Inspection on 19/11/07 for Seven Rivers Cheshire Home

This inspection was carried out on 19th 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

Seven Rivers Cheshire Home 28/11/06

Seven Rivers Cheshire Home 02/02/06

Seven Rivers Cheshire Home 26/07/05

Seven Rivers Cheshire Home 03/02/05

Seven Rivers Cheshire Home 10/06/04

Seven Rivers Cheshire Home 04/02/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Seven Rivers Cheshire Home Hall Road Great Bromley Colchester Essex CO7 7TR Lead Inspector Gaynor Elvin Unannounced Inspection 19th November 2007 10:00 Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 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 Seven Rivers Cheshire Home DS0000015362.V355193.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 and Care Homes for Adults 18 – 65*. 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. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seven Rivers Cheshire Home Address Hall Road Great Bromley Colchester Essex CO7 7TR 01206 230345 01206 231011 severnrivers@east.leonard_cheshire.org.uk www.leonard-cheshire.org.uk Leonard Cheshire Disablility 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) Mrs Gillian Mary Sleightholm Care Home 28 Category(ies) of Physical disability (21), Physical disability over registration, with number 65 years of age (11) of places Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 18 years and over, who requiring nursing care by reason of a physical illness/disability (not to exceed 21 persons) People with a physical disability who may be aged over 65 years (not to exceed 11 persons) No more than five persons may attend the home on a daily basis in addition to those 28 accommodated 28th November 2006 Date of last inspection Brief Description of the Service: Seven Rivers is part of the Leonard Cheshire Foundation, now named Leonard Cheshire Disability, an international charity provider of services for disabled people. It is a care home registered to provide nursing and personal care to adults and older people who have a physical disability. The home originates as a Georgian style mansion and has a 1960s extension and a further extension built in the 1990s. The main house is a two-storey building with access to the upper floor provided by a passenger lift. Seven Rivers is located in the small rural village of Great Bromley, and stands back from the road in its own pleasant grounds, which includes a lake. The village is geographically central to the larger towns of Colchester and the seaside towns of Clacton on sea and Harwich. However public transport is minimal although a bus route runs past the home, which serves the surrounding villages. The local train station is in a neighbouring village of Gt Bentley approximately three miles away. The main house provides a flat for accommodating visitors for overnight stays and a flat for the volunteer over sea GAP students, a charity sponsoring volunteers’ stay in the UK for work experience. Fees are calculated depending on the needs of the resident and at the time of this inspection ranged from £701.86 to £1465.93. The fees are broken down into basic board and lodging fee and administrative charges and other costs relate to the nursing and care support given to each individual. Additional costs include hairdressing, chiropodist and personal items such as toiletries. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven hours during a weekday. Some of the residents are over the age of 65 years and the majority of the residents under 65 years have high long term and changing nursing needs. We therefore focused on the appropriate core standards and outcomes according to individual needs and the report format used is for Mixed Category, majority 18 – 65 years. This report has been written using accumulated evidence gathered prior to and during the inspection. Comment cards from residents, relatives and healthcare professionals were completed and returned to the Commission and views expressed are included within the contents of this report. The Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the self-assessment provided us with good detail to assist us in understanding how the registered persons understand the service’s strengths and weaknesses and where they will address these. The inspection process included reviewing the progress of the requirements made at the last inspection on 28th November 2006, and documents required under the Care Home Regulations. Additionally a number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. Time was spent talking to residents, relatives, the Registered Manager and staff. What the service does well: The standard of care at Seven Rivers is very good and the home promotes a warm and happy environment. Residents, their relatives and health professionals all expressed their praise for the care and support provided by the management and staff team. One GP commented ‘‘I find this home very well run and very professional in its approach. Staff seek advice and always have the residents’ best interests at the core of their approach’’, another GP commented ‘‘Staff provide a very professional and caring service to residents. I find them charming, helpful, enthusiastic and very caring’’. One healthcare professional involved with the home commented ‘‘I would like to see more homes like this one in Essex’’. Another commented ‘‘very high standards are maintained by this service’’ Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 6 Residents commented ‘Quality of life in the home is good and staff are friendly and helpful’ and ‘I always receive the care and support I need, staff always listen to me but will always do what is in my best interest. Staff are always available when you need them’. The home’s real strength is the relationships that the team have built up with the residents and their families, and the way in which the service creates a positive and stimulating lifestyle. The residents felt valued and respected. Relatives commented ‘‘Over the years the staff have looked after my relative extremely well and staff have kept his mind stimulated. The service has provided a good home – well done’’ and ‘‘the home provides exceptional care and caters to all needs and requirements’’ and ‘‘they care about the residents, my ……. feels she is living within an extended family. She is treated with kindness and very good care’’ and ‘‘the service supports people to live the life they choose to the fullest extent they can, the home is friendly, they are professional and have made a good home for our …..’’