Inspection on 28/11/06 for Seven Rivers Cheshire Home

This inspection was carried out on 28th November 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seven Rivers Cheshire Home 19/11/07

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 28th November 2006 10:00 Seven Rivers Cheshire Home DS0000015362.V326684.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.V326684.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.V326684.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 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.V326684.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 2nd February 2006 Date of last inspection Brief Description of the Service: Seven Rivers is part of the Leonard Cheshire Foundation, 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, 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. Gt Bromley village has a local shop and public house. The home is set in large well-maintained grounds. The main house provides a flat for accommodating visitors for overnight stays and a flat for volunteer over sea GAP students Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days, 28th November and 12th December 2006. Six of the residents are over the age of 65 years and the majority of the residents under 65 years had high long term and changing nursing needs. It was therefore agreed the inspection would consider appropriate outcomes according to individual needs and the report format used would be for Mixed Category, majority 18 – 65 years. All of the Key National Minimum Standards (NMS) for Young Adults and for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The inspection process included reviewing documents required under the Care Home Regulations. 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 the Registered Manager, the Care Manager, the training co-ordinator, the activity co-ordinator, staff and residents. This report has been written using accumulated evidence gathered prior to and during the inspection. Comment cards from 8 residents, 2 relatives of residents, 2 GPs and 2 Specialist Nurses were completed and returned to the Commission and views expressed are included within the contents of this report. What the service does well: What has improved since the last inspection? Training opportunities provided to staff have improved. Four care staff have almost completed a National Vocational Qualification (NVQ) level 2 in Care, which will mean that the home will have exceeded the required target of carers having attained the required qualification by 16 . The majority of carers have been trained in mandatory areas. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 7 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.V326684.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4 & 5 (Young Adults) and 1, 2, 3, 4, & 5 (Older People). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates a thorough pre-admission process, giving care and attention to ensuring the home is admitting individuals whose entire assessed needs could be fully met. The home promotes the opportunity to visit the home as an essential part of the admission process. Prospective service users are provided with all the information required to enable them to make a fully informed choice about where to live. Contracts and statement of terms and conditions were in place but did not include relevant individualised information relating to fees and nursing contributions in line with regulatory requirements. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose was not reviewed on this occasion as it was assessed as meeting with regulatory requirements at the previous inspection, providing important and relevant information about Seven Rivers to current and prospective residents. This document, the latest inspection report and other relevant information were freely available to visitors and residents in the waiting area of the entrance hall of Seven Rivers. From discussions with recently admitted residents and their relatives and the care manager it was clear that the majority of resident’s needs were complex and highly dependant. Many admissions were from hospital and therefore introductory visits were not always possible but the opportunity is offered. Care Management assessments and reviews were in place and noted to be nurse led, focusing on nursing needs. A full holistic needs assessment was carried out by the home prior to admission. One new resident and their relative spoken with expressed satisfaction with the way the admission process was managed and indicated the level of care received from the service was a positive improvement to the care previously received in hospital. Clear information was given verbally to the family. Comments received from another resident stated they had ‘ been at Seven Rivers for three years, just like a big family, staff always friendly and happy, want for nothing, all needs taken care of, I wouldn’t want to be anywhere else’. Resident files examined contained Individual Placement Contracts. The most recent contracts with Suffolk County Council identified fees assessed relating to nursing within the Individual Care Programme contributed by the Primary Care Trust. The manager was advised that, where applicable, the breakdown of fees payable in relation to the services provided; reflecting the nursing contribution to which part of the fee relates, and the arrangements in place for charging and payment by or in respect of the resident, is required to be included within the individual contract and statement of terms and conditions agreed between the home and the resident; and a copy provided to the resident. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 10 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): 6, 7 & 9 (Young Adults) and 7,14 & 33 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not person centred and do not contain detailed information of the planned care for staff to follow ensuring a consistent and structured delivery of care to meet assessed needs. Residents considered they were well supported in making choices and decisions with regard to their care and day to day living. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans continue to lack a detailed approach to desired objectives and were not adequate to provide sufficient direction for carers. A sample of three care files was examined. Each care plan contained an assessment of needs based on the Activity of Daily Living model, which was suited to the client group, identifying needs holistically. The care plans reflected identified needs and required outcomes but they were still brief on methodology, for example the identified ‘need’ in one care plan stated ‘a low Water low score’ (a tool used to identify actual or potential risk for pressure sores) and ‘severely malnourished’, the action recorded to meet the identified needs stated ‘ to promote weight gain’ and ‘protect skin’. Another care plan identified nutrition as a need for one individual who had lost a lot of weight prior to admission to the home, the action recorded to meet the need stated ‘ cut up food’, ‘maintain weight’ and ‘encourage fluids’. The care planning arrangements did not give any indication of the type; frequency or method of care/support required and was more reflective of task related outcome. The care plans continue to have little indication of a ‘person centred’ approach to planning and the care management system was not adequately developed to enable, for example, a new member of staff or an agency staff to be sufficiently confident to deliver safe and appropriate care; including guidance to provide care in the most supportive and consistent manner. Care plans examined did not reflect appropriate management to promote safety and optimal independence, or provide guidance for staff in the level or type of support the resident required, particularly important with regard to varying levels of mobility the client group experience. For example, one plan identified mobility as a ‘need’, the individual was noted to be in a wheelchair, the action to be taken by staff stated ‘maintain mobility, support with 2 carers’. Further information was recorded under ‘continued evaluation’ giving further guidance to staff - ‘ prompt to use frame and encourage to walk to dining room each morning’. Potential or actual risk identified to skin integrity was not generated into a proactive management strategy within the care planning arrangements, for the prevention, detection, management or monitoring of pressure damage. Two of the three care files examined indicated that the individuals had pressure sores. The daily record for one stated a density mattress was in place and that a pressure mattress may be required and therefore for staff to monitor, another daily record stated the individual had a grade II pressure sore. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 12 Another care plan identified the individual to be at risk of pressure damage, the action to be taken by staff stated ‘change position’ and ‘Alpha Excel mattress in place’. Some relevant detailed information relating to current care needs, changing needs and care practice was noted under the headings ‘evaluation’ and ‘daily reports’. This information would be of further benefit if set out within structured care-planning arrangements. For example communication and short-term memory loss were identified needs for one resident, the action required of staff (methodology) was to listen and give time to express herself. Additional information detailing this individuals communication needs and the action required of staff to appropriately and consistently address those needs was recorded under ‘evaluation’ and could easily be missed. Evaluation records and daily reports would best be used as a source of evidence to show that care is being provided, as detailed within the care planning arrangements and that staff are following the guidelines within the care plan. It is in the homes best interests to be able to show what they are doing, along with providing evidence on which to base the monthly review and to record that they are following the assessments of need. The care plans seen did not provide with appropriate guidance to good practice and did not demonstrate or fully evidence the care being provided, which overall was good. 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. Seven Rivers Cheshire Home DS0000015362.V326684.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): 11, 12, 13, 14, 15, 16 & 17 (Young Adults), 10,12,13 & 15 (Older People). Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 14 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. Visiting arrangements were open and relaxed and staff welcomed relatives to the home. The home supplied sufficient quantity and quality of food and provided a well balanced diet that met individual needs and choices. 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, GAP students and volunteers all contribute and provide additional support for the residents to undertake activities, promote social interaction and stimulate thought. One resident commented ‘staff go out of their way to make life as comfortable and fun as possible, the carers are dedicated and they build relationships with residents and their relatives’. Residents and staff spoke highly of the GAP students and the contribution they made to the home. When they were informed that Leonard Cheshire was no longer able to continue funding the students, the residents made a unanimous decision to continue funding the students from their Leonard Cheshire service user group allocation from region. 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. One resident said the activity opportunities within the home were great and the activity coordinator is always enthusiastic and open to ideas, which he will always endeavour to pursue. Another commented they had participated in ‘Barbeques, sing-along, quiz nights and visits to the beach hut, the staff are always finding ways to keep us all occupied.’ Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 15 The care manager advised that residents were provided with the opportunity for holidays and short breaks; this summer one resident went on an exchange holiday to another Leonard Cheshire establishment, three resident’s stayed in a rented bungalow in Kent and two went on a sailing trip. Craft works created by some residents were entered into a competition at Hovendon. The inspector was impressed by the innovative production of the Seven Rivers edition of the board game Monopoly. The edition was created from an idea given by a resident. Landmarks and places of interest were based on areas in and around the home, chance cards and community chest cards were in large print and the dice were large and soft for easy handling. 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. The popular TV game show ‘Deal on Deal’ was the current project. 