Care Home: River View

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well People who live at River View receive person-centred care that meets their needs and takes account of their preferences and rights to make choices. People are supported in leading an ordinary lifestyle in their home and community with opportunities to participate in activities that are meaningful to them. As part of this people maintain good relationships with their friends and family and there is postive communication between the home and individuals` support networks to ensure they are wellsupported. People`s health care needs are met through effective liaison between the home and care professionals. Sound systems are in place to ensure that people know how to raise concerns about the home and can be confident that they will be listened to. The existence of robust policies and procedures combined with good staff training means that care workers know how to keep people safe. River View provides a homely, well-maintained and clean environment for people to live in. Visitors comment on the positive atmosphere within the home and the good standard of accommodation. Care workers receive the training they need that enables them to understand and meet people`s needs. Staff are supported well by a manager who is well-qualified for her role and who demonstrates a highly conscientious and proactive approach to promoting people`s safety and welfare. People who use the service are consulted about the care they receive and are involved in decision-making within the home. The home is run in their best interests. We received a number of very positive comments about the home from people who have contact with the service. These included; `I have always been impressed by Angela`s dedication to her clients. Personally I believe the team at River View are quite special in what they do supporting people` (health care professional); `Residents are always at the heart of all the activities and their rights and choices are respected` (care worker); `Since the first day X moved in X has always had a smile on his face and been very chatty which is a sure sign that X is very happy and content` (relative); `I would like to say that I would like to be a resident at River View. Fantastic location, very caring staff. Always a happy atmosphere. River View is a great place to live and I am very happy with X`s high quality of care. I have noticed a huge difference in X since X has been at River View` (relative); `I think they are a very good example of how to care for people with severe learning difficulties` (relative); `I am very happy here` (service user). What has improved since the last inspection? We made a requirement at the last inspection that the home notifies us of events occurring in the home where individuals` welfare is adversely affected. The home has taken action to address this and now ensures that we are informed of such incidents. What the care home could do better: As a result of this inspection we have made one requirement and some good practice recommendations. At the time of our inspection the home did not have a suitable storage facility for controlled drugs. We have made a requirement for this to be put in place so that in the event of a person using the service being prescribed a controlled drug it can be stored safely and securely. The manager of the home has told us that she has made arrangements for this work to be undertaken. While the home`s practices are generally very robust and there were many examples of good practice we identified some minor shortfalls in the areas of medication, recruitment and health and safety. The manager has informed us of the action she is taking to address these to ensure that procedures follow best practice. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: River View Throop Road Throop Village Bournemouth Dorset BH8 0DG     The quality rating for this care home is:   three star excellent 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: Heidi Banks     Date: 0 9 0 7 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 38 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 38 Information about the care home Name of care home: Address: River View Throop Road Throop Village Bournemouth Dorset BH8 0DG 01202516411 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Angela Pike-Bennett,Mrs Tracey Pike-Bennett care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home River View opened in December 2005 and is registered to provide accommodation and care for six adults who have a learning disability. The home is run by a partnership between Mrs Angela Pike-Bennett and Mrs Tracey Pike-Bennett with Mrs Angela PikeBennett being the registered manager and therefore taking day-to-day responsibility for the running of the home. River View is located in the semi-rural area of Throop in Bournemouth and comprises of a family-style home with gardens at the front and rear of the property. There is an area for parking at the front of the property. Four of the bedrooms in the home are located on the first floor with two bedrooms being located on the ground floor. Four of Care Homes for Adults (18-65 years) Page 4 of 38 Brief description of the care home the six bedrooms have en-suite facilities. The home is situated a short drive away from a local shopping centre and community facilities. The home is staffed 24 hours a day. Fees charged by the home depend on the assessed needs of individuals. At the time of the inspection we were informed that the basic fee for the service was between 700800 pounds per week. Further general information on care homes fees and fair terms of contracts may be obtained from the Office of Fair Trading at www.oft.gov.uk. Care Homes for Adults (18-65 years) Page 5 of 38 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: three star excellent 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: This was an unannounced key inspection of River View. The inspection was carried out as part of our routine inspection schedule to assess how well the home is meeting the needs of the people who live there and their compliance with the regulations and national minimum