Care Home: Rivers Reach

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What the care home does well What has improved since the last inspection? A care manager commented that the service has improved. `Welcome Packs` have been introduced. These give information about the home and are given to each resident.Recording of current events has been improved by the introduction of `Keyworker` packs. Health action plan records have been introduced. The home is involving residents more in the care panning process. Training opportunities for staff have increased. This includes adult protection training. The home is undergoing a redecoration programme and a number of areas have been completed. CARE HOME ADULTS 18-65 Rivers Reach Fontley Road Titchfield Fareham Hampshire PO15 6QX Lead Inspector Ian Craig Unannounced Inspection 14th August 2008 14:20 Rivers Reach DS0000011923.V369293.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 Rivers Reach DS0000011923.V369293.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. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivers Reach Address Fontley Road Titchfield Fareham Hampshire PO15 6QX 01329 842759 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) riversreach@iliace.com Rivers Reach Care Ltd Mrs Cheryl Marie Bainbridge Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Rivers Reach DS0000011923.V369293.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 - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 5. Date of last inspection 31st May 2006 Brief Description of the Service: Rivers Reach is registered to provide care and accommodation to five people between the ages of 18 and 65 who have learning disabilities. Each service user has a single bedroom, and shares the use of two bathrooms and two showers. Service users share the use of a lounge, dining room and kitchen. There is an enclosed garden to the rear of the home that service users are able to access. Service users are encouraged to be as independent as possible and to participate in the day-to-day running of the home by helping with shopping, cooking and cleaning. There are opportunities to access day care provision outside the home. The weekly fees range from £1586.72 to £2512.00. Rivers Reach DS0000011923.V369293.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 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and lasted for 2 hours and 50 minutes. Discussions took place with the registered manager and 2 staff were interviewed about their work at the home. A tour of the premises took place, which included seeing each of the resident’s bedrooms and the communal areas. Records, residents’ care plans, policies and procedures were also looked at as part of the inspection. Four residents were spoken to and two were asked about life at the home. The Commission sent surveys to residents to ask for their views on the service. One of these was returned. A survey was also completed and returned by a social services’ care manager. The Commission requires that care services complete and Annual Quality Assurance Assessment. This was completed by the home and information contained in it has been used for this report. What the service does well: Anyone referred for possible admission is able to visit the home to help him or her decide if they want to move in. There is a process where the home assesses the needs of those referred for possible admission, which includes liaison with health and social services. Each person living at the home has a personal file containing comprehensive details about their needs. Some of the care plan details are written in an ‘easy to read’ format and use pictorial diagrams to help residents understand the contents. Pictorial diagrams are also used to aid communication with the residents in the complaints procedure, which is also in audio format. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 6 The health and personal care needs of the people who live at the home are met. The home liaises with health care professionals such as general practitioners, dentists and community health teams in arranging appropriate medical and health care. Comprehensive details are recorded about health care needs incorporating guidance from health and social services. A social services care manager made the following comments: • • • • Regular reviews are held to enable the service users to give their views and to be fully involved in planning a service to meet their future needs. There is a good liaison with the local community team. Each person has a daily planner for the week showing that a variety of educational, occupational and social activities are available. They provide excellent care to the two service users I review. They are supported with all daily living tasks in a homely environment. A variety of activities are available and residents are encouraged to develop independent living skills, including work and college courses. The home has 2 vehicles which residents use to access community facilities. The cost of these is included in the weekly fee. There is also a budget so that each resident has an annual holiday accompanied by staff. The complaints procedure is available in a picture format. Staff are supplied in sufficient numbers to meet residents’ needs. There is an extensive training programme of courses for staff to attend. Each staff member has regular supervision. Newly appointed staff are subject to interview and checks on their suitability to work in the home. There are systems for ensuring that staff and residents adhere to health and safety procedures. What has improved since the last inspection? A care manager commented that the service has improved. ‘Welcome Packs’ have been introduced. These give information about the home and are given to each resident. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 7 Recording of current events has been improved by the introduction of ‘Keyworker’ packs. Health action plan records have been introduced. The home is involving residents more in the care panning process. Training opportunities for staff have increased. This includes adult protection training. The home is undergoing a redecoration programme and a number of areas have been completed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rivers Reach DS0000011923.V369293.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 Rivers Reach DS0000011923.V369293.