Inspection on 21/06/06 for Riverlee Care Home

This inspection was carried out on 21st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Riverlee Care Home 29/05/08

Riverlee Care Home 03/07/07

Riverlee Care Home 24/10/05

Riverlee Care Home 05/10/04

Riverlee Care Home 20/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Riverlee Care Home Franklin Close Off John Penn St Greenwich London SE13 7QT Lead Inspector Maria Kinson Key Unannounced Inspection 21st June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Riverlee Care Home Address Franklin Close Off John Penn St Greenwich London SE13 7QT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8694 7140 020 8694 7141 rebecca@sanctuary-housing.co.uk Sanctuary Housing Association (trading as Sanctuary Care) Mrs Rebecca Francisco Sowle Care Home 75 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (60) of places Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2005 Brief Description of the Service: Riverlee Care Home is a purpose built home, which is owned and managed by Sanctuary Care. The home was registered in December 2001 to provide care and accommodation for 75 older people. Riverlee Care Home is located in the London Borough of Greenwich and is close to local shops and amenities. Accommodation is provided over three floors. There are four units in the home each providing separate services, having its own staff team, communal space and bathing facilities. On the ground floor ‘Chelmer’ provides personal care for fifteen older people with dementia and on the first floor ‘Yeading-Brooke’ provides nursing care for thirty older people with dementia. ‘Ravensbourne’, on the second floor is divided into two fifteen bedded nursing units. One of which provides care for people with dementia. All of the bedrooms in the home are single occupancy with en-suite facilities. At the rear of the property there are small garden areas with flowerbeds and lawns and there are a limited number of parking spaces in front of the home. The fees charged by the home range from £455- £755 per week. This does not include additional charges such as chiropody, hairdressing, newspapers and outings. This information was provided on 15.06.06. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 21.06.06, between 10:00am–18:00pm and on 23.06.06, between 09:05am –12:20am. Prior to the inspection the service file was examined to assess information that had been obtained and received about the home since the last inspection. On day one of the inspection two inspectors spent the day on Chelmer and Yeading Brook two talking with residents, staff and visitors and observing care practices. Two sets of care and medication records were examined on each of these units. All of the communal areas and a selection of bedrooms were viewed on all of the four units in the home. On day two of the inspection one inspector examined health and safety, quality assurance and staff records. Comment cards requesting feedback about the service were sent to a random selection of residents, relatives and health care professionals. Twenty- five cards were returned to the commission, one from a resident, three from health care professionals and twenty- one from relatives. An immediate requirement was issued during the inspection in respect of a damaged fire door. The Registered Person was required to replace or repair the door within one month of the date of the inspection. The Commission have received confirmation that the fire door was replaced. One additional visit had taken place since the last key inspection to monitor compliance with requirements and recommendations. The report from this visit can be obtained from the local CSCI office on request. What the service does well: The arrangements for admitting new residents into the home were satisfactory. The home received regular support from a local GP and other professionals to meet resident’s health care needs. Most of the relatives that provided feedback about the service were satisfied with the visiting arrangements, communication, staffing and the care provided in the home. Residents told the inspectors about their experiences in the home and about the support and assistance they received from staff. Residents said they found their rooms comfortable, were pleased with the choice and quality of food and “everyone treats you well”. Staff on Chelmer and Yeading Brooke Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 6 two interacted with residents in a caring and professional manner and intervened promptly when residents became angry or agitated. Good records were maintained about complaints. There was evidence that all of the complaints logged had or were being investigated. The outcome of the investigation was recorded and any action that the manager had taken to address concerns. Staff indicated that they would report allegations of abuse or concerns to senior staff. What has improved since the last inspection? What they could do better: Some new documentation had been introduced such as wound care assessment and bedrail risk assessment forms. Staff did not always use these tools appropriately. Care plans outlined the action that staff were taking to meet residents health and personal needs but did not always include residents social needs. Care plans often indicated that residents had similar care needs and provided little information about personal preferences or preferred routines. Staff had attempted to involve relatives in care planning but relatives appeared reluctant to use visiting times to agree and discuss care Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 7 plans. Staff should consider other ways of obtaining feedback from relatives about care plans such as the communication book, which was already in use. The management of medication was mostly good but it was not always clear on the records if residents had received their prescribed medication. The home provides a regular