Inspection on 29/07/05 for Apple Court Care Home

This inspection was carried out on 29th July 2005.

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

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

Other inspections for this house

Apple Court Care Home 03/10/06

Apple Court Care Home 25/04/06

Apple Court Care Home 22/12/05

Apple Court Care Home 16/12/04

Apple Court Care Home 21/05/04

Apple Court Care Home 13/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE APPLE COURT NURSING HOME 76 Church Street Warrington Cheshire WA1 2TH Lead Inspector Anthony Cliffe Announced 29 July and 16 August 2005 09:00 th th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Apple Court Nursing Home Address 76 Church Street Warrington Cheshire WA1 2TH 01925 240245 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hallmark Healtcare (Warrington) Ltd Mr Ian Smallwood Care Home 67 Category(ies) of DE(E) Dementia over 65 (67) registration, with number MD(E) Mental Disorder over 65 (1) of places APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 67 service users to include: * Up to 67 service users in the category of DE(E) (dementia over the age of 65). * 2 Up to 1 named service user may be MD(E) (mental disorder over the age of 65. Staffing must be provided tomeet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commision for Social Care Inspection. The registered provider, must at all times, employ a suitably qualified and experienced manager who is registered with the Commissiion for Social Care Inspection. The registered manager has a qualification at level 4 NVQ in management and care or equivalent by 1st April 2005. 3 4 Date of last inspection 16th December 2004 Brief Description of the Service: Apple Court is a 67-bedded care home providing nursing and personal care to older people diagnosed with dementia and is operated by Hallmark Healthcare. The home is located in Warrington town centre and is on a main bus route and close to all local amenities and facilities.The home is a purpose built two-storey building. Each floor has two living areas that have been combined to provide one larger living group and facilitate the support of a larger group of staff, with a minimum of two registered nurses on duty at any one time.Each floor has two lounges, two dining rooms and recreational areas. Each resident has their own single bedroom with en-suite facilities. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken by two regulatory and one pharmacy inspectors due to the number of registered beds. The inspection was postponed from July 7th 2005 at the request of the registered manager. The inspection took place over ten hours as feedback was given on 16th August 2005. It included inspection of records, observation of staff practice and discussion with residents, relatives and staff. Feedback was given to the manager and deputy manager on the 16th August. One requirement remains outstanding from previous inspection visit. An additional visit was undertaken on 30th August by a regulatory and pharmacy inspector to monitor the medicine management and administration. Some improvements were noted but complete compliance with the immediate requirement was not achieved. A further monitoring visit will be carried out. What the service does well: Provides a safe and well-maintained environment for residents and is well equipped to meet their needs. Residents’ health needs are generally met to a good standard. This is supported by detailed pre admission assessments. Residents are helped and encouraged to maintain contact with friends and family and visitors are welcome at any reasonable time. The staff are friendly and approachable. Care is of a good standard and relatives’ comments support this. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 The admissions criterion at Apple Court needs to reflect that residents with severe challenging behaviour are not accepted. This must be detailed in the statement of purpose. Residents’ needs were assessed prior to moving into the home to ensure their needs could be met. EVIDENCE: The manager and deputy manager discussed the number of referrals for residents presenting with high levels of unpredictable aggressive, challenging behaviour. The manager stated that Apple Court does not accommodate residents with severe aggressive challenging behaviour and that residents accommodated may present with unpredictable challenging behaviour resulting from severe cognitive impairment. The statement of purpose however did not support this therefore both the admissions criteria and statement of purpose need to verify this. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 9 Care documents were examined for a number of residents showed that the people most recently moved into Apple Court had pre-admission assessment documentation completed. Pre admission documents were not all signed and dated by the person that completed them. The pre admission document is very detailed; from this a care plan can be developed. The pre admission assessments were supported by assessments and care plans from care managers and NHS facilities. Intermediate care facilities are not provided and this standard is not applicable. See recommendations 1 and 2. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Residents’ plans do not ensure that health and social care needs are identified and met. Apple Court did not meet the minimum standard for managing its medicines. The procedures for managing medication places residents’ health at risk from not receiving prescribed medication. Residents are not treated with dignity and respect EVIDENCE: The care plans of several residents were examined. All plans had a wide range of assessment documents fully completed, with a care plan to address residents’ identified needs. From looking at care plans, and talking with residents, the health needs of residents were generally met. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 11 Residents’ care plans recorded that the dietician was contacted, for advice on the diet of a resident who had lost weight. One resident identified at risk of falling, had a moving and handling assessment completed, together with a falls risk assessment. The resident was immobile on admission and was now walking unaided which demonstrated improvements in his health. He was taking medication and attending to his needs with assistance. There was reference to the resident presenting with physical aggression prior to and on admission. The resident had been reviewed and the aggressive behaviour calmed. The resident had settled into the home environment and had been supported to deal with his anger. The resident said’ I prefer to be at home, but this is a quiet place and helps to calm my anger’. The information regarding the resident’s move into the home was not available to confirm that reviews of his health had taken place or give details of the aggressive behaviour. Care plans showed that people’s social preferences, routines and wishes were recorded but not transferred to the social care plan. Care plans were more person centred and advised staff on the care of residents. Care plans detailed how improvements in promoting independence could be made by using diversion and distraction techniques to deal with aggressive behaviour. Two residents were identified as presenting with aggressive and challenging behaviour. One resident was identified on pre admission as mistaking other female residents as his wife and attempting to pull them out of armchairs. This information had not been transferred into his care plan. Fortunately no incidents of this behaviour had been recorded. Another resident presented with aggressive behaviour to both staff and residents and had attempted to assault them. The records for the resident referred to the use of restraint. Staff said the resident was occasionally violent. The nurse in charge clarified this by saying ‘ staff have to intervene from time to time to ensure his safety and the safety of others. When two staff approach he backs down, we take him by his hands and take him to his bedroom. This strategy is not recorded in the care plan nor has there been an analysis of behaviour to verify this is the appropriate way to manage the behaviour. Apple Court is organised in four separate units, two on each floor. The management of medicines on the two ground floor units, Crossfields and Rylands, was satisfactory. The management of medication on the first floor units Grosvenor and Daresbury was a poorer standard and some findings were of serious concern as follows; APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 12 • • • • Medicine records showed that some residents were not having their medicines according to the prescribed directions. Unacceptably high incidence of residents missing doses of essential prescribed medicines because they had not been obtained in time. A number of incidents showed residents recorded as having prescribed medicines when the doses had not been removed from the blister pack. This was of particular concern on Daresbury Unit where a nurse had signed for giving the teatime doses on 28th July 2005 yet every resident who had doses in the teatime blister pack had not been given their medicines, all the doses for Thursday teatime had not been removed from the pack. There were some examples of nurses not obtaining alternatives when medicines were not available. An immediate requirement was made at the inspection. During the inspection relatives alleged that a qualified staff member was abrupt and shouted at residents and had told their relative to shut up. It was also alleged they witnessed the staff member pushing a resident out of the way. The matter was referred by the manager to Warrington Social services. See requirements 1 to 3 and recommendations 3 to 5. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15. Residents are supported in making choices in their lifestyle and in meeting their social needs, but the choice of social preferences needs to improve. Families and friends are welcomed into the home at any reasonable time. Residents have a choice of meals in pleasing surroundings but choice and presentation of meals needs to improve. EVIDENCE: Residents’ social preferences were recorded but not always transferred into their care plans. A relative said her husband enjoyed military brass bands but this information was not recorded. Staff said that musical tapes could be obtained from the activities organiser. Visitors expressed concern that on a number of occasions residents were left unsupervised in the lounge areas while staff are either in the office or outside. They said ‘the existing staff group are great but there are no activities on, and they sit there doing nothing’. There were no organised activities observed at the time of the inspection. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 14 A relative said that she was initially reluctant to visit her husband when he first moved into the home, as she did not wish to unsettle him. Staff however had encouraged her to visit and she now visits regularly. She said that her husband’s move into Apple Court had been very positive for both of them and praised staff for their care. Other visitors said they were made to feel welcome and the environment was odour free. Another visitor said ‘ he has settled in well and staff are doing all they can to help him and me. I visit regularly and he is always clean and tidy and cleanly shaved. He likes to look smart and staff makes sure he is. I think they do a good job in looking after him. When I visit I am always welcome, the staff offer me a drink of tea as well. We sit in his bedroom and have a drink and he can do as he pleases’. Another visitor said ‘I like coming here it’s welcoming and friendly’. A resident who had insight into his mental health needs said he would have preferred to live at home but realised he could no longer care for himself. A visitor said ‘my wife doesn’t communicate but staff keep me informed on how she is. I know they help her to walk regularly each day to keep her mobile. They encourage me to take her home once a week to keep her motivated. She is well cared for and the care staff are great’. Meals were served in the dining rooms and a choice was offered. Staff chose some of the meals for residents, dependent upon the resident’s ability to eat their meal or if the resident was agitated and did not settle. Many meals were served in bowls, with residents using a spoon. The meal was fish, mashed potatoes and vegetables. The portions were blended and served separately, but on top of one another. This was effectively mashed together. The alternative offered to residents was a variety of sandwiches. A visitor said that there was little meal choice. The visitor said ’ food is ok, basic not offered a choice of meal other than sandwiches’. See recommendations 6 and 7. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints are not acted on appropriately. Residents are not adequately protected from abuse. Managers at the home need to understand the relationship between the local authority adult protection procedures and complaints. The management of physical intervention is unclear and staff are unsure what constitutes restraint therefore both residents and staff are at risk of being harmed. EVIDENCE: Prior to the inspection the Commission received a complaint about the care of a resident. The manager agreed that the records of this resident could be taken for further investigation. Three complaints were recorded since the previous inspection visit. One had not been completed and another did not contain the outcome of the complaint investigation. A third complaint regarding the conduct of a staff member in the home was investigated by the deputy manager and could not be upheld. This complaint from Warrington Borough Council should have been referred back to them under the adult protection procedures for investigation and not investigated by Apple Court. During the inspection, relatives made complaint allegations that a qualified staff member was abrupt and shouted at residents and had told their relative to shut up. It was also alleged they witnessed the staff member pushing a resident out of the way. These matters were referred by the manager to Warrington Social services. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 16 A resident presented with aggressive behaviour to both staff and residents and had attempted to assault them. The resident’s records referred to the use of restraint. Staff said the resident was occasionally violent. The nurse in charge clarified this by saying ‘ staff have to intervene from time to time to ensure his safety and the safety of others. When two staff approach he backs down, we take him by his hands and take him to his bedroom. This strategy is not clear or recorded in the care plan nor has there been an analysis of behaviour to verify if physical intervention or other strategies are appropriate to manage this behaviour. See requirement 4 and recommendation 5 and 8. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Residents live in a safe and well-maintained home, which is clean and hygienic. There is a commitment to improving the standard of accommodation for the benefit of residents. EVIDENCE: All communal areas and some bedrooms were seen. The interior and exterior of the building was well maintained. The home was free from odours. Staff in the laundry were aware of the Control of Substances Hazardous to Health guidance on the use of cleaning products. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The numbers and skill mix of staff are adequate to meet residents’ needs. The English language skills of some staff however needs to improve to show they can meet residents’ needs EVIDENCE: Two visiting families raised concern about the employment of overseas staff. A visitor said ‘staff do not speak fluent English which confuses the residents’. Another visitor expressed confidence in the staff and said they were aware of Her mother’s needs ‘but there are times when a lot of unfamiliar staff is on duty, some with broken English. They don’t know her needs and they are difficult to understand. There is no concern about the care it’s just they do not give you confidence that they know her needs’. A staff member employed at the home form Europe was interviewed and had excellent English. She works as a senior carer. The staff member said `I enjoy my work, I have had lots of training on fire, moving and handling, adult abuse and dementia care. I am supervised by the nursing staff and I supervise junior staff. I have a monthly one to one when I sit down and talk about how I do my Job, what training I need and how I can improve. They are a good team and we work well together’. See recommendation 9. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 There is no clear management, leadership and guidance in the home to ensure residents receive consistent quality care. The ethos of Apple Court is not clear. This results in some practices that do not promote and safeguard the health and safety of people living there. EVIDENCE: At the beginning of the inspection the manager clarified that since March 2005 he had been acting as the Regional Manager working fifty hours a week of which twenty hours were at Apple court. The deputy manager was appointed as the acting manager in his absence. The Commission for Social care Inspection was unaware of these arrangements and had not agreed to them. The manager confirmed that the duties of the Regional Manager were covering a geographical area from Cheshire to Walsall in the West Midlands and Wrexham in North Wales. At the feedback session on 16th August the manager stated that ‘when we were asked to accommodate the management arrangement we went into it blind, Leslie did not have a management induction as such but I was here to supervise her’. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 20 The manager confirmed at feedback that the deputy manager had not received supervision on how to investigate complaints. The manager stated that on reinvestigating a complaint regarding a staff member he ‘now believed them to be true’. This complaint was initially investigated by the deputy manager and not substantiated. Qualified staff interviewed stated they had not received management or clinical supervision for over a year. The manager stated that Apple Court does not accommodate residents with aggressive and challenging behaviour, yet care plans referred to residents with such histories. Staff on one unit were using physical intervention to manage a resident’s aggressive behaviour and recorded the use of restraint. This was not recorded as part of the management plan of this behaviour. Serious concerns about the management and administration of medication have been identified and an immediate requirement made. Serious allegations about the conduct of a staff member were made and passed to the manager to refer to the local authority under the adult protection procedures. Two requirements regarding the testing of the emergency lighting and fire alarm system and maintenance of the gas system in the home had been completed. See requirement 5. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 1 x x x x x x x APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 23 STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 29.7.05 2. OP7 3. OP10 4. OP16 5. OP31 The registered person must ensure that medicines are given and recorded reliably, safely and appropriately. 14 and 15 The registered person must ensure that records that identify service user needs and staff responsibilities in meeting their health and welfare are kept under review, including appropriate risk assessments and risk management strategies for dealing with challenging behaviour. 18(1)(i) The registered person must ensure that residents are treated with dignity and respect at all times and staff must be provided with suitable training on how to communicate with residents diagnosed with dementia. 17(2) The registered person must Schedule ensure there is a complaints (4)(11) procedure, which is appropriate and to the needs of residents, Regualtion ensures that all complaints are 22 fully investigated, and informs the person making the complaint of the outcome and action, if any to be taken. 12, The registered person must 13(6)(7) ensure that the care home is conducted to make proper provision for the health and welfare of residents including protection from abuse and inappropriate use of restraint. F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc 22.11.05 1.12.05 22.11.05 22.11.05 APPLE COURT NURSING HOME Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP1 OP3 OP7 OP7 OP7 OP12 OP15 OP18 OP27 Good Practice Recommendations The statement of purpose and admissions criteria should be amended to calrify the home does not accomodate residents who present with challenging behaviour. Staff completing pre admission assessment should sign and date when and where the assessment was completed. Details of previous care plans and reviews of care should be available to inform staff of residents previous health and welfare and changes in condition. Details of residents social preferences should be recorded in their care plans. The policy on the use of physical intervention should be clear. There should be a greater variety and choice of social activities and more oportunities for residents to engage in them. Meals should be presented in an appealing style and a greater variety of meal choices available to residents. The manager and senior staff should attend training on the local authority adult protection procedures to be clear on the locally agreed protocol. The registered person should ensure that staff can communicate with and be understood by residents and provided staff with suitable training on how to communicate with residents diagnosed with dementia. APPLE COURT NURSING HOME F51 F01 S46209 Apple Court V227649 070705 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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