standards. The inspection took place over one full day and was carried out by one inspector. The term we is used throughout this report to reflect that it is the view of the Care Quality Commission. As part of our inspection process we sent surveys to the home to be distributed to people who use the service, their relatives, staff who work at the home and care Care Homes for Adults (18-65 years) Page 6 of 38 professionals who have contact with them. A total of nineteen surveys were returned six from people who use the service, five from their relatives and friends, seven from people employed to work in the home and one from a health care professional. The feedback we received from surveys is reflected throughout this report. Before the inspection took place we also received the homes Annual Quality Assurance Assessment (AQAA). This is a self-assessment tool completed by the home which gives us information about how they meet peoples needs. It also gives us some numerical data about the service. As part of our visit to the home we spoke with people who use the service, care workers on duty, some visitors to the home and the manager, Mrs Angela PikeBennett. We looked around the premises and also viewed a sample of records which included health and safety records, medication records, staff recruitment and training records and information about people who use the service. We assessed a total of twenty-three of the national minimum standards to come to judgements about the way the service is run and the quality of care that is provided to people who live there. What the care home does well: People who live at River View receive person-centred care that meets their needs and takes account of their preferences and rights to make choices. People are supported in leading an ordinary lifestyle in their home and community with opportunities to participate in activities that are meaningful to them. As part of this people maintain good relationships with their friends and family and there is postive communication between the home and individuals support networks to ensure they are wellsupported. Peoples health care needs are met through effective liaison between the home and care professionals. Sound systems are in place to ensure that people know how to raise concerns about the home and can be confident that they will be listened to. The existence of robust policies and procedures combined with good staff training means that care workers know how to keep people safe. River View provides a homely, well-maintained and clean environment for people to live in. Visitors comment on the positive atmosphere within the home and the good standard of accommodation. Care workers receive the training they need that enables them to understand and meet peoples needs. Staff are supported well by a manager who is well-qualified for her role and who demonstrates a highly conscientious and proactive approach to promoting peoples safety and welfare. People who use the service are consulted about the care they receive and are involved in decision-making within the home. The home is run in their best interests. We received a number of very positive comments about the home from people who have contact with the service. These included; I have always been impressed by Angelas dedication to her clients. Personally I believe the team at River View are quite special in what they do supporting people (health care professional); Residents are always at the heart of all the activities and their rights and choices are respected (care worker); Since the first day X moved in X has always had a smile on his face and been very chatty which is a sure sign that X is very happy and content (relative); I would like to say that I would like to be a resident at River View. Fantastic location, very caring staff. Always a happy atmosphere. River View is a great place to live and I am very happy with Xs high quality of care. I have noticed a huge difference in X since X has been at River View (relative); I think they are a very good example of how to care for people with severe learning difficulties (relative); I am very happy here (service user). Care Homes for Adults (18-65 years) Page 8 of 38 What has improved since the last inspection? What they could do better: 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 9 of 38 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 10 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that peoples needs are assessed before they come to live there and that they have opportunities to visit before moving in. This helps ensure that the home can meet their needs and that the service user is involved in the decision-making process. Evidence: The homes Annual Quality Assurance Assessment (AQAA) told us that there has been one new admission to the service since the last inspection in 2007. The person was placed in the home by a local authority and we saw on file that an assessment had been carried out before the person had moved to the home. This indicated the involvement of the service user in the process. The individual was known to the owners of the home in another capacity and Angela Pike-Bennett told us they had a good understanding of their care needs as a result of this. Mrs Pike-Bennett showed us the diary where it had been recorded that the person had come to visit the home and have overnight stays before they moved there permanently. The service user themselves confirmed in a survey that they had been asked if they wanted to move to Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: River View and that they had received enough information before moving in to be able to make the decision that it was the right place for them. This was echoed by another person who uses the service whose relative helped them complete a survey. They told us that they had been able to visit the home, make a choice if they wanted to live there and that they had benefited from a good transition. We advised Angela PikeBennett to ensure transition visits are recorded in a more comprehensive format which demonstrates peoples involvement in the process. Mrs Pike-Bennett agreed that more work could be done in this area. Care Homes