Care Home: Riverside Court Nursing Home

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What the care home does well Information about the home and the services it can provide are available for prospective residents and their families. Copies of the information is kept in the home but people are able to request their own copies from the manager. There have not been any new admissions to the home for some time. However, people already living at the home have had their admission assessments reviewed and updated to include more detailed information in them about their needs, requirements and expectations. This helps to make sure that the care and support provided to people using this service is tailored to their individual requirements. People told us that the staff were very `kind` and `friendly`. One residents said; `staff are usually very attentive to my needs.` Another told us; the staff `are the best lot of lasses you can find here.` Riverside Court employs two activities co-ordinators, who put lots of time and effort into developing and providing a wide range of leisure and social activities at the home. Most of the people we spoke to were `very happy` at the home. They are able to personalise their rooms with their own televisions, radios, pictures, photographs and things that remind them of past events in their lives. One of the visitors we spoke to also told us that they were very happy with the home. They said that their relative as `happy and had settled down well. We like all the staff and are always made welcome when we visit.` The housekeepers at the home are included in the staff training programme. They undertake training directly related to their work but also in respect of safeguarding adults and conflict resolution to help raise their awareness of such matters. What has improved since the last inspection? At our last inspection we told the manager that all of the people living at Riverside Court had to have detailed plans of their care and support needs, including information about how those needs would be met. We saw that the manager has carried out work to ensure care plans are reviewed and updated as people`s needs change. Staff have received special training to help them understand the care planning and person centred care processes. We saw from care plans and daily records evidence to indicate that people are eating better and have started to gain weight. Where issues regarding nutrition have been identified in the reviews of care plans, the dietician or GP have been contacted for dietary advice, plans and nutritional supplements. A thorough review of the handling of medication had been undertaken to improve the way that medicines were handled and to reduce the risk of errors that could cause harm. Four out of five requirements regarding medicines handling made at the last pharmacy inspection had been met and progress had been made towards meeting the fifth requirement. A great deal of work has been completed to make improvements to the environment at the home. Faulty windows have been replaced or repaired. Bathrooms have been retiled and/or decorated and new assisted baths have been purchased and are in the process of being installed. Bathrooms have been equipped with suitable waste disposal bins to help reduce risks associated with cross infection. We found that the manager has made many improvements at the home, ensuring compliance with most of the statutory requirements we have made at previous inspections and by the implementation of the organisations improvement plan. What the care home could do better: Although there is a marked improvement in the care planning processes in place at the home, there are some areas that would benefit from further review and update, including a move towards more person centred care planning. The manager must make sure that all medicines are administered in the correct dosage so that residents receive safe and effective treatment. The recording and management of blood tests for blood-thinning medicines should be improved so that all tests are done on time and that the results can be clearly tracked to reduce the risk of errors. The manager told us that although most staff at the home have received safeguarding training some staff are still not reporting matters to her as they should. The manager is aware of resident`s rights and choices. She is aware of the legislation regarding mental capacity and deprivation of liberties and has involved appropriate people, such as social workers, to help ensure people are supported in the best way. Previously, poor records have been maintained regarding staff training and development. Although the manager has carried out some work to address this and staff have been provided with further training, there are still gaps in the training programme and records that need to be dealt with quickly. Key inspection report Care homes for older people Name: Address: Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Jinks     Date: 1 9 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 36 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 Homes for Older People 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Riverside Court Nursing Home 31 Irish Street Salmoor Way Maryport Cumbria CA15 8AZ 01900815323 01900815033 riverside.court@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 30) The maximum number of service users who can be accommodated is: 60. Date of last inspection Brief description of the care home Riverside Court is a purpose built two storey care home providing nursing care to service users within four units. Each of these units can accommodate up to fifteen people. Three of the units are for service users who have been diagnosed as being mentally infirm and the other unit is for older people who do not fall within any other Care Homes for Older People Page 4 of 36 Over 65 0 60 30 0 Brief description of the care home registration category and who require nursing care. Riverside Court is close to Maryport harbour and local amenities. There is a large car park within the grounds of the home and an enclosed courtyard style area with outside furniture provided. Full details of the charges, facilities and services offered in the home may be