Care Home: Rivelin Park

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What the care home does well People who use the service are carefully assessed before they receive a service of care and support, and they are provided with information about the care and accommodation and staff, and good opportunities to visit the service in order to decide whether or not their needs can be met there. People have their needs and changing needs recorded in a care plan and other plan documents, which take into consideration their individual differences. They are encouraged to make their own decisions about daily life, as much as possible, which may involve taking risks in order to achieve independence. However, these risks are reduced where possible with the adherence to risk assessment documents and plans.People take part in appropriate community or service based activities and pastimes, they enjoy relationships of their choosing with good advice coming from staff, and have their rights and responsibilities as citizens upheld wherever possible. Staff try to encourage their involvement in the community or advocate for them when necessary. People also enjoy a variety of meals, usually of their choosing, and assist in the provision of and preparation of food wherever possible. People say they receive the help and support with personal care and with physical and emotional health needs in a way that suits them and that is private and dignified. They are well protected by the service`s systems for controlling and administering medication. They have their views listened to and feel confident they can make representations or concerns and complaints known to staff or the manager. People live in a very homely environment that is clean and suits their preferences. Competent and qualified staff care for people in their daily lives and in sufficient numbers to meet their needs. Staff are satisfactorily recruited so people are also cared for by safe staff, though there is still some improvements to be made here. There is a quality assurance system in place, which once fully operational should self-monitor the service provided. The health, safety and welfare of people and staff are well promoted and protected. What has improved since the last inspection? This is the first Key Inspection in the service since registration in September 2007 and therefore there is no past position to compare with. What the care home could do better: The service could make sure staff do not begin working in the service until a full safety clearance has been received, so people are confident they are cared for and supported by safe staff. The service could make sure there is a registered manager in post and submit either a query on transferring the acting manager`s registration, or a new application, to the Commission, so people are confident a registered person is running the service and their needs are met.The service could make sure people or their relative/advocate sign and date the copy of their statement of terms and conditions/contract of residency, so there is evidence they are fully included in any decision making processes and they know their residency needs are met. The service could consider purchasing a medication fridge to store medicines that require lower temperature storage, so drugs are stored at the safe recommended temperature and people know their health care needs are safely met. The service could make sure staff administering medication receive an annual up-date of medication administration training and that details are retained on files, so people know their health care needs are safely met. The service could make sure staff specialist medication administration training is evidenced on their files, so that people are confident staff are competent to administer specialist medicines and people know their health care needs are safely met. The service could make sure staff receive up-dated mandatory training each year, and every three years in respect of first aid, so people are confident they are cared for and supported by well-trained staff and their needs are met. The service could make sure that fire safety drills either be recorded monthly if they are held monthly, or that the statement of purpose clearly shows the actual frequency of drills, so people are confident their health, safety and welfare is promoted and protected. The service could make sure hot water outlets are temperature tested regularly and that details are recorded in a log, so people know their safety is promoted and protected. The service could make sure a legionella water test is carried out on the hot water storage, if required, within twelve months of the registration of the service and three-yearly thereafter, so people know their health, safety and welfare are promoted and protected. CARE HOME ADULTS 18-65 Rivelin Park 32 Rivelin Park Kings Park Hull HU7 3GP Lead Inspector Janet Lamb Key Unannounced Inspection 13th March 2008 09:00 Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 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 Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivelin Park Address 32 Rivelin Park Kings Park Hull HU7 3GP 01482 823720 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) Foxglove Care Ltd Post Vacant – currently filled by Yvonne Graham as acting manager. Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 2 N/A This is the first Key Inspection 2. Date of last inspection Brief Description of the Service: Rivelin Park is situated in one of the Kingswood housing developments just to the north of Kingston Upon Hull. The house is a three-storey property with a utility room, a small cloak/toilet, a small office and an integral garage on the ground floor. There is a lounge and a dining room on the first floor, and two single bedrooms (one with en-suite shower and toilet) and a bathroom on the second floor. There is a garden to the rear of the house, accessible through the utility room or the side of the house. The home provides 24-hour care, support and accommodation to two younger adults with a learning disability, all within a community setting. People are encouraged to develop their learning, personal and social skills through programmes of activity and entertainment. The fees for staying there range from £1,300 to £1,600 per week. