Inspection on 29/05/08 for Riverlee Care Home

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Riverlee Care Home 03/07/07

Riverlee Care Home 21/06/06

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 28/09/2008.

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 29th May 2008 09:30 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.V364711.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V364711.R01.S.doc Version 5.2 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 rebeccas@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.V364711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home 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: Old age, not falling within any other category - Code OP (maximum number of places: 60) 2. Dementia – Code DE (maximum number of places: 15) The maximum number of service users who can be accommodated is: 75 3rd July 2007 Date of last inspection 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. The home is located in the London Borough of Greenwich and is within walking distance of local shops and bus routes. Accommodation is provided over three floors. There are five 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. On the first floor there are two fifteen bedded units ‘Yeading-Brooke’ 1 and 2 which provide nursing care for older people with dementia. On the second floor there are two fifteen bedded units, ‘Ravensbourne’ 1 provides nursing care for older people with dementia and ‘Ravensbourne’ 2 provides nursing care for older people. 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 £595- £840 per week. This does not include additional charges such as chiropody, hairdressing, newspapers and Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 5 outings. This information was provided to the commission on 29.05.08. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and was carried out by two inspectors. We spent two days in the home and visited four units (Chelmer, Yeading Brook 1 and 2 and Ravensbourne 1). In preparation for the inspection we read all of the information that we had received about the service since the last inspection such as concerns and complaints, comment cards, notifications and the Annual Quality Assurance Assessment (AQAA) form. We used this information to plan how we would carry out the inspection and what issues we would look at. During the inspection we spoke with six residents, five relatives, one health care professional and nine members of staff. We observed staff communicating with residents and visitors, supporting people to eat and drink and take their medicines. All of the communal areas and two bedrooms were viewed on each of the four units that we visited. What the service does well: People were supplied with written information about the service and could visit the home to view the facilities and ask questions. Staff visited people that wanted to move into the home to see what help they required and if they had any special needs. This information was used to develop a plan of care for the person. Most relatives were satisfied with the care and support that their family member received in the home. Residents had access to community health care services. Health problems were monitored and advice was obtained from other professionals if necessary. Health care professionals told us that the people that worked in the home were usually very knowledgeable. Residents were appropriately dressed and looked relaxed. They told us that staff maintained their privacy and were polite and helpful. People could choose where and how they spent their time and staff encouraged people to make decisions for themselves where possible. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 7 Family and friends could visit at anytime and were able to take an active part in their relatives care if they wished. The food that was served on the day of the inspection looked appetising and people told us, “there was always plenty to eat”. Staff received regular training updates and told us that senior staff were supportive and helpful. The acting manager was respected and trusted by staff. What has improved since the last inspection? What they could do better: Staff did not keep adequate records about medicines that were used in the home. People were at risk of receiving medicines that were discontinued and two people did not receive some of their medicines. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 8 Although staff were aware that allegations of abuse must be reported to senior staff some staff did not have a good understanding of the homes whistle blowing procedure. The range and frequency of activities had declined in recent weeks due to staff absence. Although recruitment practices had improved one reference was not checked to ensure that it was genuine. The home had experienced some difficulties in recent weeks covering staff absence and sickness. Although the acting manager was recruiting new staff an effective contingency plan must be developed to minimise the risk of this happening again. Some of the hot water that was supplied to areas that residents could access was too hot. Most of the people that lived in the home would not recognise if water was too hot and could be injured if hot water temperatures are not properly controlled. Fire drills were taking place regularly, but they did not involve the night staff. The acting manager has been managing the service for a significant period of time but has not applied to become the registered manager of the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 9 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.V364711.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. (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. Staff carried out a care needs assessment before confirming if the home could meet people’s needs. EVIDENCE: The registration certificate was displayed in the reception area. A number of people told us that they were too unwell to visit the home before they moved in but said they received information about the service from relatives that had visited the home or from hospital staff. One of the relatives that we spoke with told us that they visited the home and received a copy of the homes information booklet, which they found very helpful. Staff visited people that indicated that they might want to move into the home to find out what support they required and if they had any special needs. The Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 11 information that was obtained during this visit was recorded and shared with staff. We viewed five pre admission assessments. Some were for people that had only recently moved into the home and some were for people that had lived in the home for several years. The assessment provided comprehensive information about the persons physical, mental and social care needs. Other professionals such as care managers and psychiatrists often provided additional information for staff by sending copies of letters and assessments. Following the assessment staff wrote to the resident or their representative to confirm if the home was able to meet their needs. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 12 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. 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. Care plans showed the action that staff were taking to monitor and care for people with ongoing health care needs. People said staff treated them with respect and maintained their privacy and dignity. Staff did not always follow good practice guidelines for the safe administration of medicines. This could compromise people’s health and safety. EVIDENCE: The home was about to introduce new documentation. Staff had received training and a realistic timescale had been set for staff to transfer all of the existing information onto the new system. We examined the care records for three people that had recently moved into the home and three people that had lived in the home for several years. The files included relevant assessments, risk assessments and a care plan. Care plans were well written overall and provided suitable information for the staff Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 13 that were supporting the person. For example one of the plans that we looked at indicated that the resident’s behaviour was a potential fire risk. A detailed plan was developed to ensure that staff knew what they should do to monitor this issue and to maintain peoples safety. The strategy, drawn up with the resident, included regular reminders to keep cigarettes and lighters in a safe place, to only use designated smoking areas and an agreement to remove the persons cigarettes if they did not cooperate with this advice. Staff were advised to praise the resident when the plan was followed to reinforce compliance with the agreement. The daily care notes showed that that staff followed the plan and checked that it was still effective. Plans included guidance for staff about maintaining people’s privacy and dignity during toileting and bathing and prompts to remind staff to encourage residents to make choices about how and where they spent their time and what they wore. Plans that were developed to address people’s hygiene needs were more detailed and included information about personal preferences and routines. We noted at the last inspection that staff had obtained information about peoples life history and interests and were starting to develop care plans to meet peoples social needs. Further progress was noted with this aspect of care. All of the files that we looked at had a social care plan that was based on the person’s individual hobbies and past interests. Most of the care plans that we saw were agreed to and signed by the resident or a relative. We received written feedback about the service, from five health care professionals that visit the service and we spoke with one health care professional during the inspection. They told us that staff usually had the right skills and experience to meet people’s needs and “kept abreast of current health care issues”. Relatives said that staff were usually able to meet their relative’s needs and usually informed them about significant issues such as accidents and hospital visits. The GP visited regularly and people were referred to other professionals if necessary. Some of the residents had seen a Physiotherapist, Dentist, Psychiatrist and Continuing Care Nurse in recent weeks. One resident had some weight loss that was thought by staff members to be depression related. An appropriate referral had been made to an Old Age Psychiatrist and following this intervention the persons appetite improved. A Community Care manager had visited to investigate a request made by one resident to return to his country of birth. Whilst this did not prove to be viable, Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 14 the documentation kept in the residents file clearly identified the reasons why this was not possible and showed that good efforts were made by staff to address the issue and to find an advocate to act independently for the resident. Clear and up to date notes were kept about the treatment that was provided for one resident with leg ulcers. The records included a body map, wound assessment chart and care plan. We were told by a health care professional that was visiting the home on the day of inspection, that she was very satisfied with the care and professionalism shown by the staff that were treating the wounds. Medicines were assessed on two of the nursing units. Six medicine charts were examined in total. Records of receipt of medicines were good. Records were kept about medicines that were given to residents but it was not always clear how many tablets people were given when a variable dose (one to two tablets) were prescribed and changes were not always signed and dated. Four residents had not received some of the medicines that were listed on their medication charts. Staff told us that these medicines were discontinued but were still printed on the medication charts that were supplied by the homes pharmacist. Staff must cross these items off when the new chart arrives and sign and date their entry. This issue must be addressed with the pharmacist. See requirement 1. One medicine was marked as out of stock for seven days and one resident did not receive one of their medicines for three days, as there were no instructions about how much staff should give. Staff contacted the GP to clarify this issue but said they did not receive a response. See requirement 2. The home kept a small supply of ‘homely remedy’ medicines such as paracetemol. There were two systems in place for recording the receipt and use of these medicines on one unit. The stock levels of some homely remedy medicines did not correspond with the records. Some of the medicines that were used as homely remedies were for a named resident. See requirement 3. Failure to ensure that medicines are properly managed could result in enforcement action. One