for Adults (18-65 years) Page 12 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home demonstrates a positive, person-centred approach to care which respects peoples individuality and supports them in meeting their goals. People who live in the home have the right to make choices and their independence is promoted in various aspects of their lives. Evidence: We looked at the care plans in place for two people who use the service. We saw that a significant effort has been made to create a care plan for each individual which is accessible to them. Care plans we looked at contained simple text, photographs and pictures and they were written in a person-centred style. Care plans included information on peoples family networks and contact arrangements, information about their religion and cultural background and participation in religious festivals, their likes and dislikes, communication needs, arrangements in place to manage their money, their weekly activities and personal interests. There was information about the things each individual needs support with in their everyday life, the things they can do Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: independently and things that would make them angry or upset. For one person in the home who has a visual impairment it was noted that the home is supporting them in creating an audio care plan using a video camera. The manager described how this was being put together involving the service user in talking about the things that are important to them. We saw information about individuals personal goals on records. Discussion with staff indicated that even when individuals goals might seem unrealistic the home takes a positive approach and tries to identify creative ways of supporting people in fulfilling them, this also reflected in the homes Annual Quality Assurance Assessment. On the day of the inspection one person who lives in the home was having their annual review. Observation indicated that they were encouraged to be involved in this process and the review meeting was attended by people who are important to them including their family and their key worker. We were told by the manager that service users have regular meetings within the home to discuss issues that are important to them and make decisions about things they want to do. We looked at a sample of minutes from recent meetings. These showed that the meetings are facilitated by a person who is external to the home. The minutes we looked at showed that people had been involved in discussion about picture menus, lunch choices, activities they would like to participate in and holiday choices. It was evident from observation and discussion with people who use the service that where they have made decisions about issues these are followed up. For example, it was decided that picture menus would be a good idea and now work is being undertaken by staff to make this happen. Also, service users had wanted to continue with their usual Sunday roast lunches throughout the summer and this had been respected. The home gave us an example in their Annual Quality Assurance Assessment of how they had arranged a number of activities outside of the home for people to ensure that they had opportunities to participate in their community. However, discussion with service users had indicated that they did not want to go out so frequently and wanted more home-based activity options. This has now been put in place with a gardening group and art and craft group being organised for the duration of the summer. All the relatives of people who use the service who responded to our survey indicated that the home always responded to the different needs of individuals. We saw evidence of risk assessments on file which gave information about action staff should take to minimise risks to people in activities of daily living. A range of areas had been covered including participation in domestic tasks, outdoor and adventure activities and accessing the community. These showed evidence of being updated annually and contained some useful information about individuals needs. Mrs PikeBennett acknowledged that further development was needed with regards to the Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: homes risk assessment documentation. Indeed, we saw that where a lot of written information had been included in the risk assessments and updates had taken place they were sometimes difficult to read and this should be addressed to ensure documentation is clear and legible. The people who use the service whom we spoke with told us that they participate in a range of activities of their choice. It was clear from our discussion with them and observation of life in the home that people are supported with taking positive risks to enable them to be independent. Care Homes for Adults (18-65 years) Page 15 of 38 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 excellent 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 enjoy a lifestyle that offers them choice, control and that respects their rights to an ordinary life. They access activities that are meaningful to them and sustain positive family networks. The home is proactive in listening to what people want and responding to this. Evidence: The manager told us that people who use the service attend various day services in the community. These are the day services that people attended before coming to live at River View and discussion with service users indicated that they liked the fact they were able to continue with this part of their life even though they had moved. We were told that through their respective day services they were able to access a range of activities to meet their needs, participate in sporting activities and do college courses and work placements. One person who uses the service told us that they work at a Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: local hotel for which they get paid. They told us that they enjoyed sports and their records indicated that this was something they were given the opportunity to do on a regular basis and be part of local community sports groups. Discussion with the manager indicated that most people