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2-star. This means the people who use this service experience good quality outcomes. The first ever Key Inspection of 32 Rivelin Park has taken place over a period of time and involved sending an ‘annual quality assurance assessment’ (AQAA) document to the service in September 2007 requesting information about people and their family members, and the health care professionals that attend them, as well as asking for numerical data held in the service’s records. We received the requested information in October 2007. Survey questionnaires were not issued immediately but were taken to the service to hand out to people and their relatives on the day of the site visit. This information obtained from surveys and information already known from having had contact with the service over the last few months sine its registration, was used to suggest what it must be like living there. The first ever site visit held on 13th March 2008 was used to test these suggestions, and to interview people, staff, visitors and the service manager. Some documents were viewed with permission from those people they concerned, and some records were also looked at. All standards were assessed on this occasion. Two people, one staff, and the registered provider, were interviewed during the site visit and two visitors were also spoken to briefly, while time was spend in the service observing interaction between people, people and staff and people and visitors. All of the information collected, in conversations, through observation and in survey questionnaires was collated to report on what it is like living in Rivelin Park. What the service does well: People who use the service are carefully assessed before they receive a service of care and support, and they are provided with information about the care and accommodation and staff, and good opportunities to visit the service in order to decide whether or not their needs can be met there. People have their needs and changing needs recorded in a care plan and other plan documents, which take into consideration their individual differences. They are encouraged to make their own decisions about daily life, as much as possible, which may involve taking risks in order to achieve independence. However, these risks are reduced where possible with the adherence to risk assessment documents and plans. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 6 People take part in appropriate community or service based activities and pastimes, they enjoy relationships of their choosing with good advice coming from staff, and have their rights and responsibilities as citizens upheld wherever possible. Staff try to encourage their involvement in the community or advocate for them when necessary. People also enjoy a variety of meals, usually of their choosing, and assist in the provision of and preparation of food wherever possible. People say they receive the help and support with personal care and with physical and emotional health needs in a way that suits them and that is private and dignified. They are well protected by the service’s systems for controlling and administering medication. They have their views listened to and feel confident they can make representations or concerns and complaints known to staff or the manager. People live in a very homely environment that is clean and suits their preferences. Competent and qualified staff care for people in their daily lives and in sufficient numbers to meet their needs. Staff are satisfactorily recruited so people are also cared for by safe staff, though there is still some improvements to be made here. There is a quality assurance system in place, which once fully operational should self-monitor the service provided. The health, safety and welfare of people and staff are well promoted and protected. What has improved since the last inspection? What they could do better: The service could make sure staff do not begin working in the service until a full safety clearance has been received, so people are confident they are cared for and supported by safe staff. The service could make sure there is a registered manager in post and submit either a query on transferring the acting manager’s registration, or a new application, to the Commission, so people are confident a registered person is running the service and their needs are met. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 7 The service could make sure people or their relative/advocate sign and date the copy of their statement of terms and conditions/contract of residency, so there is evidence they are fully included in any decision making processes and they know their residency needs are met. The service could consider purchasing a medication fridge to store medicines that require lower temperature storage, so drugs are stored at the safe recommended temperature and people know their health care needs are safely met. The service could make sure staff administering medication receive an annual up-date of medication administration training and that details are retained on files, so people know their health care needs are safely met. The service could make sure staff specialist medication administration training is evidenced on their files, so that people are confident staff are competent to administer specialist medicines and people know their health care needs are safely met. The service could make sure staff receive up-dated mandatory training each year, and every three years in respect of first aid, so people are confident they are cared for and supported by well-trained staff and their needs are met. The service could make sure that fire safety drills either be recorded monthly if they are held monthly, or that the statement of purpose clearly shows the actual frequency of drills, so people are confident their health, safety and welfare is promoted and protected. The service could make sure hot water outlets are temperature tested regularly and that details are recorded in a log, so people know their safety is promoted and protected. The service could make sure a legionella water test is carried out on the hot water storage, if required, within twelve months of the registration of the service and three-yearly thereafter, so people know their health, safety and welfare are promoted and protected. 