Inspection on 30/10/07 for The Riseborough Care Home

This inspection was carried out on 30th October 2007.

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

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

Other inspections for this house

The Riseborough Care Home 04/02/08

The Riseborough Care Home 02/05/07

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 Key Unannounced Inspection 08:00 30th October, 5 and 15th November 2007 th 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.V353378.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.V353378.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.V353378.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. 14th June 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 £440 to £850. Fees are determined in relation to the prospective residents’ needs, as the home is able to accommodate both residential and nursing residents. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Riseborough Care Home (The) DS0000068327.V353378.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 30th October 2007, 5th November and 15th November took a total of twenty hours, including time spent in planning the visit. The inspectors, Carole Payne, Chris Gould and Chris Main, who visited the home on 5th November 2007, were made to feel welcome in the home during the visits. Since the last key inspection, two peripatetic managers and a proposed registered manager have managed the home. There has therefore been a lot of change in terms of the management of the service. The manager referred to in this report has since left the employment of the organization. It was, therefore, felt appropriate to meet with the new peripatetic manager of the home and the clinical services director on the 15th November 2007, to give a summary of feedback from the visit and review some of the evidence as part of the inspection. This was a statutory inspection and was carried out to ensure that the residents who are living at The Riseborough are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit and key standards met at the last key, unannounced inspection on 2nd October 2007, were also reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with eight residents living in the home and six staff members on duty. Survey forms were received from four residents, three staff members and one relative, friend or advocate. The home also returned an Annual Quality Assurance Assessment (AQAA). Throughout the inspection the management and staff team demonstrated a positive and proactive commitment to addressing any issues raised and continuously improving the quality of life for people living at The Riseborough. What the service does well: The home has policies and procedures in place to assess residents prior to moving into the home, so that they feel assured that the service can meet their needs. Clear assessments and care plans, support care giving, enabling residents’ needs to be met sensitively and compassionately. Where poor practice is Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 6 identified it is responded to, in the best interests of residents. One relative said that they feel that their family member is ‘well cared for.’ The home has an open culture to responding to any issues of concern or complaints, so that residents can feel confident that they live in a home that will listen and view any issues raised positively to improve the quality of service. Staff members are currently employed in sufficient numbers to meet the needs of residents living in the home. What has improved since the last inspection? 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 Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 7 completing the assessment. This is included as a recommendation in this report. It could not be reviewed, as the home has not had any admissions since the last inspection. The programme of training staff members in the specialist needs of people entering and living in the home, including meeting the needs of service users who are suffering from dementia, needs to continue, to ensure that residents’ needs are fully met. The provision of residents’ health care must reflect their medication, nutritional, pressure care, continence care needs and specific medical conditions. Nurses who give flu vaccines should have appropriate training and procedures for administration need improving to conform with legal requirements and protect people. The staff member providing activities should have sufficient training and experience to enable them to meet the social needs of people living at The Riseborough. Food provided to residents requiring a pureed diet should be appropriately fortified, and suitable supplement made available between meals, ensuring that residents receive an adequate and suitable dietary intake. All residents’ accommodation must be maintained at a comfortable ambient temperature, protecting residents from feeling cold, and thereby compromising their health and well-being. The home should ensure that residents’ clothing is always returned to the person to whom it belongs following laundering. It should be ensured that staff members remain on duty until their shift is rostered to finish, making sure that there always sufficient staff on duty to meet residents’ needs. There must be adequate information provided for agency staff working in the home, demonstrating that they are suitable and fit to meet the needs of the service. Staff members must have the skills that they need to deliver training, including training for permanent and agency staff members, so that they are able to meet residents’ needs. It is recommended that the home obtain information on mandatory training in a variety of languages commensurate with the ethnicity of staff. Following the departure of the manager referred to in this report, a manager must be recruited to put forward for registration with the Commission for Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 8 Social Care Inspection. This will enable the service to benefit from continuity in organisation and overall management of the service, enabling residents to benefit from a well-organised service. Hazardous substances must be securely stored at all times, protecting residents from harm. 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.V353378.