Care Home: Riverside Care Centre

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What the care home does well People can get information about what the service provides, to help them decide if it is what they are looking for. Their needs are assessed, so that their care and support can be properly planned. People have detailed care plans, so that staff have clear guidance about how to support them in ways that suit them best. Plans are reviewed regularly, so that important information can be kept up to date. Staff support people to do things they enjoy, go to places they like and keep in touch with the people who are important to them. They work hard to arrange things for people to take part in. They are also able to plan menus, be involved in shopping for food and preparing it if they wish. This helps to ensure they enjoy their food and mealtimes. People are generally well looked after. They get the support they need to keep important medical appointments and to get their medicines when they should. Staff support them to stay healthy and well. The care team is well motivated and keen to provide a good service. They treat people with respect, friendliness and warmth. Important checks are carried out on staff to ensure that they are fit for their jobs. The service is generally well run. People feel that they can approach the management team with any concerns. They are confident that any issues are listened to, taken seriously and acted upon.Riverside Care CentreDS0000041321.V377488.R01.S.docVersion 5.2 What has improved since the last inspection? In the relatively short time that the Manager has been in her current post, clear efforts have been made to meet requirements made at the time of the last inspection, and to develop the service for the benefit of the people who use it. A lot of work has been done to develop care plans so that people get the support they need in ways that suit them best. Care plans are supported with risk assessments, so that people get the help they need to stay safe. Clear arrangements have now been put in place to support people manage their money. Records about this are checked regularly, to make sure that people’s interests are properly protected. Staff are clear about their responsibilities for ensuring that people are protected from abuse. Staff records now include clear evidence that all of the important checks that should be carried out are completed, before people can work at the home. This is to ensure that people are fit for the jobs and people using the service are protected. People’s health action plans are now in place. Medication management has improved. Creams and ointments are stored separately, to avoid crosscontamination with internal medicines. Keys for medication stores are kept separate, to improve security. Protocols (written guidance) are in place for “as required” medication, to make sure that staff are clear about how and when these should be given. All of these things help to ensure that people get the support they need to stay healthy and well. The home continues to operate a rolling programme of maintenance, redecoration and refurbishment. This is to ensure that people continue to enjoy living in houses that are comfortable, clean, safe and homely. Some improvement has been made to arrangements for staff to receive formal supervision, though this needs to be carried through (see below). What the care home could do better: People’s contracts need to be updated, to include all information about fees, charges and contributions. This is so that all concerned are clear about their responsibilities. Care plans should be developed so that they include goals with outcomes that can be clearly measured. These should be evaluated regularly, to make sureRiverside Care CentreDS0000041321.V377488.R01.S.doc Version 5.2 they are kept up to date. This is to ensure that people get the support they need to achieve the things they say are important to them. Improvements should be made to people’s activity opportunities on an individual basis. This should include making some clear links between their activities and their agreed goals. This will help to make sure they can achieve those things they aspire to. Action should be taken to improve the numbers of care staff gaining formal qualifications. This is to ensure that they have the knowledge and skills they need to do their jobs well. Arrangements for staff to receive formal supervision and an annual appraisal of their performance, training and development needs should be fully implemented. This is to ensure that they get all the support they need to do their jobs well. Quality assurance and monitoring activity should be completed and reported on. This information should be shared with all interested parties. This is so that it can be seen how the views of people using the service have been taken into account. Key inspection report CARE HOME ADULTS 18-65 Riverside Care Centre Wolverhampton Road Wall Heath Kingswinford West Midlands DY6 7DA Lead Inspector Gerard Hammond Key Unannounced Inspection 28th August & 2 September 2009 09:00 nd Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Care Centre Address Wolverhampton Road Wall Heath Kingswinford West Midlands DY6 7DA 01384 288968 01384 294836 riverside@schealthcare.co.uk 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) Southern Cross Healthcare Centres Limited (Judy Williams –application to register pending) Care Home 24 Category(ies) of Learning disability (24), Physical disability (24) registration, with number of places Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 24 Physical disability (PD) 24 The maximum number of service users who can be accommodated is: 24 9th September 2008 2. Date of last inspection Brief Description of the Service: Riverside Care Centre is located in the picturesque grounds of Holbeche House. This is situated on the main A449 Wolverhampton to Stourbridge Road, near to Kingswinford. The service is registered to provide accommodation, care and support for up to twenty-four people with learning disabilities, who