Care Home: Seven Rivers Cheshire Home

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What the care home does well People enjoy living at Seven Rivers. People made positive comments about all aspects of the service and these can be read in individual sections of this report. A member of staff who completed a survey told us, "We all care deeply about each other, staff and residents. I think the place is a friendly home and I believe the residents are very happy and most care about us which is nice". Individuals are well supported with their health and personal care needs and their preferences around how these needs are met are respected. There is a competent, stable staff team at Seven Rivers and people living in the home are complimentary about the way staff provide care. People are able to choose how they spend their time and there is a range of activities in place designed to meet people`s wishes and needs. The home encourages and promotes the involvement of family and friends. Relatives told us they are made welcome and are consulted about their relatives care. What has improved since the last inspection? Since the last inspection processes around the storage, administration and recording of medication have improved and the management team carry out audits to monitor how well the system is working and identify any errors. There have been improvements in the system of care planning and individual care records are more person centred. The service has improved how it deals with issues around safeguarding people living in the home. There has been some redecoration and refurbishment throughout the home, including painting of corridors and some rooms. What the care home could do better: The management team should continue with their plans to update care plans so that they focus on people`s strengths as well as identifying their needs. This will ensure individuals are supported to maintain and build on their skills. The service should continue to build on improvements to the environment including finding ways to make communal areas more homely and repairing the damage noted to the walls in the laundry to ensure good infection control. The management team should continue to develop and improve processes around medication. Any errors identified through the audit process should be followed up robustly. Protocols to guide staff around the administration of medication taken on a PRN or `as required` basis should contain sufficient detail to ensure staff are clear about when this medication is required. Key inspection report Care homes for adults (18-65 years) Name: Address: Seven Rivers Cheshire Home Hall Road Great Bromley Colchester Essex CO7 7TR     The quality rating for this care home is:   two star good 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: Ray Finney     Date: 0 5 1 1 2 0 0 9 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 Adults (18-65 years) Page 2 of 32 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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) 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Seven Rivers Cheshire Home Hall Road Great Bromley Colchester Essex CO7 7TR 01206230345 01206231011 deborah.rich@lcdisability.org www.lcdisability.org Leonard Cheshire Disability Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Deborah Rich Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 29 The registered person may provide the following categories of service: Care Home with Nursing - code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability - Code PD Date of last inspection Brief description of the care home Seven Rivers is part of Leonard Cheshire Disability, an international charity provider of services for disabled people. It is a care home registered to provide nursing and personal care to adults and older people who have a physical disability. The home originates as a Georgian style mansion and has a 1960s extension and a further extension built in the 1990s. The main house is a two-storey building with access to the upper floor provided by a passenger lift. Seven Rivers is located in the small rural Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 29 Brief description of the care home village of Great Bromley and stands back from the road in its own pleasant grounds, which includes a lake. The village is geographically central to the larger towns of Colchester and the seaside towns of Clacton on sea and Harwich. However public transport is minimal although a bus route runs past the home, which serves the surrounding villages. The local train station is in a neighbouring village of Gt Bentley approximately three miles away. The main house provides a flat for accommodating visitors for overnight stays and a flat for volunteer overseas students. The home charges between £700 and £1,400 a week for the service they provide, according to peoples assessed needs. Additional costs include hairdressing, chiropodist and personal items such as toiletries. Care Homes for Adults (18-65 years) Page 5 of 32 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection for this service was carried out on 19th November 2007. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment, which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 12th November 2009 and included a tour of the premises, discussions with people living in the home, a visiting health care professional and members of staff. Completed surveys were received from people living in the home, members of staff, relatives and health care professionals. Observations of how members of staff interact and communicate with people living in the home have also Care Homes for Adults (18-65 years) Page 6 of 32 been taken into account. On the day of the inspection we were given every assistance from the manager, the deputy manager and the staff team. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The management team should continue with their plans to update care plans so that they focus on peoples strengths as well as identifying their needs. This will ensure individuals are supported to maintain and build on their skills. The service should continue to build on improvements to the environment including finding ways to make communal areas more homely and repairing the damage noted to the walls in the laundry to ensure good infection control. The management team should continue to develop and improve processes around medication. Any errors identified through the audit process should be followed up robustly. Protocols to guide staff around the administration of medication taken on a PRN or as required basis should contain sufficient detail to ensure staff are clear about when this medication is required. Care Homes for Adults (18-65 years) Page 8 of 32 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 Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choosing to use the service provided by Seven Rivers can be confident they understand what the home provides and that their needs will be met. Evidence: The manager told us in the AQAA, Prospective clients are given information in the Service User guide and Statement of Purpose to help them reach a decision with an informed choice. Where possible they are invited to visit Seven Rivers , with appointment times offered which are as flexible as required, including weekend and evening visiting. Here they can talk to staff and participate in any discussions and, if they wish, join us for a meal. Seven Rivers, as part of the Leonard Cheshire Disability organisation, provides anyone wishing to move in to the home with a copy of the services Statement of Purpose and Service User Guide. The Statement of Purpose sets out Leonard Cheshire Disabilitys core values, aims and objectives, the Principles of the service and the rights of people who live there. The Service User Guide clearly sets out what facilities and services people choosing to move into the home can expect as well as their responsibilities Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: when living in Seven Rivers. People were asked in surveys whether they were consulted about moving into the home and whether they received enough information. Responses were mixed, although the majority of people who completed surveys told us they were asked if they wanted to move into Seven Rivers and said that they did get sufficient information about the service. One person indicated that, as they had been unwell at the time, their relatives had made the decision on their behalf. The manager told us in the AQAA, A pre-assessment is carried out on all prospective clients to ascertain whether their needs can be met at Seven Rivers. A nurse or carer also attends this where possible so that the needs of the individual can also be placed in the context of other residents living at Seven Rivers. Through discussions the management team were able to demonstrate a good awareness of the importance of carrying out a thorough pre-admission assessment process to ensure they can meet the needs of anyone wishing to move in to the home. A sample of four care plans examined contained comprehensive assessments, which identify the persons health care needs, medication, mental health issues and what assistance is required with personal care. The manager explained that they re-assess peoples needs after they have settled in and the process of assessment continues over time as peoples individual needs change. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their needs are met in ways that they want. Evidence: The manager told us in the AQAA, The Individual Service Plans are updated as required and we aim to involve and include the resident in this and they are looking at working more closely with each resident and their significant others in formulating the Individual Service Plans and improve on care planning. We need to be more aware of the personalisation agenda and participative working. The manager told us that they are instigating improvements so that, care planning is more responsive to changing need. On the day of the inspection sample of four care plans was examined. Each care plan identifies the persons need, the aims for the individual and any interventions required. The care manager explained that they are now reviewing these to focus on identifying strengths as well as needs. There was evidence in the care plans examined Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: that they are reviewed monthly to take into account peoples changing needs. A member of staff who completed a survey told us, The care is very individual to each service user and another said, communication between residents and carers is excellent. The manager told us in the AQAA, all residents are encouraged to be in control of their lives and supported in their personal development and The residents have a coffee-making machine in the recreation room which gives them greater independence for making drinks for themselves and their visitors. There are sections in the care plans that identify the persons skills and interests. Each care plan has a personal profile that gives a background to the person, their family or other relationships, previous employment, likes and dislikes. These sections contain sufficient detail to ensure staff are aware of peoples likes, dislikes and choices. On the day of the inspection we observed that staff and volunteers working in the home consult with people and their wishes and choices were respected. As documented elsewhere in this report, the service has a range of methods of ensuring peoples wishes and choices are respected, including regular residents meetings and a quality assurance process that ensures the opinions of people using the service are sought and acted upon. As part of the inspection process we examined a range of risk assessments. Each individual risk assessment identifies the hazard, how frequently it may occur, the likelihood that any harm will be caused by the hazard and the severity of the risk. Each risk assessment then identifies what existing measures are in place, whether these are adequate and whether additional measures are needed. The risk assessments also document the family or carers view. We noted that the information in the documents is recorded using positive language to identify how best the risk can be minimised without restricting what the person can do. This ensures that the culture of the service supports and enables people to make choices about what they do. Risk assessments examined included mobilising, agitated behaviour, personal care, preparing drinks, seizures, going out and use of the Wii computer console. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seven Rivers enjoy a lifestyle that meets their wishes as well as their needs. Evidence: The manager told us in the AQAA, Residents are encouraged to lead independent lives within their capabilities and they are informed of the homes activities so they can participate in all aspects of life at Seven Rivers as they wish. There is an activities room off the dining room. On the day of the inspection people were observed playing word games in the morning and enjoying music in the afternoon. The manager told us in the AQAA, Some are involved in community activities, as well as in-house activities with the help of the staff and volunteer workers. Our volunteers Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: have increased to 8 regular volunteers with 12 available for particular events and Seven Rivers has made fresh efforts to become part of the local village and for the first time in many years we had a stall at the village fete. We hope to start promoting our regular quizzes to our neighbours. Care plans examined contained evidence of the activities people take part in. Individual preferences and interests are identified such as music, word games, film and poetry. Some of the in-house activities that people take part in include using computers, organised games and music. There is a process, the Individual Service Plan (ISP), to identify peoples aspirations around activities. The manager told us what plans for improvement they are exploring. The local colleges of performing arts and music are being contacted to see if thy would like to perform at Seven Rivers as the residents have indicated they would like more entertainment. Horticultural colleges are being contacted for their support and advice on the grounds. When asked what the home does well, a relative told us, provides mental stimulation through quizzes and competitions and having an entertainments officer is the best idea Ive come across. The manager told us in the AQAA, The residents are supported in shopping, going to concerts, taking holidays, sailing trips and Information Technology skills. Two computers and the interactive white board are in use providing access to the world wide web. When asked what the home could do better a member of staff who completed a survey told us, More trips out would be nice and more things for service users to do seven days a week and another said, we could provide more socializing for residents such as outings and maybe more in-house activities. Whilst we recognise that there is always room for improvement and progress, it was evident from our observations on the day of the inspection that people get out and about. One person told us that the home has three vehicles for going out. The manager told us in the AQAA, Visitors are encouraged and welcomed and residents are supported in their relationships with others. Records examined on the day of the inspection confirm that relatives are involved consulted about the service provided. A relative who completed a survey told us, the staff and volunteers are always polite and courteous to me and my family. The manager told us in the AQAA, Residents are consulted daily with their choice of menu by the chef. The chef has already established monthly meetings with the Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: residents, listening to their views and incorporating any changes. At lunchtime, staff were observed asking people what they wanted to eat and people spoken with told us they enjoyed lunch. Those individuals who were being supported to eat were assisted with dignity and staff were interacting well with them. The choices for lunch on the day of the inspection were boiled bacon with onion sauce or cheese lattice rolls, with key lime cheesecake for dessert. The food was freshly cooked and appeared appetising. After lunch the cook was observed to go round asking for peoples choices for the evening meal. One person told us the cook was excellent and they had enjoyed the cheese lattice and a very good cheesecake. Someone living in the home who completed a survey told us,the food sucks but when we spoke to this person on the day of the inspection they said they actually enjoyed the food. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seven Rivers are confident they are supported as they would wish with their personal and healthcare needs. Evidence: The manager told us in the AQAA, A new handover sheet is being utilised, reminding care staff of the residents daily needs and incorporating daily and future planning. A sample of four care plans was examined on the day of the inspection. There is a section at the beginning of the care plans that records what personal support the individual requires. This section includes details about the persons preferences as well as their needs and contains sufficient detail to ensure staff will be able to provide personal care consistently in ways that the person wants. Details included information such as, I prefer a shower to a bath or My favourite clothes are jeans, v-neck tee shirt and trainers. A relative who completed a survey told us the home provides, great pastoral care and encourages holistic care. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: The manager told us in the AQAA, We liaise appropriately with other members of the multi-disciplinary team and they record their visits in the individual service plans. Care plans contain evidence of how people are supported with their health care needs. There are a range of recording charts specific to the individuals needs. These include temperature charts, seizure monitoring records and Waterlow score assessments to identify the risk of someone developing pressure sores. Weight charts document peoples weight on a monthly basis. There is also evidence that people are supported to access health care professionals according to their individual assessed needs. One care plan showed input from Speech and Language Therapy services around swallowing and posture; another had evidence of input from a consultant neurologist. We had a discussion with a visiting health care professional, who was very positive about the service provided at Seven Rivers. They explained that they were confident that peoples health care needs were well met at the home and they have confidence in the abilities of the management team and the staff working in the home. A health care professional who completed a survey told us what the service does well is, Excellent care and nursing skills, high standards achieved and another said, It seems to be a very well run home and we have a great relationship with them. Another health care professional who completed a survey told us, I am part of [named health care team] and we always feel confident that patients resident at Seven Rivers receive an excellent quality of care from a good team of staff. When asked what the home does well, a relative told us, helps [my relative] to do exercises on a regular basis. The manager told us in the AQAA, We have recently undergone a pharmacy audit and are waiting for a full report. However, we have already stared implementing some of their recommendations and expect this to continue. Monthly medication audits are undertaken by the care supervisor to promote better understanding of medication administration. The care supervisor has recently passed her mentoring of student nurses and is also mentoring nurses in their medication delivery. The manager told us that their plans for improvement in this area in the next year includes, The nursing staff are to sign up for level 2 certificate in Safe Handling of Medicines. The manager further told us, The choice and ability to self-medicate needs to be further explored with the residents, though this has already been offered and sometimes refused. On the day of the inspection we examined the homes processes for supporting people with medication, including the storage and recording. There is a dedicated medication Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: room with secure storage for medication, controlled drugs and medication that needs to be stored in a controlled temperature. A new thermometer had been purchased for checking the temperature of the drugs fridge. We had a discussion with the manager about the importance of staff understanding how to use the thermometer and what is the acceptable range of temperature for the medications in the fridge, how to record appropriately and to ensure that there are processes to follow should the temperature reading fall outside the acceptable range. Where someone is prescribed medication on a PRN or as required basis, there is a protocol in place for when the PRN medication should be administered. One of the protocols examined was for the use of rectal diazepam for seizures, which contained clear information for staff to follow. Another person had a chart for recording changes in behaviour and there was a protocol for the use of oral diazepam in the management of this behaviour. The behaviour chart records what may have led up to the behaviour, the sequence of events during which the behaviour was exhibited and the consequence or result of the behaviour. However, the protocol did not specify at what point the PRN medication should be given or describe what behaviours staff should look our for. In this case the PRN protocol would benefit from containing greater detail. Staff spoken with were, however, able to demonstrate a good understanding of individuals behaviours and their needs around medication. The management team carry out a regular audit around medication. The audit of the Medicine Administration Record (MAR) sheets was examined and showed there has been a significant reduction in errors around recording over the past few months. We discussed this with the manager, who recognises the importance of following up any error and putting processes in place to prevent further occurrences. We further discussed ensuring repeated errors are dealt with appropriately including identifying any training needs. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are confident that any concerns they may have are listened to and acted upon. Evidence: The manager told us in the AQAA, Arrangements for dealing with complaints and concerns are in line with Leonard Cheshire Disability policies and we are prompt to act on complaints and concerns, which are taken seriously and Residents have a communication channel through their meetings and the Service User Association, where concerns can be brought to the management meetings and discussed. Seven Rivers has a process in place for dealing with peoples complaints. Through discussions the management team were able to demonstrate that they deal with minor concerns as and when they arise. People spoken with on the day of the inspection said they would know who to go to if they had any complaints. A health care professional who completed a survey told us, I have no concerns and feel if I did that I