had one or two home days during their week which was time for them to undertake individual activities of their choice. One person who had a home day on the day of the inspection told us they had gone horse-riding which they had enjoyed. The documentation we looked at indicated that people are given plentiful opportunities to lead an ordinary life in their home and community. We observed service users participating in household tasks and helping with cooking. We also noted from records that people access community resources such as the leisure centre, bowling alley and shops on a regular basis if this is their choice. As indicated in the previous section of the report the home has listened to people who use the service who did not want to go out as frequently and has put in place some in-house groups as a result of their consultation. Our conversations with staff and service users indicated that the home arranges an annual holiday for those who wish to go. At the time of the inspection people were excited about their holiday which was to take place the following week. The people we spoke with told us that they had chosen the same destination as the previous year as there had been lots to do there. All the people who use the service who responded to our survey indicated that they could do what they wanted to do with their time. Comments we received from the relatives of people who use the service about their family members lifestyle included; X joins in with a varied range of activities and outings which X really enjoys doing; X has a very active lifestyle which suits him; They work very hard at providing a good social life. They strive to treat each person as an individual and to meet their individual needs. The contact that individuals have with their friends and family is clearly documented in their care plans. Daily records indicated that most individuals have very regular contact with their family and there is good communication between the home and peoples families. This was confirmed by the people we spoke with and also echoed in the surveys we received from relatives all of whom indicated that the home helped their family member keep in touch with them. Discussion with the manager of the service indicated that the home aims to ensure Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: that peoples rights are upheld. We saw evidence of ways in which people are consulted about what goes on in their home and encouraged to have their say, not just about their own lives but how the home is run. We saw records that showed that when new care workers start people who use the service are asked for their views and feedback. We observed that people have access to their bedrooms at all times. They have been able to personalise their bedrooms to their taste. We also observed a situation where one individuals right to privacy was upheld and encouraged. People also have free access to all communal areas of the home, are able to make drinks for themselves and their visitors as they wish and take responsibility for having a front door key to the home. The manager told us that once a week a chef visits the home to work with service users on preparing a two-course meal for themselves. This was something residents wanted and continue to say they want to do. We observed all the people who use the service getting involved in preparing the meal and sitting down at the table to eat it. Discussion with people who use the service indicated that they can make choices about what they eat and we saw evidence of meals being documented on file, this indicating that people are offered a variety of food options. The manager expressed her commitment to ensuring that the home adopts a healthy approach to eating and had arranged for a dietitian to visit the home in the near future in an advisory capacity. Care Homes for Adults (18-65 years) Page 18 of 38 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. People who use the service can be confident that their personal and health care needs will be met. There are sound systems in place to ensure their medication is administered appropriately. Evidence: The homes Annual Quality Assurance Assessment indicates that individuals care needs are reflected in their care plans. The two care plans we looked at for people who use the service showed evidence of this and included information on aspects of care where the person was able to be independent and where they needed support. Care workers employed by the home told us in surveys that they were always given up-todate information about the needs of people they support and that methods of communication between managers and staff about peoples needs worked well. We received several comments from care workers indicating that the care needs of individuals were given the highest priority in the home. All service users who responded to our survey told us that staff at the home treated them well. This was echoed by their relatives who all indicated that the home always gives the support to their family member that they would expect. Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: The care plans and records we looked at clearly indicated individuals health care needs and where they had diagnosed conditions such as allergies. We noted that input around foot care needs had been documented in the care plan for one person but not another. The manager told us this was because the persons relative took responsibility for cutting their toe nails. We have advised the manager to make sure these arrangements are documented so that for each person it is clear how their requirements are going to be met. A record of health appointments attended was also evident for each person with information about the outcome of the appointment. These showed that people are supported to access health care from their doctor, optician, chiropodist, dentist and hospital as needed. It was clear that where follow-up appointments had been required, these had been arranged and attended as scheduled. During the inspection we saw evidence of the home liaising with a persons day service about their specific health care needs and records also showed that the home