Care Home: Rivelin House

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What the care home does well People have needs assessments to try to ensure that their individual needs can be met at the home prior to them moving in. Overall people have very comprehensive care plans, which identify how staff should support people to lead fulfilling lifestyles. People are encouraged and empowered to make informed decisions about their lives with support as required. For example one person told us, I decide when I get up and what I have for breakfast. Today I had cereals and toast. I can decide when to go out. I can decide when to do the gardening and what to spend my money on. People told us they have opportunities to lead everyday lifestyles, to access the community to go swimming and bowling and to shop and attend local luncheon groups. Overall, people are supported by comprehensive risk assessments to protect their safety and welfare. Throughout our visit we observed staff interactions with people, which were at all times respectful, empowering and friendly. People told us that they liked the staff. All of the staff were positive and enthusiastic and there was a very calm and confident approach to their support. This is what people who live at the home told us, I like all of the staff, they are alright. Another person said, I like all of the staff especially my keyworker. There was evidence that people are involved in meaningful daytime activities of their own choice. This is what people who live at the home told us, I`m going to the shops later, to buy food for everyone. I also go swimming and bowling, I like them. From our observations and from some records we could see that mealtimes were arranged around people`s needs and wants. People told us, I can choose what to have for all my meals, at the weekends I like a nice fry-up. We asked two people who lives at the home if they are offered appropriate support from staff with personal care tasks. This is what they said, I can have a bath or a shower when I want. The support worker, she has put my hair in rollers today. From the care plans it was evident that people attend regular health appointments. For example that people had seen the dentist, the G.P. and a chiropodist on a regular basis. Other specialist health professionals were also supporting people who had more complex needs. The medication procedures were checked. The home used the monitored dosage system, which the local pharmacist delivers on a regular basis. The medication was stored in clean, lockable drug cabinets. All of the staff we spoke to said they were aware of the adult safeguarding procedures and they had completed training on this subject. The inspector checked a sample of three peoples finance records. The system was easy to follow and gave a clear account of their deposits and withdrawals and receipts for goods and services purchased. At the time of the visit five people lived in the home. The home was generally clean and tidy, homely and safe. Two people showed us to their bedrooms, which were both well decorated, personalised and furnished to a high standard. One person said I like my room because Ive got a telly and a CD player. The staff interviewed told us, the relationship with managers is really good as they have regular staff meetings and feel they are approachable and will listen to them. One member of staff told us, they had regular training from the service and had completed an NVQ2 in care award. Another member of staff told us, they were offered frequent supervision and always felt able to take any concerns or problems they had to the management team. From observations and discussions with people who live at the home we found that their opinions are listened to, they take part in many activities in the home and from observations it was clear the staff are supporting people to lead fulfilling lifestyles. The AQAA report from the home detailed the way in which peoples views underpin, the reviews and self monitoring of the service through service users meetings, monthly and annual internal service reviews which involve people. What has improved since the last inspection? Medication systems had been tightened up to ensure the system was more robust to protect people`s welfare. The manager of the home was registered earlier this year by CSCI. And is appropriately qualified as a registered nurse for the role. What the care home could do better: One persons care plan must have their care plan reviewed as a priority to ensure that their needs can be met without this impinging on the lifestyle and opportunities of other people who live at the home. People need to access their regular activities in the community. Therefore the person identified during the inspection needs to have their care needs reviewed to ensure that they and other people have adequate staff support to continue with their regular activities. Two issues were highlighted during the inspection, which identified that the risk assessments in place needed to be reviewed as a priority to protect peoples health and safety. One related to a fire exit the other related to how staff managed behaviour, which challenges. The only concern voiced by staff about training was that the challenging behaviour training they had completed did not feel appropriate/or they did not feel confident to use this training with one person identified in this report. This information was given to the nurse in charge to ensure that remedial action was taken to address the staff concerns. All areas of the home should be kept clean and in a good state of repair and decor therefore the lounge areas highlighted as needing redecoration should be attended to. Stained carpets should be cleaned or replaced. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rivelin House 498 Bellhouse Road Sheffield South Yorkshire S5 0RG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shelagh Murphy     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Rivelin House 498 Bellhouse Road Sheffield South Yorkshire S5 0RG 01142577911 01142577933 Telephone number: Fax number: Email address: Provider web address: www.milburycare.