obtained by contacting the manager of the home. There are additional charges made for matters such as hairdressing, personal toiletries or the purchase of newspapers. Care Homes for Older People Page 5 of 36 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service takes into account all of the information we have received since our last visit in December 2009. We sent surveys to some of the people that live and work at the home in order to obtain their views on life at Riverside Court. We only received one survey back from a resident. We spoke to some of the people that live and work at the home, including the acting manager. We also spoke to some visitors and relatives who were at the home on the day of our visit. Our inspection was completed by three inspectors, one of whom is a pharmacist. They assessed and checked the medication arrangements in place at the home. We looked around the home to assess the environment and accommodation provided to people Care Homes for Older People Page 6 of 36 who use this service. We also looked at a variety of records that the home is required to maintain, including resident care records and staffing records. Following our inspection December 2009, we asked the provider to develop and implement an improvement plan for the service. We also issued two Statutory Requirement Notices in March 2010 in order to bring about improvements to two areas where the provider had persistently failed to comply with Regulations. We carried out a random inspection of this service in March 2010 and found that the provider had complied with the Requirements of the Notices. The acting manager completed an up dated annual quality assurance assessment (AQAA) and returned it to us. The AQAA contained information about the service and helped us to plan and target this visit to the home. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? At our last inspection we told the manager that all of the people living at Riverside Court had to have detailed plans of their care and support needs, including information about how those needs would be met. We saw that the manager has carried out work to ensure care plans are reviewed and updated as peoples needs change. Staff have received special training to help them understand the care planning and person centred care processes. We saw from care plans and daily records evidence to indicate that people are eating better and have started to gain weight. Where issues regarding nutrition have been identified in the reviews of care plans, the dietician or GP have been contacted for dietary advice, plans and nutritional supplements. A thorough review of the handling of medication had been undertaken to improve the way that medicines were handled and to reduce the risk of errors that could cause harm. Four out of five requirements regarding medicines handling made at the last pharmacy inspection had been met and progress had been made towards meeting the fifth requirement. Care Homes for Older People Page 8 of 36 A great deal of work has been completed to make improvements to the environment at the home. Faulty windows have been replaced or repaired. Bathrooms have been retiled and/or decorated and new assisted baths have been purchased and are in the process of being installed. Bathrooms have been equipped with suitable waste disposal bins to help reduce risks associated with cross infection. We found that the manager has made many improvements at the home, ensuring compliance with most of the statutory requirements we have made at previous inspections and by the implementation of the organisations improvement plan. 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 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 Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People using this service have had their care and support needs re-assessed and up dated where necessary. This helps to ensure that they receive the care and support they need with their daily living activities. Evidence: The service produces information about the home for prospective residents and their families. The documents include the Statement of Purpose and the Service User Guide. We saw that copies of these documents are available in the home, together with a copy of the homes last inspection report. These documents provide information about the home and the services it can provide and help to make sure that people choose a home that will be able to meet their requirements and expectations. The manager told us that this information is available in various formats, including via the organisations website. Care Homes for Older People Page 11 of 36 Evidence: As part of the admission process, people are encouraged to look round and view the home and the facilities available to them. People are able to meet other residents, sample a meal and observe or take part in activities. There is a trial period of at least 1 month for all new admissions. This helps the manager and the resident to be sure the home will be suitable and able to meet needs and expectations. We were unable to check that people have their care needs assessed prior to admission to the home. This is because there have been no new admissions to the home since our last visit. However, we saw that people already living at the home have had their admission assessments reveiwed and updated to include more detailed information in them about their needs, requirements and expectations. These assessments have been periodically reviewed to help ensure that the changing needs of residents are identified and their care plans are revised accordingly. The service offers nursing care and specialist care for people who may have dementia illnesses. Qualified nurses are employed at the home and additionally, some care staff have undertaken specialised training such as dementia awareness. The staff training records have not been maintained accurately. The manager is currently reviewing staff skills and qualifications to help ensure that the home is staffed by people with appropriate knowledge, experience and skills to meet the needs of the people that use the service. Care Homes for Older People Page 12 of 36 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the way in which care