communicates with peoples family and other agencies to ensure they are kept informed. All the relatives who returned surveys to us told us that the home kept them up-to-date with important issues affecting their family member, for example if they were unwell or had had an accident. Comments we received about the care provided to people who use the service included; They manage to provide really effective care for vulnerable adults. Those users under my own care are always happy, co-operative and relaxed with us and staff. Clients always appear healthy and well dressed. If we have any (health) issues Angela will do her best to understand and put a procedure in place to help the client with any additional needs. Angela has paid close attention to our preventative advice over the years (health care professional); They are very good at keeping me informed (relative); All the staff at River View look after X very well and they have done a great job. Also when I go the staff are very kind towards X...they really...care for X in many ways (relative); X is happy, contented and all his needs are met. X is also having less seizures because he is contented and not stressed. I am very happy with his high quality of care (relative). We looked at the homes medication procedures as part of our inspection of the service. Individuals have separate medication cabinets fixed to the wall of the office Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: where their medication is stored. Medication is supplied by the local pharmacy in monitored dosage systems and discussion with the manager indicated that the home has a good working relationship and regular liaison with the pharmacy team. This includes the pharmacist providing additional instruction to care workers on the range of medicines they use including the use of an Epipen for a service user who may require this. Although the manager had documented that this training had taken place and we saw a list of who had attended we have recommended that the manager ensures the record is signed by the individual who has delivered the training and that staff are deemed competent by them to undertake this task. The manager agreed to put this in place following the inspection. Records showed that staff also undertake accredited training when they come to work in the home and the manager confirmed that this is updated on a regular basis. We found that the training available to staff includes a programme of shadowing and observation following which care workers are permitted to administer medication to people. We saw that for one new senior care worker the record indicated that they had shadowed and been observed by another senior care worker. We have suggested to the manager that the person taking responsibility for assessing anothers competence has suitable additional training to enable them to do so with confidence. We noted that the home had recently had an audit from a pharmacist from the local Primary Care Trust. The home told us they had taken action to meet all the recommendations made at the time of the visit to ensure their procedures followed best practice. We noted that one person using the service had been prescribed a cream for a fungal infection. The person was reported to apply the cream themselves with staff supervision. Although its application was documented on the persons records we have recommended that information about how, why, where and when the cream should be applied is documented on their care plan. We suggested that the manager checks that training in place in the home covers the application of creams so that staff are aware of best practice in this area. At the time of the inspection we observed that the home did not have suitable storage for controlled drugs. Although the people who use the service have not been prescribed controlled drugs we have told the manager that the home must comply with legislation which requires all residential care services to have appropriate facilities to store controlled drugs. This is so that the home is not in breach of regulations in the event of a controlled drug being prescribed to an individual. Following the inspection the manager told us that she has made arrangements to ensure a controlled drugs cabinet is put in place for this purpose and that a book for recording administration of controlled drugs is also available. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: The medication administration record (MAR) charts we looked at during the inspection had been appropriately signed by care workers responsible for this task. A system to ensure medication is audited on a regular basis is in place. This helps ensure that medication is being administered appropriately to people. Care Homes for Adults (18-65 years) Page 22 of 38 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 excellent 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 empowered to raise concerns about the care they receive and can be confident that this will be responded to positively by the management of the home. There are sound policies and procedures in place to protect people from harm. Evidence: The home has told us in their Annual Quality Assurance Assessment that they have a procedure to follow in the event that people wish to complain about the service. We saw that this gives clear timescales by which people can expect to receive a response to their complaint and contact details for relevant statutory agencies have been given. We suggested one amendment to the procedure where it states that individuals should put their complaint in writing wherever possible. As individuals wishing to complain may not be able to write we have suggested that this is amended to make it clear that people can make a verbal complaint. The manager has told us that she has taken action to address this. The manager of the home has maintained a record of compliments and concerns received by the service. This was seen to contain information about the nature of issues raised and how these were responded to by the manager. People who use the service told us in surveys that they knew who to speak to if they were not happy about the care they received and