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Lisa Elaine Hall Type of registration: Number of places registered: Milbury Care Services Ltd care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: One specific service user with Learning Disabilities, over the age of 65, named on variation dated 2nd October 2006 may reside in the home. Date of last inspection Brief description of the care home Rivelin House is a care home providing personal care and nursing care for eight people. The home is owned by Milbury Care Services Limited and is situated in the Shiregreen area, of Sheffield. It is close to local shops and amenities and on a main bus route. The home is not fully accessible for all people who are wheelchair users, as the kitchen and laundry facilities are very small. There are eight bedrooms rooms for single occupancy situated on two floors the upper floor is accessed by a lift. All bedrooms Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 8 8 Brief description of the care home have an ensuite facility, accessible for wheelchairs and fitted with overhead tracks for hoists. One of the rooms has its own kitchenette, lounge and dining room, bedroom, ensuite and its own fenced garden area. The garden areas are accessible to all residents, these areas are private and appropriate garden furniture is provided. The scale of charges ranges from 1700 pounds to 3400 pounds per week. Additional charges include travel costs, hairdressing, social activities, additional meals and holidays. Prospective residents and their families can get information about Rivelin House by contacting the home manager. Copies of the statement of purpose, the service users guide and the latest CSCI inspection report are also available. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two star. This means that people who use the service experience good quality outcomes. Shelagh Murphy carried out this unannounced visit to the service over one day and the total time spent on site was 5 hours. In the report we make reference to, us and we. When we do this we are referring to the inspector and the Commission for Social Care Inspection. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. On the day of the site visit the Annual Quality Assurance Assessment report was given Care Homes for Adults (18-65 years) Page 6 of 31 to the inspector. This report detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Some information from the AQAA is included in the main body of the report. Some time was spent with the people who use the service. It was difficult to conduct conventional interviews with some people, due to their learning difficulties. However, most people were able to let us know their feelings using their specific ways of communication to let us know their thoughts about the home and the staff. We observed two people who had communication difficulties to gauge, how staff at the home supported them. It gave us some insight into how staff interacted with people, how people are supported by the staff and also an indication of peoples well being. We spoke to two people who live at the home. Three staff attended interviews with us, two relatives were sent surveys to give us their views of the service. Comments and feedback from these stakeholders have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in April 2008. The progress made has been reported on under the relevant standard in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The inspector wishes to thank the people living in the home, staff, managers and relatives for their time and co operation throughout the inspection process. What the care home does well: People have needs assessments to try to ensure that their individual needs can be met at the home prior to them moving in. Overall people have very comprehensive care plans, which identify how staff should support people to lead fulfilling lifestyles. People are encouraged and empowered to make informed decisions about their lives with support as required. For example one person told us, I decide when I get up and what I have for breakfast. Today I had cereals and toast. I can decide when to go out. I can decide when to do the gardening and what to spend my money on. People told us they have opportunities to lead everyday lifestyles, to access the community to go swimming and bowling and to shop and attend local luncheon groups. Overall, people are supported by comprehensive risk assessments to protect their safety and welfare. Throughout our visit we observed staff interactions with people, which were at all times respectful, empowering and friendly. People told us that they liked the staff. All of the staff were positive and enthusiastic and there was a very calm and confident approach to their support. This is what people who live at the home told us, I like all of the staff, they are alright. Another person said, I like all of the staff especially my keyworker. There was evidence that people are involved in meaningful daytime activities of their own choice. This is what people who live at the home told us, Im going to the shops later, to buy food for everyone. I also go swimming and bowling, I like them. From our observations and from some records we could see that mealtimes were arranged around peoples needs and wants. People told us, I can choose what to have for all my meals, at the weekends I like a nice fry-up. We asked two people who lives at the home if they are offered appropriate support from staff with personal care tasks. This is what they said, I can have a bath or a shower when I want. The support worker, she has put my hair in rollers today. From the care plans it was evident that people attend regular health appointments. For example that people had seen the dentist, the G.P. and a chiropodist on a regular basis. Other specialist health professionals were also supporting people who had more Care Homes for Adults (18-65 years) Page 8 of 31 complex needs. The