Inspection on 11/05/09 for Abbey Court Nursing Home

This inspection was carried out on 11th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbey Court Nursing Home 17/11/08

Abbey Court Nursing Home 14/01/08

Abbey Court Nursing Home 06/06/06

Abbey Court Nursing Home 10/02/06

Abbey Court Nursing Home 09/09/05

Abbey Court Nursing Home 27/10/04

Abbey Court Nursing Home 22/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS11 7AD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Yvonne Allen     Date: 1 3 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 43 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 43 Information about the care home Name of care home: Address: Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS11 7AD 01543277358 01543277876 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Restful Homes (Cannock) Limited care home 117 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: DE Minimum age 60 years MD Minimum age 50 years PD Minimum age 55 years Date of last inspection Brief description of the care home Abbey Court is a purpose-built care home, providing nursing and residential care, located within a residential area on the outskirts of Cannock. The home can accommodate up to 117 service users in the following categories; Dementia care (59), Mental disorder, excluding learning disability or dementia (10), Mental disorder, Care Homes for Older People Page 4 of 43 Over 65 0 25 80 35 59 10 0 58 1 8 1 1 2 0 0 8 Brief description of the care home excluding learning disability or dementia- over 65 years of age (25), Old age not falling in any other category (80), Physical disability (58), Physical disability over 65years of age (35). Current scale of charges range from 368 - 650 pounds per week. The home is on two floors and all areas have access via the stairs and/or passenger lift. Within the home there are a total of 13 lounges available. There are four dining rooms and ample facilities in the home including two hairdressing salons. The home has an enclosed garden with a suitable patio area. The registered care manager (RGN) is in charge of the home. First level nurses (both RGN and RMN), and teams of care assistants, provide care. Local GP practices and a pharmacist service the home. Community nurses, health service professionals, and NHS facilities are accessed as and when required. Several local GP practices and a pharmacist service the home. Activities, hobbies and entertainment take place with transport provided as required. Care Homes for Older People Page 5 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is ONE STAR. This means that the people who use this service experience ADEQUATE quality outcomes. We, the commission, carried out this Key unannounced inspection visit over two days. All of the Key minimum standards were assessed and for each outcome a judgment has been made based on the evidence we gathered. These judgments tell us what life is like for the people who live in the home. Prior to the inspection visit the Providers had completed a self assessment tool known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are met for people using the service. Care Homes for Older People Page 6 of 43 References to the AQAA have been included in the report. The ways in which we gathered evidence to make our judgments are as follows We looked at any information we have received about the service since the last key inspection. We spoke with some of the people who live in the home. We spoke with some of the staff who work at the home. We held discussions with the registered manager, operations manager and registered provider. We spoke with Social Services who place people at the home. We examined relevant records and documentation at the home. We walked around the home and visited all the communal areas and a selection of bedrooms. We carried out a comprehensive inspection of the services medication system. This was undertaken by our Specialist Pharmacist Inspector. We completed a Short Observational Framework Inspection (SOFI). SOFI is designed to give us an opportunity to record our observations during the inspection of care homes where people have dementia, severe learning disabilities or general difficulties with communication. It can enable us to look closely at practice issues and observations; it is used illustratively alongside other evidence. SOFI offers first hand experience of sitting alongside people who use the service for a couple of hours in a communal space within the care home. It gives an insight into their general well being during this time, and also into the staff interaction with the people who use the service. Observations were made of interaction between staff and people who use the service around non-personal care tasks, at lunchtime and during the Short Observational Framework Inspection (SOFI.) At the end of the second day of inspection we discussed our findings with the registered manager and registered provider. During this discussion we identified areas where we found that the service has improved and areas where further improvements are required. As a result of the inspection we have made six requirements and eighteen good practice recommendations. Care Homes for Older People Page 7 of 43 What the care home does well: What has improved since the last inspection? The way in which the service deals with concerns and complaints has changed and this appears to be working more effectively. Social Services told us, prior to our inspection visit, that they have received fewer concerns about the service. This means that the Care Homes for Older People Page 8 of 43 people who live at the home and their representatives can be assured that any concerns they might have about the home will be listened to, taken seriously and acted upon. The service has continued with its improvement plan with much of the improvements already actioned. This means that some of the outcomes for people who live in the home have improved. What they could do better: We identified several areas of the medication system which are in need of improvement. As a result of this we have made specific requirements and recommendations in order to help ensure that medication is stored, administered and disposed of safely and that the health needs of people are not compromised. Throughout the process of the inspection we noticed a difference between the quality of life and outcomes people living in the home are receiving. The service does not meet the needs of people with dementia care as well as it meets the needs of people with general nursing needs. People living on the dementia care unit are not consistently having their needs assessed, monitored and met effectively. Care is not person centered and not all staff working on this unit are fully aware of the specific needs of people or how to manage them. We have identified the following outcomes where improvements are needed in respect of dementia care. The assessment process does not always ensure that staff will have the skills to meet assessed needs and may place people at risk of harm. We identified this through a safeguarding referral prior to the inspection visit. A person had been accepted to the dementia care unit and Social Services felt that the service were unable to meet this persons very challenging needs. Examination of care plan records identified that staff did not initially have the skills and training to meet these needs. It cannot be guaranteed that dementia care will be delivered with a person centered approach. We