Care Home: Birch Court Nursing & Residential Home

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What the care home does well Riverbank provides a range of services for residents with differing needs. Riverbank provides a friendly staff team. A resident said, "The staff are lovely they always have a smile on their face and they call me by my name". Another residents said, "I feel well cared for here". Prospective residents have a full assessment prior to admission and written information is provided for them. Social activities are provided for residents and a social activities programme was in place. Residents` monies are stored securely and appropriately managed. Riverbank provides a comfortable environment with all residents having single, ground floor bedrooms. All were cleaned to a good standard. The health and safety of staff and residents is provided for. What has improved since the last inspection? Care records about residents continue to improve and the QUEST documents used by BUPA provide staff with the opportunity to gather important information about the lifestyles, life histories and health of residents. Staff interaction on some units had improved and staff engaged residents positively with dignity and respect. What the care home could do better: The recording of the receipt, administration and disposal of medicines needs improving so that residents have had their medicines properly. Residents must be consulted about their daily routines and lifestyle choices and the planning, coordination, variety and a choice of social activities so they can lead fulfilling lives. Appropriate number of staff must be working in the care home so people that use services` health, social and welfare needs are met at all times. Records of employment must be obtained for all persons employed so people that use services are protected from potential abuse. Residents` personal plans should include consistent information obtained about them and reflect residents` needs so their needs can be met. Staff should receive training on person centred thinking so they can look at residents as individuals and provide individualised care based around their individual needs, choices and wishes. Training on protecting vulnerable adults and prevention of adult abuse should include information on the local council procedures and information for staff to keep so they know what to do. All care staff should be provided with information about their responsibility and accountability for caring and protecting residents. A quality assurance system that identifies the route causes of complaints, safeguarding concerns and cause of poor staff practice and learns from then should be introduced. CARE HOMES FOR OLDER PEOPLE Riverbank Nursing Home Egerton Street Howley Warrington Cheshire WA1 2DF Lead Inspector Anthony Cliffe Unannounced Inspection 17th April 2008 09:00 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 Riverbank Nursing Home DS0000005164.V361772.R02.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. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverbank Nursing Home Address Egerton Street Howley Warrington Cheshire WA1 2DF 01925 573772 01925 240158 baileyt@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) Ms Jacqueline Mary Boylan Care Home 150 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (60), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (1), Old age, not falling within any other category (90), Physical disability (2) Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. The maximum number of service users who can be accommodated is 150 whose primary care needs on admission to the home are within the following categories: * Old age, not falling within any other category may be accommodated in Firth, Church and Bridge House: Code OP (maximum number of places: 90). Old age, not falling within any other category aged 55 years and above may be accommodated in Bridge House: Code OP (maximum number of places: 15). Physical disability in receipt of nursing care may be accommodated in Bridge House (maximum number of places: 2). Dementia over 65 years of age in receipt of nursing care may be accommodated in Victoria House: Code DE(E) (maximum number of places: 30). Dementia over 65 years of age in receipt of personal care may be accommodated in Beech House: Code DE(E) (maximum number of places: 30). Mental health problems over the age of 65 may be accommodated in Bridge House: Code MD(E) (maximum number of places: 1) 6th June 2007 * * * * * Date of last inspection Brief Description of the Service: Riverbank provides nursing and personal care for a maximum of 150 service users across five units. These units are run and managed as separate houses each with their own staff team and unit manager, with a service manager and deputy manager overseeing the whole site. Personal care is provided for up to 30 older people with dementia in Beech House. Nursing care for up to 30 older people with dementia is provided in Victoria House. Nursing care for up to 30 Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 5 older people is provided in each of the units Church, Firth and Bridge House. A main building houses central administration, kitchen, laundry and staff facilities. The home was opened in 1989 and is located in the Howley area of Warrington, close to shops, pubs, restaurants and a church and within easy reach of other town centre amenities. All bedrooms are single and are on the ground floor. There are no en-suite facilities. The home has extensive gardens that are well maintained and are accessible for service users. Fees range from £391 to £658 per week. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This unannounced visit took place on the 17th April 2008 and lasted nine hours. Three regulatory and one pharmacy inspector carried out the visit. The pharmacy inspector inspected the medicines on all five units. The visit took 5.5 hours and involved examining residents’ medicines and associated records that are required by law to show that the residents are having their medicines properly. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the manager was asked to complete a questionnaire to provide up to date information about services provided. During the visit various records and the premises were looked at. People that lived at Riverbank were spoken with to find out what they think about the services they received. Staff including the manager and unit managers and staff were also spoken with and they gave their views about the service. What the service does well: Riverbank provides a range of services for residents with differing needs. Riverbank provides a friendly staff team. A resident said, “The staff are lovely they always have a smile on their face and they call me by my name”. Another residents said, “I feel well cared for here”. Prospective residents have a full assessment prior to admission and written information is provided for them. Social activities are provided for residents and a social activities programme was in place. Residents’ monies are stored securely and appropriately managed. Riverbank provides a comfortable environment with all residents having single, ground floor bedrooms. All were cleaned to a good standard. The health and safety of staff and residents is provided for. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 8 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 Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 9 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): 1, 3 and 6 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Information is available for residents and their representatives so they can make a choice about where they live. Residents’ needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: Riverbank accommodates mainly people from the Warrington area and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. Residents or their relatives were provided with a copy of information about the facilities and services offered at Riverbank. Copies of this information and the most recent inspection report were available at the main entrance and in each unit. Information could be provided in different formats on request to head office. Survey’s returned from residents and relatives prior to the site visit confirmed that they had received information on Riverbank that helped them or their relative to choose to live there. A survey confirmed the person had Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 10 received information before choosing to live at Riverbank and wrote, ‘seemed the right place for me’. Four personal plans were examined of residents who had recently moved into Riverbank. The residents had met with the manager or registered nurse to discuss their care prior to moving in. Information was gathered and this was recorded. This included information on their physical and mental health. Copies of these documents were on two residents’ plans. The other used the format provided by the intermediate care team, which purchased beds in one of the units at Riverbank. The fourth contained information gathered at the time the person moved into Riverbank but staff said the resident had been seen prior to moving in. On residents’ care records information had been gathered prior to moving in and copies of the local council care management assessments were on file. All the QUEST documentation, the BUPA care records, was completed and included important risk assessments. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 11 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 and 10 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Records are kept of people’s personal and healthcare needs and staff care practice but they need to improve so they demonstrate that residents receive appropriate personalised care and medicines prescribed for them. EVIDENCE: Care records were looked at on all five units and the standard of there varied. Maps of life had been completed but the information in them was not transferred into care records to inform staff about residents’ lifestyle, routines and choices prior to living in Riverbank so records were not personalised and did not reflect person centred thinking. Care record were adequate and gave guidance on how residents should be cared for however on speaking to staff they did not appear to reflect the care that was being given to residents. An example of this was where information on moving and handling risk assessments had been gathered and recorded about a resident. This recorded the resident should be moved using two staff members, an Oxford hoist and medium sling. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 12 The care records for the resident’s mobility had also been completed referring to an Oxford hoist and medium sling. An accident form regarding the resident had been completed recording that the resident had been moved using a stand aid hoist. There was no explanation as to why this hoist was used could be given by staff. A further accident form recorded the resident had an accident in the bath using a fixed bath hoist. A registered nurse explained the resident now had bed baths, however care records for personal hygiene recorded the resident required a weekly bath and has no problems using the fixed bath hoist. There was no reference made to the previous accident or of any action staff may need to take following this when bathing the resident. The home had contacted the local council a number of months previously requesting an advocate for the resident and in March 2008 were still waiting for the local council to get back to them about this several months later without it being followed up by Riverbank staff. In another resident’s care records mobility was identified as a risk mainly as the residents got out of bed at night. Some of the risk assessments for the resident were written the same as every other resident and were not personalised to his needs. The care records of a resident requiring palliative care were looked at and these were detailed regarding daily living and reference was made to the involvement of the family in the resident’s care. Care records for wound management for the resident’s legs recorded that dressings were in place but did not advise what dressings to use and how often they required changing. Wound charts were completed and a body map was in place, however the wound size had not been recorded to enable staff to know if the wounds were getting smaller following treatment. The dressings used were recorded on the evaluation sheet. Records for intermediate care were looked at and care plans were in place on hospital documentation and the homes’ documents. These were adequate and contained enough information to enable staff to care for the resident during their stay at the home. The resident had been admitted with a large pressure ulcer and care records in place were detailed. Wound charts had been completed to enable staff to know how the wound was progressing. However a skin tear on the legs did not have a care plan in place to enable staff to care for the wounds. Care records referred to “ both heels being discoloured” but had not been completed to enable staff to know how this was progressing or what to do to prevent further breakdown of the residents skin. Residents registered with GP’s and Surgeries prompt routine blood tests for residents as part of annual health checks. Records recorded regular contact with health care professionals when needed. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 13 The home has company procedures to guide staff how to manage medicines. Each unit has a separate room for storing residents’ medicines containing appropriate facilities to keep them secure and well organised. The home has recently changed their supplying pharmacy. The new pharmacy has supplied new bigger medicine trolleys and provides printed forms for staff to record the audit trail of records of receipt, administration and disposal of all the medicines. It is possible to see that the residents have had their medicines properly by comparing the amount left in the records with that left in the pack. The standard of record keeping varied a lot. There were examples of very good practice such as on Church Unit where notes had been put in with the records to remind staff how to obtain medicines from the hospital and faxes from the doctor when doses changed. The majority of the records were adequate. No internal medicines were being recorded given incorrectly. There were many examples of the records not showing a complete audit trail due to missing receipt records and unexplained gaps in the records of giving medicines staff had forgotten to sign after giving the medicines. Also staff did not always record the dose of medicines like painkillers where the resident could choose how many to have. Prescribed food supplements, thickeners and creams and lotions were not recorded well. Bridge Unit has some medicines and records supplied by the community pharmacy and some from hospital. The hospital card has been changed and is now much clearer than the old one. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 14 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 and 15 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Residents’ ability to make lifestyle choices is limited as residents do not always have a choice of daily routines, social activities or leisure pursuits due to a lack of staff to provide support so some are inactive and do not socialise. EVIDENCE: Riverbank employs two activities organisers that work on the five units. There was a vacant post for an activities organiser, which the manager demonstrated had been filled. Details of the activities available were displayed on the units. Residents’ surveys returned prior to the site visit said that activities were usually arranged and available to them. Managers on two of the units said that the shortage of an activities coordinator had affected how residents; were offered choices over recreational activities and described activities as ‘being in transition’. The manager said that the activities organisers had met with the BUPA dementia care specialist to look at appropriate activities and the plan was also that the activities organisers hours would be reviewed from between 10am to 4pm to work more flexibly covering evenings and weekends. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 15 QUEST personal plans contained social lifestyle personal plans and details of residents’ family histories but personal information was not transferred into care practice so personalised care was not always offered to residents. An example of this was on a unit. A ‘bath list’ was on the wall in the office and a list of residents that were to be bathed by the night staff before they went off duty at 08:00 was displayed. When spoken with a staff member said, “ night staff have to do baths or we wouldn’t get the work done. It’s a heavy unit and you can’t get through the day or the work done if everything has to be personalised. If we could spend an hour with everyone providing care, as they want, we would do it but we don’t have those sorts of staffing numbers. We haven’t consulted or recorded anything about making decisions for them. We have discussed the capacity of people to make decisions but haven’t tried to establish if people have capacity. Yes people should be able to make choices that reflect their routines”. There did not appear to be an element of choice given to the residents regarding daily life and they appeared to be fitting in with the unit’s routines. Staff were seen to be completing care records when sat with residents instead of talking to them. On two of the units residents were seen sleeping for long periods without any activities taking place and televisions and music on. The majority of residents did not seem to be watching the television. Relatives’ surveys returned prior to the site visit described staff as caring and friendly but said communication and interaction with residents could be improved. A relative recorded, ‘qualitative care still needs improvement. Most interactions take place with residents that can engage in conversations’. A resident said, “I get looked after and have nice meals but I get bored as there’s not much going on. There’s a list up there telling you that bingo, dominoes and an entertainment afternoon was on. No one wanted to go so no one reminded me, as my memory can be poor so I didn’t go. I look forward to other residents having visitors so I can listen and chat. They also give me newspapers when they have finished with them. I would like my own newspaper but no one ever reminds me or asks if I want one. If I had one I wouldn’t be so bored” On another unit activities were happening and the activities organiser was busy with residents serving tea. Music was playing and residents could be seen tapping their feet in time. Staff sat with residents despite being short