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.V353378.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, 4, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place to assess residents prior to moving into the home, so that they feel assured that the service can meet their needs. Progress is being made in training staff to meet the specialist needs of residents living in the home. EVIDENCE: The Riseborough has not had any new admissions since the last key inspection. A recommendation was made in the last inspection report that 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 Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 11 assessment. This standard will, therefore, be properly reviewed at the home’s next inspection. The home has confirmed in the AQAA returned to the Commission for Social Care Inspection that there are policies and procedures in place, including preadmission assessment forms, to enable the service to assess prospective residents needs prior to moving in. The AQAA also confirms that staff have received documentation training and that a key worker will be assigned to new residents when they are admitted to ensure that their needs are met and they feel welcome. It has been required that staff members must receive training in the specialist needs of people entering and living in the home, including meeting the needs of service users who are suffering from dementia. The manager confirmed that four members of staff have been booked on a dementia course and will cascade their knowledge back to other staff working in the home. During the meeting with representatives of the service on the 15th November 2007, it was confirmed that further training sessions have been arranged. Specialist training undertaken since the last key inspection includes training from the Speech and Language Therapy team. It is important that a record of this specialist training is maintained on individual files. The home is, therefore, making progress in meeting this requirement. Riseborough Care Home (The) DS0000068327.V353378.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. Progress is being made in the clarity of assessments and care plans, supporting care giving and enabling residents’ needs to be met sensitively and compassionately. Where poor practice is identified it is responded to, in the best interests of residents. Residents’ healthcare needs are not adequately supported by the standard of care in the home. Management of people’s oral medication had improved so that it was given as prescribed but arrangements for creams, eye drops and vaccines need improving to safeguard people and ensure that their healthcare needs are met. EVIDENCE: Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 13 A requirement that residents’ care plans are accurate, that they are compiled from clear assessments, and that they inform care delivery in meeting residents’ needs has been met. Care records for four residents were viewed. All contained detailed assessments, including risk assessments, which inform care planning to meet people’s needs. The plans provided detailed guidance to staff members delivering care. Examples seen also included references to the wishes and preferences of residents regarding the care that they receive, including personal, social and health care needs. Plans seen had been reviewed regularly, either monthly, or according to residents’ changing needs. On two of the records seen either the resident, or family member, had been consulted regarding the care plan. One relative said that they feel that their family member is ‘well cared for.’ Two members of staff returning survey forms said that they are always given the information that they need to carry out care and meet people’s needs; one person said that this is usually the case. Two residents returning survey forms said that they always receive the care and support that they need, and two people said that this usually happens. There has been an improvement in record keeping which monitors residents’ health care needs. However, care plans did not include how to meet the needs of two service users who had a specific requirement in terms of their health. The manager ensured that these care plans were put in place following the inspection. Manual handling needs are now thoroughly described in documentation, including details such as the type of hoist and sling to be used and how the resident is to be safely helped to transfer. These details were seen in the en suites of residents so that staff can easily refer to them, when they are providing care. Pressure relieving equipment, according to assessments was in place. One relative commented that their relative ‘sits in a chair all day and it is uncomfortable.’ This relative was spoken with during the inspection and the resident had changed position during the day. The manager demonstrated an awareness of the need for residents to have appropriate pressure relief in place and change their position at regular intervals. Special chairs she confirmed are on order, for particular residents, who have specific needs in terms of positioning. Residents assessed as needing monitoring, are checked hourly and a record kept. Checks are documented on a turn chart and bed rails are also checked and a duplicate record kept of the position of the resident. For one resident it Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 14 seemed that they had not changed position from ten in the evening until after eight o’clock the next morning, yet the bed rail check stated that the resident was turned onto their left side at two in the early hours of the morning, whilst the other chart said right side. This was discussed with the manager, in terms of ensuring that charts show accurately when a resident has changed position and how frequently this is required. Nutritional needs are efficiently planned for people with special dietary needs, with particular instruction in rooms, and specific guidance written on daily fluid charts, such as the number of scoops of thickener required for residents needing thickened fluids. During the inspection a Registered nurse was giving an agency carer an induction as to how to meet a resident’s needs with specific care needs in relation to nutrition. Recording of residents’ food and fluid intake, where