medication procedures were checked. The home used the monitored dosage system, which the local pharmacist delivers on a regular basis. The medication was stored in clean, lockable drug cabinets. All of the staff we spoke to said they were aware of the adult safeguarding procedures and they had completed training on this subject. The inspector checked a sample of three peoples finance records. The system was easy to follow and gave a clear account of their deposits and withdrawals and receipts for goods and services purchased. At the time of the visit five people lived in the home. The home was generally clean and tidy, homely and safe. Two people showed us to their bedrooms, which were both well decorated, personalised and furnished to a high standard. One person said I like my room because Ive got a telly and a CD player. The staff interviewed told us, the relationship with managers is really good as they have regular staff meetings and feel they are approachable and will listen to them. One member of staff told us, they had regular training from the service and had completed an NVQ2 in care award. Another member of staff told us, they were offered frequent supervision and always felt able to take any concerns or problems they had to the management team. From observations and discussions with people who live at the home we found that their opinions are listened to, they take part in many activities in the home and from observations it was clear the staff are supporting people to lead fulfilling lifestyles. The AQAA report from the home detailed the way in which peoples views underpin, the reviews and self monitoring of the service through service users meetings, monthly and annual internal service reviews which involve people. What has improved since the last inspection? What they could do better: One persons care plan must have their care plan reviewed as a priority to ensure that their needs can be met without this impinging on the lifestyle and opportunities of other people who live at the home. People need to access their regular activities in the community. Therefore the person identified during the inspection needs to have their care needs reviewed to ensure that they and other people have adequate staff support to continue with their regular Care Homes for Adults (18-65 years) Page 9 of 31 activities. Two issues were highlighted during the inspection, which identified that the risk assessments in place needed to be reviewed as a priority to protect peoples health and safety. One related to a fire exit the other related to how staff managed behaviour, which challenges. The only concern voiced by staff about training was that the challenging behaviour training they had completed did not feel appropriate/or they did not feel confident to use this training with one person identified in this report. This information was given to the nurse in charge to ensure that remedial action was taken to address the staff concerns. All areas of the home should be kept clean and in a good state of repair and decor therefore the lounge areas highlighted as needing redecoration should be attended to. Stained carpets should be cleaned or replaced. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs assessed to try to ensure that the staff can meet their needs before they are admitted to the service. However, one person who moved in to the home recently needs to have their needs reassessed to ensure the staff can support the person appropriately Evidence: We checked three peoples had needs assessments. Two peoples needs assessments had been completed by local authority case managers. One had been completed by a nurse from Rivelin House at the point of the persons emergency admission. They were all appropriately detailed to ensure the service could assess whether peoples needs could be met at the home. However, several staff told us they believed that one persons assessment needed to be reviewed as they now knew that this person needed far more staff support than was identified at the time they were admitted to the home. This information was passed on to the nurse in charge at the end of the inspection to action as a priority. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in making decisions about their lives, and play a part in planning the care and support they need and want and the risks associated with the support plans. Evidence: We checked four peoples care plan files and found that overall they contained adequate information for staff to support people. Three peoples files showed clearly the support and care staff were offering to people and were devised in a person centred style to enable the individual to have more access to their care files. However, although another persons care needs had been identified, three staff told us the strategies used to support these needs were not always being followed consistently. For example strategies used to support the persons challenging behaviour were not used consistently as some staff felt they did not work and were not confident to use them without fear of them hurting the person or being hurt by the person. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We passed this information back to the nurse in charge and advised that the persons care plan needs to be reviewed, as a priority with support from their social worker. The nurse in charge told us this was an issue, which had already been raised and that they were in the process of managing this. We asked how people are supported to make decisions about their lifestyles. The people who use the service told us, I decide when I get up and what I have for breakfast. Today I had cereals and toast. I can decide when to go out. I can decide when to do the gardening and what to spend my money on. Another person said, I can decide what time to get up and when to have my hair done. Staff told us they supported people to make decisions about their everyday lifestyles for example what they wore, where they went to and what activities they would like to take part in. From observations