programme of activities. Many of the residents on the nursing floor require one to one support. The current allocation of activities hours does not allow for this. Care staff must receive training about providing activities for residents with dementia if they are expected to facilitate activities. The provision of vocational and health and safety training for staff was good. The training programme did not appear to take into account issues identified during quality assurance work and complaints investigations. Although complaints were managed effectively some relatives were not familiar with the homes procedure. The complaints procedure was dated 2003. This policy should be reviewed and updated if necessary. Good recruitment procedures were followed but some staff were allowed to commence work in the home prior to receipt of adequate information. Ventilation in the bathroom was inadequate. This limited resident choice and made working conditions uncomfortable for staff. The building and grounds were maintained to a satisfactory standard but some redecoration work was required. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (Standard 6 does not apply to this home). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for admitting new residents into the home were satisfactory. EVIDENCE: Records showed that staff obtained information about residents needs before they were admitted to the home. Multidisciplinary assessments and documents from sponsoring authorities were kept on resident’s files. Staff carried out a separate assessment unless the resident was an emergency admission. After the assessment visit, staff wrote to the prospective resident to confirm if the home was suitable for meeting their needs. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the care plans viewed did not fully reflect how assessed needs would be met. The management of medication was mostly good but action must be taken to improve records of administration. Staff maintained resident’s privacy and dignity. EVIDENCE: Two sets of care records were examined on Chelmer, Ravensbourne and Yeading- Brooke two. All of the files seen included a full assessment of need, a variety of risk assessments relevant to the care of older people and a care plan. The care plans seen outlined how resident’s personal and health care needs were to be met but included little information about resident’s preferences. Some of the plans on the nursing units did not state how resident’s social needs would be met. See requirement 1 and recommendation 1. One of the care plans viewed on Yeading –Brooke included information about the size, location and treatment of pressure sores. Staff completed a wound assessment record but this was difficult to interpret, Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 11 as separate records were not maintained for each sore. Advice had been obtained from the Tissue Viability Nurse. (See comments under standard 33 about pressure sores audits). Staff reviewed care plans regularly but there was little evidence on the nursing units that the resident or their relatives had contributed to this process. The manager had attempted to address this issue by writing to relatives to invite them to view and discuss care plans. Staff should continue to explore alternative ways of involving relatives in the care planning process. Staff on each shift completed daily records for each resident. This included information about changes in the resident’s health or wellbeing and significant events. Access to community health care services was satisfactory. Records indicated that some residents had seen a GP, Optician, District Nurse, Psycho geriatrician, Dentist and other health care professionals in recent months. Appointments were recorded in the diary and outcomes noted in daily care notes. Feedback from three professionals that were in regular contact with the home was good. All of the respondents indicated that staff communicated effectively, had a good understanding of resident’s needs and were satisfied with the overall care provided in the home. Some concerns had been identified by senior staff about the management of emergency situations and first aid treatment. These matters were dealt with appropriately and additional training was provided for staff members where necessary. The management of medication was assessed on two units, Chelmer and Yeading Brooke two. Medication was mostly well managed. Clinical rooms and drug refrigerators were maintained at a suitable temperature and all of the medication seen was stored appropriately. Records of receipt and disposal of medicines was good. Administration of medication was mostly good but a few gaps were noted on some charts. See requirement 2 and comments under standard 33 re medication audits. Hand transcribed entries on medication charts were countersigned and staff had recorded the date they opened medication with a limited shelf life such as eye drops. The home had developed a new procedure for the disposal of medication. The qualified nurses or senior carers on the residential unit were responsible for holding the keys for the medication room and trolleys. The home had a homely remedy procedure, which was agreed and signed by the GP. The senior carer on the residential unit was advised to obtain a more up to date copy of the British National Formulary. Observation of staff going about their duties showed that residents were treated with dignity and respect. Discussions with residents and relatives on Chelmer and Yeading Brooke two indicated that staff members treated residents with respect and were kind and helpful. Residents on Ravensbourne Unit were less able to articulate their views but gave no indication of any inappropriate behaviour from staff. All residents seen were appropriately dressed for the warm weather and looked well cared for. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provision of activities was satisfactory on the residential unit. Staff on the nursing units did not always identify or meet resident’s social needs. Residents were able to maintain contact with their friends and family and choose how and where they spent their time. The choice and quality of food provided in the home was satisfactory. EVIDENCE: The provision of activities in the home was variable. The Activities Coordinator was employed on a full time basis and the administrator provides some additional support. Some of the files viewed included a life history, social assessment, care plan and activity profile. On the nursing units some social care plans lacked detail or could not be located. See requirement 1. One resident on the nursing unit indicated that staff selected the television channel and access to the garden was dependent on staff availability. Two relatives expressed concerns about the provision of activities stating “It would be good if there was more entertainment” and “residents look bored”. There was no evidence of any activities taking place on either of the nursing units during the inspection. Residents spoken with on Chelmer Unit stated that Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 13 there were no restrictions imposed by staff members and that individual care workers encouraged them to join in activities if they wished to do so. Care staff provided assistance to participate where necessary. On the morning of the inspection half the residents on this unit were involved in an art project and there was a dancing session during later in the day. Facilities exist within the home for religious participation and any special needs in relation to culture or special diets can be catered for, this was confirmed by staff. Up to date information was displayed about the activities provided. It was noted that a number of residents from Chelmer had been involved in a trip to the reminiscence centre in Blackheath the previous day. The home does not have its own transport and is therefore dependent on the use of taxis to facilitate outings. In view of the needs of residents and the size of the home it is recommended that extra support is provided to meet residents social needs. The manager should ensure that care and activity staff receive specialist training. This should enable all staff to provide suitable occupation and stimulation for residents with dementia or other communication difficulties. See requirement 4 and recommendation 2. The commission received written feedback from twenty- one relatives and two relatives were spoken with on the day of the inspection. The majority of relatives said they were made welcome when they visited the home, were consulted and kept informed about important matters and were satisfied with the overall care provided in the home. Some relatives did include personal comments about their experiences and observations. The comments received were variable with some relatives praising staff and others expressing concerns about activities, communication and supervision. Some of the comments made by relatives are included in this report. Communication books were used to advise relatives about non- urgent issues such as the need for toiletries or new clothing. Residents that the inspectors spoke with indicated that they were able to make personal choices regarding what they ate, what they wore and where they spent their time on the unit. Records seen indicated that some residents had refused to take part in activities and had declined assistance with personal hygiene. Several residents’ rooms included personal possessions and small items of furniture. Residents were encouraged to manage their own money although in practice most were assisted by their family or an appointee. Residents specified what they wanted to eat from a varied menu and snacks and drinks were available on each unit. Some of the residents on the residential unit were supported to make their own drinks. Lunch was observed on two units, Chelmer and Yeading Brooke two. Dining tables were laid in preparation for the meal and small groups of residents with Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 14 similar interests were seated together to promote social interaction. Staff supported residents that required assistance or encouragement to eat. Lunch consisted of sausage, bacon, egg, tomatoes and potato croquettes. The manager told the inspectors that residents were consulted about the menu and had wanted to retain the ‘all day brunch’ option. Most of the residents spoken with commented that the food was generally good. One resident who explained that she had formerly been a cook herself was less enthusiastic but said the food provided was “ok”. Staff were monitoring the amount of food and fluid that one of the residents consumed each day. The records seen indicated that the resident was assisted to eat and drink at regular intervals. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns were investigated promptly. Action should be taken to ensure that relatives are aware of the procedure to follow if they have a complaint. EVIDENCE: The home had a policy and procedure in relation to complaints management, which included a timescale for acknowledging and responding to complaints. The policy was dated 2003. Seven out of the twenty- one relatives that sent written feedback to the commission were not aware of the homes complaints procedure. Records were maintained about complaints and findings from investigations. Since the last inspection the home had received four complaints. It was apparent from the records that all of the complaints were investigated and the outcome recorded. All of the complaints received in the home related to the care of residents on one unit and included concerns about staff communication. See requirement 4 and 5 and recommendation 3. The home had an adult protection procedure and staff that the inspectors spoke with were aware of the need to report allegations of abuse or misconduct to senior staff. Staff understood some of the reasons why residents may present challenging behaviour and were observed intervening in disputes between residents. Abuse training was provided for staff in 2004. Staff should receive an update, as there have been a number of changes, Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 16 including the introduction of the protection of vulnerable adults list since this time. See requirement 4. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It was evident that some redecoration and repairs were required but this issue did not pose a significant risk to resident’s health or safety. The ventilation in the bath and shower rooms was inadequate. EVIDENCE: The inspectors visited all of the communal areas in the home, excluding the laundry and main kitchen. A selection of bedrooms were viewed on each floor. All parts of the home were clean, tidy and odour free. Bedrooms were suitably furnished and spacious. Some of the bedrooms included items such as family photographs and personal belongings from resident’s own homes. This made the rooms look more homely and welcoming. The standard of décor was mostly satisfactory but some of the paintwork was scuffed, some bedroom walls were damaged and some of the tiles in the bath and shower rooms were damaged. Since the last inspection the registered company had carried out an Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 18 environmental audit and estimates had been obtained to carry out a redecoration programme. It was unclear when this work would commence or what had been agreed, other than redecorating the reception area. The Registered Person should provide the commission with a copy of the programme. Ventilation in the bath and shower rooms was unsatisfactory. Staff avoided using some bathrooms as the build up of steam and heat in some of the rooms was uncomfortable. The Registered Person had notified the commission about the action they were taking to address this issue. Quotes had been obtained to install a new ventilation system but this work would cause significant disruption and was very costly. Other options were being explored. See requirement 3. Shower rooms were identified as being a problem for staff as they were completely open areas and staff said that they got very wet when they assisted residents. The manager said that plans were in place to install shower cubicles. Staff had access to protective clothing and hand washing facilities. Clinical waste was stored appropriately. The kitchen was deep cleaned in August 2005. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number and skill mix of staff provided on each of the units was satisfactory. Recruitment practices were mostly good but some staff were employed prior to the home receiving adequate documentation. This could compromise resident’s safety. Access to training was good but further training was required to improve staff communication skills. EVIDENCE: The staff team comprised of a full time manager, deputy manager, registered nurses, care assistants, domestic and ancillary staff. All of the units visited on the day of inspection had an adequate number and mix of staff. A random check of the duty rosters requested was undertaken. These documents provided evidence that the staffing levels agreed with the commission were adhered to. The inspector was advised that forty- two percent of care staff had attained a vocational qualification in care at level 2 or above. The home was working toward meeting the standard set by the Department of Health for 50 of care staff to achieve this qualification. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 20 Four staff recruitment files were viewed. The files viewed contained all of the documents and information required by legislation. However some records indicated that staff were employed to work in the home prior to a criminal record bureau disclosure or POVA first check being obtained. See requirement 4. Thirteen staff had left since the last inspection. Despite the significant turnover of staff most of the vacant posts had been filled. The home had not used any agency staff in the eight weeks prior to this inspection. Staff were satisfied with the standard of training and support they received in the home. A weekly training session was held in the home and the manager was able to arrange external training sessions for staff where necessary. A training programme had been developed and individual training records were maintained for each member of staff. Records indicated that some staff had attended moving and handling, health and safety, food hygiene, first aid, fire safety, dementia care, medication, foot care and care planning training during the past six months. A training plan had been developed for 2006 but staff training needs identified during audits and investigation of complaints were not incorporated into the plan. See recommendation 4. The comments received from relatives about staff were mixed. A number of relatives commented that staff were helpful and approachable, stating “I am confident my relative is well looked after”, “staff are friendly and informative and greet everyone with a smile”, “staff are lovely, we see them helping residents and they sometimes give residents special one to one attention”. Other relatives said that communication between staff and residents was poor “it would be lovely if when staff approached residents with dementia they actually spoke to them and told them what was happening”, “very few staff speak to residents”, five relatives expressed concerns about staffing levels. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was well organised. Further work must be undertaken to ensure that staff use information obtained during quality assurance audits to improve care practices. The arrangements for safeguarding resident’s money were satisfactory. Good systems were in place to monitor health and safety issues. EVIDENCE: The manager was assessed by the commission as a ‘fit’ and suitable person to manage a care home for older people. The manager had completed training relevant to this post. The home had systems in place for monitoring the quality of care provided in the home. Unannounced visits to the home were taking place regularly and Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 22 the nominated person had undertaken a comprehensive audit in January 2006. Care plan, accident, pressure sore and medication audits had been undertaken in recent months. Some of the audits included an action plan but some did not state what if any, action had been taken to address the findings. This included the development of pressure sores and a higher incidence of accidents and complaints relating to one of the units in the home. See requirement 5. A resident satisfaction survey had been undertaken. The results indicated that most residents were satisfied with the food, accommodation, activities, complaints, cleanliness and care. As many of the residents have some degree of cognitive impairment the home should also seek relatives and other professionals views. The home arranged regular meetings for residents and relatives. The minutes of the last meeting included comments about activities and food. A speaker from The Parkinson’s Disease Society gave a presentation at the meeting. A maintenance technician was employed. His role included carrying out routine health and safety checks and repairs identified by staff. A random sample of in house and external health and safety checks were examined. All of the records seen were satisfactory. One of the fire doors on the first floor of the home was damaged. This issue was discussed with a local fire officer. An immediate requirement was issued to the home to replace or repair the door within one month. The commission received confirmation in writing that this issue had been addressed. The Registered Person should consider implementing regular checks to ensure that windows are secure. See recommendation 5. Accident records were retained on individual resident files and those seen in relation to two residents on each unit had been appropriately recorded and dealt with. The Deputy Manager reviewed all accident records to see if accidents were preventable or whether anything could be done to reduce the risk of further accidents or injuries. The system for dealing with resident’s personal money was examined. Two signatures were recorded for both credits and debits. Money and corresponding receipts were retained in individual plastic zip and were stored securely. The balances for the records checked tallied with the ledger and a watch deposited for safekeeping, for one resident, was also documented. The administrator undertook audits and the Regional Manager undertook spot checks at any time. The system used provided adequate protection for residents. All of the files viewed included a risk assessment relating to the use of bedrails where necessary. It was not always clear if staff understood the assessment as some parts of the form were incomplete and where staff had identified risks such as the need for extra height bedrails no action was taken. The form stated that the assessment should be reviewed at monthly intervals. There was no evidence that this was taking place. The maintenance employee Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 23 carried out regular checks to ensure that bedrails were fitted correctly and in working order. See recommendation 4. Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 16 Requirement The Registered Person must ensure individual care plans are prepared to show how residents social needs will be met. The previous timescale of 17/04/06 was not met. The Registered Person must ensure that residents receive their prescribed medication. The Registered Person must ensure the premises are kept in a good state of repair. The ventilation systems in the bath and shower rooms must be serviced and kept in working order. The Commission must receive written reports and confirmation to show when this work is completed. The previous timescales of 28/11/05 and 03/04/06 were not met. The Registered Person must ensure that new staff do not commence work in the care home until all of the information and documents listed in Schedule 2 have been obtained. The Registered Person must DS0000006768.V294789.R01.S.doc Timescale for action 22/09/06 2. 3. OP9 OP21 13 23 15/09/06 10/11/06 4. OP29 19 15/09/06 5. OP33 24 15/09/06 Page 26 Riverlee Care Home Version 5.1 ensure that: • Staff develop an action plan in respect of issues identified during quality assurance work • Quality assurance systems include consultation with residents representatives RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP12 OP16 Good Practice Recommendations The Registered Person should ensure that care plans include information about resident’s individual needs and preferences. The Registered Person should increase the allocation of activity hours. The Registered Person should: • Develop an action plan to reduce the incidence of complaints on Ravensbourne • Ensure that relatives receive information about the procedure to follow when making a complaint • Review and update the homes complaints procedure The Registered Person should ensure that relevant staff receive the following training: • The safe use and management of bedrails • Customer care and communication skills • Activities training • Person centred care planning Protection of vulnerable adults update The Registered Person should consider implementing regular checks to ensure that window restrictors are fitted correctly and in working order. 4. OP30 5. OP38 Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverlee Care Home DS0000006768.V294789.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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