Inspection on 02/12/08 for Acorn House

This inspection was carried out on 2nd December 2008.

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

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

Other inspections for this house

Acorn House 08/01/08

Acorn House 22/01/07

Acorn House 04/05/06

Acorn House 06/10/05

Acorn House 16/06/05

Acorn House 25/11/04

Acorn House 04/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn House 63 Hayes Lane Croydon Surrey CR8 5JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth OReilly     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Acorn House 63 Hayes Lane Croydon Surrey CR8 5JR 02086603363 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Medicrest Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E) (of the following age range: 65 years and over) Date of last inspection Brief description of the care home Acorn House is a 31-bed home for older people who are living with dementia. It is linked to Acorn Lodge (a similar care home owned by the same company), and the two share a large rear garden. The home is situated in the pleasant rural area of Kenley, the only drawback being that it is some distance from the nearest public transport links. The stated aims and objectives of the service are to `provide a home from home, a friendly atmosphere where staff are approachable and an open relationship is encouraged between people who use the service, staff and relatives. Fees for this service are from £400.60 to £419.00 per week. 0 Over 65 31 Care Homes for Older People Page 4 of 29 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: This unannounced inspection was carried out by one Regulation Inspector and included two visits to the service on the 2nd and 11th of December 2008. The inspector had the opportunity to speak with five people who use the service, three members of staff, the cook, two visitors and the acting manager. Completed surveys were returned by nine people who use the service, five staff and three relatives. The inspector used the Short Observation For Inspection tool(SOFI) which involves observing a small group of people, their interactions, activities and state of well being over a two hour period. The acting manager completed an assessment of the service (AQAA) which includes information on what has improved since the last inspection and plans for future improvements. Care Homes for Older People Page 5 of 29 The inspector used information from all of the above sources and their own observations to reach the judgements made throughout this report. What the care home does well: What has improved since the last inspection? What they could do better: Further work needs to be done to provide more person centred care planning. Care plans must include information for staff on how individual needs should be met and evidence of consultation with individuals or their representatives on the care plan needs to be available. More detail on the social and cultural needs and wishes of individuals would support staff in providing more individualised activities or day to day occupation. Further improvements should also be made in the daily recording. These records should include details of the physical, social and emotional support provided by staff. Where incidents of aggression have taken place staff need to record the form this aggression takes, any possible triggers, how they supported the person and the Care Homes for Older People Page 7 of 29 outcome. The acting manager should ensure that homely remedies are not administered unless approved by a GP. A review of how people who use the service are offered choices should be done particularly in relation to meals. The addition of more small tables and or stools to the lounge areas should be considered. In order to safeguard people using the service further checks on staff references need to be carried out. To assist staff and people who use the service staff should be provided with training on working with people who can become aggressive. Staff must be provided with information on the safe storage of food and must be reminded that where they find fridges are not cold enough they take action without delay. To ensure the safety of people who use the service, staff and visitors, fire drills must be carried out on a more regular basis to ensure that all staff including those who work at night are clear on what to do should the fire alarms be activated. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 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 9 of 29 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. People who use this service and their relatives are supported by staff through the admission and early stages of their stay. No one is admitted until an assessment of their individual needs is carried out. People are provided with information on what they can expect from the service. Improvements could be made through staff carrying out a more detailed pre admission assessment of needs and wishes. Evidence: People who use the service told us I like it here and this is a very nice place. All of the people who use the service who returned surveys told us they were given enough information to make a decision about moving in. Each person is provided with a welcome pack which gives general information on what they can expect from the service. One relative told us that staff were very supportive to them during the moving in and early stages of their relatives stay. Care Homes for Older People Page 10 of 29 Evidence: We looked at the records for one person who had recently moved into the service. These showed that pre admission assessments had been carried out by staff and copies of the care management assessments were available to staff. These assessments assist in ensuring that the service can meet the needs of the individual. Pre admission assessments also make sure that staff have some understanding of the individual needs of the person from day one of their stay. Staff need to take care to ensure that all the information gathered before admission is transferred to the care planning records. In one instance pre admission information included details of severe arthritis in one particular area however this was not clearly stated in the information available to staff. This service does not provide intermediate care. Care Homes for Older People Page 11 of 29 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. People who use the service are happy with the way staff deliver their care but decisions on how personal care is delivered is not consistently recorded. The management of medication is generally good and the health care needs of individuals are met. The recording of actions taken