could discuss them and they would be addressed. A relative who completed a survey told us, I have no complaints. The manager told us in the AQAA, All staff are made aware of Safeguarding Adults and the whistle blowing policy and attend training on the subject. Due to safeguarding incidents we have been proactive in raising awareness and training on Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: acts of omission and neglect. On the day of the inspection we had a discussion around recent safeguarding referrals that have been dealt with under the local authoritys safeguarding processes. It was evident through discussions with the management team that lessons have been learned, they have taken on board the issues and are committed to ensuring improved processes and procedures will be followed to improve outcomes in this area. Personnel records examined confirm that staff have received safeguarding training. A medical professional who completed a survey commented on the event that led to a recent safeguarding issue and cautioned that over-reaction to a simple mistake can be counter productive and effect morale. They further stated the Seven Rivers, Provides a stable and caring environment. Staff are very caring with a good ratio of trained nurses to residents. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in an environment that meets their needs. Evidence: The manager told us in the AQAA, The army have visited us and have been working on redecorating the thoroughfares. The doors to all the rooms are now being painted. This has brightened up the environment considerably. On a tour of the premises we observed that Seven rivers is a large home consisting of a number of different older buildings, which have had added extensions. There are separate areas for activities, training, communal lounges and a large dining area. Peoples bedrooms are personalised with ample evidence of personal possessions such as memorabilia, books, music, ornaments and collectables. Individual rooms varied in the level of tidiness and reflected peoples choice of lifestyle. Some communal areas were somewhat cluttered in appearance, such as the dining room which had games, jigsaw puzzles and books lying about that had not been tidied away. The tables in the dining room were functional for wheelchair users but gave the room a feeling that lacked homeliness, although this was somewhat improved by some modern paintings on the walls. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The manager told us in the AQAA, The maintenance department work very hard to maintain an old building and extensive grounds and The home is clean and tidy and maintained by a committed domestic team. We now have cover from 7am to 5pm and We have recruited a volunteer driver which reduces time taken out by the maintenance staff to drive people to appointments etc, allowing them to spend more time on the grounds and building. We have been able to recruit volunteers who are interested in gardening and they assist in keeping the weeds down. Throughout the home there were no unpleasant odours. Some of the carpets had evidence of stains, on the whole from spilled drinks. Staff explained that the carpet cleaner had been broken but was now repaired and domestic staff had started a programme of carpet cleaning. We observed this happening during the inspection. A member of the domestic team spoken with told us they now have a new improved shift pattern which means the work is being done better. We observed that the laundry room was clean; the flooring and walls were finished with cleanable surfaces and a member of staff working in the laundry explained that they wash the walls regularly. There was one area just inside the door where the wall was damaged and some of the brickwork was exposed. Action needs to be taken to rectify this damage to prevent risks to infection control. Bathrooms and toilets had liquid soap and paper towels available for handwashing. Staff were observed to wear personal protective equipment including gloves and aprons. On the whole we observed that the maintenance person employed at Seven Rivers worked hard to keep on top of maintaining a large building, some of which is very old. There was some damage to doorways and paintwork on lower walls, which is inevitable when taking into consideration the number of wheelchair users in the home. However, this did not have a significantly detrimental effect on the environment. When asked what the home does well, a person living in the home who completed a survey told us, good cleanliness, its always clean and a relative said, clean, calm atmosphere, lovely grounds/environment, encouraged to personalise room. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people living in Seven Rivers can confident that staff support them as they would wish by meeting their needs. Evidence: The manager told us in the AQAA, A new training co-ordinator is in post who has raised and promoted our training awareness. Through discussions, the training co-ordinator was able to demonstrate the services commitment to supporting people to complete National Vocational Qualifications (NVQ). The training co-ordinator explained that currently 63 of care staff have completed the award and the sample of staff files examined contained evidence of NVQ awards.. The manager told us in the AQAA, All potential new staff are invited to visit Seven Rivers so they have an understanding of what we offer and they recognise that what they could do better is that residents to be more involved in all aspects of recruitment, including showing potential new staff around the home. A sample of three personnel records was examined on the day of the inspection. Records are well organised with a checklist on the front showing the contents of the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: file. Records examined contained all the documentation required by