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. The inspection took place just before Christmas and the home was a hive of activity. The staff were preparing to present 50 years of the Eurovision Song Contest to the residents and the residents were preparing to present their pantomime to staff, relatives and visitors – ‘Sleeping Beauties’. The second day of the inspection took place during the homes pre Christmas celebrations, residents enjoyed a Christmas dinner with their guests and this was followed by entertainment provided by a local stage school performing and singing many Christmas favourites. The event was very well received and the visitors gave excellent positive comments. Events were planned throughout the month of December in the lead up to Christmas. Careful consideration had been taken to assign a key worker of same gender and age to one younger resident to support and promote peer and age appropriate leisure interests such as football, cinema and music. The local vicar holds Church of England services on each Friday morning in the homes’ chapel and the Roman Catholic Priest visits fortnightly. The chapel is inter-denominational and is available to everyone at any time. Daily routines and activities are arranged according to each individual’s needs and choices. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 16 Residents who spoke about the food described it as good. Meals were observed to be of good proportion, nutritious and well balanced. Assistance was given with dignity and patience. The inspector was advised that guidance and advice had been sought from the dietician with regard to specialist diets. Those residents unable to eat and received their dietary intake through other methods, met together in the sitting room at meal times to participate in other activities. Seven Rivers Cheshire Home DS0000015362.V326684.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): 18, 19, 20 & 21 (Young Adults) and 8, 9 & 10 (Older People). Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Staff engaged positively with each individual and demonstrated a good understanding of the residents they were supporting. Personal care is offered to residents in a sensitive and unobtrusive manner. The health needs of the residents were met and supported by good multi disciplinary team working. Policies and procedures for medication management were adhered to ensuring the safe administration of medication to residents. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 18 EVIDENCE: The care plans examined contained a drawn and coloured illustration of the individuals ‘circle of life’ giving a visual cue of how time is spent each day over a 24 hour period, indicating preferences for going to bed, getting up, mealtimes, rest and leisure times. Interaction between the service users and staff was observed to be very respectful and supportive throughout the inspection The service users clearly enjoy the company of the staff and spoke positively about them. Residents’ health needs are met appropriately and well monitored and 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 staff demonstrated a clear understanding of the care needs of the residents and took appropriate decisions when no longer able to meet a residents needs, medication was appropriately managed and specialist advice is received and acted upon. One GP stated that Seven Rivers ‘staff provide an excellent level of care’, another GP commented,’ Seven Rivers is an excellent home with a happy atmosphere, the patients are well cared for and the staff are excellent’. Comments from one resident stated that ‘ the care at Seven Rivers is impeccable and second to none- and this was highlighted by a recent spell in an NHS hospital where general care was negligent’. Feedback from the Nurse Lead in Continuing Care stated that the home ‘provide a high standard of care for clients and find the staff helpful and polite with a good knowledge of their clients’. The nurse also stated that no complaints had been received, the medication was appropriately managed and specialist advice was incorporated in the care plans. The Specialist Nurse in Multiple Sclerosis also stated that they had never received a complaint about the home, expressed satisfaction with the overall care provided and that staff have clear understanding of residents needs. Feedback from one resident stated ‘ I have Parkinson’s – specialist care and review is difficult to access but this is not due to Seven Rivers’. The care manager advised that the home does experience difficulty in accessing the Specialist Nurse for Parkinson’s, which is in contrast to the excellent support Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 19 received from the Specialist Nurses in Multiple Sclerosis and Epilepsy. The care manager also advised that due to the homes location and only two local surgeries the home experiences difficulty in residents choosing their own GP, only one surgery provides continuing care although home has been working closely with the other to maintain continuity with a named GP. Risk assessment tools regarding identifying actual or potential health risks, in relation to dependency level; mobility, continence, nutrition and skin viability were undertaken and evident within the residents files. 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. (See outcomes for Individual Needs.) Equipment for the prevention of pressure ulcers was observed in use throughout the home. The care plans examined were particularly brief in emotional and psychological support and health care needs such as diabetes, epilepsy and pain management arrangements. Registered nurses administered medication, based upon the sample of records inspected the receipt, administration, storage, security and disposal of medication was found to meet National Minimum Standards. The homes policies and protocols relating to medication were held in a folder, which also contained the medication administration records (MARs). The care manager had recently implemented an audit system to review the administration records every two months; shortfalls highlighted were immediately addressed with the appropriate member of staff. 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. The care plans identified medication prescribed and in some cases potential side effects and adverse reactions related to the medication being administered. In one instance care planning arrangements lacked sufficient detail for care staff to provide appropriate monitoring and management with regard to possible identified side effects and adverse reactions. It was noted that specific medication for one individual did have a potential risk and information relating to this was recorded in the daily report and was not reflected within a detailed methodology for the delivery of planned care for all staff to follow. Care management details were insufficient and uninformative stating, ‘medication to be administered by registered nurses and signed for Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 20 when given, awareness of side effects and pass information to carers’. The lack of detailed recorded care planning arrangements reduces the delivery of consistent and appropriate agreed care and could potentially place residents at risk. It was noted that the majority of residents had current and changing needs relating to a debilitating neurological disease process. In the sample of care plans examined, although the residents were on prescribed pain killers or received other methods of pain relief the plans did not reflect pain as an assessed need or detail these or other conservative methods of pain relief within care planning arrangements, to guide staff, such as positioning, relaxation or physiotherapy. 