may also have additional physical support needs. The home is divided across three purpose-built detached properties: Winter, Catesby and Littleton Houses. There is a shared driveway/car parking area at the front of the buildings. There is a garden to the rear of the properties, which is separated from the adjoining houses by a panelled fence. A brook borders the lawned area of the bottom of each garden. People’s bedrooms are situated on the first and ground floors. Each house has a shaft lift and stairway for people to access first floor rooms. All bedrooms have en-suite facilities including a level entry shower. There are communal bathrooms fitted with a hydraulic chair on the first floor of some of the units. All of the rooms are spacious and furnished to a high standard. The home should be approached directly for current information about fees and other charges not covered by these. Riverside Care Centre DS0000041321.V377488.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 Two Stars. This means that the people who use this service experience good quality outcomes. We gathered information from a number of different places to help us make the judgements found in this report. The Manager sent us a completed Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self assessment about how well the service is doing, and provides some numerical information about it. We made two visits to the home and met with people who use the service, the Manager and members of the staff team. We looked at records including personal files, assessments and care plans, staff files, safety records, previous inspection reports, and other documents. What the service does well: People can get information about what the service provides, to help them decide if it is what they are looking for. Their needs are assessed, so that their care and support can be properly planned. People have detailed care plans, so that staff have clear guidance about how to support them in ways that suit them best. Plans are reviewed regularly, so that important information can be kept up to date. Staff support people to do things they enjoy, go to places they like and keep in touch with the people who are important to them. They work hard to arrange things for people to take part in. They are also able to plan menus, be involved in shopping for food and preparing it if they wish. This helps to ensure they enjoy their food and mealtimes. People are generally well looked after. They get the support they need to keep important medical appointments and to get their medicines when they should. Staff support them to stay healthy and well. The care team is well motivated and keen to provide a good service. They treat people with respect, friendliness and warmth. Important checks are carried out on staff to ensure that they are fit for their jobs. The service is generally well run. People feel that they can approach the management team with any concerns. They are confident that any issues are listened to, taken seriously and acted upon. Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People’s contracts need to be updated, to include all information about fees, charges and contributions. This is so that all concerned are clear about their responsibilities. Care plans should be developed so that they include goals with outcomes that can be clearly measured. These should be evaluated regularly, to make sure Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 7 they are kept up to date. This is to ensure that people get the support they need to achieve the things they say are important to them. Improvements should be made to people’s activity opportunities on an individual basis. This should include making some clear links between their activities and their agreed goals. This will help to make sure they can achieve those things they aspire to. Action should be taken to improve the numbers of care staff gaining formal qualifications. This is to ensure that they have the knowledge and skills they need to do their jobs well. Arrangements for staff to receive formal supervision and an annual appraisal of their performance, training and development needs should be fully implemented. This is to ensure that they get all the support they need to do their jobs well. Quality assurance and monitoring activity should be completed and reported on. This information should be shared with all interested parties. This is so that it can be seen how the views of people using the service have been taken into account. 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 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. Riverside Care Centre DS0000041321.V377488.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 Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw that the home has a current Statement of Purpose and Service Users’ Guide. Clear efforts have been made to produce these in accessible formats for people who may have difficulty reading. These documents are to tell people about what the service does, to help them decide if it is what they are looking for. We recommend that these include clear information about the range of fees, and any other charges not covered by these. This is so that people have all the information they need. We looked at people’s personal files to see if their strengths and support needs had been assessed. This is important, as it provides a sound basis on which to plan each person’s care and support. The files we looked at all contained a current assessment. We saw that these have been kept under review, so that important information is kept up to date. Two people have moved into the home since the last inspection. We saw that a lot of work has been done since we last inspected the home, to update and improve people’s assessments and Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 10 care plans. This helps to make sure that each person’s care and support can be planned and managed more effectively. We noticed that there were no contracts on people’s personal files that we looked at. The Manager explained that these are kept on files held centrally in the administration office, and we saw these. She said that contracts are currently being reviewed and updated. We recommended that these include clear statement about all payments and contributions, and that these are signed by individuals concerned or their representatives, as appropriate. This is so that all parties are clear about their responsibilities. Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the 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 get the support they need in ways that suit them best and ensure they can stay safe. They get the help they need to make decisions about things that are important to them. EVIDENCE: We looked at people’s personal files in all three houses, to see how their care and support is planned and managed. All of the files we looked at had a current care plan, and we could see that these had been reviewed regularly. It should be acknowledged that a lot of work has been done in this area, since the last time we inspected the home. We saw that clear efforts have been made to use “person-centred” approaches. People’s care plans contained detailed guidance about how to give them support in the ways that they like. We saw that care plans are supported with risk assessments, so that people Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 12 get the help they need to keep them safe. We also saw that some good work has been done to promote people’s awareness and understanding of communication. We saw several examples of pictorial aides around the houses and people’s care plans included communication guidelines. Communication underpins every part of each person’s daily living. It is recommended that this work be continued and developed, to promote good support for individuals in making choices and decisions. We talked to the Manager about developing care plans and keeping them up to date. We saw that efforts have been made to set some clear goals with each individual. However, these are quite limited and it is difficult to see how they have been evaluated. It is important that goals have outcomes that can be clearly measured. This means that it is easy to see whether or not a goal has been achieved. However, it is positive that some work has already been done in this area, and this now needs to be built upon. It may be that this is a subject for further training and development among the staff team. We suggested that considering the “SMART” model may help in this. That is, that each goal is specific, measurable, achievable, realistic and time-limited. This also means that goals need to be evaluated regularly, in order to ensure they remain effective. We suggested that the regular key worker responsibilities already in place could be developed to cover this. Key workers already have regular meetings with each person. They could review and record progress on the goals set at the previous meeting, and agree goals for the month ahead. Doing this well could help to keep care plans “live” and ensure that people get the support they need to achieve the things they say are important to them. We saw that people are involved in day-to-day things around the house, according to their individual capabilities. We saw some people preparing vegetables for the evening meal. People told us that they help with the shopping for the house, planning the menu and doing other jobs around the home. We also saw that individuals have been referred to independent advocates, to get support with important decisions. This shows that the service takes positive action to make sure that people get the help and support they need to make choices about the things that affect them. Riverside Care Centre DS0000041321.V377488.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): This is what people staying in this care home experience: 12, 13, 14, 15,16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to go to do things they enjoy, go to places they like and keep in touch with the people who are important to them. They have plenty of variety and choice of food, and enjoy their meals. EVIDENCE: We looked at people’s records and talked to them about the opportunities they have to do things they like. We saw that people are able to have structured activities at local day centres and colleges on a regular basis. Each home has an activity file. This includes a pictorial record of events that staff have organised in the houses, day trips and so on. It is clear that staff try very hard to give people a good range of opportunities for social and leisure activities. There have been recent trips to the Special Olympics, local nature parks, Weston super Mare, and Warwick Castle. One person achieved a long held ambition to go ice-skating. “In-house” activities have included themed events Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 14 such as a beach party and BBQ, “The Good Old Days”, birthday parties, the “Animal man” and “Tickled Pink”, a visiting theatre group. We saw some residents enjoying a sing along with a member of staff who plays guitar. Another person told us that he is able to go and watch his favourite football team regularly. We saw that staff support people to keep pets including birds, aquarium fish and cats – in different houses! Other people told us that they had enjoyed their holidays. We saw that different holidays had been arranged, and people told us that they had chosen where they wanted to go. One person told us “I go out to day centre, to the shops and I can do what I want. My family visit me. I like the food here and I can have what I want. If I want I can help with the shopping”. Records show, and people confirmed, that they get the support they need to keep in touch with their families and loved ones. Some people have regular visits at Riverside, others go to see their families in their homes, and keep in touch by telephone. We noticed that activity records for individuals are rather limited. Also that a significant proportion of activities arranged are on a group basis and involve people coming into