required, has improved. There was one case where fluid intake had not been recorded during the day. A staff member highlighted this during handover. This reflects that staff members are being vigilant and highlighting any issues, which require a response. However another Registered nurse responded that fluid intake had not been recorded because the resident had spent the day in the lounge. This is not an adequate reason for not recording fluid intake and from the written evidence the resident had received no drinks during that day. At the last random inspection it was noted that some food intake charts did not record what the resident was eating, or in the case of a pureed diet, stated, in some instances, that the resident was having the same meal for lunch and supper. From records seen the variety of food provided as a pureed diet has improved and staff members are making progress in ensuring that details of dietary intake are documented. From records of intake seen residents on a pureed diet are still not being offered or taking snacks between meals or fortified supplements. One resident said that she is often hungry between meals. At the meeting on the 15th November 2007, the clinical services director said that there are fortified supplements available as required. One incontinence assessment seen stated that the resident should be helped to use the toilet four hourly, the care plan said at least twice a day. When the resident was got out of bed in the morning they were transferred straight into their chair. Records of pad changes did not include references to helping the person to use the toilet. The manager agreed that this could be highlighted with staff, so that care plans make residents’ continence needs clear and this is carried out in practice. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 15 One resident spent all day on the 30th October 2007 in their room, sat in a chair. Their legs were very swollen. In the morning, one of the inspectors had noted that they had got out of bed with knee high stockings tight around the ankles, leaving a red mark. The bed was soiled and needed changing. The inspector brought this to the attention of staff members, who removed the stockings. However, they were not replaced with anything, and this resident was observed to be cold in their room on the afternoon of the visit. (See Environment.) One resident had an infection, the signs and symptoms of which were reported to the General Practitioner, antibiotics prescribed, and a care plan in place to ensure that appropriate care was delivered whilst the resident was unwell. Visits from members of the multi-disciplinary team are recorded and daily records reflect the monitoring of residents’ well being. One resident looked after most of their own medicines. There were safe storage arrangements, a good risk assessment that indicated where they needed assistance, and records of medicines supplied to them to safeguard them and other people in the home. Other medicines are given by registered nurses, or care staff who have had additional training to protect people. The list of staff who could give medicines to people having residential care needed updating as it included one person who had not satisfactorily completed training, but we were told that they did not administer medication. We checked seven people’s Medicine Administration Record (MAR) charts with the medicines in stock and the quantities remaining indicated that they were given as prescribed. However, records of applying some creams were incomplete. Directions for giving some medicines need improving so that staff have clear instructions to follow. For example there was no record of the reason for giving one “when required” medicine or frequency of doses or maximum dose per day. Directions on the MAR chart for one person’s eye ointment had been altered from both eyes to only the left, but there was nothing to indicate who made this change and why. The care plan did not indicate which eye(s) needed treating and the nurse on duty did not know. Medicine allergies or “none known” were recorded on MAR charts seen to protect people from receiving medicines they were allergic to. A nurse had recently administered flu vaccines to some people having nursing care but there was no evidence that they had appropriate training for this, and there was no prescription from the GP, to protect people. We saw adrenaline injection supplied on prescription for one individual person but not others and the home should have obtained a stock supply that could be used for anyone who had an allergic reaction. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 16 Some information on medication in nursing care plans had improved but was incomplete, for example one did not include when to involve emergency services if fits were prolonged or repeated. There was very little information in care plans about medication for people having residential care to help staff meet their healthcare needs. Medicines were stored securely and refrigerated medicines were kept at the correct temperature. Staff witnessed administration of medicines requiring special storage and recording and the amount in stock agreed with the records. During the inspection two staff members were heard gently explaining the support that they were providing to a resident; giving reassurance and sensitive care. Staff members knocked on residents’ doors before entering. There was reference in care plans to protecting people’s privacy and dignity. Riseborough Care Home (The) DS0000068327.V353378.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 adequate. This judgement has been made using available evidence including a visit to this service. There is now an improving range of individual and group social activities and opportunities for one-to-one engagement, enabling residents to enjoy a better quality of life. Improvements to the menu have been made in consultation with residents and progress is being made with meeting individual and specialist dietary requirements and in providing a pleasant and enjoyable dining experience for people living at The Riseborough. EVIDENCE: On the files seen there were individual care plans in respect of social needs and one file seen included a family history. Individual records have started to be maintained on a regular basis detailing the time residents spend with others either in companionship or a shared activity. Given that some residents either choose to spend a lot of time in their own rooms, or are nursed in bed, one-toone time is very important. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 18 On the morning of the inspection on 30th October 2007, porridge was being served on one of the floors from an ice cream tub. This was not suitable to keep the porridge warm. The manager confirmed that a new server has been ordered to store and keep foods warm during serving. On the day of the visit the activity in the afternoon was not engaging the residents attending and was not, therefore, appropriate in meeting their social needs. The activities coordinator is currently not available and it was clear that the staff member who had agreed to step in, who said she has no training in the provision of activities in a care home, had a good rapport with the residents and was getting to know their needs and preferences. There were notice boards up in the home detailing events taking place. Individual sheets of the day’s planned activities were also on the tables at the start of lunch so that residents could see what is happening in the home. There was a requirement in the last inspection report that people be consulted about their social interests, and arrangements made to enable them to engage in local, social and community activities, enabling people to experience a varied and interesting quality of life, reflecting their personal choices and preferences. Progress has been made in meeting this requirement. Recent events include a picnic, a regular film show and making Christmas cards. The home has a pet budgerigar, which is well liked. One relative said that they enjoy sitting outside with their family member when the weather is fine. The home benefits from a number of different communal areas enabling residents to choose where they would like to be, the views they would like to enjoy, watching the television or perhaps having quiet time with a relative or friend. Residents’ religions are recorded and in the AQAA the home states that it intends to offer residents more opportunities to have visits from ministers of different denominations, according to their faith. The manager confirmed that the minibus would shortly be running, enabling some residents to get out on short trips. There are also plans to investigate other activities such as complementary therapies. On the day of the visit it was noted from the visitors book and general observation that many relatives and friends visit the home on a regular basis. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 19 One relative said that they are always made to feel welcome and another comes and spends the day and has a meal. Residents’ preferences and choices were reflected in care records seen. Staff members were heard offering people choices about where they would like to be during the day, when they required a wheel chair and assistance to move around the home. One resident in the residential wing of the home, spent most of the day sat in their chair, but seemed to be able to help with some activities of daily living, if offered the opportunity to do so; promoting independence, where possible, was discussed with the manager. Since the last key inspection the home has worked hard to listen to residents’ comments regarding food and what they would like to eat. Minutes of a recent residents’ meeting were viewed, when people were consulted regarding a new menu. The dining room is a pleasant dining environment, and trolleys are placed unobtrusively, so that residents enjoy eating. There is an open culture with discussions taking place between kitchen staff and residents living in the home about what they would like to see on the menu. On the day of the visit tables were well presented and at lunch time the assistant chef came out to speak to one resident about their meal. One resident had asked for extra and was given seconds. From the food intake charts seen they did not state that residents on pureed diets were being given any additional supplements as snacks between meals. One resident on a pureed diet said that they sometimes feel hungry. The manager said that they do have access to fortified supplements and these will be provided to residents between meals and the nutritional make up of pureed meals will be reviewed to ensure that this is in line with the requirements of the Speech and Language Therapists. One agency staff member did not realise that the red tray system that has been introduced is to ensure that residents receive the correct diet. A new member of staff was transferring food onto the tray, which was not appropriately fortified. The manager interceded and ensured that staff were organised so that the agency staff member understood the system thoroughly, so that she is able to meet residents’ needs. Riseborough Care Home (The) DS0000068327.V353378.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 adequate. This judgement has been made using available evidence including a visit to this service. The home has an open culture to responding to any issues of concern or complaints, so that residents can feel confident that they live in a home that will listen and view any issues raised positively to improve the quality of service. Appropriate adult protection training for all staff will support the service’s commitment to respond to any issue involving the protection of residents and keep them safe. EVIDENCE: The home maintains meticulous records of complaints received, reflecting that all concerns are taken seriously and acted upon. Three staff returning survey forms said that they know what to do if someone raises a complaint. One staff member said that they would follow the complaints procedure and report it to the person in charge. The four residents returning survey forms said that they always know who to speak to if they are not happy. During the inspection two residents spoken with did not feel inhibited about being open about any concerns that they had. The manager responded proactively to any issues brought to her attention during the visit. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 21 Two staff members carrying out care were heard being very sensitive to ensure that the resident that they were looking after had no worries or current anxieties. Staff members were also open about discussing any issues that they had highlighted during their shift, reflecting that people feel confident to raise concerns, and are assured that they will be responded to. The home has had a number of adult protection concerns, which have been in the process of investigation or have been raised since the last inspection, some of which have been substantiated. The organisation has been active and open in raising any issues and sharing them with external agencies supporting the protection of residents and is working to address issues raised. Staff members have received a video based training programme in adult protection, from training records seen. However the manager showed the inspectors a very detailed Four Seasons workbook, which covers all aspects of adult protection including reference to looking at local guidelines. The manager said that staff members have started to use this programme and copies of the books are with staff members. The resourcing of a trainer’s programme for the person delivering and supporting staff members with this training was discussed with the manager, so that the trainer is able to fully support staff members engaged in the programme. There was no record of adult protection training by the current trainer on the day of the inspection. A sheet regarding adult protection awareness was on the staff member’s file, but it was not completed, signed or dated. (Please see Staffing regarding training.) The clinical services director confirmed at the meeting on the 15th November 2007 that suitable training for the trainer is planned. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 22 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, 25, 26, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is undertaking refurbishments to improve the quality and fabric of the environment. The home benefits from a generally clean and hygienic environment; improvements to the laundry service are making a difference to the care of residents’ clothing. EVIDENCE: At the time of the inspection a refurbishment programme of the home was underway. A staff member said ‘once the refurbishment has taken place things will be better in the home as a whole.’ Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 23 The Riseborough benefits from delightful communal areas, which retain many original features. One relative said that they could enjoy the many different rooms and move about the home, with their family member who is in a wheel chair. The person feels ‘as though I have had a change of surroundings.’ It was noted that one area of the home where redecoration was taking place was cold during the visit and one resident was sat in their room, with little covering to keep warm. The manager undertook to immediately address this issue and has confirmed since the inspection that arrangements are in place to ensure that areas being painted can be adequately ventilated whilst residents are protected from feeling cold due to any drop in temperature. A sheet in one of the nurses’ stations detailed that bath water temperatures had been checked, but did not state the temperature. The manager undertook to ensure that this takes place, ensuring that there is a record that water temperatures are monitored and maintained within safe limits. On the day of the visit all areas of the home visited looked fresh and clean aside from one toilet, which was heavily stained. The manager undertook to attend to this. Two residents responding in survey forms said that the home is always fresh and clean; two people said that this is usually the case. One resident said ‘I am happy with the person that cleans my room.’ Staff members were observed washing their hands and wearing protective clothing during the visit. Some staff members were walking around with gloves on. It is important that gloves are used for appropriate tasks and then disposed of before moving to rooms to assist another resident. The laundry was well organised on the day of the visit, and it was evident that the home is still working hard to address issues to ensure that residents receive the correct clothing. There was quite a lot of laundry that was unlabelled and could not be returned to its owner. The manager has confirmed during previous visits that this is an issue that is being looked at with laundry staff, general staff and residents so that systems are improved, ensuring people’s clothing is returned to them. Riseborough Care Home (The) DS0000068327.V353378.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 adequate. This judgement has been made using available evidence including a visit to this service. Progress is being made in ensuring that staff members are equipped with the training and skills that they need to meet residents’ needs. Staff members are currently employed in sufficient numbers to meet the needs of residents’ living in the home. Agency staff members do not currently receive a consistently adequate induction to equip them with the skills that they require to meet residents’ needs. EVIDENCE: At the time of the visit, there were sufficient staff on duty to meet residents’ needs; this was also reflected in rosters seen. Since the last key inspection, given serious issues of concern, care staffing levels have been agreed with the home in order to meet the dependency levels of people living in the home. Administrative, domestic, laundry and kitchen staff members work in the home as well as the activities coordinator. This will need to be reviewed according to occupancy and dependency levels. At present the home is recruiting and there is a high reliance upon agency staff members. The home has endeavoured to utilise the same agency staff whilst undertaking a major recruitment drive to Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 25 take on permanent staff members. This is starting to have a positive impact on the service and skill mix, however there is still a heavy dependency upon agency staff members. On the day of the visit it was noted that at least three members of staff left the home before 8.00am in the morning when their shift should finish. The manager confirmed that staff members take handover between 7.45am and 8.00am and