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. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service People have good information about the home and are able to sample the service beforehand, so they are able to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home, so they are confident their needs will be met. The contract of residence provides people with some protection that the service on offer meets their needs. EVIDENCE: Discussion with people in the home and staff, and viewing of case files and documentation with peoples’ permission reveals people are given every choice about living in the home, with introductory visits as necessary. People have information to help them decide on whether or not they want to live there, have their individual and personal needs assessed, and receive a contract of residency. The home provides written documentation that people’s assessed needs can be met by the competence and skills of the staff group. There is a clear and detailed statement of purpose and a service user guide in place and copies are held in people’s files in picture format. People are aware Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 10 of their files and know the information is held for and on them. They rely mainly on information coming from staff to keep them informed of changes and issues related to the service of care. The documents meet the requirements of regulations 4 and 5. People are fully assessed by an officer of the placing local authority social services department, and a record of these assessments is held in people’s files. The service tends to use these assessments initially and then conducts its own information gathering through what is known as the ‘transition process.’ This is the period of time it takes for people to look at the home, receive visits from the staff that will be caring for and supporting them, spend a number of one day, weekend and then trial stays there, before they make up their mind to stay permanently. Both case files that were viewed with the permission of people in the home contain copies of the assessment documents, and information gathered. There is a pre-admission checklist, but main information gathered during the ‘transition period’ is recorded on diary sheets and then straight onto care plan documents. The service determines whether or not it can meet people’s assessed needs during the ‘transition process,’ drawing on staff experience and training and providing extra courses where necessary, and provides a written document that states needs can or cannot be met. People are informed about the independent advocacy services available to them and assistance/support is provided to help them take advantage of this. There are no advocates involved with people at the moment, but one person did have an Independent Mental Capacity Advocate (IMCA) allocated to assist them with decisions on moving to the home and how their care and support would be delivered. People have relevant contracts of residence in the form of a statement of terms and conditions, but although they have verbally agreed them, they are not signed or dated. The service is recommended to make sure these statements of terms and conditions are signed and dated. If people are unable to sign then a relative or advocate should do so. The service should also check that the contracts/statement of terms and conditions meets the requirement of standard 5.2 and regulation 5(1)(b). People spoken to said, “Staff helped me move here, they asked me about what I wanted to do. I know I have a file with everything in it.” And, “I like living here, I go out a lot.” Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People enjoy making their own decisions in life, with risk assessments being put into place where necessary that enables them to lead independent and inclusive lives. Care plans are well devised to meet needs and reviewed as requested or in line with the requirements of the providing authority. EVIDENCE: Discussion with people, staff and relatives and viewing of care plans and documents with people’s permission reveals they are encouraged to make individual choices that enable them to fulfil their needs with support from staff. They join in with the local community, engage in pastimes and occupations of their choosing and take risks if necessary. Care plans are in place for people, in case files, which follow the format of ‘goal setting, strategies to meet needs and who is responsible to assist.’ Case Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 12 files also have evidence of care plans being reviewed every six months and would be sooner if the person requests it. Care plans contain evidence that people or relatives have been consulted and where possible people sign their documents. There are also copies of the placing authority ‘community care,’ care plan and of the health authority ‘continuing nursing’ care plan. There are also specialist care plans in place for any particular medical condition people may have. People spoken to are aware of their documentation and remember the processes they have gone through to secure the placement in the home. One relative said, “It’s a shame xxxx had to leave the last home, he liked it there, but it closed and he is better off living nearer to us now. He’s settled well.” There are few limitations on facilities, choice or rights, but where a specialist programme is required then it is initiated. People have management programmes in their case files also, and discussion with the provider reveals other plans are being considered, a ‘health action plan,’ a ‘communication passport’ and a ‘patient passport.’ People are encouraged to join in with day-to-day running of the home especially where it impacts on their routine, risks and choices. People are involved in hiring staff through meeting candidates, showing them around and discussing relevant topics. People are involved in quality assurance systems to obtain their views, via people meetings and proposed surveys, which have not been sent out yet. There is no evidence of involvement with development and reviewing of policy, procedures and services, but people do influence the service they receive because staff change the service to meet individuals’ needs, especially in respect of their social and emotional needs. Standard 8 needs further development to show how and when people may be involved or consulted about all aspects of living in the home and the feedback they should be given. There are risk management systems in place and people also have individual risk assessment documents, which show how risk is reduced but may still be evident. People spoken to are open about the risks they wish to take, but need lots of support to fully understand the consequences of their choices. This was observed taking place during the site visit. One person was having trouble receiving an internet signal on a laptop, and despite being informed he did not have his own internet facility and was wrongly using someone else’s signal, he persisted in wanting to try. Possibilities are being explored to enable him to have his own broadband facility. His desire to view Internet sites is greater than his understanding that ‘piggy backing’ is illegal and so he continues to take the risk. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 13 Staff are expected to maintain good confidentiality codes and to encourage people to be discreet with the information they offer to people in the community. Practice observed is satisfactory. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People enjoy satisfying lifestyles of their choosing, with support from staff where necessary, and so they are confident their needs are met. EVIDENCE: Discussion with people, staff and relatives and viewing of case files and documents reveals people live the lifestyle of their choosing that is often guided by staff. Living at Rivelin Park is all about achieving a personal development. People have opportunities to make decisions about their daily lives, future ambitions, take risks, etc. Things don’t always go as smoothly as people would wish, but errors are used as learning opportunities. People take part in some household chores, some cooking and shopping duties and they are encouraged to learn about social situations etc. One person regularly surfs the Internet for topics Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 15 of interest and aspires to have his own dedicated Internet line. Diary notes and changes in care plans show how and when all of these things occur. Where possible people take up educational and occupational opportunities as well. Places frequented include the City Farm at Bilton, Hull College of Further Education, and such as swimming for people with a disability. People talk openly about the places they visit and why, and they clearly enjoy the opportunities available to them. People engage in bowling, holding competitions with another service, snooker and taking meals at the local pub, and particular projects such as setting up of storage facilities in the service’s garden. People have come to know their neighbours and take interest in pets and garden projects. Having the service’s lounge on the first floor enables people to view other gardens close by. One person went down to the garden to take interest in a neighbour’s dog that could be seen over the fence. Again, evidence of all that takes place is found in diary notes and from conversations with and observations of people. There are plenty of opportunities to visit relatives or friends or to have them visit the service. On the day of the site visit two relatives called in and spent time talking to people, and the staff. They have a regular routine of visiting and clearly all parties enjoy the interaction. People also have and express aspirations to have relationships with peers and partners. Advice and support is discreetly and sensibly provided from staff where and when necessary. People have freedom of choice in their daily routines and like anyone else realise there are times when they must be up and ready for the day if they are to indulge in activities and classes etc. People spend time at the weekends cleaning their rooms, or in the week assisting with shopping etc. They also help prepare lunch, usually a simple snack. All of this activity is recorded in care plans and diary notes, and is a part of people’s individual development. Meals usually follow a planned, healthy options menu that has been devised by people in the service, on the advice of staff. There are opportunities for the less healthy, liked foods though and a balance is maintained. One person prepared and made the lunch on the day of the site visit, producing toasted sandwiches for everyone. Where people have problems maintaining a good diet, they are carefully encouraged to try new foods and keep a growing list of likes for future consumption. Recognition of achievement is used to increase people’s self-esteem in aiding their personal and health development. These practices and systems were observed in operation on the day of the site visit. Meals are usually according to individuals’ wishes and are relaxed and informal. One person spoken to said, “I have cooked breakfast, like curry and sometimes help to cook.” There is a kitchen dining space for people to use, and good hygiene practices are encouraged/insisted upon. People make and Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 16 consume their own meals where possible, but staff cook the main meal of the day, usually in the evening and to fit in with any later planned activities. There are individual records held in files of the actual food people consume. The arrangements in place for providing food are satisfactory and people are happy with them. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. People who use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People enjoy a good level of support and protection with their health care and personal care, and with administration of their medicines, so they know their care and health care needs are met. EVIDENCE: Discussion with people and staff and viewing of case files and documents reveals people receive good support to maintain good personal and health care. The people living in the service tend to require more support with their personal and health care than actual assistance with it. People are self-caring in respect of their personal hygiene etc., and only require prompting. They speak of receiving good support to maintain a healthy wellbeing. One said, “But I am not ill at the moment,” when asked about what he would do if he did feel unwell. Another said, “I see the doctor, I’ve had my eyes tested. And I go to the dentist.” People did agree that they see their GP when they request to. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 18 Health care plans in place show visits form GPs and District Nurses, to the local surgery, and hospital appointments etc. There are also areas within the health care plans that cover specialist needs, e.g. epilepsy, oral and other medication administration, mental health, etc. These are accompanied by risk assessment documents, and all documents are relevant and current as the service has only been operational for six months. There are plans in hand to produce ‘health action plans’ and ‘communication passports’ for people living in the home, to improve on the ways in which health care needs can be met. There is a medication administration policy and procedure for staff to follow. There is a self-medication policy, but people in the service say they prefer staff to be in control of medicines and to give support in taking them, so it is not used. They said, “My medication is in the safe and staff give it to me when I need it,” and “My tablets are kept in there and staff support me with them. I like staff to look after my tablets.” Storage is satisfactory for the moment and may just need changing if a cooler storage is required. A designated medication fridge may be needed if any medication requiring colder storage is prescribed. Staff handing out medication have received medication administration training, with Boots Chemist. One staff file showed training had been done in March 2006, in a previous position. Another staff file showed they had received training in specialist administration of diazepam in January 2008. The provider of the service also checks staff competence at administering medicines, during their induction. Where people have not had annually updated medication administration training they need to do so, and a record of this must be maintained. The service also uses Mulberry Care testing sheets (various) to determine staff abilities in caring and such as handling medication. These should be retained on file as evidence of instruction. Controlled drugs are handled in line with the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the Misuse of Drugs Act 1971. There are no controlled drugs held in the service at the moment, but a register would be used and would contain two staff signatures. Medication administration record sheets are used and show they are being completed accurately. People in the service do not receive any lunchtime medication so the practice of handling medication was not observed. Standard 21 is not applicable at the moment. People are very new to the service and they are very young as yet. Staff say that people have little understanding of the consequences of death and any reference to such an issue would be worked through sensitively and carefully. Specialist help and advice would be sought if necessary. The provider should take time to Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 19 approach the subjects of illness and death, and determine people’s wishes as and when appropriate, and record these in case files. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People that use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People and their relatives have access to robust complaint and protection systems within the service, and so they are confident their concerns are dealt with appropriately and that they are protected from harm or neglect. EVIDENCE: Discussion with people, relatives and the staff and viewing of documents and records show there is robust complaint and protection policies and procedures in place, and that staff are appropriately trained. People said, “If I am unhappy about anything I go to the manager or the senior.” Relatives spoken to could not remember having been given any documentation on the service or on how to complain, but said they would simply talk to the staff or the manager if they had any worries. Staff are well aware of the complaint procedure and of the form to complete if anyone does have a formal complaint to make. There is a record held of complaints made and there has only been one in the first six months of the service’s registration. This was from a neighbour who had a misunderstanding of the purpose of the service and its registered status. There is also a safeguarding adults’ policy and procedure available that staff are aware of and would follow. There is a Hull and East Riding Safeguarding Adults’ Board file in place. Discussion with staff reveals they are well aware of their responsibilities and why and when to pass on any information to the Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 21 appropriate safeguarding adults’ team. They have a whistle blowing policy and have no compunction about using it to protect people. The senior staff and the management team have undertaken safeguarding adults’ training and cascaded the information down to all staff. This is to be updated in April 2008. The management team are to complete a ‘Train the Trainers Course,’ as well as cascade a learning disability manager’s training pack and DVD to staff, as part of the update. Generally staff know how to make representations for people and under what circumstances, and discussion with them reveals they are fully aware of their responsibilities. A record is maintained in a person’s file should there be cause to make a referral of this nature, though none have been made to date. There has been no referral to the safeguarding adults team or the POVA list during the early days of the service’s registration. A record would be held but is not applicable yet. There are individual programmes in place for people to help them manage their behaviour and to assist them with development. Staff undertake British Institute of Learning Disabilities training on understanding and handling challenging behaviour and certificates are held in files. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. People that use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People live in a satisfactorily furnished and equipped house that is clean, safe and comfortable, and offers sufficient space and facilities so they are able to lead independent lives. EVIDENCE: Discussion with people, relatives and staff and viewing of the premises reveals the service is suitable for its stated purpose and meets all space, size, facility and equipment standards. These standards were met on registration of the service in September 2007. The service is situated in one of the Kingswood housing developments just to the north of Kingston Upon Hull. The house is a three-storey property with a utility room, a small cloak/toilet, a small office and an integral garage on the ground floor, a lounge and a dining room on the first floor, and two single bedrooms (one with en-suite shower and toilet) and a bathroom on the second Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 23 floor. There is a garden to the rear of the house, accessible through the utility room or the side of the house. The living space belonging to people in the service is suitable and meets the size requirements. There are two bedrooms for people and sufficient shared space for them to live comfortably. Bedrooms are fitted out with appropriate and suitable furniture and fittings as listed in standard 26.2. People said, “I like living here, I have a good room, but I want my own Internet,” and “I have my own room, do you want to see it? We are getting a new office, come and look.” Heating, lighting and ventilation also meet requirements. One bathroom is available to one person and the other person has an en-suite room. Staff and people in the service share the use of the downstairs cloak/toilet. The utility room houses the laundry equipment, which is of domestic type, but satisfactory. People are encouraged and supported to do their own laundry and cleaning of their rooms on a weekly basis. Information is recorded in care plans. The premises are safe, clean and accessible to the people living there. There is now no garage parking space, but only space for one car to the front of the house, as the ground floor integral garage is being converted to an office that has its own entrance and will be occupied by two administrative staff employed by Foxglove Care Ltd. These staff will deal with all aspects of the business side of the company, it having expanded over the last twelve months to include four properties where care and accommodation are provided. There are few adaptations or equipment in the service, as people living there are physically mobile and therefore this is not necessary. Bathrooms and bedrooms have no special aids, as they are not required. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. People that use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People are cared for by staff in sufficient numbers to meet their needs, that are well recruited, trained and supervised to do the job, so people know safe staff are caring for them. EVIDENCE: Discussion with staff and viewing of files, records and documentation reveals the service is adequately staffed by staff that are well recruited, with the necessary qualifications and training, and that receive good supervision and support. Staff spoken to indicate they receive appropriate information and documentation in respect of their employment. Their files contain a recruitment checklist, which shows the steps taken to employ them. They have job descriptions and contracts of employment and are aware of the General Social Care Council code of practice. Good and effective relationships have been built up with people living in the service and were observed in operation. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 25 Staff explain they have done NVQ level 2 and one has completed level 3. Two more are also undertaking level 3. Of the eight staff and one bank staff employed in the home there are now six with level 2 and the other two are completing it - unsure what the bank staff holds. This means 67 of the staff team have the required qualifications to do the job. (This figure may be higher or lower depending on what the bank staff holds.) The Residential Staffing Forum figures recommend that there should be at least 118.2 and at the most 302.48 care hours per week provided in the service for two people with high dependency. This range of hours is dependent upon whether or not people require special assistance and also the number of hours people may spend out of the home. Information received on the AQAA shows there are 266 hours provide each week, and a copy of the roster taken from the service on the day of the site visit shows 269 hours were actually provided week commencing 10th March 08. There are always at least two staff on each shift through the daytime and one waking night staff through the night. Staffing levels are therefore considered met, and are as a result of the need to ensure people receive one-to-one staffing throughout the daytime. Staff, excluding the manager, comprise of an almost even number of males (5) and females (4), whose ages range from 18 to 35 years, and of whom seven are British and two are Caribbean. Those in senior positions are old and mature enough to undertake the role. One bank staff is currently employed to cover sickness and annual leave. Recruitment of staff is satisfactorily carried out. Staff spoken to confirm the process of recruitment they undertook and files back up the safety checks carried out on them. Documentation seen in files with permission from staff shows schedule 2 is followed. Staff undertook and received a POVA first check at least before starting to work in the service. For one person the actual Criminal Records Bureau check was received six days after they begun their induction and for another it was received nine days after they begun their induction. Where possible staff should always only begin working in the service after the actual CRB check has been received. This is a recommendation made at the end of the report. Staff references are satisfactorily obtained before staff start working and they are given