the home. There is room for some development in this area. Activity opportunities are a key indicator of the quality of life that people enjoy. True person-centred planning involves supporting people to identify the things in their lives that are important to them, and helping them to achieve them. It follows then, that there should be clear links between people’s activity opportunities and their agreed goals and plans. The development of people’s individual goals referred to in the previous section of this report needs to go hand-in-hand with their individual activity planning. There is no implied criticism of the good work that staff do to provide activities for people at Riverside, but there is room for improvement of these on an individual basis. It is suggested that this should form part of the discussions on the development of the key worker role. We looked at food stocks in the three houses and saw that these were plentiful. They included fresh fruit and vegetables, and salad items. As reported above, we saw that there were pictorial aides to help people make food choices. We also saw people helping to prepare vegetables. Each house has its own budget for food shopping. People told us that they take an active part in shopping for groceries and planning menus. The homes operate a rolling menu cycle over 3-4 week periods, though the relatively small size of each unit means that alternatives can always be provided easily. Sampling of records of meals actually taken showed evidence of plenty of variety and choice. We saw people enjoying their meals in a relaxed setting. People told us that they could have what they wanted, and that they enjoyed their food. Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People using the 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’s health and personal care needs are generally well met. EVIDENCE: During our visits to Riverside we saw that people were well dressed in good quality clothing that was age and gender appropriate. It was clear that they had received the support they needed with their personal care and hygiene. We were able to directly observe interactions between residents and staff. We saw staff respecting people’s rights to privacy and dignity by the ways in which they spoke to them and by knocking on their doors before entering bedrooms, for example. The general atmosphere in the houses is relaxed, and it is clear that people are comfortable in each other’s company. Staff spoke very positively about the people in their care. As reported above, people have detailed care plans so that staff have clear guidance about how to give them support in the ways that suit them best. Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 16 We looked at people’s personal records to see how their healthcare is planned and managed. We saw that each person has a health action plan including a record of appointments with health professionals and other members of the multi-disciplinary team. We could see that referrals have been made to other professionals appropriately, to ensure that people get the treatment, support and advice they need. Records show the involvement of the GP, Practice Nurse, Consultant Psychiatrist, Community Learning Disability Team Social Workers and Community Nurses, Speech and Language Therapist, Occupational Therapist, Audiologist, Optician and Dentist. We also saw that people’s health records included regular weight monitoring, epilepsy management plans and strategies for monitoring / managing behavioural issues where appropriate. We talked to the Manager about ways that the good work already done in this area might be developed. We suggested that the format include a checklist for future monitoring, to ensure that essential appointments continue to be scheduled and don’t get missed. As with general care planning, health action plans could include goals with measurable outcomes. The focus of health action planning should be proactive rather than reactive health care management. That is, planning to actively promote people’s healthy lifestyles, rather than just reacting when problems arise. However, these recommendations are made as matters of good practice, to build on the good work already done. We looked at medication administration records (MAR) and arrangements for handling and storing medication. We noticed that recommendations made at the time of the last inspection have been met. Keys for the medication cabinets are now kept separately in all the houses, to help promote safe and secure storage. Arrangements have been put in place for external medication (creams / ointments) to be stored separately. This is good practice, reducing risks of cross-contamination with medicines taken internally. We sample checked the medication administration record in each house, and saw that these had been completed appropriately. Sample checking of medication showed that medicines had been given as prescribed. We saw that the record included a photograph of each person, sample signatures of staff responsible for administering, and information about medication including possible side effects and contra-indications. Written protocols for homely remedies and PRN (“as required”) medicines were in place, as previously recommended when we last visited the home. Appropriate arrangements were in place for managing controlled drugs, where required. We saw that daily checks of the medicine fridge temperature were recorded as necessary. We saw that medication stores were clean and tidy, and secure. These things show that the service takes care to ensure that medication is managed and stored effectively. Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the 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 can be confident that their concerns are listened to, taken seriously and acted upon. They are protected from abuse, neglect and self-harm. EVIDENCE: The home has appropriate policies and procedures in place covering complaints and safeguarding (adult protection). We talked to people about what they would do if they have any concerns or are worried about anything. Those that were able to understand this said they knew they could talk to staff, the manager, or their families, and were happy to do this. The Manager also told us that stamped addressed cards are available on the homes. These can be sent directly to senior managers in the organisation, if people wish. We also saw that the complaints procedure has been produced in a pictorial format. However, it has to be acknowledged that formal policies and procedures are of little relevance to some of the people using this service, due to their levels of learning disability and communication support needs. They are dependent on the vigilance of the staff looking after them to be alert to changes in mood, behaviour or other “body language” as indicators that something is amiss. Conversations with staff showed that they are sensitive to these things, and knowledgeable about individuals’ usual patterns of behaviour. We looked at the complaints record and saw that concerns raised have been dealt with appropriately. Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 18 We talked to staff about safeguarding. All of the staff we talked to were able to demonstrate their understanding of the nature of abuse and the forms it can take. They were able to tell us about the things they need to look out for, as possible indicators of abuse. They also showed that they know the action they must take in the event of witnessing or suspecting abuse. The Manager has taken appropriate action in accordance with local multi-agency guidelines, following allegations of staff misconduct. We looked at staff records and saw that appropriate checks have been carried out with the Criminal Records Bureau prior to employment commencing. We also saw that proper arrangements are now in place for supporting people to manage their money. Detailed records are kept of all transactions, receipts kept and double signatures of staff involved. These records are audited regularly by the home manager, and also independently by senior managers. These things show that the service takes care to ensure that people are supported to be safe. Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 , 26, 27, 28, 29 & 30 People using the 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 enjoy living in houses that are comfortable, clean and homely. EVIDENCE: We looked around all of the houses during our visits to Riverside. We saw that people’s bedrooms are all individual in style, reflecting the personal preferences of the individual occupants. Rooms are comfortably furnished and decorated: we saw people’s personal effects including pictures, ornaments, family photographs, televisions and computers, collections of books, CDs and DVDs and equipment for playing these. We saw that some people have “astro ceilings” and other equipment to provide sensory stimulation and interest. All of the rooms have en-suite toilet and level access shower facilities. We saw that people with additional physical support needs have the equipment they need to assist with safe moving and handling. People told us that they are very happy with their rooms. Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 20 Shared spaces including lounge areas and dining rooms are comfortably furnished. Bathrooms, toilets and laundry areas in the houses were functional, and generally well organised and tidy and clean. We saw that the assisted bath in Catesby house was out of order, but advised that this has been reported and an engineer requested. We also noted that the hall and stairs carpet in Winter house is in need of replacement and that kitchen units around the homes are in need of some attention. However, a maintenance and renewal programme is in place and it is clear that routine maintenance and refurbishment is being dealt with on a regular basis. Outside spaces are attractive with garden furniture, pots and plants in evidence. We saw that staff work hard to keep the houses clean, fresh and tidy and that people are able to enjoy living in a homely environment. Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the service takes action to ensure that staff employed to work at the home are fit for their jobs. Some improvements are needed to the numbers of staff holding formal qualifications, and to arrangements for formal supervision. This is to ensure that staff have the knowledge and skills and get all the support they need, to do their jobs well. EVIDENCE: During our visits to the home we saw that there were generally sufficient numbers of staff on duty to meet residents’ assessed needs. We saw that the Manager is currently negotiating with local commissioners to authorise additional staff resources to meet the changed needs of one person. We looked at staff records to see how people are selected and recruited for their jobs. All of the files we looked at contained completed applications, two written references and evidence of checks with the Criminal Records Bureau. We also saw notes of interviews, copies of job descriptions and contracts, Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 22 health declarations and receipts for the staff handbook. These things show that the service takes action to ensure that people employed are fit for their jobs. We looked at information the Manager gave us in the Annual Quality Assurance Assessment and in the staff training and development plan. The number of staff holding formal qualifications at NVQ level 2 or above is currently below the recommended National Minimum Standard. It should be acknowledged that there have been a number of changes in the staff team in recent months. We talked to the Manager about this, and she told us that she is taking action to address this shortfall. A representative from a local college was actually in attendance at the home to meet with her about this on one of the days we visited. We saw that statutory and other training is generally well planned and delivered, from information on the training and development plan. Staff told us that they now enjoy regular opportunities