. What has improved since the last inspection? What they could do better: The service recognises there is always scope for improvement and the manager and staff demonstrate a positive and pro active approach and is encouraged to continue in good practice initiatives such as the Gold Standard Framework (GSF) for Palliative Care in Care Homes Programme to further develop the planning and provision of quality care. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 7 To improve outcomes for residents, the service must continue to develop the care planning system to address all needs and strengths in a person centred way and to include a good level of detail to understand how staff should support the resident according to their level of need and ability. They must also incorporate review and changing needs within the care planning arrangements, to enable regular and appropriate evaluation of the delivery of care. 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. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA2 and OP3 OP6 is not applicable to this service. Quality in this outcome area is good. The home gives care and attention to ensuring they only admit individuals whose entire assessed needs could be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussions with recently admitted residents, relatives and the care manager it was clear that the majority of residents’ needs were complex and highly dependent. Many admissions were from hospital and therefore introductory visits were not always possible but the opportunity is offered. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 10 One resident commented ‘‘ I was admitted at a time when I was unwell and unable to make decisions’’ another commented ‘‘ I was admitted from hospital, my family received all the information as I was unwell at that time’’. The manager had identified this issue within AQAA and future plans include further development of the Statement of Purpose, with the aid of current residents, to include photographs to reflect visually the services and facilities provided to give easy meaning and interest. Care Management assessments and reviews were in place that focused on immediate presenting nursing needs. A full assessment of needs was carried out by the home prior to admission. Both the manager and staff spoken with had a good knowledge of the individual needs of the residents. Training records reflected that staff have attended a range of training appropriate to the home’s stated purpose and the needs of the residents. The care manager and a nurse have an additional nursing qualification in palliative care to meet the end of life needs of residents. The home does not provide intermediate care; subsequently this standard is not applicable. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA 6, 7, 9 and OP 7, 14, 33. Quality in this outcome area is good. Residents were well supported in making choices and decisions with regard to their care and day to day living. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Manager has a care planning system in place that she has been developing over the last year. This was seen to have moved forward with more detailed recording and more reviews. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 12 We looked at three care plans and found that in general they were up to date and most needs identified on initial assessment had a care plan in place. Although desired outcomes were identified information was still limited about the level and type of support that was required of staff to achieve them. There remained scope for developing a more person centred approach to care planning, with greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. The care plans viewed did not reflect the social and emotional care elements of their needs, particularly for those residents who have higher nursing needs. The manager indicated that she was looking to involving care staff in the care planning process and developing the key worker system as it was recognised they had an important part to play in assessing, meeting and monitoring the social, emotional and psychological needs of the individuals The care-planning records did not fully evidence care and support provision, which overall is good. On the whole the care plans were regularly reviewed. The information recorded in the reviews did not always demonstrate if care-planning arrangements had been carried through and evaluated. For example it was not clear if counselling and anger management was sought or received for one resident with emotional difficulties. Another review indicated a weight gain of two stones but the care plan still provided instruction for the individual to have a high protein diet and nutritional supplements for poor appetite and underweight. Overall the feedback received from residents expressed satisfaction with the care they received and considered that they were able to make decisions about their lives and contribute to the decision making process with regards to meeting their care needs. Staff supported them and gave assistance where necessary. One healthcare professional commented ‘‘The home always supports individuals to live the life they choose, they will often be very flexible in supporting individuals with their ideas and will allow individuals as much freedom as possible, unless it is becoming unsafe for example the use of an electric chair. Many clients are on the borderline of maintaining independence and being safe but staff give extra support; and constant contact allows a more relaxed approach than in other homes’’. Another commented that ‘‘the service provides individualised care and meets all clients health and social care needs’’. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA12, 13, 15, 16 and OP10, 12, 13 and 15. Quality in this outcome area is good. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 14 The majority of residents benefit from social activities that are focused, well organised, creative and fun however the extent to which the activities meet the needs of the residents varies according to level of need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home views activities as being integral with care and enjoys the benefit of an innovative, creative and enthusiastic activities co-ordinator. The cook, staff, and local volunteers and the volunteer GAP students all contribute and provide additional support for the residents to undertake activities, promote social interaction and stimulate thought. Comments received from relatives included ‘the service supports people to live the life they choose to the fullest extent they can’’ and ‘‘the home is friendly, they provide activities well, they are professional and have made a good home for our mother’’. Social activities were focused, well organised, creative and fun; and provided stimulation and interest for everyone living in the home. Seven Rivers enhances the daily lives of the residents through the provision of stimulation and occupation according to their needs promoting well-being. The majority of residents meet each morning in the activities room; a smaller informal setting, where general chit chat, group discussion on current affairs and decision making with regard to day to day activities within the home, took place. Democratic decisions were made with regard to the choice and organisation of social events in and outside of the home. Residents enjoyed the planning, preparation and participation with family and friends, in large themed events put on in the home throughout the year. Resident feedback, in previous inspections, with regard to activities in the home has consistently been positive; and on each inspection the inspector has seen various television game shows recreated for resident participation and this inspection was no exception. It is not just participating in the game that provides the fun; the residents contribute to the planning and creation of the game show including the making of the props. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 15 We were advised that the activity department is virtually self funding except for staffing wages, the funds are raised by residents, relatives, staff and volunteers through table top sales, car boot sales and raffles. Routines are flexible and the staff try to arrange activities according to each individual’s needs and choices. Increasingly, people admitted to Seven Rivers are entering the end stages of a disease process and the main focus for the home is changing towards the provision of a service that delivers quality care to individuals with needs that are complex and highly dependant. Comments received from two residents ‘‘there are always activities arranged by the home but due to my inability am not able to partake in them’’ and ‘‘I take part in activities although due to nature of illness I am restricted’’ indicated that some residents experienced some difficulty in participating in the larger group activities, which could potentially lead to isolation and depression. The manager advised us that the need for the home to consider and explore alternative opportunities for stimulation and interaction more suited to individuals, with limited abilities, was recognised. Events were planned throughout the month of December in the lead up to Christmas, all of which friends and family were invited to participate. Relative comments and staff spoken with indicated that the service encouraged relatives to maintain an active role in the residents’ life following admission. Relatives informed us that they were warmly welcomed and kept informed about the resident. One relative commented that the home provides ‘‘a friendly atmosphere, always make visitors feel welcome and always organising activities and events’’ another commented ‘‘The home keeps us informed and we get letters informing us of any events we may attend ’’. Residents also benefit from their own computer and Email facilities for instant communication and contact with friends and relatives. Information provided in the AQAA advised that in the last 12 months five residents were supported to go on holiday – four to Norfolk and one to France. The AQAA identified that outings for residents could be improved by availability of staff or volunteers to assist. The home is currently looking to recruit a new volunteer co-ordinator whose role will include recruiting more volunteers and seek advocacy services for those residents with no family. The home has its own chapel and is available at any time. Two parishioners visit each Friday and hold a prayer meeting with a hymn, one of who can give Communion. Residents who spoke about the food described it as good. The resident committee meets with the chef to discuss menu planning and preferences. The menu provides a daily choice of two meals. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 16 Meals were observed to be of good proportion, nutritious and well balanced. The Inspector was provided with a meal of gammon steak, carrot and swede, mashed potato and gravy. The meal was hot and appetising. Assistance with eating was given to those residents with dignity and patience. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA18, 19, 20, 21 and OP8, 9, 10 and 11. Quality in this outcome area is good. People using this service receive care and support in a manner that promotes dignity and meets their physical and personal needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Interaction between the residents and staff was observed to be very respectful and supportive throughout the inspection. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 18 The residents clearly enjoy the company of the staff and spoke positively about them. One healthcare professional commented ‘‘the home communicates well, always acts on advice given, follows plans of care and very welcoming, individuals health care needs are always met’’. This healthcare professional indicated that the home could improve by the provision of in house physiotherapy to meet those needs for residents. The manager advised that she was looking into this issue as the home has the facilities that are currently not used. One resident commented ‘‘Staff listen to what I have to say but sometimes this is difficult for them as I have difficulty in speaking loud enough for people to hear. Due to communication difficulties it is not always possible to let staff know how I feel. Quality of life in the home is good and staff are friendly and helpful’’. The management identified in the AQAA that more one to one support for residents with communication difficulties would benefit those individuals. The manager has since made arrangements with the university for speech therapy students to have a 12 week placement at the home to gain experience working with people in a residential setting who have speech and swallowing difficulties related to long term chronic disease such as Multiple Sclerosis. This is a good practice initiative that is benefiting the residents. The manager said that this arrangement was working well and hopes it will continue. Residents’ health needs are met appropriately and well monitored. Prompt referrals are made to GP’s and relevant health professionals, where required, such as Specialist Nurses, Speech and Language therapist, dietician and physiotherapist. Feedback received by the Commission from the two local GP surgeries who attend the home indicated satisfaction with the care practice provided at Seven Rivers. They felt that individual’s health care needs are always met by the service; staff demonstrated a clear understanding of the care needs of the residents, always respect individuals privacy and dignity and support them to live the life they choose. One GP commented ‘‘ Staff provide a very professional and caring service to residents. Contact with Seven Rivers is through the nursing staff. I find them charming, helpful, enthusiastic and very caring’’ another GP commented ‘‘Excellent nursing staff, the staff have the right skills and experience and good insight into individuals social and healthcare needs. It is a very good home and I cannot think of any further improvements from a GPs point of view’’. A range of risk assessment tools was in use to identify actual or potential health risks, in relation to dependency level; mobility, continence, nutrition and skin viability, and these were seen to be generally up to date. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 19 Whilst the structure of assessment and risk assessments were in keeping with good practice, there was no indication in the care plans examined how useful or critical information obtained from the assessments informed the plan of care or how it related to the provision of care. This is particularly important for the client group who due to their chronic disease process have risk factors and changing needs related to immobility, loss of sensation, nutritional and continence needs. We noted that relevant information obtained from the assessments was not transferred into care planning arrangements. For example a significant high score indicating a very high risk for the potential to acquire a pressure sore did not have detailed care planning arrangements to guide care staff in reducing the risk, prevention, monitoring or management. The only information recorded was for the provision of pressure relieving aids such as an alternating air mattress and cushion. The home provides the necessary aids and equipment to support both staff and residents in daily living. All of the files sampled held pro forma statements consenting to the administration of medication by care staff. The pro forma did not provide adequate assessment information determining considered decisions taken or alternative strategies to care staff assuming control of medication. A risk assessment identified one individual’s personal issues in taking medication administered by staff. Staff left medication, as the resident would not take medication when given it. This is not in line with safe practice and the individual’s behaviour gave an indication of a wish to retain own control in taking medication. The choice and ability to self medicate with appropriate support arrangements should be explored with residents and this was an area for improvement identified by the registered manager and care manager in the homes AQAA. A good level of secure storage for both general and controlled drugs was provided in the medication room and medication was stored at the correct temperature. Registered nurses administered all medication. A quality assurance audit was undertaken monthly to look at the quality of recording by staff and accountability in the administration of medication and adherence to the homes policy. The audit looked at the medication administration record sheets (MARS). The care manager provides a record of all prescribed medication for residents, their side effects and contra indications for staff reference. Generic protocols for staff guidance on pain relief and constipation that identified conservative methods to be used before or in conjunction with medication management were held separately with the medication records. This practice detracts from personalised care and would best be recorded within individual care plans according to individuals assessed needs to guide all staff in tailored care delivery. Increasingly, people admitted to Seven Rivers are entering the end stages of a disease process and the main focus for the home is changing towards the Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 20 provision of a service that delivers quality care to individuals in their end stages of life. Seven Rivers have successfully achieved a place on the Gold Standard Framework (GSF) for Palliative Care in Care Homes Programme supported by local facilitators such as the National GSF team and others from the Department of Health End of Life Programme. The