knew how to make a complaint. We noted that the home Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: has employed an external person to facilitate residents meetings which gives individuals an opportunity to discuss any concerns with someone who they do not have day-to-day contact with. Peoples relatives also indicated that they knew how to make a complaint if they needed to and they also told us that the home always responded appropriately when they had raised concerns. It was evident from the records we looked at that the manager communicates regularly with relatives of people who use the service and ensures she is accessible to them when there are issues they want to discuss. Care workers employed by the service confirmed in surveys that they knew what to do if a person using the service or their relative wanted to complain. The Commission has not received any concerns about River View since their last inspection. During the inspection we saw that the home had a copy of the Bournemouth, Poole and Dorset adult protection procedure. This is important to ensure that up-to-date information on reporting abuse is available to people who work in the home. We also saw that the home has made efforts to produce an abuse policy that is in a format accessible to people who use the service. A policy on bullying has also been developed with input from a local advocacy organisation which is in an accessible format. The home has told us in their Annual Quality Assurance Assessment that there have been no safeguarding referrals or investigations carried out in relation to people who live in the home, this being confirmed with the manager at the inspection. The training records for care workers indicated that they are provided with training at their induction on protecting vulnerable adults. This is facilitated by the local authority. We also saw that update training on abuse awareness had been provided by another agency during 2008 and 2009 to refresh peoples knowledge and awareness of this area. Care Homes for Adults (18-65 years) Page 24 of 38 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. River View provides a homely, comfortable and clean environment for people to live in There are sound procedures in place to promote good practice in relation to infection control to ensure peoples welfare. Evidence: River View is situated in a semi-rural area of Bournemouth although only a few minutes drive from one of the towns main shopping centres. Accommodation is provided on two floors with people occupying single bedrooms. Four out of six bedrooms have en-suite facilities, the two remaining people sharing a bathroom. There are communal areas including a spacious lounge and kitchen and gardens to the front and rear of the property. There is ample space for car parking in the driveway to the side and front of the house. The records we looked at indicated that where there had been maintenance issues with the property, for example an issue with a window closure, this had been responded to promptly by the landlord. The manager has also told us in their Annual Quality Assurance Assessment that carpets in the home have been replaced as needed in the past twelve months. We saw that a system is in place for someone who does not work on a regular basis in the home to visit once a month and identify areas for Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: improvement in the homes environment. People who use the service told us they like living at River View and like their bedrooms. We looked at four bedrooms with the permission of the residents. All had been personalised to the individuals tastes and contained items that reflected their interests and hobbies. Comments we received about River View included; I like living here...I like my room (service user); The...accommodation is first class (relative); ...clean, caring, warm and friendly home to live in (relative); A very homely environment (care worker). We saw from the outcomes of the homes own quality assurance process in November 2008 that positive comments were also received with people remarking on the home as being well-maintained, clean and comfortable. At the time of the inspection the home presented as clean and tidy. People who use the service who responded to our survey told us that the home is always clean and fresh. Hand gel is available for people to use on entering the home. We saw that liquid soap and paper towels were provided in the communal ground floor toilet and in the kitchen to promote good practice in infection control. We also noted that in a recent residents meeting people who use the service had been given information about the influenza pandemic and stopping the spread of infection using the Catch it, Bin it, Kill it advice from the Department of Health. Peoples understanding of this had been checked with them. The homes Annual Quality Assurance Assessment indicates that care workers employed to work in the home have received training in infection control and that a folder of information from the local authority is available to them including a DVD. We looked at the records for three care workers in the home, all of which showed evidence of them having undertaken training in infection control and food safety. We observed an area of the kitchen work surface which had chipped away and have advised the manager to ensure this is repaired or replaced to provide an unbroken impermeable surface. Following the inspection the manager told us that she has made arrangements for this to be done. Care Homes for Adults (18-65 years) Page 26 of 38 Care Homes for Adults (18-65 years) Page 27 of 38 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. People who use the service receive support from care workers who are well-trained and effectively supported in their roles. Evidence: We looked at the recruitment records for three care workers employed by the home who have started working there since the last inspection. All the records we looked at showed evidence of an application form, structured interview process, two written references, a full employment history and an enhanced disclosure with the Criminal Records Bureau. All three also