Care Home: Riverlee Care Home

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What the care home does well There was written information about the service and people could visit the home to view the facilities. Care plans and risk assessments were reviewed regularly and were updated when residents needs changed. Staff worked in partnership with other health care professionals. Interaction between staff and residents was mostly good. Staff addressed residents in a caring and professional manner. Relatives told us that they could visit at any time and spend as long as they liked in the home. People were supported to eat and drink and most of the people that we spoke with said they liked the food provided in the home. Complaints were investigated promptly. Staff knew they should report concerns and allegations to senior staff and received safeguarding training. Staff had access to a comprehensive programme of training. Regular audits and surveys were carried out to monitor the homes performance and to obtain feedback about the service. There were good systems in place to protect residents money and valuables. There was a regular programme of health and safety and fire safety checks. Equipment was serviced regularly to ensure that it was in working order and was safe to use. What has improved since the last inspection? The home had recently changed to a new pharmacy supplier. Staff were positive about the change and said the home was receiving a better service. All medicines were in stock and medication changes were signed and dated. Records were kept about the receipt and disposal of homely remedy medicines. Medicine rooms were tidy and the controlled drug cupboard was only used to store medical items. The units and work surfaces in the satellite kitchens were replaced and action was taken to resolve the odour in one of the shower rooms. Parts of the home were redecorated and some of the carpets were replaced. New wheelchairs and profile beds were purchased. Some of the refrigerators were replaced and the temperature was monitored. The home had recruited some new permanent and bank staff and had developed a strategy to cover staff sickness and absence. The number of staff with a care qualification had increased. The manager returned to the home after a period supporting another sanctuary care home and a new deputy manager was appointed. Night staff had an opportunity to take part in fire drills. What the care home could do better: Residents received a contract but information about what was included in the fees was not always clear. Some of the information in care plans was vague. The care records for people who were receiving end of life were not always completed properly. Records were not always kept about the administration of creams and dressings. Guidance about the level and type of support that people required to take their own medicines was not always clear. One resident had waited several months for a new bedroom door key. There was no evidence that care staff were trained for their new activity role. Activity records were not always properly maintained. The ceiling in the medicine room on Yeading Brooke was damaged. We observed good moving and handling practices on all of the units but some equipment was not used appropriately. A trolley containing cleaning chemicals was left unattended on one of the units. Key inspection report Care homes for older people Name: Address: Riverlee Care Home Franklin Close Off John Penn St Greenwich London SE13 7QT     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: Maria Kinson     Date: 2 7 0 5 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 Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Older People Page 3 of 31 Information about the care home Name of care home: Address: Riverlee Care Home Franklin Close Off John Penn St Greenwich London SE13 7QT 02086947140 02086947141 rebeccas@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Housing Association (trading as Sanctuary Care) care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 75 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) Dementia ? Code DE (maximum number of places: 15) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 31 Over 65 15 60 0 0 Brief description of the care home 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. Care Homes for Older People Page 5 of 31 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 29th May 2008. This inspection was carried out over two days in May 2009 and was unannounced. Prior to the visit we reviewed all of the information that we had received from, and about the service in the period since the last inspection. This included complaints, concerns, notifications and the annual quality assurance assessment form that homes complete and return to the commission once a year. This information helped us to plan how we would undertake the inspection and what issues we would focus on. We sent surveys to ten people that live and work in the home and nine health care professionals that were in regular contact with the home. We received eleven responses, eight from residents, one from a member of staff and two from health care professionals. Care Homes for Older People Page 6 of 31 During the inspection we spoke to six residents, six members of staff and one visitor. One relative completed and returned a survey. The comments that we received from residents, relatives, staff and health care professionals helped us to form a judgement about the home. Some of their comments are included in this report. During the site visit we examined some of the records that were kept in the home and assessed the management of medicines. We observed staff supporting residents to eat and drink, move around the home, undertake activities and take their medicines. We visited all of the communal areas and viewed a selection of bedrooms on each unit. The fees charged by the home range from £510 to £874 per week. The fees do not include hairdressing, toiletries, activities in the community or newspapers. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The home had recently changed to a new pharmacy supplier. Staff were positive about the change and said the home was receiving a better service. All medicines were in stock and medication changes were signed and dated. Records were kept about the receipt and disposal of homely remedy medicines. Medicine rooms were tidy and the controlled drug cupboard was only used to store medical items. The units and work surfaces in the satellite kitchens were replaced and action was taken to resolve the odour in one of the shower rooms. Parts of the home were redecorated and some of the carpets were replaced. New wheelchairs and profile beds were purchased. Some of the refrigerators were replaced and the temperature was monitored. The home had recruited some new permanent and bank staff and had developed a strategy to cover staff sickness and absence. Care Homes for Older People Page 8 of 31 The number of staff with a care qualification had increased. The manager returned to the home after a period supporting another sanctuary care home and a new deputy manager was appointed. Night staff had an opportunity to take part in fire drills. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written information about the service was displayed and people were advised to visit the home before they made a decision to move in. An assessment was carried out to establish if the home would be able to meet peoples support needs. Evidence: The registration certificate and information about the service was displayed in the reception area. Although some residents were not clear if they had received a contract, we did find copies on their files. Contracts were agreed and signed by residents or their representative. The contract provides information about the room the service user will occupy, fees and the period of notice. There was some variation in the contracts as some were for new residents and some were for people that had lived in the home for several years. It was not always clear what services the fees include. Some contracts did refer people to other documents such as the service user guide. See Care Homes for Older People Page 11 of 31 Evidence: recommendation 1. Pre-admission needs assessments were completed before residents moved into the home. The assessments were dated and signed and key areas of need were identified. There was a strong focus on peoples health needs on the nursing floors. For one recently admitted resident, the pre-admission assessment was brief, though it did cover the persons main areas of need. Most of the files included input from residents relatives in the form of a life history. Some residents said they visited the home the home before they moved in but some people said they were too unwell to do this. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs were monitored and advice was sought from other professionals if necessary. Medicines were generally well managed but some work was required to ensure that adequate records were maintained about the application of creams and dressings. Evidence: We examined one set of records on each of the five units in the home. The files included pre admission assessments, care plans and supporting risk assessments. Care plans were developed from information that was obtained during the assessment and staff observations. Although plans showed what action staff should take to address peoples needs some of the guidance was not clear and could lead to inconsistent care practices. For example two care plans said residents should be supported to use the toilet regularly. It was not clear from the records how often the resident should be offered the toilet. See recommendation 2. One of the residents that we case tracked was on the Liverpool Care Pathway. This model of care is used for people that are receiving end of life care. The relevant Care Homes for Older People Page 13 of 31 Evidence: documentation was in use but it was evident that some members of staff required further support or training to use this properly. The nurse that was caring for this resident had attended a two hour training session about the Liverpool Care Pathway. See requirement 1. Plans were reviewed regularly, reflecting changes to residents needs. There was some evidence that residents or relatives were involved in this process. All of the residents that we case tracked were registered with a GP and were supported by the homes staff to receive the health care input that they needed, such as dental or optical care. It was evident from discussions and documentation seen that residents had access to health care support, such as the tissue viability nurse, physiotherapist, podiatrist, dietitian and local mental health team. We spoke to one resident who was reading a newspaper in the garden. The resident told us that they were cared for well and got all the medical support they required, including support to attend outpatient appointments. The residents file showed attendance at an outpatients appointment to see a dietitian. The report from the visit indicated that the service user was progressing well with the homes support. The service user also had a pressure ulcer that was assessed regularly and reviewed by a podiatrist. Measurements of the wound were recorded by the homes staff at different times using metric or imperial measurements. We recommend that staff use the same unit of measurement for consistency and to avoid any possible misinterpretation of findings. Continence assessments were seen on the files of residents that we case tracked. We spoke to one resident that was on a toileting programme. The person was watching television and said they were comfortable. A toileting regime chart was maintained and signed by staff when the resident was supported to use the toilet. Staff were aware of the toileting programme for this resident and told us about the observations that they make when they undertake personal care. We received written feedback about the service from two health care professionals that were in regular contact with the home. They told us that staff usually monitored residents health and social