Inspection on 02/05/07 for The Riseborough Care Home

This inspection was carried out on 2nd May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Riseborough Care Home 04/02/08

The Riseborough Care Home 30/10/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Riseborough Care Home (The) 11-13 Branksome Wood Road Bournemouth Dorset BH2 6BT Lead Inspector Carole Payne Unannounced Inspection 2nd & 3rd May 2007 08:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riseborough Care Home (The) Address 11-13 Branksome Wood Road Bournemouth Dorset BH2 6BT 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) 01202 318567 01202 318568 the.riseborough@fshc.co.uk Four Seasons (No 7) Limited Care Home 74 Category(ies) of Old age, not falling within any other category registration, with number (74) of places Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 43 service users in need of nursing care may be accommodated. The home may accommodate two service users for respite care in the age range of 40-64 years to receive either nursing or residential care. The home may accommodate two service users in the age range of 40-64 years to receive either nursing or residential care. 5th January 2007 Date of last inspection Brief Description of the Service: The Riseborough is situated in a pleasant residential area of Bournemouth not far from the town centre. At the top of the driveway, there is a parking area and to the side and rear of the home are mature gardens that are well maintained. The home is owned by Four Seasons (No 7) Limited. There is currently no registered manager of the service. Accommodation is provided over three floors, which are accessible, by either stairs or passenger lift. All rooms in the home have en suite facilities. There are several lounges and a pleasant dining room, a small chapel and hairdressing facilities. The fee range is £450 to £800. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_peop le_choos.aspx Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 2nd and 3rd May 2007 and took a total of 18 hours, including time spent in planning the visit. The representatives of the Commission for Social Care Inspection, Judith Bracewell, regulation manager, Carole Payne, regulation inspector and Christine Main, pharmacist inspector were made to feel welcome in the home during the visit. This was a statutory inspection and was carried out to ensure that the fifty-one residents who are living at The Riseborough are safe and properly cared for. Requirements and recommendations made as a result of the last inspection in January 2007 were reviewed. Visits were made to the home both during the day and in the evening, to see the daily routine. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with eleven people living in the home and fourteen staff members on duty. Throughout the inspection and following the visit the management and staff team demonstrated a positive and proactive commitment to addressing any issues raised and improving the quality of life for people living at The Riseborough. What the service does well: What has improved since the last inspection? The complaints policy now includes the address and telephone number of the local office of the Commission for Social Care Inspection. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 6 What they could do better: Assessments should be signed and dated, providing clear details regarding the time that the assessment was carried out and the competency of the person completing the assessment, assuring people moving into the home that their needs can be met. A plan must be prepared which reflects the current and changing needs of service users. Care plans for the management of diabetes need to contain sufficient information for care staff to safely manage residents’ healthcare needs. Risk assessment and care plans must inform the delivery of safe care to residents at risk of choking, protecting them from the risk of harm. The risk of pressure sores and falls must be minimised by the healthcare provided to people living in the home. Continence care and support provided to service users must be fully recorded to ensure that residents’ healthcare needs are monitored, identified and responded to. Drinks must be available at all times to residents. Where necessary, from risk assessment, fluid intake must be monitored. Where fluid intake is reduced appropriate action must be taken, including consultation with external healthcare professionals. Nurses must be more vigilant about correctly administering and recording medication to protect residents, and the registered person must ensure that this is regularly monitored to ensure that medicines are given as prescribed to meet their healthcare needs. Residents must be consulted about their social interests, and arrangements made to enable them to engage in local, social and community activities, enabling them to experience a varied and interesting quality of life, reflecting their choices and preferences. Choices and control for residents over their daily lives could be increased by improvements in staffing levels and the range of opportunities available to residents. It is recommended that the home obtain a small fridge for the residential unit so that milk and snacks can be maintained for anyone requesting such out of normal kitchen hours. Residents must receive adequate quantities of suitable, wholesome and nutritious food, which is varied, appetising and meets with their expectations. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 7 A structural engineer’s report must be provided in relation to the slope of the main lounge, ensuring that residents’ are kept safe. The home must be maintained in a satisfactory state of cleanliness and good hygiene at all times, providing residents with a clean and pleasant environment to live in. A plan for the updating and redecoration of the home must be submitted, ensuring that residents are provided with the standard of environment, which meets with their expectations and preferences. Residents’ laundry must be cared for according to individual washing instructions and returned to the residents’ to whom it belongs. Audible call alarms in all parts of the home must be installed so that staff members are able to respond to residents’ needs. Satisfactory levels of Registered nurses, care and domestic staff and laundry assistants must be maintained to meet the needs of residents living in the home. Staff members must receive training appropriate to the work that they are to perform. When paramedics arrive at the home, they must receive immediate entrance and appropriate details regarding the condition of the resident to enable them to respond to people’s urgent needs. Staff members must receive induction training, so that they are suitably skilled to meet the needs of people living in the home. From the home’s summary record of training all staff must be updated in mandatory areas of safe working practice, so that they are suitably skilled to care for people living in the home. The home should obtain information on mandatory training in a variety of languages commensurate with the ethnicity of staff. Fire drills should increase in regularity until a consistent and appropriate response level is attained. All members of staff must receive training in first aid, to include basic life support, so that they are able to respond to residents’ needs in an emergency situation. The home must ensure that they obtain and use approved equipment for blood sampling urgently to protect residents and staff from infection. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 8 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. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Thorough assessments are completed to ensure that the home is able to meet prospective residents’ needs. However not all assessments are signed and dated, providing clear details regarding the time that the assessment was carried out and the name of the person completing the assessment. EVIDENCE: Three pre-admission assessments that had been completed prior to residents moving in contained sufficient detail regarding prospective residents physical, social and psychological needs, including their choices and preferences, enabling the home to make a decision as to whether it was able to meet people’s needs. Two assessments had not been signed and dated by the person completing the assessment. Where relevant, there was information Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 11 from other health and social care professionals, supporting the person carrying out the assessment to assure residents that their needs could be met. One resident who had recently moved in said that they felt settled and had been made very welcome. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some individual plans of care fail to inform staff members of residents’ current and changing needs, placing residents at risk of harm. Care records, including monitoring of care needs, do not demonstrate that residents’ healthcare needs are fully met. The home has systems for managing resident’s medication but procedures for administering and recording medicines are not always followed and this puts people at risk of not having their medicines as prescribed. Generally people living at The Riseborough feel that they are treated with care and respect. However, in some instances, the right to be treated with dignity and respect has been compromised. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 13 EVIDENCE: Assessments completed inform the development of care plans. Not all needs identified were supported by a corresponding care plan and not all changes documented in daily records, had been supported through the completion of care plans to meet residents’ changing needs. For example there was no care plan for a resident who had needs in terms of emotional support and for another person living in the home, whose behaviour had become challenging. Two residents spoken with said that they feel that their care needs are satisfactorily met by the home. One resident said ‘I feel dirty I only get a shower once per week.’ The number of ladies with facial hair suggests lack of attention to the small needs of care that make a difference. The paramedics report that one Registered nurse was unable to recognise when a resident was in a condition of cardiac arrest and was not competent to carry out cardiac compressions. (See Management and Administration.) Monitoring charts for fluid intake and continence care had not in every instance been completed to reflect that care had been carried out. One resident was very wet in the afternoon and no care had been documented since late the previous evening. Some fluids were out of residents’ reach. This was highlighted in the unannounced random inspection report of the visit to the home on 5th January 2007. This has not been complied with. There were no cold drinks for residents in the lounge as recommended in the last inspection report, in-between the regular drinks’ rounds. Fluid charts seen did not reflect that residents had been offered and taken, or refused fluids, regularly. Residents, therefore, are not being offered sufficient drinks during the day, with particular reference to those at risk of dehydration. There were insufficient measures in place to protect residents from the risk of choking. Residents who, according to their records required a pureed diet had not on two occasions received this. One resident, who requires thickened fluids, was found on two occasions during the inspection, to have been given clear fluids. On the second occasion the resident was alone in her own room, with no assistance to hand should she swallow the water and start to choke. A staff member said of one lady confined to her room, ‘she doesn’t have her own wheelchair so we can’t move her out of the room’. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 14 Diabetic care plans did not adequately support care staff to meet individual residents’ needs, reflecting for example, recognition of an unstable sugar level and details of action to be taken. Waterlow pressure sore risk assessments are carried out. There is concern that trained staff members have not received recent training in pressure area care and that this is reflected in the inadequacy of pressure relief for some residents, change of position and the monitoring of residents’ skincare needs. Some residents’ were observed during the visits spending prolonged periods of time in their wheel chairs. Two residents had fallen asleep in their chairs after lunch and they had lurched forward with their heads in their laps. Risk assessments are carried out for the risk of falls. Recorded accidents showed that one resident had fallen twenty one times in sixteen days. Although management confirmed that referrals to the General Practitioner had been made for some residents with changing needs, this was not supported in people’s records, evidencing that appropriate healthcare and medical support had been provided. Two residents were responsible for administering some or all of their medicines but risk assessments could be improved and the quantities received were sometimes not recorded. Other medicines are given by registered nurses, or care staff who have had additional training. Most medicine Administration Record (MAR) charts are printed by the pharmacy. There was a clear record of the medicine one resident was allergic to but for most others there was no record of whether they had any allergies or not on or with the MAR chart to protect them from receiving medicines they were allergic to. Residents’ medicines are supplied in monitored dosage blister packs, or bottles and packets. Sometimes medicines were not given as prescribed. For example a nurse dispensed one tablet instead of the two prescribed until prompted twice to check and there were 4 more tablets left than expected indicated that the wrong dose had been given on four days. The handwritten directions were not easy to read and were not countersigned as checked for accuracy. Another medicine that should have been given at 7am was not given until after 10am, which could affect the person’s mobility and quality of life. There were gaps in the medicine administration records that could put residents at risk of medication being given twice. For example there were 2 gaps for one person’s medicine that could have had serious consequences if not given or repeated. Another medicine was only recorded as given twice in about 2 weeks but the reason for non-administration was not recorded and there was no indication on the MAR chart that it should only be given when needed. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 15 A check of three other residents’ medicines with the records indicated that they were given correctly but for 2 medicines in packets this could not be confirmed because staff did not record a carry forward balance or the date of starting a new pack. Records of applying some creams were poor and doctor’s instructions were sometimes not followed. For example one person’s cream prescribed twice a day was only recorded as applied once a day and another steroid cream was recorded as applied twice instead of once a day. There were separate charts to provide information on medicines that could be given when needed but some did not contain sufficient information. Medicines were stored securely and refrigerated medicines were kept at the correct temperature. Controlled Drugs (CDs) were stored correctly and administration witnessed. The balance agreed with the records but the current stock balance should be recorded after each entry in the CD register. There were concerns about nurses using lancing devices that put staff and potentially residents at risk of infection. The head of care said that she would label each device with the service user’s name and alert staff to the risk until approved devices could be obtained. The importance of obtaining suitable equipment promptly was included in a letter of concern sent to the registered person. Three residents spoken with praised the ‘care and attention’ they receive from staff. One resident said ‘they are all kind to me.’ If residents had their doors closed staff members knocked on the door before entering. During the inspection it was noted that a distressed resident was taken into the lounge to participate in an activity, which was throwing a ball to residents. The resident became increasingly agitated. A member of staff was stood with the resident, but she was stood behind her chair with her arms around her. The resident became increasingly upset. The lead nurse from the Primary Care Trust, who was present at the time of the inspection, requested that the resident be taken back to the privacy of her room. Two staff members were heard complaining disrespectfully about a resident they had attended to. On the second day of the inspection one resident’s door was open and the resident was lying on her bed with her back facing the door and net knickers exposed. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 16 Three staff files demonstrated that the staff members had not received induction training, which would include the core values of care practice, including the protection of dignity and privacy. These issues and the concern that was referred under adult protection at the time of the inspection are unacceptable and fail to protect residents’ privacy and dignity. They are not reflective of the ethos of care and protection expressed by the management team. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Activities currently fail to meet the needs and expectations of people living at The Riseborough. Residents are supported to maintain contact with family and friends, enabling people living in the home to continue to enjoy relationships that are meaningful to them. Choices and control for residents over their daily lives could be increased by improvements in staffing levels and the range of opportunities available to residents. Residents feel that the quality of food is not as good it as has been in the past. Mealtimes are, therefore, not the enjoyable experience that they have previously been for residents. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 18 EVIDENCE: A conversation with the activities organiser and some of the younger residents, plus observation of other residents shows that little activity takes place that is appropriate for the client group in the home. It was observed throughout the first day of the inspection that several residents who had been taken in to an activity session were not showing any interest or, were indeed worried by what was happening. An art and craft session was taking place; the two residents attending were sitting staring in their wheelchairs with music being played ‘at them’. A younger resident said that they had nothing to do much but had now got used to it. One resident said ‘there is no stimulation.’ A talking budgerigar provides a source of entertainment in the lounge. The activities organiser was compiling a list of resident’s interests but this has a long way to go to be of use. The mini bus had recently been off the road. One inspector visited the kitchen. The chef was in the process of preparing lunch for the day which comprised: - soup or pate, chicken pieces or quiche, new potatoes carrots and cabbage, followed by apple pie and cream. Chef accommodated diabetic residents by use of artificial sweetener. The meals were well presented but a resident did comment that they would prefer the chicken roasted and sliced off the bone. 14 pureed meals were served as separate items though the food looked a little grey when pureed. Six residents had opted to have salad instead of the items on the menu. The dining room staff said that residents are not rushed when eating and that nurses feed about 8 residents in the dining room. The food stocks were low; chef was expecting a delivery that day. Residents expressed their disappointment that they no longer had a selection of home baked cakes in the afternoon, that when they do have cake, alternate days, it is not of the previous quality enjoyed and the choice was no longer as wide as it had been. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 19 One resident said ‘the food isn’t what it used to be.’ There was a large bowl of fruit available in the dining room and squash or fruit juice was served with the meal. Chef reported that he was receiving meat supplies from a new butcher and that the quality has improved. Staff and residents spoken with felt the quality of food had deteriorated since Aromark stopped supplying the domestic services. Residential staff mentioned that they have nowhere to keep things cool at night as the main fridge is locked. Staff members’ comments about the food included: ‘Everybody complains about the food especially the loss of cakes in the afternoon.’ ‘Lots of residents complain about the food now it is not as good as it was’. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints policy and methods for recording complaints received, promoting an open ethos to the receipt of residents’ concerns. Areas of concern regarding care practices compromise the protection of people living in the home from harm. EVIDENCE: The home has a clear complaints policy and records for the recording of complaints received. The policy now includes the address and telephone number of the local office of the Commission for Social Care Inspection. The regional manager confirmed that the home is planning to update staff members in the protection of vulnerable residents from abuse. There are a number of issues referred to in this report, which affect the safe and competent care of people living at The Riseborough. The new regional manager and the registration of a manager, it is hoped, will work within the umbrella organisation to improve services for people living at the home. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The condition of the premises is showing marked deterioration therefore service users do not have the standard of accommodation that they are used to. The home is generally clean, pleasant and hygienic. The resources must be provided to ensure that satisfactory standards are maintained in all areas of the home, including the laundry service. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 22 EVIDENCE: An extensive tour of the premises took place including all four floors. A staff member said that ‘The home looks run down, it looks as though nobody cares anymore.’ The garden lounge floor has sunk in part which is currently roped off to prevent anyone straying onto the uneven surface. The carpet has stained areas, the paintwork on the French windows is shabby and there is an area of damp damage on the wall near the piano. The inspector saw one room that had been totally personalised by the resident. In many corridors the wallpaper is scraped off the walls in chunks and in places hanging off the ceiling. The WC near the hairdressing room has little paint on two sides of the wall. In the corridor outside the laundry there were boxes piled up, the back door ventilator was broken and dirty, wallpaper was hanging off and it looked as though damp was getting in. Chairs were noted that had worn areas on the arms about the premises. It was reported to the inspector that if staff members are in the dining room or clinic they are unable to hear the call alarm system Some areas of the home are still in good condition but it was very disappointing to find how much has deteriorated. One bathroom and bedroom was noted to have faeces on the floor and carpet. This was drawn to the attention of staff members who said that they knew about it and would clean it up. It had been reported by the night staff and was still waiting to be cleaned. One member of staff said that two members of staff undertaking domestic duties is not adequate to keep the home clean and hygienic at all times. Most areas of the home were cleaned to a satisfactory standard on the days of the inspection. The inspector observed the work being carried out in the laundry. The laundry assistant was keen to demonstrate that he uses rubber gloves when handling pre washed linen. However dirty linen was heaped on the floor awaiting room in the washing machines. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 23 There was a pile of clothing on a table that the laundry assistant could not return to the rightful owner as it was not marked with the resident’s name or room number. Residents commented that they sometimes did not always get their rightful clothes back and often they were damaged in the wash. It was observed that little attention was given to care labels on clothing as it was put into hot washes if it was marked or stained. The shirts hanging up in the laundry were well ironed. A resident said ‘My clothes get ruined / lost in the laundry.’ Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Current staffing levels and lack of adequate training fails to support the meeting of residents’ needs and ensure that people living in the home are in safe hands at all times. Generally satisfactory recruitment procedures, protect people living at The Riseborough. Inadequate induction to the home and problems in communication means that current training does not equip staff members to safely meet the needs of residents. EVIDENCE: At night there were two Nurses and 2 HCAs on duty in the nursing area and one SCA 1 HCA in the residential wing. This is insufficient to meet the needs of the service users. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 25 Staff reported that they had to get up residents early, from 6am in the morning as there were only two day staff on in the residential unit and as one did medication the other could not get all the residents up. Comments from staff members regarding staffing levels included: ‘We no sooner get them all [residents] done in the morning than we have to take them to lunch. There is no time for us to have a break.’ ‘A lot of residents need two to help them we are told we have to do it alone as there are not enough staff that is why so many bruises occur.’ ‘Recently there were only two staff on nursing wing at night the residential unit was left for a time without any staff.’ Residents’ comments regarding staffing levels included ‘I don’t know if staff understand their training, how can they if they don’t speak the language.’ ‘They {the staff} work very hard they don’t have time to do the jobs properly there are not enough of them.’ At present all staff members have not received training so that they are competent to meet residents’ needs in the time afforded; feedback from staff referred to the high level of dependency of residents and situations of the home being short staffed. On the residential wing it was confirmed by the manager that most residents require two members of staff either during care giving and, or during safely moving around the home. With only two staff members on duty, this leaves no member of staff to respond to other residents’ needs. Due to the serious concerns regarding staffing levels and consultation with Social Services and the Primary Care Trust a follow up visit was made to the home on 4th May 2007 and an Immediate Requirement was issued regarding ensuring minimum staffing levels are maintained, whilst the management can undertake a full review of the needs of the service and put in place suitable staffing levels to effectively meet the needs of people living at The Riseborough. In terms of the residential wing it was required that there is always a minimum of three staff on duty, as from feedback from staff members most residents require two people during care giving, leaving no one free to respond to requests for assistance. There are currently twenty-six members of care staff working in the home. The manager of the home said that six members of care staff currently hold a National Vocational Qualification in Care (NVQ) at level 2. The regional manager confirmed that the organisation has a rolling programme of training taking place, which care staff will be supported to access. Staff members’ files sampled contained the required documentation, ensuring safe recruitment practice. This includes the seeking of Criminal Records Bureau checks. Photographs were not present on two of the files sampled. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 26 In addition to these requirements it was found that staff members spoken with are still unclear regarding the procedure to admit emergency services into the home and to ensure that paramedics have clear information given to them regarding a residents’ condition. This has been an issue in the past and must be resolved expediently. Staff members must be trained in awareness of such emergency procedures. Three staff files seen included induction documentation but the records had not been completed. These staff members, therefore, had received no induction to safe working practices in the home. In some cases staff did not show a very good comprehension of the English language and it could not be demonstrated that these staff understood any training that was being given to them. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager to lead the home and assume responsibility for the effective organisation of the service. The organisation has a thorough system of quality assurance, which, when fully introduced will help to ensure that the home is run in the best interests of residents. The home does not currently fully protect the financial interests of people living in the home. Maintenance of the environment and training of staff in all areas of health and safety will ensure the protection of people living in the home. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 28 EVIDENCE: Currently the home does not have a registered manager. The proposed registered manager, the clinical lead nurse (deputy) and the new regional manager for the service were present during the inspection. The new regional manager has considerable experience in the management of care homes and expressed commitment to addressing issues highlighted in this report with the support of the organisation. It is recognised that some of these issues had been highlighted by the home and plans were already being made to address such issues as shortfalls in training. The organisation has very comprehensive systems of quality assurance, which once fully introduced, will help to ensure that the home is run in the best interests of residents. A member of staff had been playing a game for money with a resident. The benefiting of any member of staff by the financial interests of any resident is not acceptable. The fire records were checked and on the whole were in order. However the servicing for the fire fighting equipment was overdue. A fax was produced later in the day to show that the maintenance company would come the following day to carry out the task. Night staff fire drills were not taking place sufficiently often. The reports on fire drills in general for the last year showed an unsatisfactory response from staff in general. Staff members were not doing as they are trained to do. The manager said that on each occasion the reason for a poor response was different and had been corrected; however there was no record of this stating the reason for the poor response and action taken. The kitchen was reasonably clean but the extractor fan grid was dusty and greasy. Paint was coming off the walls and it was reported to the inspector that the dishwasher was out of order and had been for two weeks. Chef had requested some new equipment for the kitchen, a new can opener was delivered during the inspection. The large storage containers for dry goods were not of a very clean appearance on the outside and the small freezer was badly iced up. The lid was broken on the kitchen waste bin. (See reference to cleanliness and hygiene, Environment.) On both days of the inspection it was noted that footplates were not correctly applied to wheelchairs and residents had no means of safe foot support. On the 2nd May it was noted that one resident without footplates was being tipped backwards in their chair, in order to be transported around the home. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 29 Twelve emergency lights were not working but the home has it in hand to replace thirty six. The gas safety certificate is 4 months overdue and checks should be carried out without delay. All staff members are not trained in first aid including basic life support. One Registered nurse was unable to carry out basic life support effectively when asked to do so by paramedics. This along with updating of all other areas of training in safe working practice is required in the home to keep residents safe. (See staffing.) Riseborough Care Home (The) DS0000068327.V337895.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X 2 X X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 X X 1 Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person shall prepare a written plan. A plan must be prepared which reflects the current and changing needs of service users. (Previous timescale 5th February 2007 not met.) 2. OP8 12 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. Care plans for the management of diabetes need to contain sufficient information for care staff to safely manage residents’ healthcare needs. (This was issued as an Immediate Requirement at the time of the inspection with a timescale of 5/05/07.) 03/05/07 Timescale for action 31/07/07 3. OP8 12 and 13 The registered person shall DS0000068327.V337895.R01.S.doc 31/05/07 Version 5.2 Page 32 Riseborough Care Home (The) ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and, so far as possible, eliminated. Risk assessment and care plans must inform the delivery of safe care to residents at risk of choking, protecting them from the risk of harm and protecting their airways. Staff members must receive training and demonstrate understanding of the risk of aspiration should residents receive inappropriate food or fluids. This must inform safe care practice. (This was issued as an Immediate Requirement at the time of the inspection with a timescale of 5/05/07.) The risk of pressure sores and falls must be minimised by the healthcare provided to people living in the home. In addition equipment must be provided which supports treatment as well as minimising risk. 4. OP8 12 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health of service users. Continence care and support provided to service users must be fully recorded to ensure that Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 33 31/05/07 residents’ healthcare needs are monitored, identified and responded to. (Previous timescale 5th February 2007 not met.) 5. OP8 12 and 16 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. The registered person shall having regard to the size of the care home and the number and needs of residents provide in adequate quantities, suitable, wholesome and nutritious drink. Drinks must be available at all times to residents. Where necessary, from risk assessment, fluid intake must be monitored. Where fluid intake is reduced appropriate action must be taken, including consultation with external healthcare professionals. (This was issued as an Immediate Requirement at the time of the inspection with a timescale of 5/05/07.) 6. OP9 13(2) The Registered Person must make arrangements for the recording and safe administration of medicines received in the care home including: a) Ensuring that medicines are administered as prescribed and the Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 34 31/05/07 30/06/07 administration or reason for non-administration recorded at the time. b) Recording details of any medicine sensitivity or ‘none known’ on or with the MAR chart to protect residents from receiving medicines they are allergic to. c) Having an audit trail for medicines not in the monitored dosage blister packs e.g. by recording the date a new pack is started, or a carry forward balance on the MAR chart. d) Regularly monitoring medicine records and audit trails and recording the outcome and action taken to ensure that medicines are given as prescribed and accurately recorded. 7. OP10 12 The registered person shall 31/05/07 ensure that the care home is conducted in a manner, which protects the privacy and dignity of residents. (This was issued as a requirement in a letter of serious concern dated 8th May 2007, with a timescale of 9th May 2007.) 