of staff. The television was on and residents were watching this. Staff said they valued the activities coordinator and was on the unit each day and residents looked forward to her visits. On another unit an observation of the care and level of interaction between resident, their environment, with staff and one another was done within a communal lounge for two hours. The purpose was to get first hand experience of sitting alongside people for a couple of hours during a regular part of the day within a communal area. The care of four people was looked at. When Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 16 comparisons with the observations were made with the homes records and the knowledge of the care staff. During this two-hour observation some of the people remained within the communal area and the others moved between this area, the corridors, other communal areas. Care staff practices were good and staff were very patient, always took time to ask residents questions rather than deciding for them and people were encouraged to be active, but could also sit quietly if that was their wish. It was seen that staff respect people. All the interactions between staff and residents were noted to be good. There was a high level of engagement with residents during this period. Staff was actively engaged with residents throughout the whole of the observation period. General observations at this time were that the room was warm and music was playing in the background. Several residents were singing/humming or tapping their feet to the music. When a resident seemed to shiver staff asked if she wanted a cardigan and got her one. The unit had also produced its own newsletter to keep residents up to date with events going on at Riverbank. The new menus were displayed on the corridors of most of the units. Staff said these were new and the menu display changed daily by kitchen staff. The menu display had pictures of some of the meals on offer. A manager said the night bites menu was the reintroduction of what staff did for supper but had more focus on offering residents more choice and the opportunity of a hot snack before bed. The daily menu displayed a choice of breakfast cereals and a cooked breakfast with variety of fruit juices. There was also the choice of a variety of different preparations of eggs. Lunch had a soup starter, main choice of jacket potato with variety of fillings or smoked haddock with vegetable or sandwiches. Residents were complimentary about the meals and said they enjoyed the choice of a cooked breakfast. Surveys returned by residents prior to the site visit said they usually enjoyed the meals. A relative commented in a survey that the chef had been very helpful about their mother’s meals. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 17 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 and 18 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The awareness of the safeguarding process needs to improve so residents are protected from risk of abuse. EVIDENCE: Since the last site visit eleven complaints had been received by the home. Complaints records were looked at. Three complaints had not been completed. One of these was being looked at by an internal investigation and the local council and had not been finalised. Two other complaints received had been acknowledged by the regional manager and were being looked into. The outcome form one complaint that had not been finalised was that all units had been reissued with the philosophy of care for residents and staff had to sign this to verify they had read it. Four staff was asked questions about safeguarding during the site visit and the BUPA safeguarding policy was looked at along with staff training records Care staff said they were aware of the term protection of vulnerable adults and referred to the training they had as adult abuse awareness training. One staff member said she had her training ‘two weeks ago’ and another said her training was ‘recently’. Both were aware of the Whistle blowing policy and how to use this. They both said that during their training the local council adult protection procedure was not shown to them or discussed and no information leaflets were given to staff. Both said they were confidant about who they could report allegations to and said social services; managers, registered nurses and senior care staff. They Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 18 said they were not aware or confident they would know how to contact the local council as they did not have access to telephone numbers and did not know the procedures to follow. Staff said they could not recall the General Social Care Council (GSCC) Code of Conduct, which is the code of practice for social care workers. A manager and senior carer were asked questions about safeguarding. Both said they were aware of the terms adult protection and had received adult abuse awareness training. The manager said she had received training about two years ago and senior said she had training two weeks ago. Training was described as watching a DVD and answering questions on this. They said the local council adult protection procedure was not shown to or discussed nor any information leaflets given out. The contact numbers for the local council service reception team were available for staff to contact them with allegations of abuse as well as the out of house emergency duty team were available on the unit for staff to contact them. The manager interviewed said the unit had a copy of the GSCC code of conduct but staff was not given individual copies of this. Both the clinical services manager and registered manager confirmed this. Records provided by the home recorded that eighty staff had received training in adult abuse awareness since June 2007. Despite this Riverbank had made eight safeguarding referrals since the last site visit and two staff had been referred to the Protection of Vulnerable Adults Register. Some of the safeguarding concerns were being looked into by the police and local council. BUPA care service were giving their full cooperation with ongoing investigations Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 19 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 and 26 People who use services experience Good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Residents live in a safe, comfortable and well-maintained environment, which is equipped to meet their needs. EVIDENCE: The environment in all the units was clean and no odours noted. Satellite kitchens were clean and the cleaning schedule completed for the 14, 15th and 16th April 2008. New assisted Malibu baths had been installed in some of the units and the walls had been retiled. Flooring was to be replaced and additional pipe work was to be boxed in. Bedrooms seen were personalised with personal photographs, electrical items and some furniture. On one unit reminiscence room had been created. Bathroom and toilet door locks were broken but this had not posed a problem to individuals’ privacy or dignity as observed during the two-hour observation on the unit. The manager confirmed that a major refurbishment of several hundred thousand pounds was due to be undertaken in 2008. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 20 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 and 30. People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The numbers, recruitment and deployment of staff needs improving so residents are protected, receive personalised care and are in safe hands at all times. EVIDENCE: Staffing levels were not appropriate and the manager confirmed that staffing numbers had been affected by sickness and staff absence at short notice. Agencies were contacted to address staffing shortfalls. The staff turnover was discussed with the registered manager. The manager confirmed that the hours recorded in the Annual Quality Assurance Assessment (AQAA) regarding agency staffing were correct and had covered both care and registered nurse hours. She said that she had been conducting exit interviews with staff who had left employment and that this had shown that the caring profession was not what people expected and this was a reason why staff had left. A number of staff employed from Eastern Europe that had worked at Riverbank had also left. At the time of the site visit the home was experiencing some staffing difficulties. For example one unit loaned staff out to other units, but because staff had called in sick at the last minute and on another carer had been arranged to cover the afternoon shift then was not available the unit was short of staff so an agency was contacted at short notice. Other units also experienced staff shortages. A staff member said that the unit she worked on ran well but that Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 21 they needed more staff members. One staff member had to cover on another unit and this could affect the running of the unit from which he had been moved. Other staff commented that on the unit they worked they covered their rota; however due to issues on other units they then lose staff. A manager said staff moving around to cover other units was an issue but said that sickness monitoring had improved and people were now being asked why they had not turned up for shifts. The AQAA recorded that Sixty six care staff were employed, of these 23 had an NVQ level 2 qualification and six are undertaking NVQ level 2. 100 of catering staff and 65 of care staff received training in food hygiene. Staff files were looked at for four new staff members. Two files looked at contained all relevant information required to enable the management to be aware that the person could work with vulnerable adults. Two staff files did not contain a full employment history and one had not received two written references from a previous employer. The clinical services manager was responsible for staff training. She had introduced an induction programme for mandatory training. This comprised of health and safety, moving and handling, fire, introduction to activities, personal best and safeguarding adults. She said it also included an audit of individual staff skills following induction. Two new staff members who were on induction were spoken with. They both said they were to start induction training the following week. One said she had been shown the fire procedure on the unit and the other staff member said she had not and would ‘feel hopeless’ if there was a fire. One of the staff members described residents that required help with eating as ‘feeders’. These matters were addressed to the manager during feedback. The clinical manager had produced a training programme for 2008 from March onwards. This recorded training sessions arranged for each month. . The training programme included mandatory and induction training, Mental Capacity Act, the use of bed rails, manual handling, fire safety, and abuse awareness and prevention of pressure ulcers. Training had taken place from Coloplast on the use of wound care products. Since May 2007 eighty staff had completed training in adult abuse awareness. Only fifteen staff needed to have fire safety training updates and the training was ongoing. Fifteen registered nurses had training on wound management since April 2007 and twenty of the prevention of pressure ulcers. A copy of the most recently up to date training records were provided from which this information was taken. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 22 Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 23 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 and 38 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Management systems are inconsistent in identifying and learning from problems that effect the overall management of Riverbank so residents do not benefit from a well managed, consistent service that is run in their best interests. EVIDENCE: The home manager has been in post for two years and completed registration as manager for Riverbank. She was a registered general nurse and had the registered manager award. A deputy manager had been appointed and there was a clinical services manager that had responsibility for clinical management and training. A full time and part time administrators supported them. An area manager carries out visits required by regulation 26 of the Care Homes Regulations. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 24 Following the recent concerns over safeguarding issues at Riverbank and as part of the action plan submitted by BUPA to the local council open days were being arranged on the individual units to offer residents’ relatives to visit and discuss residents care, gather information about residents, raise concerns and update care records. BUPA had also set an action plan for improvement for the home and all of the individual units. The actions plans for the five units identified virtually the same problems on each unit with the same actions identified to remedy the problems. Problems were identified about general appearance of the buildings, fire procedures, communication not being effective as handovers were both inefficient and ineffective and communication amongst staff unclear. Issues over health and safety, medicine management and leadership were also highlighted. The improvements that needed to be made were not individualised for each unit but followed a general plan for improvement. The improvement plans did not identify if staff practice around providing individual care had been considered, or if a thorough organised management system within the home that used the findings of quality assurance or learning from complaints and safeguarding concerns to improve the overall management of the home was needed. The regional manager as part of the quality assurance programme was carrying out visits. This included monthly completion of the ‘early warning audit tool’. This was the quality assurance tool used by BUPA to look at quality of the overall management of Riverbank and included finance, health and safety, records, care of residents, recruitment, training and safeguarding. It used a traffic light system to give the home a rating. For example red, amber, green and blue. Riverbank’s rating for 2007 was amber using the BUPA quality assurance assessment. The last audit was completed in March 2008. It looked at the care of residents on two of the units and highlighted safeguarding issues on another. The estates department form BUPA visited the home in January 2008 for a six monthly review of the building and maintenance. This confirmed that the testing of portable electric equipment certificate was to be done and water temperatures not recorded from September to November 2007. The refurbishment of the care home was confirmed as commencing in 2008. A financial audit was completed in April 2008 and no issues were raised regarding residents’ finances. To support the quality assurance system questionnaires were sent to relatives and a report collated from the information received. These were done in Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 25 October 2007 and the results of these available to residents and relatives. An action plan had been produced in response to this. The survey recorded that the quality of the overall service had risen by 7 from 2006, staffing had risen by 11 , treatment of residents had risen by 39 The quality of food by 29 and activities by 26 . Meetings for relatives were held and minutes of these available. Unit managers did not have supernumerary hours but the clinical service manager was employed in a full time supernumerary capacity and available to support them. The units held their own staff meetings. Heads of department meetings were held monthly and include catering and housekeeping. The registered manager had also introduced a ‘ten at ten’ meeting so all the unit managers/ heads of department could meet and share relevant information with the senior management team on a daily basis and important issue discussed and dealt with. Monies held on behalf of residents were kept safely and securely and records of administration confirmed residents’ monies were administered correctly. Information provided by the provider in the AQAA confirmed the required maintenance and health and safety checks of the building and equipment had been completed. Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 26 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement Timescale for action 17/04/08 2. OP14 16(2)(m) (n) 3. OP27 18(1)(a) 4. OP29 19(1)(b) Schedule 2 paragraphs 1 to 9 Ensure that staffs record the audit trail of records of receipt, administration and disposal of medicines clearly and completely to show that residents have had their medicines properly. The registered person must 17/04/08 ensure that people that use services are consulted about their daily routines and lifestyle choices and the planning, coordination, variety and a choice of social activities provided so they can lead fulfilling lives. The registered person must 17/04/08 ensure that at all times there suitably qualified, competent and experienced staff working in the care home so people that use services’ health, social and welfare needs are met at all times. The registered person must 17/04/08 ensure that all records specified under Regulation 19 Schedule 2 paragraphs 1 to 9 are obtained for all persons employed so people that use services are DS0000005164.V361772.R02.S.doc Version 5.2 Riverbank Nursing Home Page 28 protected from potential abuse. 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. Refer to Standard OP7 OP14 Good Practice Recommendations Residents’ personal plans should include consistent information obtained about them and reflect residents’ needs so their needs can be met. Staff should receive training on person centred thinking and planning so they can look at residents as individuals and provide individualised care based around their individual needs, choices and wishes. Training on the safe guarding of vulnerable adults and prevention of adult abuse should include information on the local council procedures and information for staff to keep so they are aware of the procedures to follow should they suspect and need to report allegations of abuse. All care staff should be provided with individual copies of the General Social Care Council code of practice so the people that live at Riverbank will be confident staff are aware of their responsibility and accountability for protecting them. A quality assurance system should be in place that identifies the route causes of complaints, safeguarding concerns and cause of poor staff practice and learns from then so the way in which Riverbank is conducted and managed will improve and the health and welfare of residents will be promoted. 3. OP18 4. OP31 5. OP33 Riverbank Nursing Home DS0000005164.V361772.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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