of the staff and service users we saw evidence that the staff encouraged people to make everyday decisions and listened to peoples requests were empowering in their approach to people. It was also very clear that the staff knew people very well and were able to communicate with people who had communication needs and to interpret their needs and wants. Overall, people had comprehensive risk assessments, which covered issues such as risks associated with people being moved in hoists, managing behaviour, which may challenge and outings from the home for people who are wheelchair users. Two of the risk assessments we checked needed to be updated. One for a person who presented behaviour, which challenged the service and a fire risk assessment for the person who lived alone in the flat as staff had identified issues with their fire exit access. See outcome area 6. Overall, we found that people had opportunities to take appropriate risks associated with leading everyday lifestyles. These included accessing the community for outings, peoples mobility around the home and use of the equipment in the kitchen. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are treated with dignity and respect. Staff support people to be able to make choices about their lifestyle, and they are supported to develop social, recreational and general life skills. The home provides people with suitable diets to meet their individual needs. Evidence: Throughout our visit we observed staff interactions with people, which were at all times respectful, empowering and friendly. People told us that they liked the staff. All of the staff were positive and enthusiastic and there was a very calm and confident approach to their support. This is what people who live at the home told us, I like all of the staff, they are alright. Another person said, I like all of the staff especially my keyworker. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: There was evidence that people are involved in meaningful daytime activities of their own choice, which, had been planned in accordance with their wants, needs and capabilities. This is what people who live at the home told us, Im going to the shops later, to buy food for everyone. I also go swimming and bowling, I like them. Im going on holiday to Centre Parks with the staff soon. Another person told us I usually go to the luncheon club, but my legs hurt today so Im stopping at home. Another service user with support from staff told us, they were going to the park for a walk and would be buying some chocolate from the shop on the way home. Some of the staff we spoke to said, we have arranged a lot of activities for people and when there are enough staff on duty we go all over with people, shopping, swimming to the cinema etc. Two members of staff told us that it is sometimes difficult to support people to go on regular outings if one of the people who lives at the home is presenting challenging behaviour because at these times they need higher staff support than 1-1. This was feedback to the nurse in charge who advised that action was being taken to reassess the persons care needs. People who live at the home are supported to maintain and develop relationships. We asked people and checked peoples care plans and found evidence that staff supported people to make regular phone calls to relatives and also to support them to have visits and to relatives. We asked one person about this. They told us, My brother and sister visit me and I phone my Mum every week. Another person said they were regularly in touch with their parents who visit all the time. From our observations and from some records we could see that mealtimes were arranged around peoples needs and wants. People told us, I can choose what to have for all my meals, at the weekends I like a nice fry-up. Some people had soft diets and Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: one person was on a low protein diet due to their health needs. Staff reported since the change of diet, the persons did not present as much challenging behaviour as before. The staff confirmed that people are offered a choice of meals and are encouraged to go shopping with staff to buy food for meals. We checked to see if people were offered a varied and nutritious diet and menus showed that this was the case. Some people who live at the service needed to have special diets, this information was recorded in their care plans as were the appropriate swallowing assessments. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on meeting their individual needs. Evidence: We asked two people who lives at the home if they are offered appropriate support from staff with personal care tasks. This is what they said, I can have a bath or a shower when I want. The support worker, she has put my hair in rollers today. One member of staff told us, We support people as much as is needed with personal care it all depends on peoples levels of ability. In some peoples care plans it advises we just need to prompt some people and other people need us to wash and bathe and dress them. All of the people who live at the home were observed to be well dressed and their clothing was age appropriate. One person told us they went shopping for their own Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: clothes from Meadowhall. Staff told us that personal care support was offered to people on an individual basis and was flexible to meet peoples needs. For example, rising and retiring times were dependent on the individuals choice, as was the time when people were to be bathed/showered. We observed several people to be asked by staff whether they wished to have a bath or a wash and their request was respected by the staff. We then asked people for their views about whether they were supported to meet their health care needs, this is what they told us, I can go to the doctors up the road when Im not well the staff take me. I go to the hospital for check ups with my keyworker. From the care plans it was evident that people attend regular health appointments. For