contained a photograph of the employee although one photograph only showed half of the individuals face. The manager has told us that she has now taken action to address this to ensure that the photograph is clear. We noted that where pre-employment checks for one person had indicated an issue requiring discussion between the manager and the prospective employee the discussion had taken place between both parties but not documented. We have made a recommendation in light of this which the manager has told us has now been addressed. Although it was clear on individuals files that care had been taken to ensure people gave a full employment history we have also recommended that the manager ensures dates of previous employment are always clearly specified. The manager advised us that she does verify references that are taken up with the referee Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: to check that they are authentic. Records did not always indicate that this had taken place and we have advised that the manager keeps this evidence on file to demonstrate that they are following best practice. All the care workers responding to the survey indicated that their recruitment process had been carried out in a fair and thorough manner with appropriate checks being undertaken to determine their suitability to work with vulnerable adults. We were told by the manager that the home employs a chef to work one evening a week with residents in the home. We looked at the recruitment records in place for this person. It was evident that appropriate checks had been carried out on the individual before they came to work in the home and that certificates of relevant qualifications had been kept on file to demonstrate their competence to fulfil this role. We looked at the training records for three care workers all of which showed that people have undertaken an induction programme with the local authority prior to coming to work at River View and also have an in-house induction process to orientate them to the home. The majority of care workers responding to our survey indicated that the induction programme in place had met their needs very well with one indicating that this was mostly the case. We saw that certificates to evidence training courses undertaken by care workers were maintained on file. The manager has clearly explored different sources of training to ensure that the most suitable courses are identified to meet peoples needs including training in epilepsy which was scheduled for the following day. Feedback we received in surveys from care workers indicated that they were being given training relevant to their role, that helped them understand and meet the individual needs of people and updated them on new ways of working. One person indicated that they felt they would benefit from more training on health care. The homes Annual Quality Assurance Assessment tells us that six out of nine permanent workers in the home have a National Vocational Qualification at Level 2 or above. We looked at a sample of notes from peoples supervision and appraisal processes which showed evidence that individuals training needs are reviewed with them on a regular basis. Care workers responding to our survey made some very positive comments about the support and training they received from the management of the home. These included; Staff training is always up-to-date and staff are free to book any training they feel would benefit the residents and inform their knowledge; The induction has been more than comprehensive...training opportunities are offered; Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: Training is always available...am so happy to work there. Feedback we received from the relatives of people who use the service was also very positive about the care workers employed by the home. We were told that staff are friendly, professional and carry out their work well. Care Homes for Adults (18-65 years) Page 30 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. River View is run effectively by a manager who is well-qualified to do so and who demonstrates a collaborative approach. The home has efficient systems in place to promote peoples safety and welfare with the home liaising with other agencies as appropriate to ensure good practice. People who use the service are consulted about the care they receive so that the service can continue to be run in their best interests. Evidence: River View is owned by a partnership of Angela and Tracey Pike-Bennett. Angela PikeBennett is registered with the Commission as the manager and is in day-to-day charge of the home. Angela is a qualified Social Worker who has also completed her NVQ 4 Registered Managers Award. The home has told us in their Annual Quality Assurance Assessment that Tracey is also nearing completion of her NVQ Level 4 in Care and Registered Managers Award. The staff team has recently undergone a re-structure and they have appointed two senior care workers. The manager has told us that the new team structure is working well and has enabled her to delegate some responsibilities. Discussion with the manager indicated that she is keen to use the Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: experience and skills of her staff team in creative ways and this was also acknowledged by care workers in surveys who commented that they value the management approach of the home and the fact that they are enabled to make a genuine, active contribution. The management team operates an on-call service to ensure that staff working in the home are supported outside of office hours. The feedback we received from care workers and people who have contact with the service indicates that the home runs well and people have confidence in the management of the home. There are clear lines of accountability and people know who they need to go to if they enounter any issues. Comments we received from people who use the service and their relatives indicated that they would have no hesitation raising issues with the manager if they needed to and felt confident that she would respond effectively. We observed that systems of communication are in place including team and