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 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 in April 2007. 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 in April 2007 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. Seven Rivers Cheshire Home DS0000015362.V326684.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): 22 & 23 (Young adults) and 16, 18 & 35 (Older People). Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a comprehensive and accessible complaints and adult protection policy and procedure. 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 stated that they have not had any cause to complain, and although they indicated a low awareness of the complaints procedure felt comfortable to discuss any concerns with the management and felt they were listened to. Residents 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.V326684.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. The homes complaints record was examined and one resident had brought a complaint to the attention of the management. The complaint was managed appropriately, according to procedure and to the satisfaction of the complainant. Records demonstrated details of complaint, investigation, outcome, action to be taken and recommendation for future practice. 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. Progress had been made in the arrangements for adult protection. Since the last inspection the home has demonstrated a responsible and proactive approach in protecting vulnerable adults following Local policy guidelines, working in partnership with the Local Authority and other multi professional agencies, within an agreed structured strategy, to address an allegation of abuse. Following extensive investigation the allegation was not upheld. Seven Rivers Cheshire Home DS0000015362.V326684.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): 24, 29, 30 (Young Adults) and 19 & 26 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The old age of the main building of Seven Rivers affects the ability of the home to provide a completely suitable environment with regard to the accessibility of the bedrooms on the first floor of the main house. The home provides a safe, well-maintained environment that is accessible to the residents, homely and meets individual assessed needs. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 24 Areas of the home inspected were clean and tidy and free from offensive odours. Specialist equipment and aids were available to promote optimum independence and well-being. Rooms clearly presented individuality with personal possessions and photographs around them. EVIDENCE: The home created a comfortable and homely ambience and areas seen were cleaned to a high standard. 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. Leonard Cheshire continues to invest in the ongoing repair and maintenance of the building, currently attention to the leaking roof. The residents were informed through the residents meeting that only essential maintenance will be carried out due to financial constraints, although it was hoped redecoration to some bedrooms will be carried out in the winter months. 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. 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. The grounds were well maintained, attractive and accessible to the residents. Seven Rivers Cheshire Home DS0000015362.V326684.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): 32, 33, 34, 35 & 36 (Young Adults) and 27, 28, 29, 30 & 36 (Older People). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff was adequate to meet resident’s needs. Staff training is provided in a planned way, to ensure understanding, knowledge and skills are provided for to meet the general and specialised needs of the residents. The residents were protected by the homes recruitment procedures. A stronger emphasis on formal recorded supervisions is required to enable staff to reflect and develop own practice and have a stronger link to care practice issues. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 26 EVIDENCE: The inspector was advised that the home currently had a full compliment of staff and that there were no staff vacancies. The staff rota indicated the home was staffed by 2 registered nurses and 9 care staff am and 2 registered nurses and 6 care staff pm. A monitoring visit report received by the Commission indicated that due to difficulty in recruiting domestic staff a trial of new working was implemented during August to enable care staff to include domestic tasks within their duty and cover the domestic vacancy. Although staffing levels appeared adequate on the day of the inspection, there was no evidence available to confirm how the staff ratio was calculated. The inspector was advised that staff ratio was worked out on Leonard Cheshire’s individual placement costing according to the residents assessed needs. A calculation in this way does not take into consideration time required for training, annual leave and other non-care tasks the staff have to undertake. Since the last inspection the service had achieved the minimum required proportion of carers having attained an NVQ qualification in care at level 2, ensuring a competent staff team to support the residents. The training and development matrix indicated that four members of staff were nearing completion and this would bring the total of NVQ assessed and competent staff to 66 . The matrix also indicated 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. In response to a recommendation made at the last inspection staff had received a short training awareness in bereavement provided by the CO-OP. Whilst this level of training is satisfactory as an introductory level of training to support staff in provision of care, further development is required in the programme to ensure that the basic level of training is complimented by further initiatives. Particularly with regard to palliative care, emotional support grief and loss. 