example that people had seen the dentist, the G.P. and a chiropodist on a regular basis. Other specialist health professionals were also supporting people who had more complex needs. There was evidence in the care plans that some people had attended appointments with specialist health professionals. One person had a condition, which meant they needed to wear an oxygen mask at night and there were clear instructions for staff in the care plan of how to use the apparatus safely. We checked to see if people had moving and handling assessments in place, they did and they been reviewed. The staff on duty told us that none of the people who lived at the home were able to administer their own medication. Therefore the nurses on duty were responsible for these tasks. We checked peoples drug sheets and found that a system had been introduced which identified the medication prescribed, the dosage, reason for use and review dates. This was good practice and ensured that staff were made aware of these details. The medication procedures were checked. The home used the monitored dosage system, which the local pharmacist delivers on a regular basis. The medication was stored in clean, lockable drug cabinets. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the safeguarding policies and procedures as the staff knew how to respond to allegations of abuse. Peoples rights are protected and there are procedures to ensure all allegations of abuse are thoroughly investigated. People who use the service are able to express their concerns and have access to a complaints procedure. Evidence: We asked people whether they liked living at Rivelin House and this is what they said, I like my bedroom. I like the staff and I like gardening. Another person said, I like it when its quiet. The home has a complaints procedure for people. This is in accessible formats, it was called, letting us know what you think. We asked people whether they knew how to make a complaint one person said, Yes, I would report the situation. Another person said they would tell the staff. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The staff told us that other people who had more profound needs would need to rely on relatives or their key workers to support them to make complaints. The nurse in charge told us that no complaints had been made at the home since the last inspection. All of the staff we spoke to said they were aware of the adult safeguarding procedures and they had completed training on this subject. The nurse in charge also confirmed this. She also advised that a copy of the new local area safeguarding adults procedure was now in the staff office for everyone to access as required. We saw evidence that the home has a whistle blowing procedure. The nurse in charge informed us that over the last year no adult safeguarding referrals have been made to the local safeguarding adults team. The inspector checked a sample of three peoples finance records. The system was easy to follow and gave a clear account of their deposits and withdrawals and receipts for goods and services purchased. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the accommodation offered to people was of a good standard. People had been supported to personalise and make their houses homely in order to meet their specific needs. Evidence: At the time of the visit five people lived in the home. The home was generally clean and tidy, homely and safe. Some areas of the home were observed to need re decorating including the lounge area, as there had been a leak from an upstairs bathroom and some of the paint had peeled from the walls. Some carpets in communal areas such as the hallway and stairs were stained and action to address this will be needed. The kitchen was also generally clean and tidy. We asked people what they liked about their homes and this is what they told us, I like going in to the garden. I do gardening with the staff and Im growing my own herbs. Another person said they liked the new sofa in the lounge area. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Two people showed us to their bedrooms, which were both well decorated, personalised and furnished to a high standard. One person said I like my room because Ive got a telly and a CD player. The en suite bathrooms had ceiling hoist to aid people moving between their bedroom and the bath safely. This made access to the bathrooms much easier for people. The bathrooms checked were clean and appropriately adapted to meet peoples needs. Water temperatures were checked and were within the appropriate range to prevent people from being scalded. Outside there is a communal garden area with patio furniture. The garden was well maintained and attractive. In relation to fire exits the staff told us their concerns about the ability of a service user to safely access their flat using a wheelchair. There was a lip between the fire escape door and the ramp to access the path, the path was quite mossy and staff said this could be quite slippy when wet. The path down to the front gate was quite narrow which meant that a member of staff needed to go in front of the service user to open the gate. All of this information was passed on to the nurse in charge to deal with as a priority as this could pose a risk to the persons safety. People who live at the home and the staff said there were adequate washing and drying facilities in the home to keep peoples laundry clean. There was evidence that staff had completed infection control training and that measures were in place to wash soiled laundry safely. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people are supported by a staff team are appropriately trained, skilled and experienced to meet their needs. People are supported by the homes recruitment practices. Evidence: On the day of our visit there were six support workers on duty and the nurse in charge to support five people who live at the home. One person has 2-1 staff support during the day and another person had 1-1 staff support throughout the day. This staffing level was adequate to meet peoples needs on the day of the visit. One member of staff told us, they had regular training from the service and had completed an NVQ2 in care award. The only concern voiced by staff about training was that the challenging behaviour training they had completed did not feel appropriate/or they did not feel confident to use this training with one person identified in this report. This information was given to the nurse in charge to ensure that remedial action was taken to address the staff concerns. Another member of staff told us, they were offered frequent supervision and always felt able to take any concerns or problems they had to the management team. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The staff interviewed told us, the relationship with managers is really good as they have regular staff meetings and feel they are approachable and will listen to them. From our observations we saw a lot of good staff practice. For example staff were very tuned in to peoples communication styles, they were moving people appropriately using individuals aids/hoists appropriately and safely and they were supporting people with very complex needs in a professional and safe manner. We also observed the relationships between staff and people who lived at the home. This showed that staff had positive regard for all of the people who lived in the home, they were informal but respectful in the way they spoke to and of people. This was very positive to see as the people who lived at the home responded positively to the staffs approaches. The nurse in charge said and some of the staff confirmed, that they had induction training and completed most of the required mandatory training. This included fire safety, first Aid, food hygiene and infection control. Other training that had been either planned or completed included, NVQ2 awards, managing challenging behaviour and adult safeguarding. However, the nurse in charge also told us that some staff needed to be trained in moving and handling people and that this training had been requested from the training department but had not been organised yet. We advised that this issue must be raised with the managers line management to address as a priority in order to keep people safe. Three staff recruitment records were checked. We found these contained the information required including CRBs, application forms, proof of I.D, two references. We checked a sample of supervision records, which showed that staff were being regularly supervised. This had enabled the manager to monitor staff development and accountability. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is now appropriately registered with the Care Quality Commission (CQC). There are good relationships between the managers and staff team and it was clear this had a beneficial effect on the services offered to people. Evidence: The manager of the home was registered earlier this year by CSCI. And is appropriately qualified as a registered nurse for the role. The staff reported that the manager is supportive and listens to them. From observations and discussions with people who live at the home we found that their opinions are listened to, they take part in many activities in the home and from observations it was clear the staff are supporting people to lead fulfilling lifestyles. The AQAA report from the home detailed the way in which peoples views underpin, the reviews and self monitoring of the service through service users meetings, monthly and annual internal service reviews which involve people. It stated people had been encouraged to choose new home furnishings, to revise menus and as a result of Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: peoples requests staff rotas had been changed to ensure people could access more community events. The service has health and safety policies and procedures in place, this ensures peoples safety and welfare. However, the training for staff to support people safely maybe compromised if they are not adequately trained or confident to carry out the practices. (See standard 35 requirements). Therefore requirements to address these issues were passed on to the nurse on duty on the day of the inspection and have been included in this report with short timescales to comply. The nurse in charge said the regional operations manager visits the home to carry out regulation 26 visits, and records of these were shown to the inspector. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 The people highlighted must have their risk assessments reviewed. To ensure that any risks associated with their present care plan arrangements are still appropriate to meet their needs. 30/04/2009 2 2 5 The person identified at the inspection must have their needs reviwed. This will ensure that the persons needs can be appropriately met by staff at the home. 30/06/2009 3 24 23 The risk assessment relating 30/04/2009 to the fire exit access from the flat needs to be reviewed and any remedial action to safeguard the person needs to be taken. To ensure the home is safe for all people. Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 35 13 The staff must be offered moving and handling training. To protect people from harm. 30/06/2009 5 35 13 The staff must be offered appropriate support and training to manage the support of people whose behaviour challenges the service. To protect peoples welfare. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 People need to access their regular activities in the community. Therefore the person identified during the inspection needs to have their care needs reviewed to ensure that they and other people have adequate staff support to continue with their regular activities. All areas of the home should be kept clean and in a good state of repair and decor therefore the lounge areas highlighted as needing redecoration should be attended to. Stained carpets should be cleaned or replaced. 2 24 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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