in relation to health care could be improved. Care planning does not provide good information for staff on how care and support should be provided. Care plans are not person centred or individualised. Daily recording could be improved to provide more detailed and clearer information. Evidence: We looked at a sample number of care plans and associated records including those for one person who was new to the service. The care plans provide information on the basic needs of individuals but do not provide clear information on how these needs will be met. At the time of the last inspection of the service a requirement was made for care planning to include information on how assessed needs will be met, what actions have been taken to meet needs, evidence of consultation and information on possible triggers for aggressive behaviour. This requirement will be restated in this report. Care Homes for Older People Page 12 of 29 Evidence: Staff have made progress in including some of the likes and dislikes of individuals but care planning is not person centred or individualised. The information available on individual personal history was brief. Daily recording by staff continues to focus on the physical care provided. This information does not provide detailed information on the support provided and gives little information on the emotional support or condition of the person. We observed one instance where staff were physically attacked by one person who uses the service. We found staff to lack confidence in dealing with this incident. The manager informed us that this was a rare occurrence. We saw in the daily recording staff had noted on a number of occasions that this person had been aggressive. However there was no further information as to what form this aggression took, any possible triggers, how staff supported the person through these episodes or what was found to be successful in assisting the person. Staff later informed us that they felt they could benefit from training on dealing with incidents like this. We discussed with the manager the need to include all information about the person and their care in the daily record including the outcome of hospital or GP visits, phone calls to relatives and appointments made on the persons behalf. We were told by the manager that a copy of the care plan is sent to the representatives of people who use the service for their comments on a regular basis. We found no record of this on any of the care plans seen. The manager informed us that the service was to receive support from the local authority through the care home support group to provide more person centred care planning. Records showed that people who use the service have good access to health care services. Health and medication reviews are carried out on a regular basis by GPs. Staff reported good links with community nurses, opticians and dental services. All of the people who use the service who completed surveys told us that they receive the medical care and support they need. We looked the records kept on medication and found that medication was well managed. Medication administration sheets were up to date and records are kept of all medication coming into the service and being returned to the pharmacy. Individual medication profiles are kept which show all the medication a person is or has taken during their time at the service. The profile also provides staff with information on what each medication is for along with possible side effects. Care Homes for Older People Page 13 of 29 Evidence: The service keeps a list of homely remedies which could be provided to people who use the service without prescription. We found this list had not been signed as approved by a GP. The manager told us that there had been some difficulty in getting a GP to sign the list. This medication should therefore not be administered by staff. We observed staff taking care to protect the privacy and dignity of individuals throughout these visits to the service. Staff were seen to offer support and advice in a discreet and caring manner. Care Homes for Older People Page 14 of 29 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. People who use this service are provided with opportunities to take part in a variety of activities. Staff understand the importance of including and communicating with everyone in the activity group. Staff have good communication skills which they adapt to the needs of individuals. Improvements in the care planning could lead to more personalised day to day occupation for individuals. People who use the service enjoy the food on offer. Improvements could be made in the way choices are offered particularly around meals. Staff are working on improving meal times to make these a more relaxed social event in the day. Visitors feel supported by and welcome by staff. Evidence: We observed staff providing a good variety of activities throughout the day in the main lounge. These included large floor games, singing, dancing, chair exercises and talking with individuals. Staff worked well to involve everyone, moving from one person to another using good communication techniques. People who use the service were seen to respond in a positive way to the staff attention with lots of laughter, smiling, chatting and touching. Staff continued to include one person who had been physically aggressive to wards them earlier in the day which showed that staff were comfortable Care Homes for Older People Page 15 of 29 Evidence: in including people who can be challenging in activities. Seven people who returned surveys said there were usually activities arranged which they could take part in and three people said there were always activities they could take part in. The information available in relation to social and cultural needs and wishes in the care planning was limited. Improvements in these areas could assist staff in providing more individualised activities. People who use the service told us that they enjoyed the food provided. We saw staff supplying drinks, biscuits and cake regularly through the day. The menu for lunch was written up on a board in the dining room. This information was not easy to read. The cook informed me that alternatives for the main meal include, sausages, tuna, jacket potato, salad, sandwiches, eggs and cheese. The way in which people offered choices at meal times could be improved with the use of a photographic menu and cooking and offering two options at the table. We saw staff standing while assisting people to eat. The manager reminded staff to sit down. At the time of the last inspection a recommendation was made to review mealtimes to provide more opportunities for people to help themselves and