Adult protection procedures are in place but staff must ensure all information is recorded to ensure residents are protected. EVIDENCE: The pre inspection questionnaire stated that the home had not received any complaints within the last twelve months. It also confirmed that the home has an adult protection policy, which was last updated in February 2006, and staff have attended adult protection training. The complaints procedure is displayed in the entrance of the home. Daily records for one resident stated that one resident had made allegations of assault. No further information was available. A member of qualified staff said further information had not been recorded because it was confidential. This is not good practice and does not protect residents at the home. This was discussed during the feedback session following the visit to the home. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy and decoration is reasonable. However, there were clear health and safety issues that had not been addressed. Some residents do not have access to hot water in their rooms. EVIDENCE: A full tour of the building was carried out. The inspectors looked around all communal areas and most bedrooms. The home was clean and tidy throughout and generally the home was odour free. There were two areas that had a slight odour but this was being effectively managed. The gardens were very pleasant and well maintained. Generally the décor was satisfactory. Many bedrooms were personalised and some residents had brought their own furniture with them. This is good practice and demonstrates that residents are encouraged to make their rooms homely. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 18 Since the last inspection, a small quiet room with lava lamps has been created. Staff said this area was used if residents get ‘worked up’. Residents can freely wander around the ground floor communal rooms. There are three dining areas and three lounges. Staff felt that residents benefited from having good space and the freedom to walk around these areas of the home. The call bell system was tested in most areas. Many activation points did not work and call leads were only in place in three rooms, hence the majority of residents would not be able to call for assistance. The call bell panels are situated on the first floor and the call bells cannot be heard in most areas of the building. Several beds were fitted with bed rails. One resident said he did not require them and they were a nuisance. Staff confirmed that he did not require bed rails and they could be removed. Another bed that did have rails, did not have protectors. Staff were aware this breached health and safety guidance, therefore posing a risk to the resident. Water temperatures were checked in most bedrooms and bathrooms. In some sinks and baths the water was too hot and you could not hold your hand under the water flow, other sinks and baths had no hot water. Staff said this was not a recent problem, and some residents had bowls in their sinks. Staff confirmed these were used to obtain hot water from other areas because there was none available in some rooms. All windows above ground floor level were fitted with restrictors but some gaps were too wide. An audit of all windows should be carried out to make sure they meet the health and safety guidance. The en-suite floor in two rooms and the wooden floor in a corridor were very slippery, one of the inspectors slipped whilst looking around. Apparently a substance that had been used to clean the carpet had gone on to these floors. A system must be introduced to ensure cleaning products are used appropriately. All sinks had a soap and towel dispenser fitted above them but several soap dispensers were empty. In one section of the home, the lights in the corridor and two bedrooms were not working. The staff said this was temporary because the fuse had blown. There were some minor maintenance issues noted and this included, light bulbs not working, locks on bathroom doors not working, a curtain hanging off the rail, a mirror on the floor, a sash on window not working, no front on a vanity unit, no tops on taps in one bathroom and a bedroom, no toilet roll Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 19 holder in one bathroom, top drawers of a cabinet broken, handles broken on several items of furniture. Riverview DS0000019902.V301973.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate but because staff time is not used as effectively as it could be, residents do not receive enough input from staff. The behaviour and work practices of some staff are unacceptable. One member of staff had been recently recruited and this was done using a thorough process. The home has identified where there have been shortfalls in past recruitment processes and they have taken action to rectify this. EVIDENCE: During the inspection there was evidence that many of the care practices and staff approaches were not appropriate and they did not meet the national minimum standards for Older People. The report contains examples of where the home failed to meet these standards. Some comments made by staff on the day of the inspection were inappropriate and demonstrated that staff knowledge of good care practice and behaviours towards residents were unacceptable. Comments included describing residents as “psyche patients”, “boys and girls”, “wetters and feeders”. This demonstrates that residents are not seen as individuals. The home was also described as an asylum. When discussing the importance of moving residents only when it is in their best interest and it should include consultation with relatives, one member of staff responded by saying ‘this is not a hotel’. There were also occasions when Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 21 personal information about residents was discussed in communal areas in front of other residents and staff. Management at the home must take urgent action to address these issues. The pre inspection questionnaire stated that 13 care staff (50 ) hold NVQ level 2 or above. The National minimum standards for Older People anticipate that this would indicate that residents are in safe hands. However, the evidence from the site visit confirms that the expected outcome has not been achieved. Management should look at how staff can implement the principles of the NVQ award. The pre inspection questionnaire also stated that staff have attended a range of training courses, including; Moving and handling, incontinence assessment, fire awareness, first aid, adult protection, infection control, positive dementia. Each staff has a file that contains training certificates. Two files were looked at. Both had a range of certificates and staff had completed at least one training course within the last six months. An individual training record is maintained but this was not looked at during this inspection. There is a very low turnover of staff. Most staff have worked at the home for a long time and know the residents well. There were sufficient staff on duty on the day of the inspection and staff said they thought that staffing levels were appropriate. Copies of staff rotas were sent with the pre inspection questionnaire. Only one new member of staff had started working at the home since August 2005. These records were looked at. All relevant information was available, including an interview assessment, and had been obtained prior to employment. This is good practice. The administrator had been updating personnel files for all existing employees. A full audit has been done and they have identified that some information is not available. Staff have been asked to provide the relevant information is missing. Eleven staff do not have criminal record checks. These have all been applied for but this should have been carried out a long time ago. Riverview DS0000019902.V301973.