Inspection on 20/06/05 for Bewick Lodge

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Bewick Lodge 11/03/08

Bewick Lodge 15/01/07

Bewick Lodge 15/05/06

Bewick Lodge 04/01/06

Bewick Lodge 12/10/04

Bewick Lodge 15/06/04

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

CARE HOMES FOR OLDER PEOPLE Bewick Lodge Waverly Crescent Lemington Newcastle Tyne NE15 8AN Lead Inspector Irene Bowater Announced 20 June 2005 09:30 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. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bewick Lodge Address Waverly Crescent Lemington Newcastle upon Tyne NE5 8AN 0191 264 7267 0191 264 7296 bewick@fshc.co.uk Bewick Waverly Ltd 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) Vacant CRH 45 Category(ies) of DE(E) Dementia - over 65 (45) registration, with number of places Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th October 2004 Brief Description of the Service: Bewick Lodge is a 45 bedded care home with nursing providing care for older people with enduring mental health problems. The home is purpose built and is physically attached to another home on the same site The home is set in large landscaped gardens,close to local amenities and has good local transport links. The home has 45 single bedrooms 18 of which have en-suite facilities. There are two floors with lounges and dining rooms on each floor. There are sufficient bathing and toilet facilities in all areas. The first floor is accessed by stairs and a passenger lift. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place over seven and a half hours. This was the new managers first inspection since coming into post. Comment cards were sent out prior to the inspection for residents, other professionals and residents representatives to complete. Only six comment cards were returned to the Commission. All of these commented positively on the care and services provided. The home was required to complete a pre inspection questionnaire regarding the service and care delivery. The returned documents formed part of the inspection process. The inspection focused on the requirements from previous reports, information provided from the pre inspection questionnaire and the quality of life for the people who live in the home. A tour of the premises took place and a range of records inspected. The home manager assisted throughout the inspection. Ten staff, one visitor and 3 residents were spoken to throughout the day. What the service does well: The staff work well as a team and endeavour to improve life for the residents in the home. The residents have mental health problems and the staff support them to maintain their independence for as long as they are able. The staff have a good understanding of individual needs and promote residents right to privacy and dignity. The residents’ representatives all confirmed that they were satisfied with the care and that they knew that all complaints were dealt with appropriately. The home benefits from a designated activities organiser who puts in a lot of effort arranging events and entertainment inside and outside the home. The menus provide daily choices and alternatives for all meals. The meals are nicely presented and residents are able to choose where to eat. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home must provide a statement of terms and conditions (or contract) for residents who purchase their care privately. The assessment, admission and care planning must improve to ensure that staff know how to care for each individual resident. Advice from other specialists must be sought and put into practice to ensure all health care needs are met. The home should ensure that fortified and specialist diets are catered for and that records are available. The staff must ensure that all procedures for the safe administration of medicines are followed to protect residents from harm. The home must ensure that staff receive statutory training at the required times with records kept. The staff need further specialist training so that they know what to do if there is a suspicion of abuse and further training in dealing with challenging behaviours should be sought. To ensure the home is safe and comfortable the repairs, redecoration and refurbishment must continue. In order to ensure the home is hygienic and free from infection the staff must follow the infection control guidance and procedures at all times. Staff must be employed correctly so that residents are protected from any harm. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 7 The domestic and laundry hours should be reviewed so that there are appropriate staff in the home at weekends. The staffing levels should be regularly reviewed to ensure the dependency, experience of staff and layout of the building are taken into account to ensure residents assessed needs are always met. The residents personal allowances should be individualised and any interest added to their own accounts. The new manager must progress with the application to become registered manager of the home. The staff require up to date moving and handling and fire training. All risk assessments require reviewing and up dating. The home must consult with the Fire Officer regarding the use of appropriate fire. door closures. A secure garden area should be provided to allow residents safe and free access to the landscaped gardens especially in the summer months. 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. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3, The home has not yet produced a Statement of Terms and Conditions for residents. Without this the rights and obligations of the resident and provider is not clear. There is no consistent admission systems in place to ensure that residents assessed needs will be met on admission. EVIDENCE: The home still has not provided terms and conditions of residency for those who are self funding. There was evidence to show that the local authority funded residents were provided with contracts. The care plans showed that not all residents have a preadmission assessment carried out by the home and not all the admission documentation had been completed. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.