identified this during examination of care plan records and observations of care practices. Care plan documentation is sometimes incomplete and inconsistent leaving staff who deliver care on the dementia care unit confused and unsure about individual care needs. An example of this was that staff were unsure whether a person had a pressure ulcer and, as such, she was not receiving the appropriate pressure relief support and prevention whilst she was sitting out in a chair. Also, it could not be guaranteed that people will be observed and supervised on the dementia care unit. During the inspection visit we had to intervene twice and point out to staff where people needed assistance. Activities on the dementia care unit are not person centered and it cannot be guaranteed that people with dementia care will have their social and therapeutic needs met. The dining process on the dementia care unit does not ensure that preferences and Care Homes for Older People Page 9 of 43 choices are upheld and does not promote dignity for people. Attention to cleanliness and presentation of the dementia care unit is needed in order to ensure that people live a clean and pleasant environment. On the first inspection day, areas of phase two of the dementia care unit were poorly presented and not in keeping with infection control policies. As a result of the above areas highlighted for improvement it cannot be guaranteed that the home is always managed in the best interests of the people who live there. This is what people told us about the service They could water her plants and keep the vases clean. Maybe a giant sized TV. Minibus for taking residents on trips would be useful as other transport is expensive. Provide smoking area indoors for residents who smoke. Indoor facilities for people who have smoked for seventy plus years would be nice. 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 10 of 43 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 11 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they are offered a place at the home and people receive information in order to make an informed decision. The assessment process should ensure that staff will have the skills to meet assessed needs and may place people at risk of harm. Evidence: In their AQAA the Providers tell us about their open door approach. They say that information they receive from the person coming into the home helps them to create their individualized care plan. They say through pre admission assessment they can tell if they are able to cater for the needs of an individual. They tell us that people wanting to come into the home are provided with a brochure, Statement of Purpose and Service User Guide, outlining all the services offered at the home including the scale of charges. They say that, people and their families are encouraged to come and visit the home and to spend time there meeting other people. This is in order to Care Homes for Older People Page 12 of 43 Evidence: ensure that the home is the right place for them and can meet their needs. They explain that people are given a contract, either through their funding body or a private contract if they are self-funding. They tell us that all of the people coming into the home are assessed by the Primary Care Team as to their nursing needs and the payment for this which they are entitled to. The Providers say that everyone comes into the home initially on a trial period in order to make sure that the placement is suitable. They also tell us that the pre admission assessment now takes into account the deprivation of liberty and mental capacity act. We looked at a number of individual care plans and saw that a pre admission assessment of peoples needs is completed prior to them moving in the home. Discussions with the registered manager identified that she goes out to meet people in their own environment or in hospital and carries out an assessment of their needs. The manager told us that she only admits people to the home when she is sure their individual needs can be met. Prior to this inspection visit, and since we did the last key Inspection at the service, we have been made aware, by Social Services, of a person who has been admitted to the home with very challenging behavioral needs. Social Services concerns were that the home, at the time, were unable to meet this persons needs and raised this as a Safeguarding Investigation. We telephoned the home not long after this persons admission, and spoke to the deputy manager who informed us that there had been some initial difficulties but that this person now appeared to be settling in. During this inspection visit we met with this person and looked at the records of care relating to him. We identified that, initially, staff struggled to understand and to meet this persons needs. Staff were not initially equipped with the skills and training to be able to manage this persons behavioral needs. We did note, however, that outside agencies including the Mental Health Nurse Specialist were called in by the service to offer support and advice to the staff. After the initial difficulties, and, as the care plan states, the person Seems to be settling down now and getting used to the environment. It is recommended that the pre admission assessment process ensures that staff have the appropriate skills and training to meet the needs of a person before their actual admission into the home. On the surveys we sent out people stated that they had received enough information about the home before they came in and had received a contract. Comments included My daughter has the contract. Care Homes for Older People Page 13 of 43 Evidence: I came round with the family and liked the home. My daughter and son told me about it and I came to look around. I got information from family members who came to look at the home. My family have got my contract. Mom isnt aware of the contract but I have it. Mom didnt come to look around but I did. I was able to visit and talk to carers and matron before she moved in. Care Homes for Older People Page 14 of 43 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal, nursing and health care needs are monitored and met but it cannot be guaranteed that dementia care will be delivered with a person centered approach. Care plan documentation is sometimes incomplete and inconsistent leaving staff who deliver care on the dementia care unit confused and unsure about individual care needs. The medication process requires tightening up in order to ensure that people are safeguarded and health care needs met. Evidence: In their AQAA the Providers tell us that they Uphold privacy and dignity and promote autonomy. They say that All care plans are individual and appropriately writtenand that Each person is supported to make their own decisions and take risks. The home uses an Individual care planning approach which is regularly evaluated and updated. The home work with the person and their families or represenatative to provide the best possible support plan. Care Homes for Older People Page 15 of 43 Evidence: We have not received any further concerns about this outcome area since the last Key Inspection. We contacted Staffordshire Social Services prior to this inspection visit to discuss any issues arising from the recent Large Scale Investigation. They confirmed that the improvement plan appears to be taking effect and the service are continuing to implement this. We spoke to people who live in the home about the care they are receiving and this is what they