person was receiving their medicines covertly. A risk assessment showed why this was necessary and the arrangements were discussed and agreed with the resident’s relative. Staff were advised that this decision should be made in conjunction with other professionals such as the GP, CPN or psychiatrist. Medicines that required special storage arrangements were kept in a secure cupboard and were checked and administered by two members of staff. One Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 15 of the controlled drug medicine cupboards was used to store resident’s personal property such as jewellery. See recommendation 1. The medication room and medication refrigerator temperature was monitored. Some of the temperatures recorded were above the recommended level but discussions with staff and examination of the records indicated that this issue was resolved. The medicine rooms were shared by the staff from two units and were quite congested. It was difficult to gain access to some of the cupboards. Staff should see if any items could be stored elsewhere. See recommendation 2. Medication audits were taking place but they did not state what aspects of medicine management should be assessed. This could result in staff assessing different issues and could make it difficult to identify trends and compare the results. A standard tool should be developed which includes the issues that we identified during this inspection. See recommendation 3. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of activities had declined in recent weeks but should improve once the activities coordinator returns to work. Relatives said they were able to visit at anytime and could spend as long as they liked with their family member. The menu was varied and people said they liked the food that was prepared in the home. EVIDENCE: The activities coordinator had been absent for a period and the part time activities assistant had decided to give up the activities side of her post. As a result of these combined events, people told us that there had not been as many activities as there usually were. The manager said the activity coordinator was planning to return to work soon. Records were kept about activities that were carried out by care staff and the activity co-ordinator. Records showed that some people attended mass, spent time with their visitors and watched television in recent weeks. There was also some evidence that staff had spent ‘one to one’ time with some residents but it Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 17 was not always clear what they did during these sessions or if residents enjoyed it. Some of the records that we examined indicated that it was often the same residents that took part in activity sessions. This issue was also raised by a staff member who commented that, “some clients get more attention with activities than others”. It was not clear in the records if this was because other people did not want to join in. See recommendation 4. In the period since the last inspection a large TV screen was purchased for the ground floor activities room. This facility was used to create a cinema type environment with ice creams and sweets for people to enjoy during the film. Residents and staff members reported that this was a popular activity and plans were in place to extend the choice of films available and to show some home made videos that featured residents and their families. Relatives said they could visit their family members at anytime and could spend as long as they liked in the home. There were regular meetings for relatives and residents and the minutes showed that people were advised about new developments, could raise concerns and suggest improvements. People were encouraged to choose what they ate and wore but a number of people found it difficult to make more complex decisions without support from relatives and staff. Relatives said that staff talked to them about their family member’s care needs and contacted them if they had any concerns or required support. One person told us that staff look after their relatives welfare and health but still try to let her have her own little bit of independence. Lunch was observed on two units. People were able to choose what they wanted to eat from the menu and could request alternatives if they did not like any of the listed options. One person refused to eat their lunch but agreed to have a banana sandwich. The meal looked appetising and residents told us that it tasted good. One relative said the soup tasted homemade and was always very good. This person said the chef often visited the unit during the lunch period to see if residents enjoyed their meal and to get feedback about the menu. People were encouraged to eat and assistance was provided for people that had difficulty eating independently. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 18 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. 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. People knew who to speak to if they wanted to make a complaint and felt they were listened to. The home worked in partnership with other agencies to ensure that allegations of abuse were investigated and vulnerable people were protected. EVIDENCE: The complaints procedure was displayed in the main reception area. 80 of relatives knew how to make a complaint and said staff usually responded appropriately when they raised concerns. Complaints were recorded in a file. The file had been reorganised since the last inspection, old complaints were removed and archived and information was now easier to follow. There was a summary sheet at the start of the folder so that the acting manager had an overview of complaints and could see if there were any reoccurring trends. The home was receiving less concerns and complaints than it used to. The home had received four complaints in the past twelve months compared with eight complaints in the same period last year. The records showed that complaints were investigated and a formal response was sent to the complainant within 28 days. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 19 We spoke to staff about the homes procedure for safeguarding residents. Staff were aware that they must report concerns or allegations to senior staff and said they would document what they were told or observed. There were variable levels of understanding about abuse and whistleblowing amongst staff but some of the staff that we spoke with had not attended abuse awareness training. See recommendation 5. The acting manager notified The Commission for Social Care Inspection (CSCI) about significant events that occurred in the home such as serious accidents, and deaths and reported safeguarding issues to the local authority. Three concerns were investigated under local authority safeguarding procedures in the period since the last inspection. Although none of the concerns raised were substantiated the acting manager did identify staff training needs and areas for improvement whilst carrying out investigations. The records showed that staff acted quickly to protect the interests of a resident whose finances were being abused by a relative. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable and welcoming. The new features in the garden provide additional interest and stimulation for residents. EVIDENCE: There was a full time maintenance person. The maintenance person was responsible for undertaking repairs, carrying out health and safety checks and ensuring that the garden and grounds were safe and tidy. The building was well maintained overall but some of the paintwork was chipped around the lower door frames and there were some outstanding issues that need to be addressed. The lock was not working in the shower room on Ravensbourne 1 and the flooring in some of the en suite rooms was lifting at the edges. The acting manager agreed to pass these issues onto the maintenance person to address. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 21 On Yeading Brooke 2 there was a musty smell in the shower room and the bathroom was cluttered with mobility aids. Both rooms looked rather clinical in appearance. Some of the kitchen surfaces and cupboard door handles were chipped or broken. See recommendation 6. All areas were clean and tidy and residents said the home was always fresh and clean. A significant amount of work had been undertaken in the garden to provide more stimulation and interest for residents. Some additional seating had been provided in the shaded parts of the garden, a water feature with fish was installed and some raised flower beds were built for residents to use. Work had been undertaken to improve the ventilation in the bathrooms. This made bathing more comfortable for residents and the people that were supporting them. Residents were able to bring some of their own furniture and belongings into the home if they wanted and could arrange their belongings to suit their needs. Most of the bedrooms that we visited were homely and welcoming. A local environmental health officer inspected the main kitchen in March 2008. Some recommendations were made but the report indicated that the kitchen was satisfactory overall. The refrigerator on Yeading Brooke 2 was not maintained at a suitable temperature for the storage of chilled foods. See recommendation 7. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 22 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. 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 home had experienced some difficulties sustaining adequate staffing levels during periods of staff sickness and absence. Recruitment practices had improved. This protects the people that use the service. Staff were supported to develop new skills and to keep up to date with current practice. EVIDENCE: It was evident during discussions with staff and relatives that there had been difficulties maintaining adequate staffing levels in recent weeks. Two relatives told us that staff were always very busy and that often people had to wait a considerable amount of time for help to use the toilet. One resident on Yeading Brooke asked for the toilet several times and was reassured that help was coming. This resident had to wait an unreasonable period of time for assistance and possibly only received help because we reminded staff that they were still waiting for the toilet. On the day of the inspection this unit had four instead of five care staff due to staff absence. There were three empty beds on the unit. One member of staff was administering medicines and trying to monitor residents in the lounge whilst the two other members of staff were supporting residents with personal care. All of the staff that we spoke with raised concerns about staffing. Staff told us Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 23 “we are often short of staff” and said they were often moved to Ravensbourne to help out, leaving their own unit short staffed. One staff member said it was very “hard” to cope when staff were sick and sometimes there are only “four staff for thirty residents”. Staff told us that senior staff did try to cover staff sickness by contacting staff that were off duty and temporary (bank) staff but said agency staff were never used. The list of bank staff was accessible but staff told us that a significant number of the staff on the list were students and could only work at specific times and for a limited number of hours each week. The acting manager acknowledged that there had been some difficulties with staffing, in recent weeks. See requirement 4. 42 of the care staff that worked in the home had a National Vocational Qualification in Care (NVQ). The number of care staff with a recognised care qualification had increased and it was evident that the home was working towards meeting this standard. A number of people that we spoke with or received written comments from said the home had some very good staff. We were told that “senior staff are excellent”, “some of the staff are fantastic”, “the staff are always cheerful, helpful and patient with everyone”. The recruitment records for the three most recently appointed members of staff were examined. The files were well organised and met the requirements of this standard with the exception that one reference was not checked to ensure that it was genuine. See requirement 5. The manager and senior staff were responsible for organising and facilitating training sessions for staff. Senior staff attended a course for trainers and completed an assessment prior to taking on this role. Staff could also attend external training sessions. Six members of staff completed a comment card about the home and we spoke with nine members of staff during the inspection. Staff said the training provided in the home was good. They told us that they had access to suitable equipment and felt supported by senior staff. New staff attended induction training. The induction-training course covers all of the common induction standards and includes a written assessment to check that staff have understood what they learnt. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager has provided good continuity of care for residents and staff during the manager’s absence. There were systems in place to monitor and improve the quality of care provided in the home and to safeguard people’s money. Health and safety issues were usually well managed but some concerns were identified about the arrangements for controlling hot water temperatures. EVIDENCE: An acting manager was responsible for managing the service during the Registered Manager’s planned absence. The acting manager is a registered mental health nurse, a NVQ assessor and has a teaching diploma. The acting Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 25 manager had expressed an interest in undertaking the registered managers award and was hoping to start this course in 2008. The commission were notified about the manager’s absence but were not aware that the manager would be away from the home for nine months. As the manager has now been managing the home for over 6 months he should apply for registration. See recommendation 8. The home had systems in place for monitoring the quality of care and services provided in the home and for obtaining feedback from residents and relatives. Regular audits were carried out to ensure that staff were following procedures and to identify concerns. In recent months the acting deputy manager had completed medication and care record audits. We were told that staff were advised about audit findings but it was not always clear on the audit form if any action was taken to address concerns. The manager agreed to add another section to the form to record what action, if any was taken by the person completing the audit to address the findings and to check that the matter had been addressed. Residents and relatives meetings were held every three months, the regional manager visited the home regularly to speak with staff, residents and visitors and the company sent out a detailed satisfaction survey once a year. The administrator was responsible for looking after money and valuable items for residents. We looked at some of the records that were kept about people’s money and talked to the administrator about how she ensured that people’s money and valuables were kept safe. There were clear procedures for staff to follow and money records were checked during monitoring visits and audits. All incoming and outgoing money was recorded and all entries were checked and signed by the administrator and the resident or a witness. Receipts were kept for items that were purchased for residents or services that were provided by other professionals such as hairdressers and chiropodists. Money and valuables were stored securely. The money and valuables held for four people were checked and were found to be correct. Fire safety arrangements were good. Regular checks were undertaken to ensure that the fire alarm system, emergency lighting, fire extinguishers and fire doors were in working order and equipment was serviced regularly. There were regular fire drills but drills usually took place during the day and did not include staff that worked night duty shifts. See recommendation 9. The home had a dedicated maintenance person. The maintenance person carried out regular health and safety checks and routine repairs within the home and grounds. Health and safety records were sampled. All of the Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 26 records seen were up to date and corresponded with the information that was provided by the acting manager in the Annual Quality Assurance Assessment (AQAA) report. Hot water temperatures were tested regularly. Some of the temperatures recorded were above the recommended level. It was not clear from the records if any action was taken to address this issue. See requirement 6. Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 27 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Medication records must be accurate and up to date. Specifically: • Staff must record how many tablets they give to residents when a variable dose (i.e. 1-2) tablets are prescribed • Ensure that medicines that are discontinued are crossed through and the amendment is signed and dated • Ensure that medication changes are signed and dated Staff must ensure that medicines are obtained in a timely manner and are available for use by residents. Adequate records must be maintained about the receipt, use and disposal of homely remedy medicines. A contingency plan must be developed to cover planned and unforeseen staff absence. A copy of the plan must be forwarded to CSCI by 25/08/08. DS0000006768.V364711.R01.S.doc Timescale for action 22/09/08 2. OP9 13 22/09/08 3. OP9 13 22/09/08 4. OP27 17 25/08/08 Riverlee Care Home Version 5.2 Page 29 5. OP29 19(1)(c) 6. OP38 13 References for staff must be 25/08/08 verified to ensure that they are genuine. This will help to protect the people that live in the home. Hot water temperatures must 25/08/08 not exceed 44oC, in areas that are accessible to residents. High water temperatures create a scalding risk to vulnerable people. 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. 4. 5. 6. Refer to Standard OP9 OP9 OP9 OP12 OP18 OP19 Good Practice Recommendations The controlled drugs cupboard should not be used to store resident’s jewellery. Medication rooms should be reorganised. Staff should be able to access all of the areas and cupboards in the room. Internal audits of medication should identify and address the issues that we found during this inspection. The home should recruit bank activity staff to cover prolonged absence. This will ensure that residents have access to a regular and varied programme of activities. All staff should receive training about the company’s safeguarding and whistle blowing procedures. The chipped and broken cupboards and work surfaces in the kitchen on Yeading Brooke 2 should be replaced. The musty odour in the shower room on Yeading Brooke 2 should be investigated and resolved. Refrigerators that are used to store chilled foods should be kept at 8oC or cooler. The acting manager should submit an application to CSCI to become the registered manager for the service. All staff should have an opportunity to take part in fire drills. 7. 8. 9. OP26 OP31 OP38 Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Riverlee Care Home DS0000006768.V364711.R01.S.doc Version 5.2 Page 31 - 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. 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