Inspection on 28/11/05 for The Riverside Nursing Home

This inspection was carried out on 28th November 2005.

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

The inspector 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 Riverside Nursing Home 22/02/07

The Riverside Nursing Home 27/04/06

The Riverside Nursing Home 27/06/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Riverside Nursing Home 9 Church Street Littleborough Rochdale Lancashire OL15 8DA Lead Inspector Diane Gaunt Unannounced Inspection 28th November 2005 09:30 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 The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 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. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Riverside Nursing Home Address 9 Church Street Littleborough Rochdale Lancashire OL15 8DA 01706 372647 01706 372372 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Shabnam Arshad Mrs Nomalungelo Lucille Lugayeni Care Home 25 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (25) of places The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 25 service-users, to include: Up to 25 service-users in the category of OP (over 65 years of age). Up to 15 service-users in the category of DE(E) (Dementia over 65 years of age) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. The Registered Person must ensure that a full assessment is undertaken of the Manager`s training needs and that of the care staff in relation to caring for service-users with Dementia. Any ensuing training plan must be implemented and regularly reviewed. The service should at all times employ suitably qualified and experienced members of staff, in sufficient numbers to meet the assessed needs of the service-user group, including at least 6 hours Registered Mental Nurse input each day. The Registered Provider must ensure that any future service-user, or their representative, make a positive and informed choice in respect of choosing to stay in either Room 20 or Room 21. The Registered Person must ensure that suitable screening is supplied and fitted around the bed and washbasin area in Room 16 prior to the room being left as a double. 27th June 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Riverside Nursing Home is located in the centre of Littleborough close to shops, Post Office and other amenities. It provides easy access to Rochdale and Todmorden. Originally a private house, the stone building has been extended and adapted to provide nursing care and accommodation for 25 people aged 65 years and over. Within this number, up to 15 people with dementia over the age of 65 years can be accommodated and cared for. The home provides 23 single and 2 double bedrooms. Level access is provided to the home. Accommodation is on two floors, a passenger lift is provided. A small patio area is provided and is used by residents in fine weather. Parking for approximately 8 cars is provided in the forecourt of the home. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 2 days, taking 12½ hours in total. The pharmacy inspector was at the home inspecting arrangements for medication for 1½ hours of that time. The home had not been told beforehand that the inspectors would visit. The inspector looked around the building and looked at paperwork about the running of the home and the care given. Five of the seventeen residents, five visitors, three care assistants, a care manager, the registered manager and the registered owner were spoken with. Carers were watched as they went about their work. The inspector had visited the home in August 2005 to check whether requirements made at the inspection of 27 June 2005 had been met. Progress was noted but not all requirements were met. Requirements listed at the end of the report include seven that had not been fully met since the last inspection. What the service does well: What has improved since the last inspection? Improvements to the building had continued: the large lounge, dining room and most of the bedrooms had been decorated; all the misty double glazing had been replaced; the call system had been improved so that one system operated throughout the home and a smoke free room had been provided for staff to have their breaks in. New driers have been bought for the laundry and extra laundry hours provided so washing was done more quickly. Staff made sure that residents had enough underwear and clothes to wear. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 6 Records of medication administration were more clearly completed. Protection of Vulnerable Adult (POVA) checks and Criminal Records Bureau (CRB) checks were taken before staff started work and staff’s photographs and copies of their training certificates were kept at the home. The Statement of Purpose and Service User Guide, which describe what the home does and who works there, were accurate and up to date. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 7 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 The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 4. Helpful, up to date information was written and provided at the home to enable prospective residents or their relatives to make an informed choice about where to live. In emergency admissions, this information was given verbally. Not all staff had received appropriate training with regard to dementia care to ensure understanding and meeting of needs. EVIDENCE: The home had updated their detailed Statement of Purpose and Service-User Guide since the last inspection and copies were provided to CSCI. Residents and relatives spoken with did not recall receiving copies of these documents although they were seen to be available in the entrance area and in bedrooms. The majority of residents spoken with had moved into the home in an emergency and due to the urgency of their admission had not been given the documents prior to admission. In these situations care managers had provided verbal information about the home that residents/relatives verified as being accurate, although in one instance a relative had not fully understood the extent