told us. As far as I am aware my mother is looked after very well and her needs are met. She is always clean and dressed well. My relative is warm, well fed and clean. My mother would have to go a long way to get the care and attention she receives at Abbey Court. I am very pleased with the overall attention to my mothers needs and the care she receives - she is happy and so am I. She has already received medical support straight away. All the family are happy with the care. Its very good here they look after me well. Nice girls happy to help. I get my tablets in the morning and at teatime. I feel that mom does receive care and support as needed. We examined records relating to the care of people who live in the home and case tracked individual people to identify whether the care that is documented in their plan is being delivered accordingly. The AQAA, completed by the service prior to the inspection visit, states that All care plans are individual and appropriately written. We found that this is not always the case. The home does record peoples risk of developing pressure sores, falls, moving Care Homes for Older People Page 16 of 43 Evidence: and handling and nutrition as well as other risks. However, some of the documentation was incomplete and in some instances the information was not consistent. Also staff were unsure about the care of person in respect of pressure area treatment. Some staff we spoke to said No she has no sore bottom another said She must have a pressure sore she has the special mattress. Staff had also written into the handover book that pressure damage was evident. We looked at the care of this person because she has a pressure sore. Pressure area care included the provision of an air overlay mattress to help with pressure relief but when the person is sitting out of bed only a propad cushion is in use. We suggest the home seek the advice of the Tissue Viability Nurse Specialist about supplying an air cushion for people who are at risk of developing pressure sores, to sit on. The AQAA states that The home uses an individual care planning approach. We found that staff do not appear to be able to think in a person centred way. The focus of their day was to make sure the drinks were done, baths were next, in a very task orientated way. Staff were reliant on the activity coordinator to provide the stimulation for people. Records of challenging behavior are being recorded. However, the chart we saw for one person was limited in its information, it did not contain information about managing challenging behavioral episodes. This was relating to a person who had been admitted to the home since the last Key Inspection, the same person to whom we have referred to in the previous outcome. Staff were initially unable to meet this persons assessed needs and, as a result, Social Services carried out an investigation under the Safeguarding procedure. Care staff spoken to said that they had taken part in dementia training over a twelve week period and that it had covered what to do with challenging behavior. We asked how they keep themselves and others safe when a person is being physically aggressive. They told us We dont pull them and we make sure there are no hazards, we dont want to cause bruises. Asked outright if the staff had had training in restraint, No we dont use it. The services policy also states this. We are still unsure about how staff are managing the physically aggressive episodes of the person admitted with challenging behavioural needs. This is because there is no clear guidance for staff in his care care plan and no records of specific action for staff to take in these events. It is recommended that the way in which staff recognize and manage challenging behavioral needs is made clearer and specific actions should be documented in the care plan. Care Homes for Older People Page 17 of 43 Evidence: Other care needs we observed included an indwelling catheter, but the care plan was limited for information, there was no detail about the size of catheter and the batch number. We have since been informed that a catheter diary is maintained for each person with an indwelling catheter. The staff have also documented check for signs of urinary tract infection but havent recorded what signs these might be in order to guide staff. Bed rail risk assessments have been completed for people but they appear to be a one off assessment, a person has bed rails in place but the risk assessment for this has not been reviewed since 23.02.09 Whilst we were looking around the home we noted that staff were rarely in the day room with people. We noticed that a person who live in the home was standing above another person who also lives in the home and was standing on her feet in an attempt to move around her and move out of the room. The lady was shouting It hurts. We saw the carer sitting in the corner of the lounge completing care notes and making no attempt to move and help until she saw us standing in the doorway. It is recommended that care staff are more regularly supervised with a view to further training in how to react and intervene when this is needed to keep people safe. In the other lounge we noticed that one lady had undressed herself and was naked from the waist up, we summoned assistance from care staff in order to protect this persons dignity. As a result of the Short Observation Framework Inspection (SOFI) the subsequent evidence was available. This part of the inspection was carried in the small lounge by the main entrance between 10:20 and 12:00. We continually observed four people during this time, although one person went to their room at 11:00 because they had visitors. Staff came in to complete tasks such as bringing in a cup of tea or to sit with people and chat or look at photographs. The activities coordinator spent 5 minutes with three of the four people individually talking about cookery and playing dominoes during this time. Staff were polite and respectful and people who use the service did get appropriate interaction or responses. One person who uses the service was supported by staff to go outside for a cigarette, foot plates were not used on the wheelchair and this information was shared with the manager on the first day of the inspection. The reason for not using the footplates is documented in this persons care plan. Care Homes for Older People Page 18 of 43 Evidence: Sometimes staff entered the room and only spoke with another staff member; we would recommend involvement with people who use the service on each occasion. When staff did speak the people observed they became animated, responsive and engaged, and it was clear they enjoyed this interaction. When no one was in the room, approximately 20 minutes of the time frame, people who use the service closed their eyes and at no time engaged with each other. The television was on for the duration but no one watched it. We offered immediate feedback to the manager following this observation. The pharmacist inspector visited Abbey Court on the 13th May 2009 as part of the key inspection to fully assess the way the home was managing medicine on behalf of the people who used the service. In summary the medicines management systems within the home were found to be adequate but needed further improvements to ensure that those living in the home were adequately safeguarded. We found that the medication records for the two dementia units were kept in the upstairs medication room. We found that the service was recording the quantities of the