GSF programme is a 1 year long phased programme attending workshops and training events for improvements in care and sharing examples of good practice. The Gold Standard Framework identifies people in need of special care and provides a framework of clear, quality objectives in assessment and recording of needs and the planning and provision of care. The initial preparation is being carried out to commence early in 2008. This is a positive initiative to assess, evaluate and improve current practice and quality outcomes for service users and the Commission look forward to reviewing the progress achieved in the forthcoming inspection process. The management of Seven Rivers are currently preparing for the implementation of the Mental Capacity Act and the implications of, particularly in relation to supporting the individual in the decision making process with regard to end stages of life, another good practice initiative. The home aims to provide palliative care in the most dignified and comfortable manner and provides support to the family. The home has arrangements in place, which enable family and friends of the resident to stay and help with care, with the residents’ agreement. Staff support the family and the home’s other residents during the bereavement process. Compliment cards seen reflected relatives satisfaction with the care provided at the end of life for the individual and the support shown towards the relatives during this time. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA22, 23 and OP16, 18 and 35 Quality in this outcome area is good. People who use this service can be assured that satisfactory arrangements are in place to promote their protection from abuse and that any concerns they or their representatives may raise will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback from GPs and Specialist nurses who regularly visit Seven Rivers stated they had not received any complaints about the home and that they were satisfied with the overall care provided to the residents in the home. Those comments, received by the Commission, from residents and relatives stated that they were aware of the home’s complaints procedure but have not had any cause to complain. They felt comfortable to discuss any concerns with the management and felt they were always listened to. Resident’s meetings are held monthly, records of minutes indicated participation and good discussion around issues in the home and suggestions were acted upon. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 22 The CSCI had not received any complaints with regards to this service during the last twelve months. An Adult Protection policy and procedure, including Whistle Blowing, was in place, which ran in conjunction with Local policy and Department of Health ‘No Secrets’ guidelines. Records showed that staff had received training from Leonard Cheshire on issues relating to the protection of vulnerable adults. Staff were observed to interact with the residents appropriately and residents appeared relaxed and comfortable with the staff. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA 24, 30 and OP19, 26. Quality in this outcome area is adequate. People who use this service can expect to live in a homely, clean environment. This judgement has been made using available evidence including a visit to this service. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 24 EVIDENCE: Areas of the home inspected were clean and tidy and free from offensive odours. Despite the environmental problems due to the age and design of the main house, in general, the home is well maintained and suited to residents’ needs. The size and standard of accommodation varied considerably in different parts of the home, depending on whether the rooms were in the original building or in one of the newer extensions. Areas of the original building require upgrading. Whilst some bedrooms and communal areas have been re decorated and some re carpeted, the décor of the remainder of the home requires attention to improve outcomes for the residents and this should be incorporated into the refurbishment programme and budget. Woodwork is chipped and damaged from wheelchairs and re-decoration is required in corridors. Each room provided access to the call system with alternatives available for those persons unable to use the system. Varied aids were observed such as overhead tracking hoists, manual hoists, pressure relieving mattresses and monkey poles. The corridors had rails to assist mobility and toilets and bathrooms had appropriate rails and grab rails. A passenger lift provided access to the first floor. Following difficulties in maintaining the large expanse of grounds the home had recently recruited the help of two volunteers. The immediate grounds and pathway to the large lake were well maintained, attractive and accessible to wheelchair users and a programme of gardening work included the creation of flowerbeds and small gardens around the main buildings that are visible from inside the house. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA 32, 34 and 35 and OP 27, 28, 29 and 30. Quality in this outcome area is good. The homes robust recruitment and selection process and thorough induction and training programmes ensure an effective staff team to support and protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission received positive feedback from healthcare professionals, residents and relatives regarding the staff team. Residents indicated that the staff were caring, friendly and helpful, they always listen and do what is in the residents best interests. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 26 One GP commented ‘‘Staff provide a very professional and caring service to residents. Contact with Seven Rivers is through the nursing staff. I find them charming, helpful, enthusiastic and very caring’’. Another GP commented ‘Nursing staff are excellent. The staff have the right skills and experience and good insight into individuals social and healthcare needs’’. One healthcare professional who has an interest in the home commented ‘‘Staff have right skills and experience to support individuals and I give talks to staff on any knowledge gaps’’ and ‘‘the service provides flexibility for individuals needs and has an energetic team who work hard to make a happy home. The staff are reliable staff and interested in their clients’’. Another commented ‘‘staff appear trained to a high standard and have the right skills and experience’’. One resident commented ‘‘the staff always treat me well, they are always very nice, helpful and friendly and I am very happy’’. We reviewed the recruitment procedures at the home and found that they remain robust and that all required staff checks and documentation is in place to help ensure suitable staff are appointed for the job. Opportunities were offered to residents to participate in the recruitment process of prospective new staff. All new staff commenced the Leonard Cheshire Induction and Foundation programme and this was in line with Skills for Care requirements and the learner log matched up with the Skills for Care Common Induction & Foundation Standards. This incorporates a competency-based element to the training to ensure new staff fully understand the way in which the service is required to support the residents. The home has a training programme in place and uses the services of the organisation’s training department to move the programme forward. The training and development matrix showed that the majority of staff had received training in mandatory areas such as Health & Safety, Infection Control, Food Hygiene, First Aid, Fire Safety Awareness, Moving and Handling and Protection of Vulnerable Adults, and refresher courses have been undertaken within adequate timescales. The Leonard Cheshire foundation provides training pertinent to the needs of the residents relating to disability, diversity and equality and courses titled ‘Disability and the Law’ and ‘Disabled and You’ had either been or were being accessed by all employed staff. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 27 The service had achieved more than the minimum recommended proportion of care staff having attained an NVQ qualification in care at level 2, ensuring a competent staff team to support the residents. A previous requirement relating to the service developing and increasing its supervisory arrangements for staff had been addressed. Records inspected demonstrated that staff received supervision on a regular basis and in various forms. This included one to one practical working that provided staff with hands on support and direction in their care delivery. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA 37, 39, 42 and OP 31, 33, 35 and 38 Quality in this outcome area is good. The home is efficiently and professionally managed and run in the best interests of the people who use the service. This judgement has been made using available evidence including a visit to this service. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 29 EVIDENCE: Mrs Sleightholm, the Registered Manager, maintains an open and transparent relationship with staff and residents. The Care manager assists her and together they provide a clear sense of leadership and direction. They continue to demonstrate a positive and pro-active attitude towards the development of the home and care outcomes for the residents. All the comment cards received by the Commission from residents, relatives and healthcare professionals indicated overall satisfaction with the service provided. Discussions with staff indicated that they felt they received appropriate guidance and support from the Registered Manager. Staff and residents spoken with felt the Manager was approachable and supportive. Resident consultation is promoted through regular resident meetings. The home was progressing in developing its quality assurance and monitoring systems to provide sufficient evidence to demonstrate an open and analytical review of the care and support currently provided at Seven Rivers. The home had progressed with various internal quality audits being undertaken to identify weaknesses as well as strengths in service provision. This informed action plans for improvement in outcomes for residents. Future plans included reviewing and improving social care for the frailer resident with high nursing and dependency needs. The AQAA was returned to us by the date it was requested. All sections were completed and the document contained clear, relevant information that is supported by evidence seen during the inspection. The AQAA clearly indicated that the manager was aware of the areas that they still needed to make improvements and that they were going to address these. The home works to a clear health and safety policy and health and safety practice is well managed in the home and at a regional level and adequate training in this area is provided to staff. Assessments of risk relating to safe working practice were evident and all maintenance and service agreements were carried out and in date. People who use the service are supported to manage their own money where possible, and where this is not possible appropriate safeguards are in place such as Court of Protection. Records relating to the safekeeping of personal finances were in good order. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 3 40 X 41 X 42 3 43 X 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Seven Rivers Cheshire Home Score 3 2 3 3 DS0000015362.V355193.R01.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations More work needs to be completed on the social and emotional care elements of care planning, particularly for those with high nursing and dependency needs. There remains scope for developing a more person centred approach to care planning, with greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. Keeping all parts of the home in a reasonable state of decoration will improve outcomes for residents. 2. YA24 Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI. Seven Rivers Cheshire Home DS0000015362.V355193.R01.S.doc Version 5.2 Page 33 - 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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