and support needs are recorded and kept up to date. There are still some areas that need further attention, but generally the needs, wishes and preferences of people using this service are respected and promoted. Evidence: On the day of our visit to the home there were 38 people living at Riverside Court. There have been no new admissions to the home since our last visit in March 2010. At our last inspection we told the manager that all of the people living at Riverside Court had to have detailed plans of their care and support needs, including information about how those needs would be met. The manager told us that she is in the process of reviewing the information held about the needs and preferences of each resident and that some of the information for some of the residents is very sparse. Families, friends and advocates are helping to provide the manager with important information about individuals needs, wishes and Care Homes for Older People Page 13 of 36 Evidence: preferences, where necessary. During this visit to the home we looked at a sample of care records belonging to some of the people that live at Riverside Court. We saw that the manager has continued to ensure care plans are reviewed and updated as peoples needs change. Staff have received special training to help them understand care planning and person centred care. We noted that the plans contain much more relevant and detailed information relating to the day to day care and support needs of the people that use this service. There are clear and detailed instructions for staff to follow and this helps to ensure that residents receive the care they need and expect. Care plans include an element of risk assessment to help ensure residents and staff are safe and protected from the risks of harm or injury. Nutritional assessments have been undertaken and where necessary care plans have been drawn up with the involvement of the dietician, doctor or specialist nurse. Daily records also confirm that people have access to a variety of health care professionals when they need them. From the information contained in care plans and from our observations and discussions with people who live at the home, we noted that the service has improved under the new manager and people are generally well cared for. The manager told us that she regularly carries out random checks on care plan records to make sure they are up to date and contain all the necessary information to support individuals properly. Any gaps in the records are discussed with the staff responsible for maintaining care records and this helps to make sure they are quickly completed properly and accurately. We saw examples of where the manager has done this. Although there is a marked improvement in the care planning processes in place at the home, there are some areas that would benefit from further review and update, including a move towards more person centred care planning. Another example are the food and fluid intake/monitoring records, which need some adjustments to ensure things are recorded consistently and with sufficient detail. Additionally, where people are waiting for appointments to see healthcare professionals, a system should be set up to ensure these are followed up and people received the treatment or consultations they need. On the day of our visit to the home there appeared to be enough staff on duty to meet Care Homes for Older People Page 14 of 36 Evidence: the needs of the residents. However, it seemed that there had been some issues during the morning as the people we spoke to told us that they were late having breakfast, getting up and going for a shower. One person we spoke to was still in bed when we visited them. They told us that they are not usually in bed at this time and they had to wait this morning. They added that breakfast had been late too. This person has poor mobility and is prone to developing pressure ulcers. They told us that staff take care of their skin and positioning and added, staff are usually very attentive to my needs. Another person we spoke to was sat in their dressing gown waiting to go for a bath. They told us they had lived in the home for about a year and said that the staff were one of the best lot of lasses you can find here. This person had no complaints and would not be worried about speaking their mind if there was anything wrong. They also told us the staff seemed to be behind that morning. We noted that the morning medication round on one of the units, had taken the nurse over two hours to administer. The lunchtime medication was due to be administered two hours later. We discussed this with the nurse and with the manager as it may mean that people do not get their medication at regular intervals, as prescribed. Both the manager and the nurse told us that the timings of the medication rounds can be adjusted. The manager needs to ensure there is a clear protocol to ensure staff work consistently and medication is administered as prescribed by the doctor. We looked at records for receipt, administration and disposal of medication and these were much more accurate. With the exception of the occasional discrepancy these were good so that the treatment received by residents was clear. We did a stock check of a sample of medicines and these were in order so they could be accounted for. At the last inspection we made a requirement that medicines must be administered in the correct dosage. There has been progress towards meeting this requirement and the majority of medicines that were checked were given correctly. However, there were a couple of medications that had not been administered in the dosage intended by the doctor. For example, one resident started a new medication and the specialist had advised that this be given in a low dose for the first week and then increased. However, records showed that the resident received a higher initial dose than was intended. Staff quickly realised the mistake and sought advice. We looked at a sample of care plans for management of health care and medication. These were much improved and contained adequate information to ensure that Care Homes for Older People Page 15 of 36 Evidence: residents were managed appropriately. We checked the administration