monthly medication received into the home pretty well. Unfortunately we found that the home was not always recording the medication that was received part way through the month. We found when examining the records of one person who used the service that there were more signatures on the Medicine Administration Record (MAR) chart than the actual quantity received and this was because the home had failed to record a further supply arriving in the home. We also found that some medication, which had been carried over from previous months, had not been accounted for in the records and therefore as a consequence the home did not know whether this medication was being used appropriately. We found this particularly concerning with one of the people who had been prescribed some anticoagulant tablets because without an initial quantity at the start of the MAR chart it was not possible to establish whether the person receiving the anticoagulant tablets had received the correct dose. We found that each unit downstairs had its own medication room and the medication records for each of the units were kept in the corresponding room. We examined the records of one of these units and found that the unit was not actually recording the quantity of medication received; instead the staff were just ticking the entries to indicate that the particular medicine had been received. We again found that this unit did not operate a system of accounting for the medication being used from the previous month. We found overall from the records of both medication rooms that the home could demonstrate that the Care Homes for Older People Page 19 of 43 Evidence: medication packed into the Monitored Dosage System (MDS) was being administered as the doctor had intended, when comparing the MDS system with the MAR charts. For the audit process we were able to examine the MDS system of the downstairs unit to establish the quantities that had arrived, however in subsequent months when the MDS system has been returned an accurate audit process will not be possible because the service will only have the records where the exact quantity received had not been recorded. We found that we were not able to fully establish whether the non MDS medicines had been administered due to the failings in recording the receipt and the carrying forward of medicines. For those non MDS medicines that we could audit we found a number of anomalies. We found with some cholesterol lowering tablets that 48 tablets had been received and 5 tablets had been administered according to the MAR chart. We therefore expected to find 43 tablets left but instead we found 44 tablets remaining. We also found for the same person an anomaly with their prescribed analgesia. We found that 94 tablets had been received and 36 tablets had been administered according to the MAR chart. We therefore expected to find 58 tablets left but instead we found 60 tablets remaining. We found with some tablets used to treat vitamin deficiency that 28 tablets had been received and 17 tablets had been administered according to the MAR chart. We therefore expected to find 11 tablets left but instead we found 25 tablets remaining. We found that medicines being disposed of were being entered into a disposal record book. We found that some of the entries had not been signed by the person who had completed the record. We also found that where the entries had been signed only one person had signed to confirm the disposal. The home was advised to ensure that two people witness the destruction of the medication and sign the disposal record accordingly. We found that the carers were applying both medicated and emollient cream/ointments to people who used the service. We found that the applications of these creams/ointments were not being recorded. We found overall that the care plans did not contain a great deal of information about the administration of medicines. In particular we found little or no information about how and when medicines prescribed on a when required basis should be administered. We found that one of the people who were using the service was holding and administering their own medication. We found that a risk assessment had been completed but the documentation did not highlight the risks posed to the other people living in the home. We also found that the risk assessment did not identify what medicines had been assessed. We found that staff were signing the MAR chart, which indicated that they were administering the medication. In fact the staff were signing the MAR chart to indicate that they had checked with the person that they had taken their medication at the correct time. The distinction between administering and monitoring needs to be made clear on the MAR charts when a person is self administering. We also found that Care Homes for Older People Page 20 of 43 Evidence: this person was self administering a cream that required it to be stored in a fridge. This cream had not been stored in the fridge and as a consequence posed a risk of the person not receiving the correct dose of the cream. We also found that the home had to disguise the administration of medication to one of the people who used the service in the best interests of the person. We found that the home needed to improve their management of this process. We found the home needed to ensure that they had evidence that the decision to undertake the administration of medication in this way had the support of the multidisciplinary team members involved in the care of this individual. The home must also ensure that that the process of disguising the medicine in food or drink does not affect the stability of the medicines themselves. The home must also ensure that the administration of this medication is done consistently between the nursing staff. On the subject of security and storage of medicines we found that some medicines were being stored in a room that was too hot to comply with the manufacturers requirements. On the day of the inspection the medication room temperature downstairs was measured at 30 degrees centigrade and the maximum temperature specified by most manufacturers is 25 degrees centigrade. We found that the home was not regularly measuring the maximum room temperature in any of the medication rooms. The home must measure the maximum room temperature on a regular basis and if the temperature of the rooms is greater than 25 degrees centigrade steps must be taken to rectify this. We found that the home had Controlled Drug cabinets in each of the three medication rooms. We found that these cabinets did not comply with the Misuse of Drugs (Safe Custody) Regulations because they had not been secured to the wall properly. We found that medicated creams/ointments were being insecurely stored in the rooms of people who used the service. We found that one of these creams was required to be stored in a fridge at all times. As a consequence of this cream not being stored in the fridge there was a risk that this person would not receive the correct dose of the cream. We found that the home was not measuring and recording the maximum and minimum temperatures on a daily basis. The maximum and minimum thermometers attached to the two fridges examined indicated that at some point the medication had not been stored within the accepted temperature range. The home was advised to discard the medicines contained in the fridge and obtain new supplies. We also found that there were a number of medicines found in both fridges that did not required cold storage