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the manager is a qualified nurse she is not suitably qualified because she does not have a relevant management qualification. Quality monitoring systems are not robust or effective, therefore internal systems do not identify where the home is failing to provide a good service. Financial recording systems cannot be properly audited, therefore residents’ finances are not safeguarded. EVIDENCE: The manager is an experienced general nurse and she has worked at Riverview for over three years. The last inspection identified that the manager must complete a management qualification. Since the inspection, the manager has completed an NVQ level 2 in team leading. The course tutor has stated the manager could start NVQ level and this would take approximately a year to Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 23 complete. The manager said she is leaving her post in May 2007 and therefore would not have time to finish the award. Visits by the registered provider are carried out every month and a copy of the report is sent to the CSCI. Some maintenance problems have been identified during these visits. Discussions with residents and staff are also held but these are recorded as general discussion. The visits have not identified the problems that have been highlighted during this inspection. Visits by the registered provider must be robust. Various residents’ records were looked at. But as stated under the health and personal care and complaints and protection section of this report, some key information was not recorded. Some information was also repetitive, for example “settled day”, “settled night”, “no concerns”. It is important to ensure relevant information about residents is recorded to enable proper monitoring of residents’ health and welfare can be monitored. Several electrical items had been tested to make sure they were safe and had stickers to confirm they did not need to be tested again until October 2006, however, some electrical items did not have stickers on or had stickers that were out of date. A system needs to be introduced to make sure all electrical equipment is tested. The pre inspection questionnaire stated that policies and procedures are available and regular maintenance and health and safety checks are completed at the home. Fire equipment and bath hoists had been serviced within the last twelve months. The manager is appointee for one resident, these financial records were looked at. The administrator cashes a cheque from the post office and gives the resident a weekly personal allowance, the resident signs to say they have received this allowance. However, details of the full transactions are not recorded, and there was no record of how much money had been cashed at the post office and how much money had been paid towards the cost of the fees. This must be recorded and receipts from the post office should be retained. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 24 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 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 1 X 3 1 2 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 X 2 2 Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 25 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. 1 Standard OP2 Regulation 5 Requirement The registered provider must ensure residents receive information about the accommodation to be provided and the fees payable, by not later than the day on which they become a resident. Any changes in accommodation must be carried out through a formal consultation process and new terms and conditions must be agreed. The registered person must ensure care plans contain sufficient information about challenging behaviour, continence care and preferred bedtime routines. Timescale for action 30/09/06 2 OP7 15 30/09/06 3 OP10 12 The registered provider must ensure that staff are aware of the care plans and have clear instructions on how the care plans should be implemented. The registered person must 30/09/06 ensure residents are treated with respect and their dignity is preserved. This relates to practices that are detailed in the main body of the report. DS0000019902.V301973.R01.S.doc Version 5.2 Page 26 Riverview 4 OP12 OP27 12 5 6 OP18 OP37 OP19 17 23 7 OP22 13 8 9 OP25 OP29 23 19 10 11 OP31 OP33 18 26 12 OP35 17 13 OP38 13 The registered person must encourage and assist staff to have good personal and professional working relationships with residents. This relates specifically to staff spending time with residents and appropriate interaction. The registered person must ensure all relevant information relating to residents is recorded. The registered person must ensure address the maintenance issues identified in the main body of the report. The registered person must ensure unnecessary risks to the health and safety of residents are so far as possible eliminated. This relates specifically to the call bell system, bed rails, window restrictors, flooring, and hot water temperatures The registered person must ensure wash basins and baths have a hot water supply. The registered person must ensure criminal records checks have been carried out for all staff working at the home. The registered manager must obtain a recognised management qualification. The registered person must ensure regulation 26 visits are carried out in a way that enables him to accurately form an opinion of the standard of care provided. The registered person must ensure all financial transactions that are carried out on behalf of residents are recorded and all receipts must be kept. The registered person must ensure all electrical portable appliances are tested. DS0000019902.V301973.R01.S.doc 30/09/06 30/09/06 30/11/06 30/11/06 30/09/06 30/09/06 31/12/06 30/09/06 30/09/06 30/09/06 Riverview Version 5.2 Page 27 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 Refer to Standard OP15 OP28 Good Practice Recommendations The registered person should make sure residents meal times are in pleasant surroundings and staff should offer assistance discreetly and individually. The registered person should encourage and assist staff that have completed the NVQ award to implement the principles. Those who have not completed should be encouraged to do so. Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Riverview DS0000019902.V301973.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!