to make meal times more of a social event. The manager informed us that staff were working towards developing meal times. Care Homes for Older People Page 16 of 29 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. The complaints procedure is supplied to everyone living at the service and on display in the building. People who use the service and or their representatives understand how to make a complaint. The service understands the procedure for protecting people and staff are provided with training on safeguarding adults. Evidence: All of the people who use the service who returned surveys told us that they knew what to do if they wanted to make a complaint. The service has its own complaints procedure and we saw this was on display. Systems are in place to record any complaint along with a record of the actions taken to investigate and the outcomes. No complaints have been recorded. Surveys returned by relatives raised no complaints. Staff told us through surveys they knew what to do should they receive any complaint and staff we spoke to during visits to the service were well informed in this matter. Records show that staff have taken part in safeguarding training. This was confirmed by staff we spoke to during our visits. Staff are aware of their personal responsibility to report any suspicion or allegation of abuse. Care Homes for Older People Page 17 of 29 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. People who use this service are provided with a comfortable and homely environment. Staff work effectively to keep all areas clean and free from offensive odours. Additional tables or stools should be provided in lounge areas. Evidence: All of those people who use the service who returned surveys told us that the service was always fresh and clean. We observed staff taking care to make sure any spillages were cleaned up quickly and found all of the areas we saw to be clean and free from odour. At the time of our visit work was in progress to improve bathrooms around the building. The manager informed us that an annual refurbishment plan was in place which helps in ensuring that improvements are regularly made. A number of bedrooms have been redecorated and plans are in place to continue this work throughout the service. We saw that people who use the service are encouraged to bring in their own possessions which helps in personalising their bedrooms. Individuals told us that they liked their rooms and felt quite comfortable. Care Homes for Older People Page 18 of 29 Evidence: We observed that when drinks were given out in the lounge areas there were no tables available. Also when staff were supporting people to drink or eat snacks there were no suitable seats available for them to sit down with the person. Consideration should be given to purchasing small tables and or stools, which could be stacked away when not needed, so that staff can sit down with people and there is somewhere for people to rest their cups and plates. Risk assessments have been completed on the use of stair gates. Care Homes for Older People Page 19 of 29 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. People have confidence in the staff who support them. Staff have developed good relationships with people who use the service and their families or representatives. Good opportunities are available for further training which assists in improving the skills and knowledge of individual staff members. Further training on avoiding and dealing with behaviour that can be challenging would be of benefit to all of the staff group. People who use the service are protected through the checks carried out on staff before they start work. Further work needs to be done to confirm references which have not been sought directly by the service. Consideration should be give to gaining access to publications and journals on dementia care to keep up to date with training, conferences and good practise issues. Evidence: All of those people who use the service who returned surveys told us that staff listened to them and acted on what they said and that there were always staff around when they needed them. When we visited the service people told us that staff were lovely, kind and patient. We received no negative comments from people who use the service about the staff. Relatives told us through surveys and during our visits that staff were pleasant, patient, and understanding. One person described staff as a first class team and another said I have always found staff to be very helpful. Care Homes for Older People Page 20 of 29 Evidence: Staff told us through surveys and at the time of our visits that they were kept well informed of the changing needs of individuals and all felt they had good opportunities for training. We looked at the recruitment information for three staff, two of which were relatively new staff. Appropriate checks were seen to be carried out including Criminal Records Bureau Checks on all staff before they start work in the service. These checks assist in safeguarding the people who use the service. Two references were seen to be available for all staff. However in two instances these references were not sought directly by the service and were addressed to whom it may concern. The organisation should either find a way to confirm this is a genuine reference or seek references from other people who know the person concerned. Records showed and staff confirmed that there were good opportunities for training. Staff felt they were provided with a good induction when they first started at the service. This was reflected in the training record and on the staff rota where new staff were seen to be supernumerary for their induction training. We saw that some staff have only completed a one day training course in dementia care. Other staff we spoke to during our visit were in the process of completing a more lengthy and detailed distance learning course in dementia care. The manager informed us that consideration was being given to senior staff being provided with more advanced levels of dementia care training. This would assist in providing support and guidance for staff and ensuring that the service provides appropriate support for people living with dementia. Consideration should be given to accessing publications on dementia care to provide up to date information on good practise. We observed staff communicating and working in a very positive way with the people who use the service. Staff were seen to be patient, encouraging and sensitive to the needs of individuals. We did observe staff dealing with a difficult situation on one visit. This observation along with discussions with staff indicated that further training on working