conditions and as a consequence did not need to be stored in the fridge. Care Homes for Older People Page 21 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities on the dementia care unit are not person centered and it cannot be guaranteed that people with dementia care will have their social and therapeutic needs met. The dining process on the dementia care unit does not ensure that preferences and choices are upheld and does not promote dignity for people. Evidence: In their AQAA the Providers tell us that Activities in the home endeavor to be as flexible as possible taking into account the individual wishes and abilities of people. They say that Special occasions are celebrated such as peoples birthdays and other special events, where the home is decorated. Also The home are well served by the local churches from several denominations and also have entertainers coming into the home including some from the local community. They tell us that there is An open visiting policy where visitors are welcome at any time. They say that Some people also go out with their families and friends on a regular basis. They tell us that Regular trips out are arranged for people to places of interest or out shopping or for lunch. In respect of meals provided they say that Special diets are catered for and choices and preferences are upheld including cultural dietary requirements. Care Homes for Older People Page 22 of 43 Evidence: We received the following comments back from surveys we sent out prior to the inspection visit and from talking to people who live in the home. I cant do all the activities as I am in bed. I find the food is good and a good variety. Contact and support from the staff is always important. The puddings are the best of all. Nice girls and I like playing bingo. Tea time is my favorite. I like the kiddies coming in at Christmas. I like the food. I like playing bingo and singing. I am not a pudding eater but I like all the other meals. I cannot do sewing but I join in with the other activities. They keep an eye on my wifes eating habit as she is a very poor eater and they give her what she likes. Sometimes my relative would like to go out into the fresh air. We observed meal times on the dementia care unit. The meals arrived on the hot trolley, pureed food is served and put onto plates and dishes for people and staff are careful not to mix the food but everyone has gravy, no one is given the choice. We also noted that two peoples dinners are served in dishes one is an orange Tupperware dish. When we asked the manager she confronted the staff who told her that the person in question throws plates and smashes them. We have asked the home to consider the use of a plastic plate rather than the Tupperware bowl. The service needs to think about promoting the dignity of people living on this unit. Care Homes for Older People Page 23 of 43 Evidence: The manager told us that she had purchased plates that were divided so that pureed food could be served separately, staff said they didnt use them because they were too heavy and people couldnt get the food out of them. We also observed staff assisting people during dinner time, they did this discreetly, maintained eye contact and a good level of conversation with the person whilst they were assisting them. We noted that some staff ignored people when serving dinners, placing food over the persons head onto the table and not acknowledging them. All people living on phase two of the dementia care unit have plastic beakers to drink from, staff said that this is because they would break glasses. Asked if they had had many incidents involving cups, plates and other crockery being thrown, they said only one lady does it. We asked the service to consider providing glasses for people to use in order to promote dignity. We sat and observed in each of the lounges on the first floor, in one lounge there were two people with the television on and no one watching it, one person was staring out of the window and another was asleep. The larger lounge had more people sitting in it and the music was so loud that if the people watching the televisions wanted to they couldnt hear them. However in the music lounge people were chatting amongst themselves and dancing to the music. We spoke to the newly appointed activity person, she has been in post for three weeks and previously worked as a nurse in the home. She told us the activities are getting better but we have to raise alot of funds for them. She said that they are going out on trips and that they have planned a sky dive to help raise funds and travel for trips. The home celebrates peoples birthdays, the activities person said that she has time to spend with those people who are in their bedrooms all day doing some one to one. I go in and make sure that they have the telly or the radio on. We asked how she knew this was what people wanted, she said Its better than silence. We identified that there is no real understanding of peoples choices and individual wishes. We identified lots of labeling of people, The poorlies, The feeders. The activity trolley has lots of equipment, and the activities person is especially pleased with the way her reminiscence groups are going. People seem to get a lot of enjoyment out of them. Other activities include singsongs, board games, skittles and footballs, darts and bean bag throwing. Care Homes for Older People Page 24 of 43 Evidence: Church services are held for those people who want them. Peoples religious needs are taken into account and catered for by the home. Methodist, Roman Catholic, Church of England, Pentecostal and Baptist for example visit the people in the home. At the time of the visit none of the people are taken to the church in order to attend a service. We observed lunch being served on the ground floor unit. Most people were sitting in the dining rooms but some were taking their meals in their bedrooms. We observed staff talking to people about their meal and people were seen having choices. One person told me I am working my way through the alternatives menu. We sampled the main menu and pudding and found this to be appetizing and well presented. We chatted to people in the dining room and they told us that they liked the meals served at the home and they appeared to enjoy their meal. Staff were polite, helpful and respectful. We observed a member of staff feeding a person in bed in her room. This person was nursed on a profiling bed which was positioned quite flat at the time. This person would have benefited from being sat more upright and began coughing on a couple of occasions. The staff member had also brought in another persons meal into this bedroom. When we asked her who the meal was for she told us that it was for another person and that she needed to feed her next. Not only had this meal gone cold but it should not have been brought in to another persons bedroom due to the risk of cross infection. Care Homes for Older People Page 25 of 43 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home will listen to any concerns people may have but this process cannot always guarentee that specific issues are addressed and outcomes recorded. The systems in place help to keep people safe but the pre admission process is always robust enough to ensure peoples safety. Evidence: In their AQAA the Providers tell us that Checks are carried out on all staff prior to them commencing employment at the home. They also say that Staff receive safeguarding training on induction and continuous