of when required sedatives and records clearly justified why these were administered and showed that care plans were followed. We checked the management of a resident taking a blood-thinning medicine that needed regular blood tests and dosage adjustment. The records were hard to follow with information kept in different places in the residents file. This made it difficult to follow the changes. We noted that some blood tests were not done on the intended day although staff at the home were not responsible for doing these tests. The manager should, however, have clear arrangements in place so that tests are done on the correct day and not delayed, and that records can be easily tracked to show the changes to treatment. Other changes to medication were checked and good records were kept of when and why these changes took place. We checked medicines liable to misuse, called controlled drugs and a stock check was in order. The manager had reviewed the ordering procedures for medication so that medicines did not run out. Regular audits of medication were being done so that concerns are identified and managed without delay to keep residents safe. Training in medicines management was being arranged with the supplying pharmacy. The manager had started to assess the competencies of staff in the handling of medication to make sure that they follow good practice to reduce the likelihood of medication errors. Care Homes for Older People Page 16 of 36 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the nutritional support and meals available at the home. This helps to promote the health and wellbeing of people using this service. Evidence: The people who contributed to our assessment of this service told us about some aspects of their daily lives and of the activities that are on offer at the home. Riverside Court employs two activities co-ordinators, who put lots of time and effort into developing and providing a wide range of leisure and social activities at the home. Care staff also contribute and help to provide the activities on offer at the home. Records and photographs of events and activities are kept and made available to people living at the home. Some of the residents we spoke to told us that there are things to join in if they wish. Not everyone likes to participate in some activities and choose to stay in the privacy of their own room. We observed staff working with some of the residents who have dementia. Staff put music on and there was some singing in one of the lounge areas, some of the residents who were walking or sitting in other areas of the unit went to look what was Care Homes for Older People Page 17 of 36 Evidence: going on and joined in. Most of the people we spoke to were very happy at the home. They are able to personalise their rooms with their own televisions, radios, pictures, photographs and things that remind them of past events in their lives. People told us of some of the activities available at the home and there was a programme of a variety of events on display in the reception area. Events ranged from coffee mornings in the home, to meals and trips out, entertainers and the prospect of a mini zoo visiting the home. As well as this there are impromptu games available, such as cards, dominoes and other board games. People are able to take their favourite newspapers and magazines if they choose and the local library also provides a service to the home. One person told us that Now and then the vicar comes and brings holy communion. One of the people we spoke to had their own telephone to help them keep contact with their relatives and friends. They also preferred to use their own bed linen to help make the room even more personal. People are able to receive their visitors when they want and are able to see them in one of the communal areas or in the privacy of their own room. We saw some visitors during our time at the home. They were made welcome by the staff and offered refreshments. One of the visitors we spoke to told us that they were very happy with the home. They said that their relative as happy and had settled down well. We like all the staff and are always made welcome when we visit. A food audit has been carried out at the home, menus have been reviewed and the chef has spoken to residents to find out their likes and dislikes. In addition to this the organisations chef has visited Riverside Court to give advice on nutrition and menu planning. We saw the lunch time meal served at the home, people were reminded of the choices on offer that day. The residents we spoke to told us that if they wanted something different they usually got it if requested. One person in particular would like to have more salads and fresh foods on the menu rather than lots of stews or casseroles. Another person confirmed that there are choices at mealtimes. This person enjoys a cooked breakfast every day. They added; breakfast and lunch are generally OK but Im not too keen on soup and sandwiches for tea, but there are alternatives. Care Homes for Older People Page 18 of 36 Evidence: We saw people helped to the table for their meal and settled by staff. Where people needed assistance this was done sensitively and relaxed with staff speaking to people throughout. Dining rooms were clean and tidy with nicely laid tables, which contributed to a pleasant environment for eating. We saw from care plans and daily records evidence to indicate that people are eating better and have started to gain weight. Where issues regarding nutrition have been identified in the reviews of care plans, the dietician or GP have been contacted for dietary advice, plans and nutritional supplements. We saw that food and fluid intake/monitoring records are kept but, these need some adjustments to ensure things are recorded consistently and with sufficient detail. People generally looked much better than we have noted at previous visits to the home. Care Homes for Older People Page 19 of 36 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safeguarding and complaints processes in place at the home are not always adhered to with consistency. This potentially places people using this service at risk or harm or abuse. Evidence: The home has organisational safeguarding