residents meetings, shift handovers and sound record-keeping which enable people to share information. Comments we received from care workers included; Am so happy to work there. The management is very good. We always work as a team; Management are supportive and approachable. Messages and important information gets passed around and reaches relevant individuals. The home also maintains good communication with peoples relatives and day services and comments we received indicated that this is highly valued. As indicated in the section of the report on Individual Needs and Choices the home consults with people who use the service through residents meetings which are facilitated by someone who is not regularly employed by the home. The manager has told us that she believes this is important so that residents can express their views openly. We saw that there is a comprehensive quality assurance process in place in the home. People who use the service and those who have contact with them have been sent surveys by the home asking them for feedback on various aspects of care delivery. Surveys designed for people who use the service were in an accessible format and the home had made arrangements for them to be supported by individuals external to the home in their completion to ensure objectivity. Surveys had also been sent to peoples families, friends, day services and health and social care professionals. We looked at the outcomes of the most recent quality assurance process held in November 2008 and found that people had responded very positively to the surveys with many excellent outcomes being achieved. The manager told us that an annual Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: development plan has been put together based on this feedback which is on display in the office of the home. The manager showed us the various audit systems in the home which ensure that good practice is maintained. Monthly visits to the home by a person who is not regularly employed by the service take place and their findings are recorded. The home has sustained a positive track record in responding promptly to requirements and recommendations made by the Commission in order to comply with the law and meet the national minimum standards. We looked at a sample of health and safety records in place in the home. We saw that water temperatures are checked and recorded on a regular basis and that refrigerator and freezer temperatures are also monitored. The sample that we looked at showed that temperatures were in a safe range and records were complete. Angela Bennett told us that the home has a fire risk assessment in place that has been done by an external fire safety agency. The home has liaised with the local fire and rescue service about work that needs to be done and at the time of the inspection a community safety adviser was visiting the home to offer specific advice on meeting the needs of one resident in the event of an emergency. Angela Pike-Bennett was observed to liaise with the persons care manager about the issues raised. We looked at the risk assessment in place for one person who uses the service who has removed the radiator cover in their bedroom. We have recommended that the manager expands on information in the risk assessment and ensures that checks are carried out on the surface temperature of the radiator on a regular basis to ensure that thermostats are working correctly and a safe temperature is maintained. Following the inspection the manager advised us that the risk assessment has been rewritten and checks will be carried out on the radiator temperature when it is being used. The records of care workers that we looked at showed that they had all undertaken suitable training in emergency first aid to enable them to respond appropriately in the event of an accident. People were also seen to have up-to-date training in moving and handling. Since the last inspection Angela Pike-Bennett has informed us of events occurring in the home where peoples well-being has been a concern. She advised us at the inspection that she is clear about what incidents need to be reported to us in accordance with the regulations. Care Homes for Adults (18-65 years) Page 33 of 38 Care Homes for Adults (18-65 years) Page 34 of 38 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 35 of 38 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 20 13 You must ensure that there is a suitable storage facility for controlled drugs in the home. You must do this to ensure that controlled drugs are stored appropriately in the home in the event of a person being prescribed them. 18/09/2009 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 20 You should ensure that a record is put in place that demonstrates that individual care workers have been deemed competent to use an Epipen with a person who may require this intervention. This should be signed by an appropriate health care professional. Where individuals have been prescribed creams you should ensure that care plans contain information that tells the care worker why they have been prescribed and where, when and how they should be applied. Care Homes for Adults (18-65 years) Page 36 of 38 2 34 You should ensure that where issues are identified in preemployment checks your discussion with the prospective care worker and the decision made in relation to their employment is documented. You should ensure that where people give a full employment history in support of their application the start and end dates of their previous employment are clear. You should maintain evidence on file to indicate that references have been verified with the person who has supplied them. 3 42 You should ensure that information in the risk assessment for the person who has removed their radiator cover is expanded to ensure that this is reviewed on a regular basis and that checks on surface temperatures form part of the homes health and safety audits. Care Homes for Adults (18-65 years) Page 37 of 38 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. 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. Care Homes for Adults (18-65 years) Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!