updates. They tell us that The home has a clear and accessible complaints procedure and that Safeguarding and whistle blowing procedures are available at reception and at each nurse station throughout the home. They tell us that there is an open door policy at the home with the manager encouraging people to raise any concerns they might have. Also contactable is the director of operations whose mobile phone number is prominently displayed. They tell us that The home actively seeks the views of the people who live there and There is a weekly matrons forum during which people can come and talk to the manager about any aspects of life in the home. The Providers tell us that The home have introduced new forms for staff to complete when people raise concerns - these can then be audited. They also say that A record of complaints is kept including any action taken. Care Homes for Older People Page 26 of 43 Evidence: The service has changed the way they deal with complaints since the last key inspection. Anyone making a comment or grumble, but not wishing to make a formal complaint is acknowledged in writing. The manager thought a letter had gone out to relatives about this but it has not. We have recommended the service offers clear and succinct information about their procedures within the Service User Guide and the Statement Of Purpose. The complaints procedure is clearly displayed on various notice boards throughout the home and can be easily accessed. The manager advised us that they hold a managers forum every Thursday but no relatives or people who use the service have attended or raised any concerns in these sessions. There are ten complaints recorded in the complaints log since November 2008. There is information on most of the complaints, with records of action and outcome, but not on all. We recommend the home ensures all complaints, grumbles or comments offer a clear audit trail and conclusion. One complaint we read evidenced that an accident report should have been completed, we asked to see the report but it had not been undertaken. All accidents must be logged in the accident report book; we have made a requirement about this under the outcome headed Management and Administration. This is because the home must adhere to Health and Safety legislation and record all incidents, this helps to keep people who use the service safe. We looked at how the service keeps people safe from harm and abuse. This process starts with the recruitment of staff. By looking at staff files and talking to staff we were able to identify that staff recruitment is robust and that staff undergo stringent checks before being offered employment at the home, including Criminal Record Bureau (CRB), Protection Of Vulnerable Adults (POVA), and written references. Staff also confirmed that they receive training in POVA and when we talked to them about their knowledge of this they were aware of their responsibilities and actions in the reporting of abuse. We have been notified about one Safeguarding incident by the local authority since the last Key Inspection which was investigated by them. We have discussed this in the report under the outcome Choice of Home. Care Homes for Older People Page 27 of 43 Evidence: This is what people told us about the way the service handles concerns and complaints No real complaints, but minor niggles have been dealt with straight away. I will tell a member of staff if I have a concern. Speak to matron. Can always approach any members of staff. Always see matron to talk to her and let her know how I am. Care Homes for Older People Page 28 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is built and adapted to meet the needs of people but attention to cleanliness and presentation of the dementia care unit is needed in order to ensure that people live a clean and pleasant environment. Evidence: In their AQAA the Providers tell us that The home is well maintained and in accordance with infection control guidelines. They say that The home complies with all the requirements of fire safety and Environmental Health Office. They tell us that the home is purpose built and adapted to meet needs of people. There is a Laundry and kitchen. They also say that All rooms are en suite and some ground floor rooms have patio doors. The home is Secure from intruders and CCTV externally. We visited all the units throughout the home and went into some of the bedrooms and all the communal areas. We looked at the pressure relieving equipment in use where it was identified that a person had their alternating pressure mattresses set to firm when, according to their care plan this should have been set to medium. It is recommended that staff adhere to the care plan instructions when setting the pressure on air wave mattresses so that people are not placed at risk of developing pressure ulcers. Care Homes for Older People Page 29 of 43 Evidence: We also noted that a number of bed rails did not fit the beds properly and some were the wrong type to use with the particular bed and mattress. This resulted in unacceptable gap distances between the bed and the bed rails and posed a risk of entrapment. As a result of this we made an immediate requirement for the Provider to ensure the safety of people. The service took immediate action and ordered new profiling beds, which incorporate fitted bed rails. The maintenance person was very effective in managing this and also took advice about bed rail safety from the local health authority. The environment is purpose built with large corridors and all the bedrooms have en suite rooms off. When we visited the dementia care unit on phase two on the first day of the inspection the tea room where drinks and snacks are made was in a poor state of cleanliness and the tea trolley was in need a thorough clean. The floor was dirty and there was a cupboard door missing. There were also biscuits in a box on the floor. However the next day when we visited this room was cleaner and the biscuits had been removed. We also noted that the shower room located nearby had a badly stained floor and the shower seat was dirty and, in places, rusty. The manager told us that the shower room floor is stained because of the rust off the shower seat. The bathroom hoist was in need of a good clean as it was soiled underneath. The toilet had no hand paper towels. The manager told us that this is because it was pulled off the wall by a person who lives in the home and needs to be replaced. Linen replacement is needed, some of the pillows are very thin and lumpy, duvets are thin and towels are thinning. The other areas of the home we found to be clean and well presented. Peoples bedrooms were seen as part of our case tracking, they were personalized and looked very welcoming. People are encouraged to bring in some of their possessions when they first move into the home. Lounges and dining rooms are well presented and people were observed enjoying all areas of the home. The staff have started to paint a mural on the entrance to the dementia care unit and it is recommended that this be continued along the corridor areas in order to help make the environment more stimulating for people who live on this unit. Care Homes for Older People Page 30 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home are cared for by a skilled and competent staff team who have been trained to meet their needs. Evidence: In their AQAA the Providers tell us that The recruitment procedure is robust and staff are carefully selected to work at the home. They also say