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Inspection on 16/06/05 for Rivington View Nursing Home

Also see our care home review for Rivington View Nursing Home for more information

This inspection was carried out on 16th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The discreet manner in which staff members care for residents means that their privacy is respected. Residents said that staff respected their need for privacy and dignity, for example by always knocking before going into their rooms. They also said that staff members spoke to them in a respectful way. Residents, relatives, the 2 GPs and the District Nurse all said that they were satisfied with the care provided in the home. One relative said, "The care is great, my mum is well looked after". Residents` preferences are taken into account when planning their care. For instance, residents said that they could choose what time they get up or go to bed. At mealtimes, residents can choose from a selection of varied, healthy dishes. They can choose to eat either in the dining room, or in their own room. Residents said that they enjoyed the food. One said, "The food is really good and there`s enough to eat" Residents feel confident that any complaints or concerns that they might bring up would be dealt with by the home. The home is comfortable, clean and hygienic, providing a pleasant environment for those who live there. Residents were pleased with their rooms and with the home environment in general.

What has improved since the last inspection?

Since the last inspection, the home has made some improvements to help promote the protection, safety and well-being of the residents. For example, staff members have now had some training in adult protection to ensure that they understand that they have a responsibility to protect residents by reporting any suspicions of abuse. Also, some individual health monitoring records have improved.

What the care home could do better:

Not all care plans contain information about how social and emotional needs will be met, and one care plan needs to be updated following a change in the resident`s dietary needs. Care plans need to include accurate, up to date information in order to assist staff to provide the care and help that residents need. Residents` weights need to be checked at least monthly so that problems with health and nutrition can be quickly picked up and dealt with. Some social activities are organised by care staff but they do not have time to do this every day. There is a need to offer individual and group activities daily so that residents can add more interest and variety to their lives. On the whole the home is well looked after. To keep up these standards, the home needs to arrange for the dining room carpet to be cleaned. Residents would benefit, by being able to sit out safely, if the garden were enclosed. The home also needs to be able to show that residents have been offered a key to their bedroom door. Pre-employment checks for staff need to be more thorough. Two recent recruits had been allowed to start work without a criminal records check. This can potentially put residents at risk. The Acting Manager needs to be given specified hours, within her working week, to be spent on management duties. This is to ensure that she has enough time to fully attend to her management responsibilities. The home has not yet produced a development plan to show how the standards in the home are being reviewed and improved upon. The home needs to seek the opinions of a wide range of people, and to report on the comments received so that people know that their views are being noted and acted upon. In order to promote the safety of residents and staff, the home needs to make sure that fire alarms are tested weekly. There is also a need to attend to the fire safety matters that were identified by the Fire Safety Officers during their visit on July 4th.The Service Users` Guide needs some additions so that residents, and others, are provided with the information that they need about the home.