of need the home catered for within the dementia category of registration. In order to ensure every resident or their relative has up to date information about the home, arrangements were made during the inspection to The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 9 reissue each of the documents and be more proactive in promoting their use in the future. Evidence was available on file that residents were all assessed prior to admission, either by the care manager, the registered manager, or both. It was only with regard to emergency admissions that the registered manager did not assess. With regard to the meeting of assessed needs, the manager is an RGN (Registered General Nurse) and RMN (Registered Mental Nurse) and has had some training with regard to dementia care. Another RMN works nights, and a bank nurse with an RMN qualification is also employed. In addition, ongoing training is being provided for nursing and care staff in dementia care. Observation of two of the longer serving staff on duty showed their understanding of the needs of people with dementia; they were seen to communicate appropriately; were observant; and reacted in an appropriate way, on occasion diffusing potentially challenging situations. Required training had not been provided for all staff however and some of the training provided had been via videos. Whilst video training is informative, staff would benefit from more detailed training programmes that offer the opportunity for discussion and development of skills. A matrix recorded completed training and courses booked but a long-term plan addressing each staff member was not provided. This is a condition of registration. Since registration the home had not catered for any residents from ethnic minority groups and there was no general information available for staff. The registered provider said she had information that she would make available to staff to build up a bank of knowledge. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 9 Residents’ health and care needs were appropriately met on an ongoing basis. Procedures were in place to facilitate the safe handling of medicines, but complete disposal records were not maintained, so it was not possible to confirm that unwanted medicines were disposed of correctly. EVIDENCE: Feedback from residents, relatives and a care manager was positive with regard to the personal and health care provided. Although care plans were not inspected in detail they were seen to be regularly reviewed. Those interviewed said that healthcare professionals were contacted as and when necessary to ensure needs were met by appropriate professionals. On both days of the inspection the manager was involved in reviews, one with a care manager, resident and relative and another with a psycho-geriatrician. Risk assessments were held with care plans and were regularly reviewed. They addressed areas such as nutrition, moving and handling, skin care, falls and smoking. The incidence of pressure sores at the home was low, one person with pressure sores was being cared for at the home at the time of the inspection. The use of food and fluid monitoring charts, turn charts and regular pressure relief ensured residents were given the care they needed to make a speedy recovery from pressure sores. Appropriate mattresses and The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 11 cushions were in use. Residents were weighed monthly, their weights monitored and appropriate follow on action taken. Staff provided exercise for residents in the form of ball games and walks into Littleborough for those who wished to participate. Qualified nurses administered all the homes’ medicines. There was a policy to support self-administration but none of the residents chose to self-administer at the time of the inspection. Policies and procedures describing medicines handling had been implemented but were in need of up dating to reflect the new arrangements for the disposal of unwanted medicines. They also needed to be expanded to include procedures for the use of homely remedies. The pre-printed medication administration records were generally up-to-date; handwritten entries were signed, independently checked and countersigned. Records of medicines received into the home were maintained, but required records for the disposal of unwanted medicines were not made. Separate records of controlled drug handling were maintained. Medicines were securely stored within the medicines room. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Provision of social activities remained in need of further development to ensure each residents’ needs were met. Contact with family, friends and community was maintained ensuring residents did not become isolated. Residents would benefit from being able to exert more control over their lives. A balanced diet was provided but the inclusion of convenience foods cooked by care staff at teatime reduced the overall quality. EVIDENCE: Activities at the home had not developed since the last inspection despite information being made available at the home. Interviews with staff highlighted their need to receive more help and guidance from the manager in this respect. Staff encouraged residents to play dominoes, dance, exercise, answer quiz questions, play and listen to music. Musical entertainment was provided by an organist on a regular basis. The home had purchased some art materials and puzzle books which one resident was enjoying during the inspection. Observation showed that some residents were initiating interaction and expressing their views and feelings but others spent a considerable time sleeping or sitting without occupation. The need for further person-centred activities for residents remains. Feedback from relatives was positive with regard to arrangements for visiting. They said they could visit whenever they wished through the day and evening and were made to feel welcome. Observation supported these views and on The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 13 the evening of the inspection the lounge was very lively with visitor involvement. Visitors