for training. Staff records also show that formal supervision is also currently below standard. However, we saw evidence that some improvements have been made to this recently. If this trend is continued then this matter should be resolved satisfactorily. We talked to the Manager about this as well. She told us that consideration is being given to delegating some responsibility for supervision to senior staff on the houses. She suggested that some of the problem related to a previously negative attitude or lack of understanding about the purpose of supervision among some staff. We recommended that a supervision contract / agreement be developed, so that all parties are clear about their responsibilities in this regard. Doing this should help people to have a positive experience of supervision meetings, and get the most out of them. We noted that annual appraisals for staff have not yet been done. The Manager told us that this too is a work in progress: it should be acknowledged that she indicated this when she completed her Annual Quality Assurance Assessment before our visit. Riverside Care Centre DS0000041321.V377488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,38, 39 & 42 People using the 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 service is generally well run for the benefit of the people of the people who use it. EVIDENCE: The Manager has worked at the home for several years. She has been confirmed in her current post recently, having “acted up” since March this year. She is qualified to NVQ level 4 and holds the Registered Managers’ Award (RMA). Since coming into post she has worked hard to address issues raised at the last inspection and her efforts to develop the service in the short time she has been in post should be acknowledged. Staff we spoke to told us that the Manager and Deputy are very approachable, and that they are comfortable Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 24 raising any matters of concern with them. One of the team leaders told us “Things have improved recently. Care plans are much better and working relationships among the staff teams are good. We help each other out and can go to the Lodge (manger’s office) about anything”. The Manager and staff team spoke positively about their roles, and of their desire to develop and improve the service for the benefit of the people in their care. We looked at arrangements for quality assurance and monitoring of the service. We saw that some reports required under Regulation 26 (Care Homes Regulations 2001) were available for inspection. These should be completed at least every month. The Manager told us that pictorial questionnaires have been distributed around the homes, and we saw some of these on people’s personal records that we looked at. She said that questionnaires were being distributed to residents’ families and to other professionals, but that this is a work in progress. Information from this exercise needs to be collated and evaluated. This should be reported on, showing how people’s views have been used to underpin the review and development of the service. The report should be made available to all interested parties. We sampled records relating to health and safety in the service. The home’s maintenance man has general responsibility for these matters. We saw that regular checks had been carried out on the fire alarms and emergency lighting systems, and fire-fighting and other essential equipment serviced as required. We saw that checks of fridge and freezer temperatures and water outlets had been done regularly, and that lifts, hoisting and assisted bathing equipment had been serviced. COSHH stores were secure. We saw that health and safety checks are being dealt with systematically, and records kept appropriately in support of this. These things show that that the service takes action to ensure that people living and working in the home stay safe. Riverside Care Centre DS0000041321.V377488.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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 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 3 2 X X 3 X Version 5.2 Page 26 Riverside Care Centre DS0000041321.V377488.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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. 1. 2. Refer to Standard YA5 YA6 Good Practice Recommendations Update contracts to include clear information about fees, charges and contributions. This will ensure that all parties are clear about their responsibilities. Develop care plans to include goals with measurable outcomes, and evaluate these each month. This will help to ensure that people get the support they need to achieve the things they say are important to them. Establish clear links between people’s activity opportunities and their agreed goals. Develop activity opportunities for people on an individual basis. This is to ensure they get the support they need to achieve their goals and aspirations. Take action to increase the numbers of staff holding recognised formal qualifications. This is to ensure that they have the knowledge and skills they need to do their jobs well. Ensure that staff receive regular formal supervision and an annual appraisal of their performance and training and DS0000041321.V377488.R01.S.doc Version 5.2 Page 27 3. YA14 4. YA32 5. YA36 Riverside Care Centre 6. YA39 development needs. Develop a supervision agreement so that all concerned are clear about their responsibilities. This is to ensure that they get all the support they need to do their jobs well. Ensure that visits and reports on behalf of the Registered Provider are completed each month. Collate and evaluate information from quality assurance and monitoring activity. Produce a report on this, showing how the views of people using the service have been used to underpin its review and development. Make the report available to all interested parties. Riverside Care Centre DS0000041321.V377488.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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