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have information to allow them to make an informed choice about moving into the home. The home ensures that it accommodates those whose needs it can meet. EVIDENCE: Each resident’s records include a Welcome Pack and a Service Users’ Guide, which give information about the service provided and the staff. Since the last inspection, the manager has introduced a Welcome Pack for those considering a move in to the home. This includes photographs of each staff member and details of the service. Pictorial diagrams are used for easier understanding by the resident. A resident described how he/she was able to look around the home and meet the staff and other residents before deciding to move in. The manager explained how an assessment is carried out when someone is referred for possible admission to the home. This involves a visit to the person where an Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 10 assessment is carried out. Staff from the home were also involved in a transition meeting with other professionals to discuss the planned placement. Records of these assessments and meetings are held with residents’ meetings. Regular reviews and reassessments take place, which the residents are involved in. This was confirmed by records, the staff, the manager and social services’ care managers. Contracts, called, Terms and Conditions of Residence, are completed for each person. For some residents there is social services contract between the resident and the home. Rivers Reach DS0000011923.V369293.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are comprehensively assessed and recorded in care plans. Residents are able to contribute to decision making in the home and are able to chose how they spend their time. EVIDENCE: Assessments and care plans were looked at for 3 residents. These detail each person’s needs and how staff should meet these needs. Assessments and care plans are divided into the following sub headings: • Self help skills • Communication • Domestic skills Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 12 • • • • • • • Social skills Community skills Personal relationships and sexuality Academic skills Activities Environment skills Challenging behaviour Guidelines are recorded for various needs including health, behaviour, money management, mental health and medication. The home is developing its care plans so that they directly involve the residents. A ‘person centred’ care plan called, ‘Listen to Me Workbook’ was seen for one resident. The home has introduced a format for recording residents’ significant daily needs and activities. Risk assessments are carried out and recorded where residents undertake an activity, or have a behaviour, that presents a risk. Guidelines are set out for staff to follow. There is a Service Users’ Charter in each person’s file, which is in pictorial format for easier understanding. This gives details of the residents’ rights and the services they are entitled to. Residents’ meetings are held where discussions take place about how activities and menus are to be organised. A resident stated that he/she is able to spend his/her time as he/she wishes. The staff and the manager explained how the home is flexible when catering for changing needs and wishes. The manager also stated that residents are able to choose colour schemes for redecoration of individual bedrooms and the communal areas. Bedrooms reflect each resident’s taste and personalities with different colour schemes, and personal possessions such as videos, televisions, and hobby items. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person’s individual lifestyle needs are assessed and catered for by providing, or arranging, a range of meaningful educational, occupational, social and leisure activities. EVIDENCE: Each person has a weekly planner showing activities for each day. These include college courses, work placements, trips to the cinema and theatre, outings to the pub and shopping. A resident described how he/she attends meaningful work with a local media company. Another resident stated that he/she is supported to go shopping and take part in other community based Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 14 activities. One person states that he/she enjoys using the computer and using DJ equipment. Residents and staff confirmed that holidays are arranged. One resident stated that his/her holiday in Weymouth, accompanied by a member of staff, was ‘fantastic.’ The home provides a holiday budget of £250.00 for each person. There are 2 cars for transporting residents to community facilities; the cost of this is included in the fees. Residents contribute to devising the menu plans, take part in shopping trips for food and help prepare meals. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are met. EVIDENCE: Staff expressed the view that residents’ care and health needs are met. Each person has a Health Action Plan, giving details of how health needs are to be met. These show appointments with dentists, general practitioners, district nurses and opticians. Behaviour and mental health needs are also assessed with guidelines for staff to follow. These include specific plans from health and social services. Care plans include guidance for staff in assisting each person with their personal care. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 16 The home’s medication procedures were looked at. Staff receive training in handling and administering medication. The home’s medication system is audited by the supplying pharmacist and the home’s management. Medication recording sheets are signed by staff each time a resident takes his or her medication. Stocks of medication show that residents receive medication as prescribed. Where residents have occasional medication for identified symptoms these are set out in a care plan with guidance for staff to follow. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes account of residents’ views. There are procedures for ensuring that residents are protected from harm. EVIDENCE: The home has a complaints procedure, which is in pictorial and audio format for easier understanding. The complaints procedure is supplied to each resident and is held with their records. There is a logbook for recording any complaints. A resident stated, ‘Home manager, link worker, key worker- all listen to me when I am not happy.’ Staff receive training in adult protection. This was evidenced from interviews with staff, training records, training plans and discussion with the manager. The home has procedures for dealing with any suspected abuse, which each staff member reads and the records a signature to acknowledge this. Guidelines are recorded for staff to follow in dealing with challenging behaviour and staff receive training in strategies for physical intervention. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 18 Residents receive support in handling their finances. Records are maintained of amounts deposited, withdrawn and a corresponding balance. Receipts of any purchases made by residents are held with these records. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a generally well-maintained, clean and homely environment where they are able to express themselves. EVIDENCE: Each resident has his or her own bedroom. Locks are installed on bedroom doors should residents wish to lock their room for privacy or security. Bedrooms contain numerous items of personal possession: posters, video collections, toys, ornaments, televisions, books and items related to hobbies. Residents are able to choose colour schemes for their rooms. One bedroom seen has recently been redecorated. Another resident’s room is due to be redecorated. The occupant of this also stated that his/her chest of drawers is to be replaced as it is damaged. Other areas of the home are also in need of Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 20 repair, including damage to a bedroom ceiling from a leak. These were discussed with the manager and are included in the home’s refurbishment plans for the months ahead. There is a lounge, which residents were seen to use. A resident’s budgie lives in a cage in the living room. A dining room overlooks the garden, which has an area where residents can sit. A resident was relaxing with a drink whilst sitting on the veranda. The walls of the hall and living areas include photograph displays of residents taking part in various activities. Toilets and bathrooms consist of the following: ground floor toilet plus two bathrooms on the first floor. The home was found to be clean. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 21 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): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are supplied in sufficient numbers to meet residents’ needs. The staff team are well trained and newly appointed staff undergo checks on their suitability to work with vulnerable adults. EVIDENCE: Staffing levels were discussed with the manager and the staff. The home aims to have at least 3 care staff on duty from 8am to 8pm each including weekends. The manager’s working hours are in addition to this. Care staff state that the home has sufficient numbers so that residents can take part in individualised activities programmes. The staff rota and observation show that the home maintains these staffing levels. There is a staff training programme of various courses including the following: moving and handling, fire safety, food hygiene, health and safety, first aid, Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 22 adult protection, strategies for crisis intervention prevention, medication, autism, infection control, challenging behaviour and makaton. Seven of the twelve care staff have, or are studying, the National Vocational Qualification (NVQ) level 3 in care. A further two staff have NVQ level 2 in care. Care staff confirmed the availability of the training programme. There is a set induction process for new staff, which is based on nationally recognised standards, which is recorded. The manager also completes an abbreviated induction checklist, which shows newly appointed staff have instruction in the home’s procedures for health and safety and medication, as well as other subjects. Recruitment procedures were looked at for 3 staff who have recently started work in the home. These show that the following checks are carried out prior to the staff starting work: criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks as well as obtaining 2 written references. Staff also complete a health questionnaire and have an interview; these are recorded. Staff confirmed that these checks are carried out. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 23 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, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home, where their views are considered in future planning. The home promotes the health and safety of residents and staff. EVIDENCE: The manager is currently studying the Registered Manager’s Award and has completed NVQ level 3 in care. She has 19 years experience in care work and has completed numerous training courses. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 24 The owners have a quality assurance system called, ‘Quality Management Policy for improving standards and the effectiveness of an organisation.’ This includes asking the residents and their representatives for their views on the service provided. The manager intends to develop this system of survey. A care manager commented that residents’ views are taken account of at regular reviews. A monitoring system is used and there are plans for the future maintenance of the home’s environment. The manager also stated that the service is to be subject to a formal review by the organisation in September 2008, which will include a reassessment of the staffing levels. Monthly visits are carried out by the owners and an audit report is completed. Staff receive training in first aid, food hygiene, infection control, fire safety and moving and handling. This was confirmed from training records and discussion with the staff and the manager. The home’s appliances are serviced and maintained by suitably qualified persons. The fire logbook shows that the home’s management follows fire safety procedures including carrying out fire drills. Radiators are covered to protect residents from possible burns. Temperature controls are installed on taps to control hot water on baths and showers to protect residents from possible scalding. Staff also check the water temperatures with a thermometer when supporting residents with a bath or shower. Regular checks are also made of the hot water temperature being controlled by the control devices. Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 25 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 3 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 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X 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 3 X 3 X 3 X X 3 X Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 26 N/a Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rivers Reach DS0000011923.V369293.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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