with people who can become aggressive would be of benefit to the whole staff group. Staff told us they felt well supported by the manager and felt their work was well organised. Care Homes for Older People Page 21 of 29 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. People who use the service and their representatives are consulted on the way the service operates. Staff are well supported in their role by the management team. Regular checks are carried out to protect the health and safety of people who use the service, staff and visitors. Further work needs to be done to ensure that all of the checks required are carried out on a regular basis and that action is taken should any faults be noted. More frequent fire drills should be carried out to give people the opportunity to practise. Evidence: The service has had an acting manager for some time. The manager informed us that she had now applied for registration with the Commission. Staff said they felt well supported by the manager and people who use the service told us that the manager is very kind and a nice person. Care Homes for Older People Page 22 of 29 Evidence: People who use the service are consulted through regular meetings where they can raise any issues. We looked at the record of the last meeting which was held in November of this year. We noted that information on the actions taken to address any issues raised was now being recorded. The organisation also carries out their own survey of people who use the service on a regular basis. This assists with ensuring the quality of care is maintained and ensuring that the views of people who use the service are sought and taken into consideration. The manager informed us that an annual development plan for the service was not yet available. Relatives meetings are arranged together with the other service on the site. Staff do not hold any cash for individuals who use the service. Any money spent on their behalf is taken from the homes petty cash and an invoice will be raised by the head office. Staff carry out regular health and safety checks. We looked at a sample of the records for these checks. Weekly tests are carried out on the fire alarm system and regular professionals maintenance visits are logged. We noted that the last recorded fire drill was carried out in January 2007. The manager should ensure that regular unannounced fire drills are done. This will make sure that all staff are given the opportunity to practise the actions to be taken and will allow staff to assess how individuals they support might react should there be a fire. Since the last inspection of the service new fridges have been supplied. However the temperature records showed fridges still to be operating at too high a temperature. The manager felt that the thermometers being used may be faulty. The manager must make sure that staff know the safe temperature for the storage of food. Staff must report any instances where food appears to be being stored above safe levels. Staff should note on the temperature records when they have reported faults. The temperature of hot water supplied through the building had not been checked since October 2008. The manager informed us that the member of staff who was responsible for these checks was currently not working at the service. This task needs to be reallocated to another member of staff to ensure the safety of people who use the service. We saw that staff are keeping a record of the temperature of the water before they support anyone into a bath. This assists in protecting individuals from accidental scalding. Care Homes for Older People Page 23 of 29 Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 In order to make sure that 17/04/2009 the needs of individuals are met care plans must include:- How assessed needs will be met. What actions have been taken to meet needs. Evidence of consultation with people who use the service and or their representatives. Information on possible triggers for aggressive behaviour. Care Homes for Older People Page 25 of 29 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 29 19 Where the service has received references they have not sought directly further checks must be made to confirm the accuracy of these references. To safeguard people using the service. 27/02/2009 2 30 18 Staff need to be provided 27/03/2009 with training on working with people who may display challenging behaviour. To meet the needs of and protect people who use the service. 3 38 13 Staff must be provided with information on the safe storage temperatures for food. A record of actions taken should these temperatures be exceeded must be in place. 20/02/2009 Care Homes for Older People Page 26 of 29 To ensure the health and safety of people who use the service. 4 38 23 Regular fire drills must be carried out and recorded. To ensure the health and safety of people who use the service, staff and visitors. 20/02/2009 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 7 To ensure that assessments of need and reviews of the way support is provided can be carried out, daily records should be more detailed and include the social and emotional needs and support provided as well as the physical support. Clear, detailed information should be recorded on any episodes of aggression along with any possible triggers, the support provided and outcomes. To make sure that information is easily available and actions are followed through staff should include in the daily notes details and outcomes of any health care appointments or visits. Homely remedies should not be administered unless approved by a GP. In order to offer a more personalised activities and occupational programme more detailed information on the social and cultural needs and wishes of individuals should be sought during assessments and following admission to be included in care planning. To provide people who use the service with more opportunities to make informed choices a review of how people are offered choice particularly around meals times should be done. Staff should continue to review how meals are served, how support with food is given, aids for eating and drinking, promoting independence and how meal times could be made more enjoyable. Consideration should be given to providing small tables or stools in lounge areas so that people who use the service Page 27 of 29 2 7 3 8 4 5 9 12 6 15 7 15 8 20 Care Homes for Older People have space to rest cups and plates and staff have easy access to seating. 9 30 Consideration should be given to accessing publications and journals in dementia care to provide information on training and keep up to date with good practise. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!