that staff should not leave the premises until their shift is completed. There are twenty-two members of care staff working in the home. There is currently one member of staff with a National Vocational Qualification in Care (NVQ) at level 2, with six members of staff holding an equivalent qualification. There are currently no members of staff members who possess an NVQ at level 3. The manager is hopeful that there will be new staff members starting work shortly who have qualifications in care. Since the last inspection visit the home has improved the recruitment process. Records seen showed that thorough recruitment checks had taken place. The home holds some copies of Criminal Records Bureau checks, it is important that originals are kept until viewed by an inspector and then the documents appropriately destroyed, with records of numbers, date of issue and clearance kept. Thorough recruitment checks are now undertaken to ensure that applicants are suitable to work in the home environment and care for residents. As part of the recruitment process dates of previous employment on application forms are checked against any references received. Reasons for gaps in work histories must be clearly stated. A reference from people’s last employer is sought. The home did not have adequate information regarding agency staff working in the home, to ensure that they have undergone the recruitment checks and have the skills that they need to support the service in meeting the needs of residents. The inspectors met with two members of care staff who had recently started work in the home. They both said that they were in the process of completing the induction programme. Neither had their records with them. Four Seasons has a detailed induction programme, which the manager confirmed, complies with Skills for Care (the National Training Organisation’s standards). Since the last key inspection the home has made some progress with the completion of mandatory training for all staff working in the home. However, as there have been a lot of staff changes this has, understandably, been difficult to keep pace with ensuring that all new and existing staff receive training in key areas of practice. The manager confirmed that further training sessions are booked in and will keep the Commission for Social Care Inspection Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 26 updated of progress. The home’s summary of training shows that shortfalls still exist, but that completion of training is improving. It was noted that much of the training records seen on staff files was a video based training session with a questionnaire, which is signed off by a senior member of staff. One questionnaire, showed that the staff member had difficulty in understanding the questions asked. It was recommended in a previous report that the home obtains information on mandatory training in a variety of languages commensurate with the ethnicity of staff. A new member of domestic staff said that they had received manual handling, fire training and training in infection control since they had started work in the home. The senior member of staff supervising key training had no record of receiving up to date training in these areas. There was an incomplete record of adult protection awareness, which was not signed and dated. This staff member had also taken responsibility for health and safety training in the home. However there was no record that they had undertaken any training in this area of practice. It is important that staff members leading training possess a thorough knowledge of the subject area, which they are supporting staff to understand and carry out in practice. The manager showed the inspectors workbooks for adult protection awareness produced by Four Seasons and a list of other training guides; the workbook seen provided a very thorough skill base, for training staff in the home in a key area of practice awareness. The manager said that it is intended that these workbooks will be used in the future and the clinical services director has confirmed that the trainer will be receiving additional training, to support them to oversee training in the home. One member of agency staff was sent to the home to replace a member of staff at short notice on the morning of the visit, and the Registered nurse providing an induction, was clearly under pressure for time and the induction to the service was not adequate, to ensure that the staff member was fully aware of all health and safety procedures and the needs of residents prior to starting work. Another member of agency staff had been to the home once before, but was unaware of the home’s system for ensuring that residents receive the correct diet, when meals are served; this was promptly identified by the manager and addressed. However it must be ensured that all staff members who are unfamiliar with the routines, environment and needs of residents living in the home, are fully equipped with the skills and training so that they are able to fulfil their roles. Riseborough Care Home (The) DS0000068327.V353378.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. Since the inspection the manager has left the service, leaving the home without the continuity of a permanent manager in place, placing residents at risk due to lack of adequate, stable management to organise and manage the service. The home has thorough systems of quality assurance and safe handling of residents’ monies. Hazardous substances left around the home; put residents at risk of harm. EVIDENCE: Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 28 The manager of the home referred to in this report has since left the service. However an experienced peripatetic manager has been appointed to manage the home whilst a new manager is actively recruited. It is intended that this manager will remain at the home until a new manager is recruited. The Registered nurse who was delegated responsibility to oversee the nursing wing of the home has also left her permanent post since the last inspection. The person responsible for the residential service remains in post and the clinical services director has a base at the home and spends some time each week at the home. At the meeting on the 15th November 2007, the peripatetic manager confirmed that he would not be at the service