CARE HOMES FOR OLDER PEOPLE RIVINGTON VIEW NURSING HOME Albert Street Horwich Bolton BL6 7AW Lead Inspector Sue Evans Announced 16 June 2005 th 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 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. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rivington View Nursing Home Address Albert Street Horwich Bolton BL6 7AW 01204 694325 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Rivington View Limited CRH N - Care Home with Nursing 33 Category(ies) of OP Old age - 33 registration, with number PD Physical disability - 4 of places TI Terminally ill - 3 RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Within the maximum registered number 33, there can be up to 33 OP, 3 TI, 4 PD The service should employ a suitable qualified and experienced Manager who is registered by the CSCI One named service user (SW) may be accommodated in the category of PD.The home`s categories of registration to automatically revert back once SW is no longer accommodated at the home. Date of last inspection 9th December 2004 Brief Description of the Service: Rivington View is a privately owned care home providing 24 hour care for up to 33 older people, most of whom need nursing care. Within that number, the home can accommodate a small number of people who are terminally ill or physically disabled. A qualified nurse is on duty at all times. Rivington View is a purpose built, two-storey home, situated in the centre of Horwich, close to bus routes, shops, and other community facilities. The home has 21 single bedrooms and 6 doubles. There is a lounge on each floor, a dining room and a meeting room on the ground floor, and bathrooms and toilets on both floors. The home is fitted with suitable adaptations and equipment such as a passenger lift, assisted baths, portable hoists, and grab rails. In addition to nursing and care staff, the home also employs cooks, kitchen assistants, domestic assistants, and a maintenance worker. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over 8¾ hours on 16th June 2005. More than half of this time was spent watching what went on in the home, talking at length to 5 residents and more briefly with 3 others, talking to 2 visiting relatives, and interviewing 3 staff members. The inspector also looked round some parts of the building, ate lunch with the residents, examined some key records, and interviewed the Acting Manager. Written comments were also received from a resident, a relative, two GPs and a District Nurse. A further visit was made to the home on July 4th after concerns about fire safety in the home had been reported to the CSCI. Two Fire Safety Officers accompanied the inspector on this second visit. Most of the concerns were not upheld. Since the last inspection, the Registered Manager had left. An experienced nurse has become temporary manager until a permanent appointment is made. What the service does well: The discreet manner in which staff members care for residents means that their privacy is respected. Residents said that staff respected their need for privacy and dignity, for example by always knocking before going into their rooms. They also said that staff members spoke to them in a respectful way. Residents, relatives, the 2 GPs and the District Nurse all said that they were satisfied with the care provided in the home. One relative said, “The care is great, my mum is well looked after”. Residents’ preferences are taken into account when planning their care. For instance, residents said that they could choose what time they get up or go to bed. At mealtimes, residents can choose from a selection of varied, healthy dishes. They can choose to eat either in the dining room, or in their own room. Residents said that they enjoyed the food. One said, “The food is really good and there’s enough to eat” Residents feel confident that any complaints or concerns that they might bring up would be dealt with by the home. The home is comfortable, clean and hygienic, providing a pleasant environment for those who live there. Residents were pleased with their rooms and with the home environment in general. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Not all care plans contain information about how social and emotional needs will be met, and one care plan needs to be updated following a change in the resident’s dietary needs. Care plans need to include accurate, up to date information in order to assist staff to provide the care and help that residents need. Residents’ weights need to be checked at least monthly so that problems with health and nutrition can be quickly picked up and dealt with. Some social activities are organised by care staff but they do not have time to do this every day. There is a need to offer individual and group activities daily so that residents can add more interest and variety to their lives. On the whole the home is well looked after. To keep up these standards, the home needs to arrange for the dining room carpet to be cleaned. Residents would benefit, by being able to sit out safely, if the garden were enclosed. The home also needs to be able to show that residents have been offered a key to their bedroom door. Pre-employment checks for staff need to be more thorough. Two recent recruits had been allowed to start work without a criminal records check. This can potentially put residents at risk. The Acting Manager needs to be given specified hours, within her working week, to be spent on management duties. This is to ensure that she has enough time to fully attend to her management responsibilities. The home has not yet produced a development plan to show how the standards in the home are being reviewed and improved upon. The home needs to seek the opinions of a wide range of people, and to report on the comments received so that people know that their views are being noted and acted upon. In order to promote the safety of residents and staff, the home needs to make sure that fire alarms are tested weekly. There is also a need to attend to the fire safety matters that were identified by the Fire Safety Officers during their visit on July 4th. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 7 The Service Users’ Guide needs some additions so that residents, and others, are provided with the information that they need about the home. 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. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 1 The Statement of Purpose and Service Users’ Guide contain useful information about the home. However, some additions are needed to the Service Users’ Guide so that prospective residents have enough information to help them decide whether they would like to live in the home. EVIDENCE: Residents had been given copies of both the Statement of Purpose and Service Users’ Guide. These contained useful information about the home including details of its facilities, the experience and qualifications of the staff, and a copy of the complaints procedure. The Statement of Purpose contained all the necessary information. However, the Service Users’ Guide still needed a few additions in order to provide prospective residents with full information about what to expect from the home. These additions included a copy of the terms and conditions of residence, details of where a copy of the most recent inspection report can be found, a selection of residents’ opinions of the home, and the telephone number of the CSCI. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 10 Some care plans need to be updated and expanded to reflect any changes in residents’ needs, so that they provide detailed guidance to assist staff in providing the necessary support to residents. Health needs are kept under review so that any changes can be dealt with promptly. However, residents’ weights need to be checked at least monthly to assist staff in identifying any problems with general health and nutrition. Discreet care practices in the home mean that residents feel that they are treated with respect and that their privacy is upheld. EVIDENCE: Records showed that the care plans were reviewed every month. Staff members said that any changes in residents’ care needs were passed on at the staff “handover” meetings at the start of each shift. They also said that they had access to the care plans. Staff members were asked about the needs of three of the residents. They were consistent in their descriptions of how they helped and cared for them and this matched with the information given by the residents. However, one of the three care plans had not been updated when the person’s dietary needs RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 11 changed. Only one of the three care plans contained detailed information about how social and emotional needs were to be met. The home must ensure that care plans reflect all current needs to ensure that staff have up to date information about how residents’ needs are to be met. Risk assessments covered areas such as moving and handling, falls, nutrition, pressure sores and general health and safety. Since the last inspection, the home had made sure that any risk assessments covering use of bed rails were agreed and signed by the resident’s next of kin. Records showed that health needs were monitored, for example by completing turning charts, and food and drink charts. However weight was not being checked every month. Records, and discussions with residents, showed that the home had contacted specialist services if necessary, for example GPs, opticians and the podiatrist. Care staff understood that they must report any concerns to senior staff. They demonstrated an understanding of pressure sore prevention. From observations, and from talking to residents, relatives, and staff, it was clear that residents’ personal care, such as washing, bathing and attention to things such as the cleaning of spectacles and dentures, was attended to appropriately. Staff members gave examples of how privacy and dignity were promoted in the home, for instance when attending to personal care. Residents were satisfied that their privacy was respected, for example they said that staff members knocked on their bedroom doors before entering. Care plans included reference to how privacy and dignity needs should be met. During the inspection, staff members spoke with residents in a natural, friendly way. Residents said that that staff members were always polite and respectful. Staff members understood about confidentiality procedures, including their duty to share otherwise confidential information with an appropriate person, for example if a service user was thought to be at risk. Residents said that staff members did not discuss other residents’ private business in front of them. All the residents and relatives who were spoken with during the inspection said that they were satisfied with the care provided. One resident said, “Staff are very good”. A relative said, “ The care is great, my mum is well looked after”. The two GPs and the District Nurse, who sent in written comments, said that they were satisfied with the care provided in the home and that staff members demonstrated a clear understanding of the care needs of the residents. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13 and 15 Residents have choice about their daily routines, spending their time as they prefer. However, there is a need to improve the frequency and variety of the activities offered so that residents can add more interest and variety to their lives. Flexible arrangements for visiting mean that residents can continue to see their family and friends as they wish. The meals are substantial and offer choice and variety, providing residents with a healthy diet. EVIDENCE: Residents said that they got up and went to bed at the time they chose. Their wishes about this had been included in their care plans. Residents said that they did as they chose throughout the day. Some chose to stay in their rooms rather than use one of the lounges. Residents and staff members talked about some of the activities provided. These included bingo, dominoes, crafts, and baking. The Acting Manager said that pub lunches were organised about once a month. Some residents said that they did not like organised group activities so they followed their own individual interests such as reading, crosswords or watching television. Records showed that activities were not provided every day. The home did not have an activities organiser and it was left to care staff to arrange activities. They said that they usually did this during the afternoons. Whilst this may be RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 13 possible when the home is fully staffed, staffing shortages or emergencies mean that care staff are needed for other duties and are unable to carry out activities. A visiting relative, and a resident who sent in written comments, both said that the home did not provide enough activities. There is a need for the home to provide a mixture of group and individual activities every day to ensure that residents are provided with interest and variety in their lives. Representatives from two local Churches visited the home regularly to offer Communion to residents. Residents said that they could have visitors at any time. Relatives said that they were made welcome in the home and that they could meet with their relative in private. One relative commented that it would be nice if there were tea or coffee making facilities for visitors. The Acting Manager said that the home was happy to provide drinks for visitors and she would make sure that visitors were made aware of this. Residents said that they enjoyed the food. They said that there were choices, and that they had plenty to eat. One said, “The food is really good and there’s enough to eat”. Residents said that they could have a cooked breakfast if they wanted, and that they were always offered a choice at lunchtime. Some people said that they chose to have their meals in their own rooms rather than the dining room. Planned menus showed that a varied and healthy diet was provided. The cook said that, for those residents who needed to eat a pureed diet, each element of the meal was pureed separately so that its appearance and flavour was preserved. The inspector ate lunch with the residents in the dining room. The atmosphere was unhurried and residents said that they had enjoyed the meal. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 and 18 The home has a written complaints procedure, and residents feel that any concerns would be dealt with properly. Protection policies, and staff members’ understanding of adult protection, ensure that the home has the means to be able to respond appropriately to any suspicion or allegation of abuse. EVIDENCE: The home’s complaints procedure included a statement about the right of the complainant to report any concerns direct to the CSCI. Residents said that if they were unhappy about anything they would speak to one of the nurses. They felt that they would be listened to, and that their concerns would be dealt with properly. One resident said that he might complain to a CSCI inspector. Staff members understood their responsibilities in protection and whistle blowing. Since the last inspection, staff members had been asked to read and sign the adult protection and whistle blowing guidelines. The Acting Manager said that most staff members had watched a video covering these topics, and then completed an evaluation form to show that they had understood what their responsibilities were. This was confirmed by one of the staff members, and details were included in staff training records. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 15 RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19, 22, 25 and 26 Ongoing redecoration and refurbishment, the employment of maintenance and domestic staff, and the attention given to the promotion of good hygiene, have resulted in a clean, comfortable, satisfactorily maintained home for residents. EVIDENCE: A partial tour of the building was undertaken. Areas looked at were the lounges, dining rooms, and some bathrooms and toilets. The home is on two floors and it has 21 single bedrooms and 6 doubles. The garden at the side of the building is not enclosed. The home had been refused planning permission to erect a fence. The Acting Manager said that they were considering planting hedging so that residents could sit out in privacy and safety. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 17 The home was clean, comfortable and satisfactorily maintained. The home employs a maintenance worker, and the owner ensures that standards are maintained by arranging for ongoing redecoration and refurbishment. In order to keep up these standards, the Acting Manager was asked to arrange for the dining room carpet to be deep cleaned or replaced. The home was fitted with adaptations and equipment suited to the needs of the residents. These included grab rails, portable hoists, passenger lift, assisted baths, and nurse call. The call button in one of the lounges was tested. Staff responded quickly to it. Residents said that staff members always responded promptly to the nurse call. The home was warm and clean, and odour free. The two domestic assistants shared the domestic tasks. One said that there was a written cleaning schedule. Good hygiene is promoted in a number of ways including the use of protective clothing, and safe hand washing. All bathrooms, toilets, and bedrooms now have a supply of hygiene hand rub dispensers to reduce the risk of MRSA. Nursing staff carry their own portable dispensers. Although there are no concerns about hygiene practices in the home, it is recommended that care staff are given some training in infection control to enable them to increase their knowledge and understanding in this area. Residents were environment. satisfied with their bedrooms, and with the general Bedrooms were not inspected this time but there is an outstanding requirement from the last inspection in respect of bedroom door keys. The home needs to demonstrate that residents, subject to risk assessment, have been offered a key to their own bedroom. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Planned daytime staffing numbers are sufficient to meet service users personal and health needs but social needs do not receive as much attention as they should. Failure to carry out criminal records checks before allowing new staff members to start work potentially puts residents at risk. Staff are trained in relevant topics to provide them with the knowledge and skills that they need to meet the needs of the residents. EVIDENCE: Planned staffing numbers met minimum requirements. Rotas showed that a qualified nurse was on duty at all times and that, in addition to care staff, the home employed cooks, kitchen assistants, an administrator, and a maintenance worker. Some staff, residents, and relatives did not think that there were always enough staff on duty. One resident said that staff were very good but said, “They are often short staffed”. The District Nurse who provided written comments also felt that staffing levels could be improved. She said that she often had to hunt for staff, and that they were always busy. The Acting Manager said that cover was usually arranged for planned staff absences but when the absence was at short notice it was difficult to find cover. The owner needs to review the staffing situation. Evidence throughout this report suggests that, when fully staffed, the numbers are enough to attend to the health and personal care needs of the residents. However, evidence also suggests that social care needs are not receiving as much attention as they should. The home needs to allocate a number of dedicated hours each RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 19 week to activities provision to ensure that a range of individual and group activities are taking place each day. This could be done by recruiting a specialist activities worker, or by increasing care staff hours so that they have enough time to provide a good range of activities. During the last inspection, a requirement was made for the home’s staff recruitment checks to include health declarations, and recent photographs. This had been done in most cases. However, two new recruits had been allowed to start work without the required CRB (Criminal Records Bureau) disclosures and POVA (Protection of Vulnerable Adults) register checks. This potentially puts residents at risk. The home was required to take immediate action to address this. Staff members gave examples of some of the training that they had undertaken. These included moving and handling, fire safety, and health and safety. One person said that she had almost completed NVQ level 2. The training file contained individual training checklists and copies of certificates. These showed that some staff members had done training in other topics such as wound care. The home was using induction booklets for new recruits. The Acting Manager said that nursing staff acted as mentors for new recruits during their induction. The Acting Manager, and staff members, said that rotas were arranged so that experienced, skilled staff members worked alongside those with less experience. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and38 The Acting Manager is skilled and experienced but she needs to be given specified hours, within her working week, to enable her to carry out her management responsibilities. The home has introduced some methods to check out the quality of the service but needs to expand on this, and to report on the outcomes so that people will know that their views are being noted and acted upon. To ensure that the health and safety of residents and staff is fully promoted, a number of fire safety matters need attention EVIDENCE: Since the last inspection, the Registered Manager had left, and a successor had not yet been appointed. In the meantime, one of the nursing staff was covering as Acting Manager. She had worked in the home for a number of years and demonstrated that she had the skills and experience to take on the management role. However, she was still carrying out all her usual nursing RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 21 duties, and had not been given any supernumerary hours to enable her to complete the extra work that a manager is responsible for. This meant that she was taking paper work home. The owner needs to review the Acting Manager’s workload to ensure that she has a satisfactory number of supernumerary hours. The home had made some progress in respect of reviewing the quality of care. For example, in June 2004, questionnaires had been sent out to regular visitors to the home. Discussion took place with the Acting Manager about how to carry out a meaningful audit on the service. This should include finding out what residents, relatives, staff, and regular visitors, such as District Nurses, think about the quality of the home. This could be done by the use of anonymous questionnaires, and individual and group meetings, for example residents and relatives meetings. The owner and manager also need to carry out their own audit to see where improvements could be made. The outcomes need to be summarised into an annual report which includes the areas identified