that Induction training for new staff is comprehensive. The Providers say that The home is staffed according to the needs of the people who live there. They say that Staff are encouraged to undertake training to National Vocational Qualification (NVQ) standards and well over fifty per cent have this to level two and above. They tell us that there is a Good staff training and development programme in place. We spoke to several staff members during our visit to the home. They told us that they are supported with their training needs and that training has included the following. NVQ training, mandatory training such as moving and handling and fire safety We spoke with the two laundry assistants on duty and they told us that they are happy and feel supported. We spoke with a staff member who has recently started to work at the home and she Care Homes for Older People Page 31 of 43 Evidence: told us that she had received a Good induction and that she had needed to wait until her POVA check was clear before she was able to start to work at the home. She also told us that she worked with a mentor for two weeks and found this Really helpful. A Registered Nurse told us that the service are Flexible and Very supportive. She went on to say that Although I am a general nurse I have a certificate in dementia care. She also confirmed that she had done fire safety , moving and handling, POVA and medication update training. She told us that she attends regular three monthly staff meetings and said We sit down and talk. We spoke with a care assistant who told us that she has completed NVQ level 2 in care. She also told us I help new starters with their induction training and show them what to do. The carer also confirmed that she has completed first aid, dementia awareness, moving and handling, health and safety, fire safety and infection control training. The carer had not had any training in POVA yet but, when questioned about reporting abuse she told us that she would Go straight to the nurse in charge and report it. When we looked at the staff training programme we noted that some POVA training had been carried out on May 4th 2009 and more was planned. We looked at staff files and found the recruitment procedure to be robust. Staff undergo the required checks before being offered employment at the home. During our inspection of the dementia care unit we identified that staff do not appear to be able to think in a person centred way. The focus of their day was to make sure the drinks were done, baths were next, in a very task orientated way. Also, as we have previously identified, staff members working on the dementia care unit are not always observant or supervising people effectively. We had to alert staff that one lady was sitting in a chair in the lounge and was naked from the waist up. Also, we had to ask a care assistant sitting in the same room, to intervene and when a gentleman was treading all over another persons feet causing her distress. This is what people told us about the staff who work at the home Nice girls, happy to help. We find everyone is very helpful. Care Homes for Older People Page 32 of 43 Evidence: I can always approach any member of staff. The staff are always pleasant. The staff give dad lots of help and assistance throughout the day. The following are comments we received from the staff who work in the home Very supportive manager. Occasional blips in staff numbers because of sickness but usually sorted out as soon as possible by matron. Regular training updates. There is an open door policy. We have supervision sessions, staff meetings and hand overs. We are always given up to date information about the care of the people in the home by the nurse in charge or matron. We are also given up to date information about any changes in the persons care plan. Yes my induction covered all the aspects of the job and training given before i started the job. On the days of the inspection visit their appeared to be sufficient staff available to meet the needs of the people who live in the home and to supervise people in communal areas. Although we did meet a staff member in one of the lounges who would benefit from further training in how to supervise people and we have highlighted this earlier in the report. We looked at the record of staff numbers, the duty rota, which, again, appears to indicate that there are a satisfactory number of staff provided. However, as discussed with the manager at the time, the provision of staff are at her discretion, and should be provided according to the numbers and dependency needs of people who are living in the home at any one time. The manager confirmed that she monitors the provision of staff closely and adjusts numbers ans skill mix accordingly. Care Homes for Older People Page 33 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the outcomes areas in this report have been highlighted for improvement. This indicates that the home is not always managed in the best interests of the people who live there. Evidence: In their AQAA the Providers tell us that there is a good management structure where the Registered Manager is supported by the Operations Manager and Providers - who all visit very regularly. Also they say that there is a good administrator and human recourses manager. Maintenance records are kept up to date and equipment is serviced regularly by external contractors. The home has Up to date policies and procedures and is financially viable. There is a Quality Assurance procedure in place and audits of all areas are carried out. This includes Obtaining the feedback from people who live in the home. The home is also Quality assessed by external agencies. The registered manager was present throughout the inspection visit and was also Care Homes for Older People Page 34 of 43 Evidence: supported by the registered provider and operations manager. Sarah, the manager, has managed this service for many years and has a deputy manager to support her in her role. Sarah possesses the necessary skills and qualifications to manage the home and people tell us that she is Approachable and Supportive. Sarah updates her knowledge continually by attending various study programmes which are relevant to enhancing her training and management needs. Sarah states that she runs an Open door policy where people who live in the home and their representatives are able to come and talk to her whenever they need to. Also There is a weekly matrons forum during which people can come and talk to the manager about any aspects of life in the home. These are some of the comments we received about the management of the service Very supportive manager. There is an open door policy. I can always speak to matron. From observations it is evident that the manager makes herself known to people who live in the home and is well thought of. There is a Quality Assurance system in place at the home and this includes occasionally seeking the views of people who live there. In order to ensure that this system is effective the service should demonstrate how they take peoples views into account including any action taken as a result. We were given a copy of the services Monthly Quality Audit Tool which is completed by the manager and signed by the operations manager. This tool looks at most of the services offered including finance, health and safety, reportable incidents, complaints, recruitment, training, medication, care plans and wound management, among others. People are encouraged to hand in their money to the home