care needs and maintained their privacy and dignity. The rooms for storing medicines were maintained at a suitable temperature. In the period since the last inspection the rooms were reorganised to make it easier for staff to locate items and access hand washing facilities. There was no natural light in the room and the artificial lighting was not very bright. The home should try to improve Care Homes for Older People Page 14 of 31 Evidence: the lighting by using a higher wattage bulb. One medication refrigerator was not working but a new one had been ordered. In the meantime, drugs needing refrigeration were stored on another unit. Controlled drugs were checked and the stock held matched what was recorded in the CD register. We looked at seven medication charts. Records of receipt and administration of tablets and liquid medicines were good. But records about the administration of dressings and creams were not always maintained consistently. See requirement 2. One resident was taking their own medicines with some prompting from staff. Staff completed an assessment to identify potential risks and had recorded some risk management strategies. However the arrangements for supporting the resident were a little unclear with both staff and relatives taking responsibility at different times for supporting the service user. See recommendation 3. The balance of two homely remedy medicines were checked against the records and were found to be correct. The records that were kept about the receipt, use and disposal of homely remedy medicines had improved. Staff members addressed residents by their preferred name and were seen to respect peoples privacy, for example by knocking on bedroom doors before entering. One resident said they were waiting to receive a new bedroom door key. The residents file included a care plan dated November 2008 that stated admin to provide a duplicate key. The monthly reviews since that date stated the resident required a new room key. See recommendation 4. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff will require some additional training if the new activity programme is to achieve its aim. The home operates an open visiting policy for friends and family. Mealtimes were well managed and most people said they enjoy the food provided in the home. Evidence: Each unit had an activity corner, where the activity programme was displayed and equipment was stored. The home has one full time and one part time activity leader. The provider had recently decided that care staff should become more involved in activities delivery. There was no evidence on the training records that staff had received any training for this role. See recommendation 5. The activities leader was responsible for setting up and overseeing individual and group activities and care staff support residents to undertake activities. The activity leader was also responsible for booking outside entertainers, driving a locally hired minibus, arranging trips and liaising with visiting church ministers. Plans had been made for school children, a pat the dog service and local police horses to visit the home. During the inspection we saw staff talking and reminiscing and undertaking manicures and hand massage with residents. A mobile sensory unit was used on one of the units. Care Homes for Older People Page 16 of 31 Evidence: The activities programme gave general information about the morning and afternoon sessions without stating what specific activities would be available. The activities coordinator explained that once she knows what activities staff are doing she fills in the details on the programme. On some of the nursing units staff did not have time during the morning shift to undertake group activities with residents as they were busy supporting people with personal care tasks, administering medication and supervising residents that were agitated. One care worker said if we are busy we might have to leave activities till the afternoon and another member of staff said residents were supported to undertake activities after lunch. If activities are not provided in the morning the programme should be amended. Activity records were variable. Residents said the home provides regular activities but this was not always evident on the activity record sheet that we saw in residents files. Some residents said they enjoyed the weekly film show but two residents said they would like to go out more frequently. This issue was also identified in the homes own survey. See recommendation 6. Residents that we spoke with said they were able to make decisions about how and where they spent their time. On the ground floor unit residents said they could choose when they went to bed and when they got up and were able to do what they wanted as long as it didnt disturb the other people that live in the home. At the time of our visit one resident was doing some washing in her room, another person was having a rest on their bed and some of the other residents had just returned from a visit to the hairdressers. We spoke to one visitor who said they could visit their family member at anytime and could stay for as long as they wanted. Another relative said they visited daily and were normally informed of any change of routine. There were regular relatives and residents meetings and a record was kept about issues that were discussed. We observed staff serving lunch and supporting people to eat on two units and observed supper on the ground floor unit. The tables were nicely laid out with tablecloths, mats and a floral display but there were no condiments on the tables on one of the units. The meals were served from hot trolleys brought from the kitchen by catering staff and care staff wore blue aprons while handling food. The food served during the lunch period matched the menu on display, with soup to start and a choice Care Homes for Older People Page 17 of 31 Evidence: of two main meals. Plate guards were available to promote residents independence and additional assistance was provided where necessary. People that we spoke to during the lunch and supper period said they enjoyed their meal but written feedback from residents was mixed with 50 of residents saying they always like the meals at the home and 37.5 saying they like some meals. The manager should monitor this issue. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns were investigated and action was taken to put things right, if necessary. Staff were aware of local safeguarding procedures and allegations were followed up and referred to the relevant agency for investigation. Evidence: The complaints procedure was displayed in the main reception area. Complaints were recorded in a file. There was a summary sheet at the front of the folder so that the manager had an overview of complaints and could see if there were any reoccurring trends. The home had received seven complaints in the past twelve months. We looked at the action that was taken by the home to investigate and resolve four complaints. The records showed that staff acted quickly when concerns were raised and took prompt action to investigate the issue. The complainant received a letter advising them about the outcome of the investigation and in some cases the complainant was invited to meet the manager to discuss her findings. Some of the discussions that took place during meetings were not recorded. See recommendation 7. We received two complaints about wheelchair footplates and the management of continence issues in November 2008. We saw evidence in the homes complaints records that the concerns raised with us were investigated and addressed by the manager. Care Homes for Older People Page 19 of 31 Evidence: The manager notified us about significant events that occurred in the home. Three members of staff were asked about their roles with regard to safeguarding the residents in their care. All of the staff members had completed relevant training and were aware of their reporting responsibilities. One carer said whistle blowing was included in the training that she attended and she was aware there is legislation that offers her protection in this respect. We also spoke to one member of staff about the management of challenging behaviour. The staff member spoke about the use of distraction techniques for calming residents who were distressed or angry and about recognising any trigger factors. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home provides comfortable personal and communal space for residents and their visitors. Evidence: We viewed all of the communal areas and sampled at least two bedrooms on each unit. The home employs 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 and grounds were well maintained and the issues that we identified during the previous inspection had been addressed. There was evidence of a leak on the ceiling in the medicine room on Yeading Brooke unit. Action must be taken to repair any damage as medicines and sterile dressings were stored below this area. See requirement 3. In the period since the last inspection the kitchen units and surfaces were replaced in the satellite kitchens on all of the units, some carpets were replaced and some areas were redecorated. There was an open plan dining room and lounge on each unit and a small quiet room. The lounges were nicely furnished but some redecoration was required. We were told Care Homes for Older People Page 21 of 31 Evidence: that this work was planned. There was a television and music system for residents entertainment. 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. There was equipment and systems in place to regulate and check hot water temperatures. A communication was seen from the providers health and safety adviser to the manager about how to maintain safe hot water temperatures. One of the temperatures that we tested was above the recommended level but was satisfactory when it was tested by the provider in May 2009. The manager should recheck the hot water temperature in the bathroom on Yeading Brooke 1. All areas were clean and tidy and residents said the home was always fresh and clean. Each unit had a sluice room with disinfector in working order and hand washing facilities. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team had stabilised. Service users were protected by the homes recruitment practises. Staff were trained to observe health and safety issues and deliver safe care. Evidence: When we arrived in the home there were two qualified nurses, five care workers and a student nurse on Yeading Brooke and Ravensbourne. There was one additional carer on Yeading Brooke to provide one to one support for a resident. There were three care staff on duty on the ground floor residential unit. The home had recruited a number of new permanent and bank staff since the last inspection and had developed a plan to cover staff sickness and absence. Staff said there were adequate staff to meet residents needs and told us that agency staff were only used if permanent or bank staff could not cover a shift. The number of staff with a care qualification had increased to 83 . This exceeds the standard set by the Department of Health. We examined the recruitment records for three new members of staff. The files were well organised and contained all of the necessary documents and checks. Some of the references were not verified to ensure that they were genuine. See recommendation 8. Care Homes for Older People Page 23 of 31 Evidence: The home provides a comprehensive programme of training for staff. This includes distance learning packages, local authority training sessions, training facilitated by external trainers and in house training sessions run by senior staff. In the period since the last inspection some members of staff had attended first aid, moving and handling, fire safety, principles of care, dementia awareness, induction, safeguarding, continence, team leader, NVQ 2 and 3, infection control, food hygiene, communication, diabetes and challenging behaviour training sessions. Staff told us about the training they had attended in recent months and said they had found some of the sessions very useful. There were regular unit meetings and general meetings that all of the staff could attend. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well organised and managed. There were systems in place to monitor and improve the quality of care provided in the home and to safeguard peoples money. Resident safety could be compromised if staff do not follow procedures consistently. Evidence: The registered manager had recently returned to the home following a period supporting another sanctuary care home. The manager has relevant experience and had undertaken relevant training. A new deputy manager was recently appointed. Staff said the manager was helpful and supportive. One staff member said the manager and deputy make sure the home is tidy and the residents are well treated. The administrator was responsible for safeguarding residents personal money if they were not able to look after it themselves or wanted staff to do this on their behalf. Excellent records were kept about money that was received in the home, returned to Care Homes for Older People Page 25 of 31 Evidence: residents or used to purchase items for residents. Receipts were kept for purchases made for the resident or for services that they used such as hairdressing and chiropody. We checked the money records for three residents to ensure they matched the balance of money in the residents envelope and that there was an explanation about how the person had used their money. The records were easy to read and understand and were well organised. There were two signatures for all transactions and regular checks were carried out by the manager and regional manager to ensure that residents money was safe and staff followed company procedures. The same standard of record keeping was maintained in respect of valuable items that were stored for residents. This home has excellent systems in place for safeguarding residents money and maintains clear and up to date money records. There were 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 company procedures and to identify concerns. In recent months the deputy manager had completed medication and care record audits. The area manager carried out regular unannounced visits which included consultation with residents, relatives and staff and satisfaction surveys were sent to residents and relatives. A sample of the homes maintenance records was inspected. This included gas, electrics, lifting equipment and hot water temperatures. The records showed that equipment was inspected and serviced regularly. Bed rails were checked but it was not clear what staff were checking or who was undertaking the checks. The form should be updated to provide clear information about the type of checks that are carried out. The most recent environmental health food safety visit by Greenwich Council took place in April 2009, and the report was available for inspection. The Council had given the home a food hygiene award. 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. The records showed that there were regular fire drills and some of the drills included staff that work night duty shifts. We saw staff helping people to move around the unit using handling techniques and equipment. Wheelchairs were used appropriately and footplates were used to support residents feet. Most of the transfers that we saw were carried out professionally but on Ravensbourne we observed staff transferring two residents with a standing hoist, one of whom could not stand and the moving and handling assessment for the other resident said they were non weight bearing. Standing hoists should only be used Care Homes for Older People Page 26 of 31 Evidence: with residents that can weight bear. See requirement 4. Hazardous substances were stored securely on four out of the five of the units that we visited. On Yeading Brook one, a trolley containing cleaning chemicals was left in the corridor unattended. The staff member was aware of the risks when questioned. See recommendation 9. Care Homes for Older People Page 27 of 31 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 Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 18 Action must be undertaken to ensure that staff know how to use documentation such as the Liverpool Care Pathway. This will provide evidence that staff can meet residents health and welfare needs. 04/12/2009 2 10 13 Adequate records must be maintained about the administration of creams and dressings. To provide a record of the treatment and care that people receive. 20/11/2009 3 19 23 Repair the damaged ceiling in the medicine room on Yeading Brooke. To prevent contamination of any items that are stored in this room. 04/12/2009 4 38 13 Staff must use moving and handling equipment in 20/11/2009 Care Homes for Older People Page 29 of 31 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 accordance with the instructions and guidance that is provided by the manufacturer. To maintain staff and service users health and safety. 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 2 2 7 The contract should state what care and services are covered by the fees. Information in care plans should be easy to understand and specific. The use of words such as regularly should be avoided. The type of support required by people that take their own medicines should be discussed and agreed with the individual and described in their care plan or risk assessment. Lost keys should be replaced promptly. Action should be taken to increase the provision of activities outside the home. Staff should receive training appropriate to the work they perform. This includes activity training and information about maintaining adequate activity records. A record should be kept about issues discussed during meetings with family members. References should be checked to ensure that they are genuine. Staff should store hazardous chemicals securely. Senior staff should monitor compliance with health and safety procedures. 3 9 4 5 6 10 12 12 7 8 9 16 29 38 Care Homes for Older People Page 30 of 31 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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