policies and procedures in place together with the local authoritys guidelines and procedures. There is a complaint process and people participating in this assessment told us that they know who to speak to if they are not happy about something. The manager takes safeguarding matters and complaints seriously and reports them to the relevant authorities. She has told us of the complaints and safeguarding matters that have occurred at the home and is looking at how to ensure staff adhere to their training with regard safeguarding procedures. Most staff at the home have received training in the safeguarding of vulnerable adults (abuse) from a recognised trainer. However, the manager told us that some staff are still not reporting matters to her as they should and some incidents are only found during routine care plan audits carried out by the manager. We saw evidence to confirm that where staff have failed in their duties, the manager has taken appropriate action to help ensure people living at the home are protected Care Homes for Older People Page 20 of 36 Evidence: from harm or unsuitable staff. The manager is aware of residents rights and choices. She is aware of the legislation regarding mental capacity and deprivation of liberties and has involved appropriate people, such as social workers, to help ensure people are supported in the best way to promote and protect their interests. She told us that some staff do not fully understand this legislation and she is trying to obtain some relevant training for all staff to help improve their knowledge and understanding. We did see evidence of some documents on care files that are not properly completed and may not be in the best interests of the person concerned. We spoke to the manager about these at our last visit to the home as they need further attention to ensure they are used appropriately. Care Homes for Older People Page 21 of 36 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, 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. 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 provides a warm, clean and pleasant environment for the people that live at Riverside Court. Evidence: We looked around the building during our visit to the home. This was to assess the environmental standards following the statutory requirements we had made at our previous inspection. A great deal of work has been completed to make improvements to the home. Faulty windows have been replaced or repaired. Bathrooms have been re-tiled and/or decorated and new assisted baths have been purchased and are in the process of being installed. Bathrooms have been equipped with suitable waste disposal bins to help reduce risks associated with cross infection. We found that the home was clean and tidy. Communal areas such as the dining rooms and lounge areas were bright and airy. People are able to access the garden areas freely from the downstairs lounge. Gardens are equipped with seating areas and provide a pleasant and safe outdoor area for the people that live at Riverside Court. Communal areas, toilets, bathrooms and corridors are equipped with grab rails and hand rails to help people access these area as independently as possible. We found the rails to be securely fitting and in a good state of repair. However, some of the assisted toilets had no plug in the sinks making it difficult for people to use them for Care Homes for Older People Page 22 of 36 Evidence: washing. Some of the emergency call bells were tied up off the floor making them inaccessible to people who may need help from staff. We noted that other improvements had been made at the home. Some of the bedroom doors have had door guards fitted. It is planned that all the bedroom doors will be fitted with these. The manager told us this was not because of a visit from the fire officer, but to improve fire safety for the people who choose to leave their bedroom door open. We spoke to some of the housekeepers that work at Riverside Court and looked at a sample of their training records. We saw that housekeepers are provided with National Vocational Qualifications appropriate to their work. Other training included, infection control, manual handling, fire awareness, health and safety and working with hazardous substances such as cleaning materials. The housekeepers have also been included in the training related to safeguarding adults and conflict resolution to help raise their awareness of such matters. We spoke to the housekeepers and complimented them on the cleanliness of the home as there was much improvement. This had been helped by the renovations of the bathrooms and the housekeepers were pleased that the bathrooms have had some work done on them. They told us that they are provided with sufficient cleaning materials, although some are better quality than others, and are provided with protective clothing. They told us of the areas of the home that have been decorated and other areas that are scheduled to be redecorated and/or have carpets and curtains replaced. They are going to be involved with the selection of the soft furnishings for the bathrooms when they are finished in the hope to make them more homely and cosy. We saw that the home has a maintenance record book in place to help ensure things are reported and dealt with quickly. Staff are required to write in any repairs needed or environmental faults they come across. The maintenance man at the home uses this book to plan his work and help make sure the home is well maintained. Dates and signatures are kept of when the work is completed or where further specialist intervention is needed. Care Homes for Older People Page 23 of 36 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are generally supported by a sufficient number of staff. There are some gaps in the staff training records and training programme, which may at times compromise the well-being of people using this service. Evidence: We looked at a selection of records relating to the staff complement at the home. The staff rotas show that there are generally four staff on duty on each floor during the waking day and three staff on each floor at night. This includes one qualified nurse and three or two carers. We noted that there