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.V326684.R01.S.doc Version 5.2 Page 27 It was disappointing to note that the training co-ordinator had been advised that due to financial restraints non-statutory mandatory training was currently suspended. A sample of staff files were examined, and although disorganised, all files contained details and documentation, relating to the staff member, required by regulation. The files included a statement of confirmation of satisfactory Criminal Record Bureau disclosure received for each member of staff by the centralised HR department. There was no documentary evidence that the Registered Manager had actually seen the disclosure. 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. Recorded formal supervision was provided albeit infrequently. The sample of four staff files examined provided documentary evidence of only two or three recorded formal supervisions carried out in the last eleven months. The care manager felt there was an improvement in recognising supervision as a valuable process and also accepts that the process should be carried out more frequently. The supervisory process incorporated the supervisors’ agenda and the staff member was invited to bring any issues or concerns to the meeting. The agendas were discussed but noted to be limited and not reflective of practice or competence. Other forms of supervision were discussed which could be incorporated into the process to stimulate interest and enthusiasm, provide additional topics for agenda and promote development and competence, all with equal benefit but are required to be recorded. The care manager said she would address this. Seven Rivers Cheshire Home DS0000015362.V326684.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): 37, 39, 42 (Young Adults) and 31, 33, 35 & 38 (older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 29 EVIDENCE: Mrs Sleightholm maintains an open and transparent relationship with staff and residents and provides a clear sense of leadership and direction. All the comment cards received by the Commission from residents, relatives and healthcare professionals indicated overall satisfaction with the service provided. The manager continues to demonstrate a positive and pro-active attitude towards the development of the home and care outcomes for the residents. 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. There was no indication that the homes quality assurance system had been further developed since the last inspection visit. Quality monitoring and assessment specific to the homes on going care provision was not yet developed. Residents were previously provided with questionnaires but these had not been used to inform a cycle of planning- action – review in respect of the service delivered and care outcomes for residents. An open and analytical review of the service is required to ensure continuing improvement. The inspector was advised that the Registered Manager was currently working on a quality assurance self assessment system, developed by and for Leonard Cheshire. 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. Risk assessments with regard to moving and handling recorded appropriate measures to be taken to reduce the risk particularly in relation to using a hoist such as, carry out an individual moving and handling assessment, staff to be trained in moving and handling, weekly checks to be carried out on the condition of the slings, regular hoist servicing and ensure emergency lowering buttons in place and working. The service pre inspection questionnaire indicated that all maintenance and service agreements were carried out and in date. Seven Rivers Cheshire Home DS0000015362.V326684.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 3 2 3 3 3 4 3 5 2 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 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 3 43 X 1 3 X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Seven Rivers Cheshire Home Score 3 3 3 3 DS0000015362.V326684.R01.S.doc Version 5.2 Page 31 Yes 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 YA5 OP2 Regulation 5A (1),(2), (3),(4), (5). 5B(1),(2), (3),(4) Requirement 5A(2) The registered person shall provide to each service user a statement specifyinga) the fees payable by or in respect of the service user for the provision to the service user of any of the following servicesi) accommodation, including the provision of food; ii) nursing; and iii) personal care, and except where a single fee is payable for those services, the services to which each fee relates; b) the method of payment of the fees and the person or persons by whom the fee is payable. 5A(4) And as to whether a nursing contribution is to be paid in respect of nursing provided at the care home to the service user Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 32 Timescale for action 01/03/07 2. YA6 OP7 15 Schedule 3 (1)(b) 5A(5) Where a nursing contribution is paid in respect of nursing provided at the care home to the service user, the registered person shall provide to the service user a statement specifyinga) the date of payment and the amount of the nursing contribution. The Registered Manager must 01/03/07 ensure individual care plans reflect all assessed needs including emotional and psychological health needs and detail all information required for care staff to give appropriate support and consistency. Repeat requirement not met within given timescale October 2005 and May 2006. The Registered Manager must 01/03/07 ensure staff receive regular, recorded covering all elements of the supervision process. Repeat requirement not met within previous given timescale May 2006. The Registered Manager must 01/04/07 continue to develop an effective quality assurance and monitoring system to measure the homes success in achieving the homes aims and objectives, meet individuals needs and inform practice. Repeat requirement not met within given timescale, October 2005 and July 2006. 3. YA36 12,18 4. YA39 24 Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 33 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 OP27 YA33 Good Practice Recommendations The registered manager should demonstrate that ratios of care staff are determined according to the assessed needs of residents, and a system operated for calculating staff numbers as required to include staff training and supervision requirements and annual leave, in accordance with guidance recommended by the Department of Health. Seven Rivers Cheshire Home DS0000015362.V326684.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Colchester Local Office 1st Floor, 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.V326684.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!