appropriate supervision in line with the requirements of standard 36. Induction details are held in files and show that it takes approximately one week to complete an induction. Staff then go onto the Learning Disability Award Framework course before doing NVQ’s. There is a training and development plan held in the service, which shows all mandatory courses to be completed, and that more than half of the plan has Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 26 already been achieved. Some of the training is done by following and completing the Mulberry in-house written test sheets after watching DVD etc. These cover such as fire safety, first aid, food hygiene, epilepsy, infection control etc. Other training is done externally, such as the Foundation Certificate and specialist medication administration competence. Where mandatory training courses have been done whilst employed elsewhere and is more than twelve months old, staff must up-date it annually. This is a recommendation made at the end of the report. Some staff have completed specialist administration of certain drugs, but others are now to do an oral specialist medication administration course, to enable people to receive their specialist, required as necessary, medication in a timely fashion. Staff have their own training record and hold copies of certificates obtained on file. Supervision of staff has begun and records show some sessions were carried out in December 2007 and some in January 2008. This must continue in line with the requirements of standard 36. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43. People that use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People enjoy the benefits of a well run service, that is soon to be quality assured, that is based on relevant policies, procedures and safe working practices, and that is financially sound, so they are confident the good conduct and management of the service means their care needs are met and enables them to lead fulfilling lives. EVIDENCE: Discussion with people, staff and relatives and viewing of records, service and maintenance certificates and documentation held reveal the service is well managed, both operationally and financially, has a good ethos, and that the service is quality assured. This and policies and procedures, record keeping and safe working practices are all used to ensure the health, safety and welfare of people and staff is promoted and protected. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 28 The manager of the service holds NVQ level 4 In Care, is currently undertaking NVQ level 4 Registered Manager’s Award and is contemplating doing a degree in Health & Social Care. She is the registered manager of another service belonging to Foxglove Care Ltd., which closed in June 2007 due to flooding. She has recently been deployed as the manager of Rivelin Park and is proposing to become joint manager of the two services when the other one reopens. This is to be requested through the Registration Team at CSCI. The manager has one team leader to deputise in her absence and the collective style of management is open and inclusive. People that live in the service are consulted on every opportunity about the service of care and support they receive. There is an open door policy in respect of the office and people and staff seek advice and support daily as necessary. This was observed on the day of the site visit and people and staff are comfortable. There is a company quality assurance system in operation that involves an audit tool, sending of surveys to people, relatives and staff, and holding of key worker, staff and house meetings on a monthly basis. Surveys have not gone out yet though as the service has only been running for six months, but when they do the results of outcomes will be analysed. There is a three monthly newsletter that the company produces. All other comments in care reviews or expressed daily by people and relatives are taken into consideration. Under regulation 24 the service will need to produce a report of any review of the quality assurance systems in use, and send a copy to us at the Commission. Meanwhile systems need to develop further and the service needs to be tested out. The company has a policy and procedure manual for staff to use, which covers the requirements of appendix 3 of the regulations. These must be kept up-todate and reviewed annually. Staff are aware of them and where they can be found. People are not completely involved in developing these polices etc., but they do influence how policies are changed to meet their needs. All records are kept up-to-date, are data protection compliant and meet the requirements of regulation 17. The management and staff team are aware of their responsibilities to promote and protect the health, safety and welfare of themselves and people living in the service. There are policies, procedures and safe working practices for fire safety, first aid, food hygiene and infection control, but not for moving and handling of people particularly, as they do not require assistance with mobility. Areas sample checked for compliance are fire safety records, Legionella certificate, hot water temperatures, first aid trained staff, risk assessment documents and accidents and how they are dealt with. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 29 There is a fire policy, procedure, evacuation plan and a risk assessment that was completed November 2007. There is also a Code of Practice for the event of fire. The main front door is kept locked for people’s safety and security, but all staff hold and carry a door key for egress on a routine daily basis and in the event of an emergency. There are weekly equipment checks, and monthly fire drills all of which are recorded. The record only shows drills were carried out in January and February though. Records must be accurate and kept up-to-date. If the frequency of drills is not to be as regular as monthly this needs to be stated in the ‘statement of purpose.’ Staff receive fire safety training, there is evidence some was done in February 2008. ‘Amtech’ carried out a full fire safety system check on 28/06/07 before the service was registered. There is no evidence required yet that fire extinguishers have been maintained, as they have only been in place for six or so months. The service has yet to have a legionella water test carried out as the house is relatively newly built. This test must be done every three years and it is recommended it be carried out within the next twelve months at the end of the report. There are thermostatic control valves fitted to hot water outlets to ensure people have safe use of the hot water. The staff need to make sure temperatures are checked on a regular basis and recorded in a log. This is recommended at the end of the report. There are now six from eight staff with a first aid qualification and therefore always one staff on shift has the knowledge to deal with any emergency first aid situation. A file seen for one staff shows the course was done in February 2006. Another staff did first aid awareness in December 2007. First aid training should be up dated every three years and the manager is to monitor this to make sure training does not lapse any longer. Risk assessment documents are held for the service in general in respect of fire safety, accidents, using the kitchen and such as electrical equipment etc., and there are also risk assessments in place specifically for individuals that relate to their personal health and safety and the activities they take part in. These should be reviewed when the home has been registered a year and then annually thereafter. Several were seen in files viewed with people’s permission. There is an accident record sheet held in each person’s file for each accident that occurs, which shows thorough detail of the accident. There is also a brief summary log/sheet in each file that shows basic details of accidents. These are data protection compliant and are only held in individuals’ files. Staff accidents are recorded in a general accident book. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 30 Information viewed shows people are treated quickly and appropriately should an accident occur and those requiring hospital treatment would receive it. There has been no referral of a person to an accident and emergency department during the first six months of the service’s registration. Additional information seen to evidence that health, safety and welfare of people is maintained, includes a general Health & Safety Policy document, gas safety certificate dated 22/06/07, electrical safety certificate dated 20/06/07 and an electrical safety maintenance report carried out by Phoenix Precision Electrical on 02/12/07. The service is now one of a chain of four belonging to Foxglove Care Ltd, and therefore has the backing of a company that has a business and financial plan. The company director ensures there are systems for planning budgets and staffing levels, selecting managers and staff, and for monitoring the quality of the service. There is public and employers’ liability insurance cover for the sum of M£5 with Ecclesiastical Insurance that expires in December 2008. There is a clear and understood organisational structure of management and staff that is stated in the service’s statement of purpose. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 3 3 3 3 2 3 Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No, as this is the first KI 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 YA34 Regulation 19 Requirement The registered provider must make sure staff do not begin working in the service until a full CRB clearance has been received, so people are confident they are cared for and supported by safe staff. The registered provider must make sure there is a registered manager in post and submit either a query on transferring the manager’s registration, or a new application, to the Registration Team, so people are confident a registered person is running the service and their needs are met. Timescale for action 31/07/08 2 YA37 8 and 9 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA5 Good Practice Recommendations The registered provider should make sure people or their relative/advocate sign and date the copy of their DS0000070626.V361148.R01.S.doc Version 5.2 Page 33 Rivelin Park 2 YA20 3 YA20 4 YA20 YA35 5 YA35 6 YA42 7 YA42 8 YA42 statement of terms and conditions/contract of residency, so there is evidence they are fully included in any decision making processes and they know their residency needs are met. The registered provider should consider purchasing a medication fridge to store medicines that require lower temperature storage, so drugs are stored at the safe recommended temperature and people know their health care needs are safely met. The registered provider should make sure staff administering medication receive an annual up-date of medication administration training and that details are retained on files, so people know their health care needs are safely met. The registered provider should make sure staff specialist medication administration training is evidenced on their files, so that people are confident staff are competent to administer specialist medicines and people know their health care needs are safely met. The registered provider should make sure staff receive updated mandatory training each year, and every three years in respect of first aid, so people are confident they are cared for and supported by well-trained staff and their needs are met. The registered provider should make sure that fire safety drills either be recorded monthly if they are held monthly, or that the statement of purpose clearly shows the actual frequency of drills, so people are confident their health, safety and welfare is promoted and protected. The registered provider should make sure hot water outlets are temperature tested regularly and that details are recorded in a log, so people know their safety is promoted and protected. The registered provider should make sure a legionella water test is carried out on the hot water storage, if required, within twelve months of the registration of the service and three-yearly thereafter, so people know their health, safety and welfare are promoted and protected. Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rivelin Park DS0000070626.V361148.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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