are times when staffing levels may be reduced. The manager told us that this only happened if staff go off sick at short notice. The home do have some bank staff that they can call upon, but these staff are not always available at short notice. Once the home begins to admit new residents again, the manager must ensure that staffing levels and expertise reflect the assessed needs and requirements of the people that use this service. We looked at the recruitment records for some of the staff that work at this home. We saw that people complete application forms, references are taken up and prospective employees are required to have a criminal records bureau check and safeguarding of vulnerable adults (SOVA) list check. Where registered nurses are employed,the Care Homes for Older People Page 24 of 36 Evidence: manager ensures that their professional registration and qualifications are verified. We also looked at the general training records for staff employed at the home. They have previously been maintained very poorly. The manager explained to us that a lot of training has been done, but that it has not all been recorded. She is aware that there are gaps in the training records and programme and plans to deal with these matters quickly. We saw evidence of recent training that staff have completed. This included; safeguarding (abuse) training via Cumbria County Council, moving and handling, fire safety, food hygiene, person centred care planning, conflict resolution and care of medicines. The home also has two people who are trained to provide moving and handling training to staff. The manager has told us that approximately one third of the care staff at the home have gained a National Vocational Qualification in care or health and social care. This qualification helps to ensure that people using this service are supported by care staff that understand their needs and requirements. We spoke to some of the residents and staff at Riverside Court. People said that there are usually enough staff on duty to meet their needs, although on the day of our visit they did say that things seemed a bit delayed. They told us that if they use their call bells, staff usually attend to them quickly. Most of the people we spoke to said that staff were very nice, extremely kind and attentive to their needs. We spoke to a variety of staff including qualified nurses, care staff and ancillary staff. They told us of the training they had recently undertaken to help them with their work. They spoke to us about the new manager and the improvements they have seen at the home recently. One person said; She (the manager)does more around the home, explains what changes she wants and more importantly why. She always explains about the legality. The home is certainly much better since she came. Another person said; the new manager is helping with staff morale. She is very supportive and everyone knows where they stand with her. We were also told; We have had training updates in manual handling and person centred care planning. I found the care planning training helpful in trying to understand the needs of people with dementia. The staff involved in our inspection told us that the new manager was good and that they were beginning to feel more settled than of late, the previous frequent changes Care Homes for Older People Page 25 of 36 Evidence: in manager were partly blamed for the unsettled feelings. Care Homes for Older People Page 26 of 36 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Improvements have been made to help ensure that the home is run in the best interests of the people that live there. Evidence: The manager at the home has worked for the organisation for some time as a peripatetic home manager. She has extensive experience in the management of care homes. She told us that she intends to make an application to us, the Care Quality Commission, for registration as the manager of Riverside Court. We found that the manager has made many improvements at the home, ensuring compliance with most of the statutory requirements we have made at previous inspections and by the implementation of the organisations improvement plan. We visited the home in March 2010 and saw that improvements had been made. We found at this most recent visit that further work has been done to improve the quality of services at Riverside Court. There are some areas that still require attention but she has provided information verbally and in the AQAA of how she plans to address these Care Homes for Older People Page 27 of 36 Evidence: matters. A member of staff spoke to us about the manager they said; She does more around the home and explains what changes she wants and more importantly why. She always explains about the legality of things. The home is certainly much better since she came. We looked at a variety of records that the home is required to keep, as well as speaking to staff, residents and visitors to Riverside Court. We found that people have generally noticed an improved difference at the home. Records are generally more up to date and accurate and there is evidence to confirm they are frequently reviewed with additional random checks or audits from the manager. Where the manager identifies gaps in the records, these are followed up with the care staff responsible to ensure that they are amended and updated. Weekly risk monitor reports are maintained and provide the manager with information such as the incidence of pressure ulcers, safeguarding referrals, weight gains/losses, complaints and changes in individual health care needs. This helps to make sure that people using this service are being supported properly with further action taken when necessary. The care records we looked at contain an element of risk assessment, both general and specific, for example in relation to falls, pressure ulcers or challenging behaviour. We did note that risk assessments and care plans for falls generally give sufficient information but lack strategies for staff to follow should some one fall on the floor, for example how they should deal with this including how they would they get the resident off the floor safely. Care plans are much improved with clear details and actions recorded. They are not