for safe keeping. We checked the home systems in place and found that these are good with little change from the last inspection report. Receipts for monies in and out are also kept on the computer and are audited yearly to make sure that systems are correct. Care Homes for Older People Page 35 of 43 Evidence: We checked the records relating to the maintenance of equipment at the home and, as previously, we found these to be exemplary. There is a person responsible for keeping these records and ensuring that checks and servicing is carried out on all equipment used in the home. This person is also very proactive and demonstrated this very well when we identified that some of the bed rails were unsafe for use, not only replacing these but ordering new beds and actively seeking guidance from the health authority which included staff training in bed rail safety. The service complies with the requirements of Environmental Health and Fire safety. A requirement has been made to ensure that all accidents are logged in the accident report book. This is because the home must adhere to Health and Safety legislation and record all incidents. This helps to keep people who use the service safe. The reasons for this requirement have been highlighted previously in this report in the outcome Complaints and protection. The recommendations and requirements we have made in this report indicate that the Quality Assurrance sytem is not totally effective in ensuring good quality outcomes for people. Also overall management of the service is in need of further improvement to ensure that outcomes and aspects of life for people who live in the home are improved. Care Homes for Older People Page 36 of 43 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 37 of 43 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 9 13 13 (2) The registered person 24/06/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs safe Custody Regulations 1973 and the guidelines from the Royal Pharmaceutical Society of Great Britain. 2 9 13 13 (2) The registered person 24/06/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Care Homes for Older People Page 38 of 43 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 Staff who handle prescribed treatments must be competent and their practice must follow current written policies and procedures to ensure that individuals receive their treatment safely and correctly. 3 9 13 13 (2) The registered person 24/06/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The provider must make arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. 4 9 13 13 (2) The registered person 24/06/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Appropriate information relating to medication must be kept in risk assessments and care plans in order to ensure that staff know how to use and monitor all Care Homes for Older People Page 39 of 43 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 medication including when required, covertly administer and self administered medication. This is so that all medication is administered safely, correctly and in accordance with the prescriber. 5 9 13 13 (2) The registered person 24/06/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The records of the receipt, administration and disposal of all medicines for people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. 6 38 17 17(2) Schedule 4. 12 (a). The registered person shall keep a record of any accident. All accidents must be logged in the accident report book. This is because the home must adhere to Health and Safety legislation and record all incidents. This helps to keep people who use the service safe. 26/06/2009 Care Homes for Older People Page 40 of 43 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 3 It is recommended that the pre admission assessment process is made more robust. This is to ensure that staff have the appropriate skills and training to meet the needs of a person before their actual admission into the home. It is recommended that documentation in care plans is made clear and consistent. This is so that staff are aware of the needs of people they are looking after. It is recommended that care staff are more closely supervised with a view to further training in how to react and intervene to keep people safe. It is recommended that the home seek the advice of the Tissue Viability Nurse Specialist about supplying an air cushion for people who are at risk of developing pressure sores, to sit on. Bedrail risk assessments should be reviewed more regualrly in order to identify any changes required and to ensure that people continue to be kept safe. It is recommended that the way in which staff recognize and manage challenging behavioral needs is made clearer and documented in the care plan. The recording of the receipt, administration and disposal of Temazepam tablets should be recorded in a bound book where the pages are numbered. This is to ensure that none of the pages containing information can be lost or misplaced. Activities should be made more person centered on the dementia care unit so as to help ensure that the social and therapeutic care needs of people are met. The service should ensure that peoples meals are not taken into other peoples bedrooms. This is to help avoid cross contamination and to help ensure that people are served meals at the correct temperature. The service should ensure that, when people are fed in bed, this is done safely so as to avoid choking. The service should consider revising the type of crockery and drinking glasses used on the dementia care unit in order to help promote dignity for people living in the home. 2 7 3 8 4 8 5 8 6 8 7 9 8 12 9 15 10 11 15 15 Care Homes for Older People Page 41 of 43 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 12 16 We recommend the service offers clear and succinct information about their complaint procedures within the Service User Guide and the Statement Of Purpose. We recommend the service ensures all complaints, grumbles or comments offer a clear audit trail and conclusion. It is recomemnded that the mural be continued along the corridor areas on the dementia care unit in order to help make the enviroment more stimulating for people who live on this unit. It is recommended that attention is given to replacing the rusty shower seat in the shower room on phase two of the dementia care unit. This is in order to ensure that the shower seat is safe and comfortable for use and to avoid further staining of the floor. It is recommended that staff adhere to the care plan instructions when setting the pressure on air wave mattresses so that people are not placed at risk of developing pressure ulcers. It is recommended that the service undertakes an audit of linen and replaces worn linen, duvets and pillows. This is so that people who live in the home can benefit from comfortable warm bedding. It is recommended that the cleaning programme be improved on the dementia care phase two area in order to improve the presentation of the shower room. Also equipment used at the home should be clean so that infection the spread of infection is avoided. In order to ensure that the Quality Assurance system is effective the service should demonstrate how they take peoples views into account including any action taken as a result. 13 16 14 19 15 22 16 22 17 24 18 26 19 33 Care Homes for Older People Page 42 of 43 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. Care Homes for Older People Page 43 of 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!