for improvement, and the action needed to carry out those improvements. A copy of the report should be supplied to the CSCI. A copy should also be available to residents, and others, so that they know that their comments are being listened to and acted upon. Examination of the fire book showed that alarms had not been tested every week. The Acting Manager was required to take immediate action to ensure that alarms are tested weekly. Several other safety records were checked. These included electrical installation, gas safety, servicing of passenger lift, servicing of portable hoists, portable appliance tests, servicing of fire extinguishers, and servicing of the nurse call system. The servicing of the nurse call system was overdue by a few days. Following the first inspection visit on 16th June, concerns were reported to the CSCI about the safety of the emergency lighting system, which had failed several weeks before, and about whether the fire doors on the first floor were safe. This prompted a second visit on July 4th, with Fire Safety Officers. On examining the ceiling lights, it was noted that the emergency lighting units were lying on the plastic covers and needed to be fastened to the bulkhead. However, some of the other concerns that were raised were not upheld - new batteries had been installed following the failure of the emergency lighting system, and fire doors on the first floor met with safety standards. Some certificates for the fire alarm and emergency lighting servicing included the statement “see checklist” but the owner of the home said that the she had not received the checklists. She was asked to try and locate them. The last service of the fire alarms took place on 17th May 2005, but the owner said that the emergency lighting service had not been done because of the problems with the old batteries. She said she had asked an engineer to visit to complete this service. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 22 Fire Safety Officers identified several other potential fire hazards, unconnected with the concerns referred to above. Details of these can be found in the “Statutory Requirements” section of this report. The Environmental Health Food Safety Officer visited the home on 24/1/04 and was satisfied with the catering arrangements. RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x 3 x x 3 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 2 x x x x 2 RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement The Service Users Guide needs some minor additions. (Timescale of 31 January 2005 not met) Care plans need updating and expanding to cover all current needs. Residents weights must be checked and recorded in line with their individual nutritional assessments. This must be at least monthly. The home needs to ensure that staffing levels allow for a daily programme of individual and group activities to be carried out. The dining room carpet needs deep cleaning. The home needs to ensure that, subject to risk assessment, residents are provided with a bedroom door key if they wish to have one. Bedrooms nust however be accessible to staff members in emergencies. (Timescale of 31 March 2005 not met) Criminal records checks must be completed for new staff members before they commence employment. Timescale for action 30 September 2005 31 August 2005 31 July 2005 2. 3. 7 8 15 12(1) 4. 12, 27 16(2)(m) (n) 18(1)(a) 16(2)(c) 12(4)(a) 31 October 2005 31 August 2005 31 August 2005 5. 6. 19 24 7. 29 19 Immediate RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 25 8. 31 12(1) 18(1) 9. 33 21,24 10. 11. 38 38 23(4) 16(1) 23(4) 12. 38 23(4) The Acting Manager must be allocated specified supernumerary hours to enable her to carry out her management responsibilities. When completed, the results of the quality monitoring exercise need to be summarised into a report. A copy of the report must be available to service users and to the CSCI. (Timescale of 31 March 2005 not met) Fire alarm tests must be carried out every week. The registered person must provide the CSCI with up to date certificates to show that the fire alarms, emergency lighting, and nurse call system have been serviced, and meet with safety requirements. The registered person must provide written information to the CSCI detailing what action has been taken to address the fire safety matters identified by the Fire Safety Officers on 4/7/05. These were: Attention is required to ensure that emergency lighting units are fixed to the bulkheads. The two end staircase enclosures must not be used for storage. The treatment room door must be kept locked. Vents in the lift motor room need to be re-set after the weekly fire alarm test. This must be recorded in a suitable log book. The doors to rooms 1 and 22 require maintenance to allow them to effectively self close onto their relocates. 31 July 2005 31 October 2005 Immediate 5 August 2005 31 July 2005 RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 26 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 19 26 Good Practice Recommendations The home is advised to continue to seek options for the provision of an enclosed garden area where people can safely sit out. Although the home promotes good hygiene practices, it is recommended that care staff be given training in infection control to enable them to increase their knowledge and understanding in this area. The home is advised to instigate regular residents and relatives meetings so that information can be exhanged, and opinions sought. 3. 33 RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton, BL6 6HG 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 RIVINGTON VIEW NURSING HOME F56 F06 S5695 Rivington View V215529 160605 Stage 4.doc Version 1.30 Page 28 - 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. 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