as person centred as they could be but the manager told us this will be worked on. She audits a sample of two care plans per week to check their accuracy and quality. They are discussed with staff during supervisions and any shortfalls identified are followed up. We saw evidence to confirm that staff now receive supervision and support with their work. One person told us; I am responsible for supervising staff but have not had any formal training, this has been discussed in my supervision with the manager. She has told me what is expected and what needs to be done for effective supervision and I can discuss things with her if I need to. Care Homes for Older People Page 28 of 36 Evidence: The records we looked at generally confirm that the manager notifies us (CQC) and social workers, of any matters that adversely affect the well-being of people living at Riverside Court. This helps to make sure that people are protected from harm and are receiving the most appropriate care and support to meet their needs. The manager also monitors accidents that occur at the home, including the type of accident and the time it occurred, which helps to check whether the accident could be related to any other factors. However, there are some gaps in the records as we found some accidents recorded in individual daily notes that have not been formally reported to the manager. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) Staff must ensure that 01/02/2010 medicines are administered in the correct dosage so that people receive safe and effective treatment. This was to have been met by 01/02/09. 2 11 12 The wishes and feelings of 30/04/2010 people using this service must be ascertained and taken into account as part of the health and care provision. People using this service must be enabled, with the help of advocates if necessary, to make decisions about the care they receive in respect of their health and welfare. 3 30 18 All staff employed at the 31/03/2010 home must receive appropriate training in accordance with the aims and objectives of the home and to meet the changing needs of people living at the home. This was to have been met by 31/03/09. 4 31 9 The service must be run and 31/03/2010 Page 30 of 36 Care Homes for Older People 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 managed by a qualified, competent and experienced person who is registered with the CQC. 5 38 13 The health and safety of 01/02/2010 people using this service must be protected and promoted. Unnecessary risks to the health and safety of people using this service must be identified and so far as possible, eliminated. Care Homes for Older People Page 31 of 36 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 4 18 The provider must be able to 01/08/2010 clearly demonstrate that the home can meet the assessed needs and specialist needs of people using this service. People using this service must be confident that the staff supporting them are suitably qualified, competent, experienced and able to meet their needs and expectations. 2 9 13 Staff must ensure that medicines are administered in the correct dosage and as the doctor intended. People using this service must receive safe and effective treatment. 22/06/2010 3 18 13 Robust arrangements must be in place to ensure people using this service are protected from harm, injury or abuse. 31/05/2010 Care Homes for Older People Page 32 of 36 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 People using this service have a right to live in a safe environment. Staff need to understand that incidents and concerns must be reported to the manager consistently. 4 30 18 Staff must be provided with 31/08/2010 sufficient training that is relevant to the work that they are to perform. Records of training and development must be accurately maintained. People using this service need to be confident that staff are qualified and capable of meeting their needs and requirements. Accurate record keeping helps the manager to monitor performance and identify gaps in staff training and development programmes. 5 31 9 The service must be run and 31/07/2010 managed by a qualified, competent and experienced person who is registered with the CQC. People using this service and staff benefit from a home that is run and managed by Care Homes for Older People Page 33 of 36 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 a suitable and qualified person. 6 38 13 Records and reporting procedures relating to risk assessments, accidents and incidents must be be accurately maintained. People using this service must be protected, as far as practicable from the risks of harm or injury. 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 14/06/2010 1 7 Work should continue to ensure care plans are written in a person centred manner and contain accurate and up to date information. It is highly recommended that recording and management of blood tests for blood-thinning medicines be improved so that all tests are done on time and that the results can be clearly tracked to reduce the risk of errors. Where people need to have their food and fluid intake monitored for whatever reason, detailed records should be maintained to help ensure that dietary intake is suitable and satisfactory. This will help ensure people are not placed at risk of harm due to insufficient or unsuitable dietary intake. People using this service should have access to emergency call bells at all times, including bathrooms and toilets. This will help ensure that people are able to summon the help of staff if required. Sinks should be fitted with plugs so that people can use them for washing their hands and face for example. 2 9 3 15 4 19 5 21 Care Homes for Older People Page 34 of 36 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 6 27 Staffing levels at the home should be kept under review, taking into consideration the aims and objectives of the service to ensure that the assessed needs of people living at Riverside Court are met appropriately. People responsible for the supervision of staff should be provided with suitable training to help them carry out this role effectively. 7 36 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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