regulation including two written references, proofs of identify and enhanced Criminal Record Bureau (CRB) disclosures. Overall the recruitment and selection process at Seven Rivers is robust. The manager told us in the AQAA, The staff are well trained, new staff have a thorough induction programme with Leonard Cheshire Disability, based on Skills for Care Induction training. There are identified staff who mentor new staff to the home. A check list has been formulated to ensure all areas specific to Seven Rivers are brought to their attention. On the day of the inspection we had a discussion with the training co-ordinator about the homes induction process for staff. The first day of the induction is an in-house orientation, which is followed by a two day formal induction course. This covers Leonard Cheshire policies and procedures, awareness of core values, models of care, effective communication, infection control, food hygiene awareness and theory of moving and handling. Staff follow an induction using the Skills for Care common induction standards and then complete an assessment booklet. The Leonard Cheshire also includes completing a learning log as evidence of what the person has learned. The training co-ordinator provided us with the homes training matrix and explained how they ensure staff working in the home receive updated training as and when necessary. The training co-ordinator demonstrated an excellent knowledge of the training needs in the home and explained how they ensure training is relevant and provided promptly. Staff spoken with on the day of the inspection were knowledgeable about their roles and were aware of their responsibilities. Personnel records examined contained evidence that staff have completed a range of both basic training and additional courses relating to peoples individual and health care needs. Training certificates examined include Disability Equality, Working in an Empowering Way, Working with People with Swallowing Difficulties, Protection of Vulnerable Adults (now referred to as safeguarding), Manual Handling Practical Training and Fire Prevention. A health care professional who completed a survey told us the home has, likeable, caring carers who tend to stay for a long time and any training sessions are always well attended and often instigated by staff or managers. A member of staff who completed a survey told us, I have noted they are continually improving their systems of how things are done. I think they are encouraging every Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: member of staff to do better by involving them in the development and updating of documentation. Another staff member said, The home provides good care and good training for the staff. Someone living in the home who completed a survey told us, The care staff are great, kind and understanding and a relative stated, the staff are always friendly and helpful and look after my [relative] very well. Another relative told us, they are very approachable and professional. The staff are always polite and friendly. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Seven Rivers can be confident that the service is managed in their best interests. Evidence: Through discussion, the manager explained that she has now almost finished the Registered Managers Award (RMA) and NVQ level 4 in care. During the course of the inspection we had detailed discussions with the manager and deputy about their specific roles. The management team were able to demonstrate that their skills complement one another to ensure the smooth day to day running of the home. The manager told us in the AQAA, An independent National Service User survey is carried out to ascertain the views of individuals. On the day of the inspection we examined the homes processes around how they assess the quality of the service they are providing. As part of their quality assurance Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: programme surveys are distributed to people living in the home and the responses are analysed. An action plan is then devised to address issues raised. The manager explained that there are a range of regular meetings, which are held to ascertain peoples views and they record what is discussed and what actions are to be taken. There is evidence that the chef has monthly meetings with people in the home; there are also managers meetings with residents, staff meetings, night staff meetings, nurses meetings and carers meetings that are held bi-monthly. A sample of Health and Safety documentation examined on the day of the inspection was all found to be in order. This included maintenance of the Arjo hoists, Fire Alarms, Gas Safety certificate and Fire Extinguishers. We saw evidence that Health and Safety meetings are held approximately every four to six weeks, which are attended by carers, domestic staff, kitchen staff and maintenance staff. Water temperatures are taken before people bathe. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The management team should continue with planned improvements to the care plans to focus on peoples strengths as well as their needs. The management team should continue to improve processes around medication, including development of the audit process to further reduce the occurance of errors and improvements to PRN protocols to ensure clarity of when as required mediction is used. The home should continue to build on improvements to the environment, including ensuring the environment is less cluttered and more homely. The home should continue with improvements to the way the home is maintained, including ensuring the laundry walls are repaired to reduce the risk of infection. 2 20 3 24 4 30 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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. 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. 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