8. OP12 16 The registered person shall 31/08/07 having regard to the size of the care home and the number and needs of residents consult people about their social interests, and make arrangements to enable them to engage in local, social and community activities, DS0000068327.V337895.R01.S.doc Version 5.2 Page 35 Riseborough Care Home (The) enabling people to experience a varied and interesting quality of life, reflecting their personal choices and preferences. 9. OP15 16 The registered person shall having regard to the size of the care home and the number and needs of residents provide in adequate quantities suitable, wholesome and nutritious food which is varied, appetising and meets with residents expectations. 31/07/07 10 OP19 16 and 23 The registered person shall 30/06/07 having regard to the number and needs of residents ensure that: The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. A structural engineer’s report must be provided in relation to the slope of the main lounge, ensuring that residents’ are kept safe. The home must be maintained in a satisfactory state of cleanliness and good hygiene at all times, providing residents with a clean and pleasant environment to live in. A plan for the updating and redecoration of the home must be submitted, ensuring that residents are provided with the standard of environment, which meets with their expectations and preferences. Residents’ laundry must be cared for according to individual Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 36 washing instructions and returned to the residents’ to whom it belongs. 11. OP22 16 The registered person shall having regard to the size of the care home and the number and needs of residents ensure that there are: Audible call alarms in all parts of the home so that staff members are able to respond to residents’ needs. 12. OP27 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. (This was an issued as an Immediate Requirement in a follow up visit to the home on 4th May 2007, with a timescale of 4th May 2007.) Satisfactory levels of Registered nurses, care and domestic staff and laundry assistants must be maintained to meet the needs of residents living in the home. 13. OP30 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working DS0000068327.V337895.R01.S.doc 30/06/07 31/05/07 31/05/07 Riseborough Care Home (The) Version 5.2 Page 37 at the care home. Staff members must receive training appropriate to the work that they are to perform. When paramedics arrive at the home, they must receive immediate entrance and appropriate details regarding the condition of the resident to enable them to respond to people’s urgent needs. (This was issued as a requirement in a letter of serious concern dated 8th May 2007, with a timescale of 11th May 2007.) 14. OP30 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home. Staff members must receive training appropriate to the work that they are to perform. Staff members must receive induction training, so that they are suitably skilled to meet the needs of people living in the home. From the home’s summary record of training all staff must be updated in mandatory areas of safe working practice, so that they are suitably skilled to care for people living in the home. 15. OP31 10 There must be a registered DS0000068327.V337895.R01.S.doc 31/07/07 31/08/07 Version 5.2 Page 38 Riseborough Care Home (The) manager in place who is suitably skilled and qualified, with the relevant experience, to ensure that the well-being of residents is promoted and protected. 16. OP38 23 The registered person shall ensure that The gas safety certificate is 4 months overdue and checks should be carried out without delay. 17. OP38 13 The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and, so far as possible, eliminated. Footplates must be applied to wheelchairs, supporting residents’ feet when they are transported around the home. (This was issued as an Immediate Requirement at the time of the inspection with a timescale of 5/05/07.) 18. OP38 13 The registered person must obtain and ensure the use of approved lancing devices for blood testing to protect residents and staff from infection as per Medical Device Alert (MDA) reissued December 2006. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for DS0000068327.V337895.R01.S.doc 31/05/07 31/05/07 11/05/07 19. OP38 13 and 18 31/07/07 Riseborough Care Home (The) Version 5.2 Page 39 the health and welfare of residents. All members of staff must receive training in first aid, to include basic life support, so that they are able to respond to residents’ needs in an emergency situation. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 40 No. 1. Refer to Standard OP3 Good Practice Recommendations Assessments should be signed and dated, providing clear details regarding the time that the assessment was carried out and the competency of the person completing the assessment. The home should follow guidance from the Royal Pharmaceutical Society including: a) Having relevant information on administration and monitoring of medication in care plans so that staff are aware of residents’ needs and how to meet them. b) To ensure that medicine directions that are handwritten on the MAR chart have been transcribed correctly a second nurse should check and countersign them. 2. OP9 3. OP15 It is recommended that the home obtain a small fridge for the residential unit so that milk and snacks can be maintained for anyone requesting such out of normal kitchen hours. It is strongly recommended that the home obtain information on mandatory training in a variety of languages commensurate with the ethnicity of staff. It is recommended that no staff member should engage in any interaction with residents, which involve residents’ personal monies. It is recommended that fire drills increase in regularity until a consistent and appropriate response level is attained. 4. OP30 5. OP35 6. OP38 Riseborough Care Home (The) DS0000068327.V337895.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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