had a choice of where they met with relatives – either in their bedrooms, the lounges or the dining room, although other than bedrooms, a designated quiet place to visit was not provided. Two residents regularly went into Littleborough unaccompanied. residents went out with relatives or to local shops with staff. Other Religious services were not held at the home, although representatives of two churches visited residents at the home regularly. The choices residents made each day varied, dependent upon their mental frailty but residents generally chose what time to get up, go to bed, what clothes to wear, where to spend their day. Others chose to go out, had responsibility for collecting their monies from the Post Office and managing their accounts. The majority of residents’ monies were managed by relatives. Residents and relatives were involved in care planning and, in the main, had been asked to sign their agreement on review. Residents were not routinely asked for their choice of food or if they wanted keys for their room on admission. Resident/relative meetings were not held to enable their contribution to decision making within the home. Advocacy advice was not routinely given on admission although it was agreed that this would be included with the Statement of Purpose, Service User Guide and complaints information to be given on admission. There had been a change of cook and menus since the last inspection, although care staff continued to cook the teatime meal. Menus were planned over a 3 week rather than 4 week period and were more repetitive. They also contained more pies, sausages, beef burgers, pizzas and other processed foods than previously when steaks or casseroles were served more regularly. Pies were home cooked but there was a reliance on processed foods at teatime and as an alternative at lunchtime. Salad had been introduced with the sandwiches and fruit was offered in desserts. Milk puddings were served 3 times each week. Whilst the menu stated that fresh fruit was available at all meal times, staff were not proactive in offering this to residents. The inspector ate tea at the home – fish fingers, chips and tinned tomatoes were served. The fish fingers did not contain much fish and the chips had been freshly cooked but then left in the oven to keep warm whilst the carer went to assist residents. Residents were not offered a choice of meal prior to it being served but sandwiches were offered along with fish fingers and chips. Staff informed the inspector that residents were not routinely offered a choice of food and no records were kept of residents’ choices. Staff were seen to give appropriate assistance in a pleasant and encouraging manner. One relative expressed pleasure at the resident’s weight gain that was attributed to staff skill in encouraging eating. Suitable provision was The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 14 made for those needing special diets i.e. diabetic and soft diets. The cook ensured diabetics were offered as much choice as other residents by using sweeteners in desserts. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents/relatives were confident that complaints would be listened to, taken seriously and acted upon. EVIDENCE: The complaints procedure was easy to understand and gave an assurance that complaints would be responded to within 15 days. A copy of the complaints procedure had been placed in each resident’s room along with the A-Z Service User Guide. It was also displayed in the entrance hall. However, none of those interviewed were familiar with the procedure although all said they would go to the manager in the first instance and in their experience this had been effective. The provider said she would issue further copies of the complaints procedure to ensure all residents and relatives were familiar with it. The home kept a record of complaints, four had been recorded since the last inspection, each had been addressed by the manager or, in her absence, the provider. One complaint had been investigated by CSCI since the last inspection. This was with regard to staff interaction with residents; quality of teatime food; deterioration in care standards during the manager’s extended holiday; inadequate activities; and inadequate cook/laundry support. Each element was upheld and requirements made. Action had been taken to address each of the areas but issues around teatime provision and regular activities remained in need of further action. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Sufficient and suitable communal space, facilities, aids and adaptations were provided and refurbishment was ongoing to improve the comfort afforded residents at the home. However, provision did not meet the standard throughout. The home was hygienic and odour free in the main. EVIDENCE: The home is located in the centre of Littleborough close to shops, Post Office, churches and pubs. Buses to and from Rochdale stop not far from the home and the railway station provides a link to local and national train services. The motorway network is easily accessible. Accommodation is on two floors and a passenger lift is provided ensuring residents can access all parts of the home without using steps. For those who wish to use the stairs, rails are provided to either side. Likewise, handrails are provided on both sides of the majority of corridors. Level access is provided to the front door. Suitable aids and adaptations were provided to meet residents’ needs, although individual slings for those residents needing the hoist were not allocated. There was good provision of level access showers, assisted baths, raised toilets and grab rails throughout. Toilets and bathrooms were accessible to residents and The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 17 commodes were provided in bedrooms. A number of commodes were in need of replacement/refurbishment, as were some easy chairs in bedrooms. The call system had been upgraded the week prior to the inspection so that one system operated throughout the home. Sufficient communal space was provided in a large lounge, dining