during the Christmas and New Year period. This report contains a requirement that a suitably qualified nursing manager is in place to oversee the service during this period. On arrival at the home one of the inspectors accompanied the manager as she made a regular and routine tour of the home, checking on the well being of residents and ensuring that staff members were fully engaged and aware of their roles with regard to the morning routine. The home returned an Annual Quality Assurance Assessment as part of this inspection, which was thoroughly completed. The record reflects the home’s commitment to look at its service and the organization’s resolution to continuously strive to improve all areas of care provision in the best interests of residents. The document states that a ‘date dot’ system has been introduced in the kitchen ensuring that once food is opened it is not kept beyond its expiry date. The home has efficient procedures in place for safeguarding residents’ financial interests, taking appropriate action when there are any concerns regarding the safe handling of residents’ monies. Since the last key inspection the home has taken steps to ensure that all staff working in the home are fully trained in manual handling, ensuring the safety of residents. It was noted during the inspection that hoists were being moved around the home in the lift to be used on other floors. The manager confirmed that in addition to the current stand aid in use, an additional hoist of this type is on order. During the visit it was noted that cleaning trolleys containing cleaning fluids were left unattended around the home. The manager confirmed that immediate action would be taken to ensure that domestic staff do not leave hazardous substances unattended when carrying out cleaning duties. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 29 Maintenance records seen showed that regular routine maintenance takes place of equipment and facilities in the home. Fire records viewed demonstrated that routine checks are undertaken of fire equipment. There were two separate records of drill practice; one list stated the date and recorded that all staff had attended; another was thorough and contained the required information, which included a list of all staff taking part in the drill. Riseborough Care Home (The) DS0000068327.V353378.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 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 1 2 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Riseborough Care Home (The) DS0000068327.V353378.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 OP4 Regulation 12 and 18 Requirement Staff members must receive training in the specialist needs of people entering and living in the home, including meeting the needs of service users who are suffering from dementia. (Timescale 25/10/07 not met.) Timescale for action 31/12/07 2. OP8 12 The provision of residents’ health 15/12/07 care must reflect their nutritional, pressure care, continence care needs and specific medical conditions. The Registered Person must make arrangements to ensure that prescribed creams, are administered as prescribed and recorded. All residents’ accommodation must be maintained at a comfortable ambient DS0000068327.V353378.R01.S.doc 3. OP9 13 31/01/08 4. OP25 13 15/12/07 Riseborough Care Home (The) Version 5.2 Page 32 temperature, protecting residents’ from feeling cold, and thereby compromising their health and well-being. 5. OP29 19 There must be adequate information provided for agency staff working in the home, demonstrating that they are suitable and fit to meet the needs of the service. Staff members must have the skills that they need to deliver training, including training for permanent and agency staff members, so that they are able to meet residents’ needs. There must be a suitably Registered nurse manager in post at the home to cover the absence of the peripatetic manager over the Christmas and New Year period, ensuring that the home is well managed and the safety and well-being of residents managed effectively. The registered person must ensure that a manager is appointed to the service, subject to recruitment checks and notice periods, within the timescale set. Hazardous substances must be securely stored at all times, protecting residents’ from harm. 15/12/07 6. OP30 18 31/12/07 7. OP31 8 15/12/07 8. OP31 8 31/01/08 9. OP38 13 15/12/07 Riseborough Care Home (The) DS0000068327.V353378.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 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. This was not reviewed at this inspection. 2. OP9 There should be relevant information on administration and monitoring of medication in care plans so that staff are aware of residents’ needs and how to meet them. (Repeated) The home should review and update procedures for administering vaccines to comply with good practice and legal requirements see CSCI guidance “Professional Advice: Immunisation in Care Homes (Nursing)” available at www.csci.org.uk. The staff member providing activities should have sufficient training and experience to enable them to meet the social needs of people living at The Riseborough. It should be ensured that food provided to residents’ requiring a pureed diet is appropriately fortified, and that suitable supplement are made available between meals, ensuring that residents’ receive an adequate and suitable dietary intake. The home should ensure that residents’ clothing is always returned to the person to whom it belongs following laundering. It should be ensured that staff members remain on duty until their shift is rostered to finish, making sure that there always sufficient staff on duty to meet residents’ needs. It is strongly recommended that the home obtain information on mandatory training in a variety of languages commensurate with the ethnicity of staff. DS0000068327.V353378.R01.S.doc Version 5.2 Page 34 3. OP12 4. OP15 5. OP26 6. OP27 7. OP30 Riseborough Care Home (The) Repeated. Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 35 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. Extracts may not be used or reproduced without the express permission of CSCI Riseborough Care Home (The) DS0000068327.V353378.R01.S.doc Version 5.2 Page 36 - 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!