CARE HOMES FOR OLDER PEOPLE
Atherton Lodge Nursing Home 202 Pooltown Road Ellesmere Port South Wirral CH65 7ED Lead Inspector
Wendy Smith Unannounced Inspection 22nd May 2007 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Atherton Lodge Nursing Home Address 202 Pooltown Road Ellesmere Port South Wirral CH65 7ED Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 3554089 0151 3560141 Par Nursing Homes Limited Mrs Sue Maudsley Care Home 49 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (40) of places Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for a maximum of 49 service users to include: * Up to 40 service users in the category of OP (old age not falling within any other category * Up to 9 service users in the category of DE(E) (Dementia over the age of 65 years) Date of last inspection 4th January 2007 Brief Description of the Service: Atherton Lodge is a two-storey detached property that has been converted and extended into a care home with nursing for 49 older people. It is situated within a mile of Ellesmere Port town centre and is close to local shops and amenities. There are attractive gardens with access for residents and ample parking space. The home’s fees are from £343.34 to £417 per week. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit took place on 22nd May 2007 over six and a half hours. The two regulatory inspectors were Wendy Smith and Paul Ramsden There were 38 residents living at the home, all older people. Nine people were accommodated in the dementia care unit and 29 in the main part of the home. A tour of the building, including all communal areas and most bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the proprietor, the home manager and assistant manager, residents, staff and two visitors. Some of the information contained in this report is taken from the preinspection questionnaire that was completed by the manager. Comments cards were provided for residents, visitors and visiting professionals. Seven questionnaires were completed by visitors and two by GPs who visit the home regularly. These contained many very positive comments and a small number of negative comments. What the service does well:
People interested in coming to live at Atherton Lodge have an assessment to ensure that the home will suit their needs. Some very positive comments were received from relatives including: I would like to commend all the staff including the domestic staff who always find time to talk to the patients if they are walking around: There is great communication between staff (always pleasant) and relatives: Most staff have a good rapport with the residents and recognise their specific personalities and needs: A very happy home, relaxed and friendly with approachable staff. The staff working on the dementia care unit had a positive attitude towards the residents and engaged well with them. Continuity of care is provided for the residents by a number of very experienced care staff who have worked at Atherton Lodge for a long time and have achieved a national vocational qualification in care. The manager and deputy have both been in post for more than ten years and the home owner visits regularly and is involved in the day to day running of the home. Records showed that all plant and equipment in the home is serviced and maintained in good condition. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Make sure that the pre-admission assessment is documented in detail so that staff can be aware of the needs of new residents. The care plans should better reflect all of the residents’ needs and preferences including their social, emotional and spiritual needs, and their likes and dislikes for example in food and drink. Some of the beds and the bedrails are very old and are no longer fit for purpose. These need to be replaced without delay to ensure that all residents have the right kind of bed to meet their needs and that the bedrails are safe for use. Some bedrails were not fitted correctly leaving a gap between the head of the bed and the top of the rail. This presents a risk of the person’s head getting trapped. The temperature of the drug storage room was a lot higher than that recommended on the medicine labels. This may affect the quality of the residents’ medicines. Ensure that when printed instructions are not provided with medicines that staff handwrite all the details from the medicine label onto the record sheet, these should be checked by a second person and both sign the record. This is so that staff have clear instructions how to give residents’ medicines. The complaints folder should give a full picture of any complaints that have been made and should show how the complaint was investigated and what the outcome was. This will show that complaints are taken seriously and addressed in full. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 7 Arrange for new staff who have not had training about adult protection to receive this training so that they are aware of how residents should be protected from abuse. There were a number of parts of the home that had an unpleasant smell of urine. The cause of the smells should be investigated, for example in one bedroom it was from a duvet, and addressed. Some windows do not have window restrictors fitted and could be a risk to residents. Paper towel dispensers should be fitted close to all basins where staff wash their hands to ensure that correct procedures can be followed for the prevention of the spread of infection. All staff working in the home must have a Criminal Records Bureau disclosure to ensure that they are suitable and safe to work with vulnerable people. Provide further training for staff working with residents who have dementia to give them more in-depth knowledge about dealing with challenging behaviour. Whilst there have been significant improvements over the last eight months, a number of issues identified at previous visits, some of which relate to the health and safety of residents, have not been addressed in full. There needs to be a detailed development plan to identify areas needing improvement and how this will be achieved. This plan should be drawn up in consultation with staff, residents, relatives and other stakeholders, and with regard to current best practice guidance for the care of people with dementia. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People interested in coming to live at Atherton Lodge are assessed by a senior member of staff to ensure that their needs can be met in full. EVIDENCE: Evidence from looking at care plans and speaking with the manager showed that people are assessed before their admission to the home is agreed in order to determine whether their needs can be met in full. This assessment is not always documented in any detail, which means that staff do not have written information about all the needs of a new resident. Information about the home is provided in a brochure in each bedroom. Atherton Lodge does not provide intermediate care. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met to their satisfaction. The management of residents’ medicines has improved to ensure that they always receive their prescribed drugs. EVIDENCE: A sample of care plans was looked at. Since the last inspection the care plans have all been reviewed by the manager and the assistant manager and a system had been introduced to ensure that the information about residents is kept up to date. Good daily comments were written by the care staff. There were some examples where information had been written in the care plan but was not followed up. For example, the bowel charts for two residents showed long gaps of nine and ten days without any bowel movement but this had not been identified as a problem. Another care plan had an entry that showed a resident had lost 20 kg in weight over a month. On investigation it was clear that the entry was incorrect, but it was of concern that no-one had
Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 11 noticed it. In another care plan the key worker wrote that the resident had ‘really red and sore eyes’ but this was not mentioned anywhere else in the care plan to show that anything had been done about it. The way that the care plans are written and presented is based on a ‘medical model’, and this makes it difficult for the care plans to be written so that they show a holistic picture of the residents’ needs. There were no social assessments and no record of residents’ personal preferences in areas such as what they like to eat and drink or what they like to wear. This is very important for those residents whose needs are due to dementia rather than physical frailty. Several care plans identified that the resident ‘requires assistance with all activities of daily living’, which is a very generalised statement and does not really mean anything in terms of the individual. There were no residents with a pressure sore and this shows that good care is being given to frail residents who spend a lot of time in bed. The care plans recorded visits by the continence advisor and other medical professionals. Two GPs who visit the home regularly completed Commission for Social Care Inspection comments cards. Their replies were all positive including the comment: Very good home. I have every confidence in the staff and their care of the residents. Relatives who completed comments cards were mainly happy with the care provided. One relative said that he pointed out to staff that his wife’s hair needed cutting and this had been done by next day. Two people commented on good communication between staff and relatives. One relative considered that basic care, i.e. personal appearance, is not always to the desired standard. She had visited and found her father unshaven, with food debris on his face and untidily dressed. She commented that: The situation appears to be dependant on which member of staff delivers the care. Some are EXCELLENT but others are lacking. In general the management of medicines had improved and the records showed that residents always receive their medicines as prescribed. There is a new medicines storeroom that is more spacious, however the temperature of the drug storage room was a lot higher than that recommended on the medicine labels. This may affect the quality of the residents’ medicines. The temperature was not being monitored. When medicines had been brought into the home without a printed medicine administration record sheet, the nurses did not always handwrite the full details of the medicine, how and when it should be given, what quantity had been received, and the entries were not always signed or dated. There were good records of controlled drug administration. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives expressed satisfaction with the arrangements for daily living. EVIDENCE: On the dementia care unit at least one member of staff spends most of their time in the lounge with the residents and residents are engaged in social activities and interactions throughout the day. It was pleasing to see carers spending more time in the main lounges with the residents and this should be continued when occupancy increases. One relative commented that: There is nothing more to do that would improve the quality of life and care that my mother receives, and another relative wrote: I would like to commend all the staff including the domestic staff who always find time to talk to the patients if they are walking around. Visitors considered that they were always made welcome, and one person described Atherton Lodge as: A very happy home, relaxed and friendly with approachable staff.
Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 13 Residents spoken with were satisfied with the meals that they receive. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by a clearly explained complaints procedure and most staff have received training to make them aware of how vulnerable people should be protected from abuse. EVIDENCE: Information provided in the bedrooms for residents and their visitors contains a very clearly written complaints procedure. A record is kept of any complaints received, but the records looked at did not detail the full sequence of events from start to finish including what action had been taken to address the complaint. A relative commented that: They have always acted on any concern we have raised. There have been two adult protection referrals since the last Commission for Social Care Inspection but neither of these found any abuse of residents had taken place. Most of the staff members have received training about adult protection but the newer members of staff have not. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment, and some of the equipment provided, need to be improved to provide a safer, more pleasant and comfortable place for people to live in. EVIDENCE: There has been considerable investment in the environment over recent months and the overall standard of accommodation has been improved for all residents. The gardens and outdoor areas were tidy and well-maintained. A tour of the building showed that there were still issues needing to be addressed to provide a better environment for the residents. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 16 There were a number of areas that smelled unpleasantly of urine. In one bedroom the smell came from a duvet that had a clean cover on. A vacant bedroom had an unpleasant odour, a stained carpet, and there was a pair of slippers and stockings under the bed. There are some old tatty chairs in the bedrooms and they are not comfortable to sit in. The assistant manager said that the better chairs had been put into the lounges. There were also a lot of very poor lumpy pillows. Two bedrooms had badly fitted and damaged carpets. There were bins without lids in a bathroom. There were boxes of stockings and tights in bathrooms, which should not be shared between residents. Some wheelchairs were being used without footrests. There are a number of old hospital type beds and only one modern nursing bed. Two of these old beds have bedrails that are unsafe and should be taken out of use. Some bedrails were fitted too far from the head of the bed presenting a risk of the head/neck being trapped. This was explained to the maintenance person who took immediate action. He explained that he checks the beds and bedrails regularly and said that some needed frequent attention to keep them safe. Paper towel holders need to be fitted in all sluices and by other communal wash basins so that staff can maintain good hand hygiene to prevent the spread of infection. The windows in some of the new bedrooms are not fitted with window restrictors and this is a potential risk to residents. The maintenance person has been carrying out, and recording, regular radiator temperature checks and making adjustments as needed. He said that he would like to fit radiator covers. The chemical store room was not locked. One relative considered that the personal laundry service was poor and that clothes were not ironed. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Enough qualified and experienced staff are on duty at all times to meet the needs of the residents, however there remains a need for further training to develop staff expertise in caring for people with dementia. EVIDENCE: The home employs eleven nurses, 26 care assistants and eleven ancillary staff. On the morning shift there are three, sometimes four, nurses and six care assistants. In the afternoon and evening there are two nurses on duty with seven care assistants. At night there is one, sometimes two, nurses with care assistants making the total up to five. Agency staff members are used to cover any shortfalls and the manager said that she has found a good agency that sends the same staff who have got to know the residents. One relative commented that: They are very helpful. They are very caring and kind. Eleven of the care assistants have a national vocational qualification level 2 in care and some have achieved level 3. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 18 A sample of staff records was looked at. The last two new members of staff each had a Criminal Records Bureau disclosure and both had two good references. There were no Criminal Records Bureau disclosures for the ancillary staff and these must be applied for. For one of the nurses and one of the care staff, the Criminal Records Bureau disclosure was from another employer. An application must be made for new disclosures for Atherton Lodge. Since the last inspection there has been no progress in providing more indepth dementia care training for staff. On a notice-board in the main corridor there were two advertisements for training events about dementia being held by the Primary Care Trust at a very reasonable cost, but no places had been booked for Atherton Lodge staff. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some improvements to the running of the home, but there needs to be a clear plan of how the service will develop to ensure that the changing needs of residents can be met in full. EVIDENCE: The manager and deputy have both worked at the home for over ten years. They have built a good staff team and have good relationships with both professional visitors and residents’ relatives. They have worked together to improve the care plans and the medicines through monitoring and auditing. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 20 Whilst there have been significant improvements over the last eight months, a number of issues identified at previous visits, some of which relate to the health and safety of residents, have not been addressed in full. The home owner discussed her intention to increase the number of places provided for people with dementia but there was no clear plan in place for this. There needs to be a detailed development plan to identify areas needing improvement and how this will be achieved. This plan should be drawn up in consultation with staff, residents, relatives and other stakeholders, and with regard to current best practice guidance for the care of people with dementia. There are satisfactory arrangements for residents to be able to keep small amounts of personal spending money in safekeeping. Information provided by the manager showed that equipment is regularly tested and maintained as required. The maintenance person has considerable experience in a health and safety role and can provide training for staff in fire safety and other health and safety subjects. Regular fire drills have been reinstated. Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 13(4)(c) Timescale for action Beds and bedrails that are no 30/06/07 longer fit for purpose need to be replaced without delay to ensure that all residents have the right kind of bed to meet their needs and that the bedrails are safe for use. Bedrails must fit correctly with no more than 4” gap between the head of the bed and the top of the rail to eliminate the risk of a resident’s head getting trapped. Timescale of 30/12/05, 30/09/06 and 31/01/07 not met in full. Ensure that when printed 29/05/07 instructions are not provided with medicines that staff handwrite all the details from the medicine label onto the record sheet, these should be checked by a second person and both sign the record. This is so that staff have clear instructions how to give residents’ medicines. Fit window restrictors to any 30/06/07 windows where there is a risk to residents. Timescale of 28/02/07 not met
DS0000018711.V333371.R01.S.doc Version 5.2 Page 23 Requirement 2 OP9 13(2) 3 OP38 13(4)(c) Atherton Lodge Nursing Home 4 OP29 19 Criminal Records Bureau 29/05/07 disclosures for all staff working in the home must be applied for to ensure that they suitable and safe to work with vulnerable people. Timescale of 11/01/07 not met 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 Refer to Standard OP3 Good Practice Recommendations Make sure that the pre-admission assessment is documented in detail so that staff can be aware of the needs of new residents. The care plans should better reflect all of the residents’ needs and preferences including their social, emotional and spiritual needs, and their likes and dislikes for example in food and drink. The temperature of the drug storage room was a lot higher than that recommended on the medicine labels. This may affect the quality of the residents’ medicines. The complaints folder should give a full picture of any complaints that have been made and should show how the complaint was investigated and what the outcome was. This will show that complaints are taken seriously and addressed in full. Arrange for new staff who have not had training about adult protection to receive this training so that they are aware of how residents should be protected from abuse. There were a number of parts of the home that had an unpleasant smell of urine. The cause of the smells should be investigated and measures taken to deal with them. 2 OP7 3 OP9 4 OP16 5 OP18 6 OP26 Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 24 7 OP26 Paper towel dispensers should be fitted close to all basins where staff wash their hands to ensure that correct procedures can be followed for the prevention of the spread of infection. Provide further training for staff working with residents who have dementia to give them more in-depth knowledge about dealing with challenging behaviour. There needs to be a detailed development plan to identify areas needing improvement and how this will be achieved. This plan should be drawn up in consultation with staff, residents, relatives and other stakeholders, and with regard to current best practice guidance for the care of people with dementia. 8 OP30 9 OP33 Atherton Lodge Nursing Home DS0000018711.V333371.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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