room and lounge/diner, although the latter was rarely used. It was awaiting decoration and refurbishment. Following the last inspection this room had been designated for use by residents receiving nursing rather than dementia care. Other changes to communal space since the last inspection included the staff room being designated as a smoking room for both staff and residents, and the quiet visitors room designated as a smoke free staff room. This meant that a visitors’ room was no longer available. On the day of the inspection the dining room was used for a case review and for relatives to speak with residents quietly although there was a constant flow of people through the room during parts of the day. The smoking room had previously been the staff room and staff notices were still displayed on the notice board. The room was being used as a storage area and was in need of upgrading to make it both welcoming and homely for residents’ use. An outstanding requirement is in place with regard to replacement of the floor covering. A garden was not provided for residents although a small patio area overlooking the river to the rear of the home was available. The home provided 23 single and 2 double bedrooms, although neither of the double rooms were let as doubles at the time of the inspection. All rooms met minimum size standards and some were quite spacious. However, staff were observed experiencing difficulty in using a hoist in one of the smaller bedrooms. Locks with individual keys were not provided to bedroom doors. Star locks were fitted and staff locked the doors during the day. None of the residents had chosen to have a key and these agreements were recorded on file. However, the inspector was informed by a resident and relative that keys were offered keys later in their stay rather than on admission. Adequate lighting was provided in the home and new light shades were to be provided. Radiators in rooms 14, 15, & 18 were very hot. The inspector was advised this was a result of the heating engineer adjusting the boiler on the day of inspection. Radiators were checked later in the day and found to be at an acceptable temperature, although their capacity to burn is of concern. Since the last inspection all misty double glazed windows had been replaced and the decorating/refurbishment programme continued. All the bedrooms in the extension to the house had been decorated as had the dining room and main lounge. These rooms were awaiting carpeting and new furniture. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 18 Timescales for compliance had passed, the inspector was informed the home was waiting delivery of furniture which had been purchased abroad some months ago but not yet delivered. The maintenance and renewal plan consisted of documentation of the refurbishment programme. Day to day repairs were reported by staff, logged in a maintenance book and addressed by the handyman. Inspection of the building showed that some lockable space and handles on wardrobes were in need of replacement. Residents and relatives considered the home was kept clean although inspection identified four carpets in need of cleaning. Two of these rooms had a particularly strong malodour. Action was taken to clean the carpets on the day of the inspection, all of which are to be replaced as part of the refurbishment. Observation and discussion with staff confirmed there were satisfactory infection control practices at the home. Additional laundry equipment had been purchased since the last inspection and laundry hours increased to ensure that laundry was attended to within a reasonable timescale. Inspection of the laundry showed that there was no longer a backlog. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Whilst minimum staffing levels were met, the lack of a full time cook and changing demands on staff from Rapid Response residents meant staffing levels needed to be kept under review. EVIDENCE: Rotas for the week of the inspection and 2 previous weeks showed that minimum care hours were provided each day and an additional carer had been provided on one day during this period. However, on the day of inspection, staff were seen to be very busy throughout the day and did not get a break until well into the afternoon. The afternoon carer did not arrive for work until part way through teatime, observation showed that care staff did not have sufficient time to complete all required tasks in a satisfactory time. Comments regarding the quality of the food prepared can be found on page 14. Staffing had been improved since the last inspection but the regular change of short term residents via Rapid Response referrals continued to be demanding on staff time. Kitchen staff continued to finish work at 2.00pm – and on one week had finished at 1.00pm, leaving carers the responsibility of preparing and serving food and drink after this time. With the exception of the cooks, improvement was noted in the provision of ancillary hours. The majority of residents and relatives spoke well of staff whom they said had a good understanding of residents’ needs, although one person interviewed considered some staff were less caring than others. Relatives considered communication with them regarding residents’ needs was good. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 20 The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 A registered manager who was fit to be in charge of the home was in post but was in need of management training. The home had a number of quality assurance systems but these were in need of further development to ensure the home was run in the best interests of residents. Whilst provision of health and safety training had improved, some practices did not promote and protect health, safety and welfare of residents. EVIDENCE: A registered manager was in post and was seen to manage the home satisfactorily. She is an RGN and RMN and had experience of working with people with dementia. She did not hold a management qualification but was undertaking the Registered Managers Award at the time of inspection and had a projected completion date of June 2006. The home has the Investors in People Award, and a number of quality assurance systems were in place e.g. regular review of care plans, staff meetings, supervision of staff and circulation of family questionnaires. These The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 22 were last circulated in June 2005. Feedback was seen to be positive in the main and action had been taken with regard to any identified areas. The results of the feedback were not published however and residents were not canvassed for their views. Residents and relatives meetings were not held. There was no current annual development plan other than the refurbishment plan. Staff continued to attend health and safety training on an ongoing basis but did not have up to date training in each area. With regard to moving and handling, staff were observed drag lifting a resident to enable them to sit more comfortably in a wheelchair. It was noted that a risk assessment had been made and agreed with regard to non-use of bumpers to bedsides, upholding the resident’s wishes. The dangers were discussed with the resident during the inspection and agreement reached to the use of the bumpers for safety. All other bedsides in use were seen to have bumpers on them. With one exception, regular maintenance checks were undertaken in line with legislation. Action was taken during the inspection to satisfactorily address this area. The decorator had left paint, white spirit, ladders and other equipment in the smoking lounge during a 2 week break from the premises. When the matter was raised with the provider immediate action was take to remove the items and make it safe for the resident to access. None of the staff had been delegated responsibility for health and safety oversight in the building. The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 2 3 3 2 2 2 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 1 The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4OP30 Regulation 18 Timescale for action An up to date training plan for all 31/01/06 grades of staff must be provided and adhered to with regard to training in the care of people with dementia. Complete records of medicines 19/12/05 segregated for disposal must be maintained. The medicines policy and 10/01/06 procedures must be updated to describe: • the new arrangements for handling unwanted medicines. • the handling of homely remedies. Following consultation with 31/01/06 service users, a programme of activities must be arranged, to include person-centred activities (Previous timescale of 11/05/05 not met). Teatime menus and the quality 31/12/05 of the cooking must continue to be monitored and reviewed to ensure residents are offered appetising and nutritiously balanced meals at teatime. (Previous timescale of 31/10/05 not fully met) DS0000061887.V266723.R01.S.doc Version 5.0 Page 25 Requirement 2 3 OP9 OP9 13.2 13.2 4 OP12 16 5 OP15 16 The Riverside Nursing Home 6 OP20 16 7 OP20 16 8 OP20 16 9 10 OP23 OP24 23 23 11 OP24 16 12 13 OP24 OP25 16 13 14 OP27 18 15 OP38 13 The furniture in the lounges and dining rooms must be replaced. (Previous timescale of 01/09/05 not met) Dining chairs suitable for the service users must be provided. (Previous timescale of 01/09/05 not met) The vinyl flooring in the designated smoking lounge must be replaced. The floor covering must be fire retardant. (Previous timescale of 01/09/05 not met) Sufficient space must be provided in the bedrooms of residents requiring a hoist. All service users personal accommodation must be redecorated. (Previous timescale of 01/09/05 not fully met) Rooms occupied by service users must have adequate furniture, bedding and other furnishings including curtains and floor coverings. (Previous timescale of 01/09/05 not fully met) Worn commodes must be replaced. Radiators in rooms 14,15 & 18 must be monitored and any with surface temperatures of 43°C or over must be covered. Staffing levels must be continuously monitored to ensure sufficient staff are employed to meet the changing needs of residents, including those admitted via Rapid Response. Staff must all complete training in moving and handling and be regularly observed and monitored to ensure safe practice. Monitoring should incluse completion of a competence assessment with regard to each worker. DS0000061887.V266723.R01.S.doc 31/01/06 31/01/06 31/01/06 31/12/05 31/01/06 31/01/06 31/01/06 19/12/05 31/12/06 31/01/06 The Riverside Nursing Home Version 5.0 Page 26 16 OP38 13 Staff must complete training in food hygiene, 1st Aid, health and safety and infection control. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 6 Refer to Standard OP9 OP10 OP15 OP15 OP18 OP20 Good Practice Recommendations Records of the denaturing of controlled dugs should be witness signed. Following risk assessment, locks operated by individual keys should be offered to residents in place of current locks. Keys should be offered to residents on admission. Residents should be offered a choice of food each meal and a written record kept of their choices. A full time cook should be employed. The acting manager and deputy should attend Rochdale MBC Protection of Vulnerable Adults training and cascade the information down to all staff. Further consideration should be given to the designation of communal space to ensure a smoking room, visitors’ room, lounge for residents with nursing needs and a smoke free staff room for non-smoking staff are provided. Hoist slings should be allocated to individual residents. All staff should undertake foundation training within 6 months of employment. Quality assurance systems should be developed to include more regular use of questionnaires, resident/relative meetings, publication of questionnaire findings and an annual development plan. A designated staff member should have oversight of health and safety matters at the home. 7 8. 9 OP22 OP30 OP33 10 OP38 The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Riverside Nursing Home DS0000061887.V266723.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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