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) 7,8,9,10 There is no clear or consistent care planning systems to provide staff with the information they need to meet residents’ personal and health care needs. The care plans lack detail regarding wound care and nutritional status, which has the potential to put residents health care at risk. The staff do not follow the procedures for the safe administration of medicines, which place residents at risk and harm. The staff have an understanding of residents needs and endeavour to promote their rights to privacy and dignity at all times. EVIDENCE: Each resident has a plan of care that is based on a recognised nursing model and should ensure all aspects of the health, personal and social care needs are identified and planned for. The care plans were not detailed to include individuals assessed needs regarding their nutrition, mental health and wound care. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 11 The plans were not up to date and not regularly reviewed. Several of the risk assessments were out of date and the care plans were not always signed and dated. There was little evidence to show that relatives or residents representatives are involved in the care planning process. The care plans did not detail the action staff was taking regarding wound care. Little information was available to inform staff what specialist mattresses were in use or what hoist to use. There was no evidence that residents’ blood sugar levels were taken and recorded. Residents who have poor appetites or have difficulty in eating did not have their weights recorded, had no care plan and there was no evidence that dieticians have been involved in their care. The staff were able to deal with the residents who were exhibiting challenging behaviours, however the care plans did not detail how their care was to be managed or what preventative measures could be put in place to reduce their anxiety and the upset this caused to other residents. Throughout the day it was evident that the staff have formed good relationships with residents and ensured that their dignity and privacy were maintained at all times. The activities organiser has in the process of completing social histories for each resident living in the home. These records were nicely presented and detailed. The home has policies and procedures for staff to follow to ensure the safe administration of medicines. A random audit of the Controlled Drugs was satisfactory. There were no gaps on the Medicine Administration Records however the handwritten directions did not have two signatures. The alarm system to the Controlled Drug cupboard was not working. The home do not check, record, date or sign for any medicines which are returned the pharmacy therefore an audit to ensure residents were receiving all medicines prescribed was not possible. Not all the residents had clear identification on their records, which places Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 12 residents at risk from receiving the wrong medication. Throughout the day the staff worked extremely hard to ensure the residents right to privacy and dignity was maintained especially in regard to personal care giving. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.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) 12,13,14,15 The social care needs of residents meets their lifestyles and personal preferences. The residents are supported to maintain links with the local community, relatives and representatives when able. The staff enable the residents to exercise choices and maintain control over their daily lives as far as they are able. The home provides a varied menu with choices available. Further development of this service is needed to ensure all specialist dietary needs of residents are met. EVIDENCE: The home benefits from an enthusiastic activities organiser who is employed for 21 hours a week. All of the residents have an activity plan, which is evaluated each month. The records show what activity each resident has been involved in and whether they enjoyed it or otherwise. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 14 There is a wealth of pictorial evidence of activities that have taken place both within and outside the home. Reminiscence materials are readily available and the corridors have old newspaper cuttings displayed. There is a planned rolling activities programme, which specifies what is taking place each morning and afternoon. On the day of inspection two of the residents enjoyed sitting in the gardens with a member of staff and in the afternoon they were preparing for the arrival of the singer who entertains them each month There were not many visitors to the home on the day of inspection, however one relative said that they visit every day and are always made welcome. The six comment cards returned indicated that relatives are always welcome at any time and relatives can meet with residents in private. Given the mental health status of the residents it would be difficult for them to develop links with the local community. The home has a four weekly menu, which offers variety and alternatives for each meal. The residents were observed enjoying a leisurely breakfast and lunch on the day of inspection. The lunch meal was of ample portion size, hot and well presented. Hot and cold drinks were available throughout the day. The kitchen is shared with the adjoining home. This was found to be clean and well organised. Appropriate recordings of fridge, freezer and core food temperatures are maintained. Food supplies apart from fresh fruit and vegetables were plentiful. The cook said the order should have been delivered at the weekend but had been delayed. The kitchen staff are told how many meals to cook including any special diets. They do not know the residents’ names or actual preferences regarding food and only had limited knowledge of how to fortify foods for those who have poor appetites or have lost weight. The home does not maintain a record of the residents’ choices of meals taken on a daily basis. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.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) 16,18 The complaints process is now satisfactory with some evidence that relatives feel that their concerns are listened to and acted upon. The arrangements for protecting residents are not satisfactory placing them at possible risk of harm or abuse. EVIDENCE: The home has comprehensive policies and procedures in place, which give details of how and to whom to complain should a resident or their representative wish to do so. The six comment cards that have been returned confirmed that relatives knew the process. One relative said that any concerns were taken seriously and resolved as soon as possible. There is a new manager in post and the location of any previous complaint documents could not be located. The home has comprehensive policies and procedures in place for staff to follow to ensure the Protection of Vulnerable Adults. There was no evidence available to show that any staff have received the required training. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 16 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) 19,20,21,24,26 The location and layout of the home is suitable for the residents who live there. There is no, secure outdoor garden area for residents to use safely or freely. The standard of the environment currently does not provide residents with a clean odour free living place. The quality of bedroom furniture and fittings has the potential of placing residents at risk of harm. The infection control procedures are not being flowed which place residents and staff at risk. EVIDENCE: The location and layout of the home is suitable for the residents who live there. There are extensive well-maintained gardens surrounding the home which residents can only access when supervised by staff. There is no provision of a safe secure area for residents who have mental Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 17 health problems to freely access. There is general damage to paintwork and doors in the corridors and the corridor carpets are dirty and marked. There are lounges and dining rooms on each floor, which are pleasantly furnished and decorated. The radiators were generally dirty, dusty and stained with liquid spillages. The plastic on radiator guards was missing in places and the guards were generally dirty. The carpet in the upstairs lounge was stained and marked. The small kitchen area on the first floor was untidy, the window was broken and the vinyl flooring worn stained and sticky. There are sufficient bathrooms and toilets near to all bedroom and communal areas and eighteen bedrooms have an en-suite facility. Bathroom 4A the flooring was rippled. Bathroom 6A the flooring was damaged. Several of the bathroom and en-suite flooring although clean was showing signs of wear and tear. The emergency call cords did not reach skirting level in bathrooms, toilets and en-suite rooms. All of the bedrooms are single en-suite. The bedrooms are decorated to a reasonable standard, however the furniture is marked, some of the drawers in dressing tables are ill fitting and broken. The wardrobes are free standing and residents’ personal items are stored on top of wardrobes. Many of the residents have brought personal items in with them which makes each room individual and reflects their previous lifestyles and preferences. Two of the bedrooms had a strong odour and one bedroom carpet was badly stained and had cigarette burns. The laundry is separate from the resident areas and was generally clean and organised. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 18 The washing machines have specific programmes for disinfection programmes and staff were aware of infection control procedures when dealing with soiled linen. The home has a sluice on both floors. On the day of inspection both were unlocked and smelly as the used continence pads were not disposed of appropriately in the clinical waste bins. The staff were unable to wash their hands, as there was no liquid soap or paper towels available. The linen trolleys store both clean and soiled linen and were kept in the sluice rooms. The floors were sticky, dirty and the sluice hopper had not been cleaned or flushed. The plastic is missing from the commode storage shelves. The light cords were grimy and dirty in all areas. There is one sluice disinfector in the home, which was working. The bed rail protectors were all grimy and stained with food and other spillages. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 19 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) 27,29,30 The home is adequately staffed with qualified nurses and care staff. The lack of designated domestic staff at weekends could have a detrimental effect on resident care and general housekeeping. The procedures for the recruitment of staff have not been followed resulting in residents being placed at risk. The provision of training continues, however the lack of training in safe working practices has the potential to place residents and staff at risk. EVIDENCE: The home always has a Registered Mental Nurse on duty throughout the twenty-four hour period. There have been some changes to the previously required staffing levels at the home. Currently the home is staffed as follows. 2 Registered Mental Nurses 8am to 8pm 1 Registered Mental Nurse 8pm to 8am 5 Care Staff 8am to 8pm 3 Care Staff 8pm to 8am There are laundry and domestic staff employed .It was confirmed that there are no domestic staff for the weekend duties and care staff are able to pick extra shifts should they wish to do so. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 20 There is a designated activities organiser, administrator and maintenance person. The chef and kitchen staff are shared with the adjoining home. The new manager is a Registered Mental Nurse and works supernumerary hours. A sample of staff files showed that not all files had two references, completed application forms, medical clearance or proof of identity. Criminal Record Bureau checks were carried out. The training records were disorganised and not up to date. The newly appointed manager is aware of the shortfalls and is endeavouring to resolve the problems with lack of up to date training in safe working practices. There was evidence that some staff have completed specialist training. This includes Supervisory Management, Safe Handling of Medicines, Customer Care, Dementia Care, Infection Control, Palliative Care and Drug Awareness. There was no evidence to support that staff have received training in Protection of Vulnerable Adults or Challenging Behaviours. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 21 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) 31,35,36,38 A new manager is in post who demonstrates leadership qualities and is endeavouring to improve the quality of care for residents. Residents are unable to have individual personal allowance accounts or have interest accrued on an individual basis. The staff are receiving suitable supervision support from senior staff. There continues to be issues in the maintenance of the building and care practices, which pose potential risks to residents’ health and safety. EVIDENCE: There is a new manager in post who is currently completing his application form prior to being interviewed with the Commission for Social Care Inspection to become Registered Manager. The home does not operate individual accounts for residents’ personal Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 22 allowances. Currently the personal allowances are kept in a single account, which is non-interest bearing. Individual records are available for all residents’ money, which could be crossreferenced to bank statements. There are plans to return to the system of banking personal monies individually. The manager is in the process of commencing structured supervision and appraisal systems for all staff. All staff have not received up to date training in moving and handling and fire training. The accident records are up to date and detailed. A monthly analysis is carried out which details the type of injury, the time, the area with action and outcomes documented. The risk assessments for the safe use of bed rails are available, however the home does not record the code of bed rails in use for individual residents. The fire risk assessment has not been up dated for this year. Several of the fire doors were chocked open by wooden wedges and small items of furniture. Contract maintenance certificates were available and up to date. The flooring in the lift was sticky and bubbling. The weekly maintenance checks were up to date but not signed. As stated in other parts of the report there are some issues, which pose a risk to residents and staffs health and safety. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 23 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 x 1 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 2 2 x x 2 x 2 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x x x 2 3 x 2 Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? 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 OP 2 Regulation 5 Requirement The home must provide a statement of terms and conditions(or contract) for residents who are self funding. The home must ensure that all residents have a comprehensive needs assessment completed which is dated and signed by appropriately qualified staff. OUTSTANDING SINCE OCTOBER 04 The home must ensure that all residents have a care plan which sets out in detail the action which needs to be taken to ensure all aspects of health and personal care needs are met. Risk assessements must be up to date and signed by the author. The care plans must be reviewed at least monthly,updated to reflect changing needs and current objectives with actions and outcomes recorded. OUTSTANDING SINCE OCTOBER 04 The home must ensure that specialist advice is sought and acted upon in regard to wound care and nutritional status. The treatment of pressure sores Timescale for action 1st September 2005 Ist September 2005 2. OP 3 14,15 3. OP 7 15 1st September 2005 4. OP 8 12,13,17 1st September 2005 Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 25 5. OP 9 13 6. OP 15 12,13,16 7. 8. OP 18 OP 20 12,13 23 with action taken must be recorded on a continuing basis. Nutritional screening must be undertaken on admission,weights recorded monthly and action taken regarding any weight loss or gain. The home must ensure that there is a record of all medicines received,returned or disposed of to ensure there is no mishandling. The Controlled Drug cupboard warning light requires repair. Handwritten dirvetions on the MAR sheets require twp witness signatures. All residents require suitable identification on the MAR Sheets. The home must ensure that specialist dietary needs of residents are always catered for with records maintained. The home must progress with Prtection of Vulnerable Adults training with records maintained. The home must ensure that the carpets in corridors are deep cleaned. The carpet in the up stairs lounge requires replacing. Repair and repaint damaged paintwork on doors and skirting boards. Clean all radiators and radiator guards and replace plastic on the guards. Repair the broken window in the up stairs kitchen and replace the vinyl flooring. The home must ensure the flooring in bathroom 4A and 6A is replaced. The bathroom ,toilet and ensuite floorings require replacement via a refurbishment 20th June 2005 1st September 2005 1st September 2005 1st December 2005 9. OP 21 23 31st March 2006 Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 26 programme. 10. OP 24 23 The home must ensure that broken ill fitting bedroom furniture is replaced. The wardrobes must be fixed to the walls to prevent toppling. Personal items must not be stored on top of wardrobes. Replace three identified bedroom carpets. The home must ensure that the staff follow the policies and procedures for the control of infection including the safe handling and disposal of clinical waste. Liquid soap and paper towels must be available in sluices. The commode shelving must be repaired or replaced. The sluices must be cleaned on a regular basis. The light cords must be sheathed to enable daily cleaning. The bed rail protectors require regular cleaning. The sluice doors must be kept locked when not in use. Altenative storage for the storage of clean linen is reguired. The home must ensure that thorough recruitment procedures are followed at all times. The home must ensure all staff receive statutory and specialist training to meet the assessed needs of residents with records kept. The manager must progress with application to become registered manager. All residents personal finances must be banked individually,so that interests to their accounts can be accrued. 1ST December 2005 11. OP 26 13,23 1st September 2005 12. 13. OP 29 OP 30 7,9,19 12,18 20th June 2005 1st October 2005 14. 15. OP 31 OP 35 9 20 1st October 2005 1st October 2005 Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 27 OUTSTANING SINCE APRIL 04 16. OP 38 12,13,23 The home must ensure that all staff receive fire training at the required intervals with records kept. All staff must receive initial and up dated moving and handling training. The fire risk assessment requires up dating for 2005. The risk assessments for bed rails and the use of hoists must include the specific codes. The emergency call cords must reach skirting level. Advice must be sought from the Fire Officer regarding the use of door closures. The flooring in the lift requires replacing. All maintence records require signing. 1st September 2005 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. Refer to Standard OP 19 OP 27 Good Practice Recommendations The home should provide a safe,secure garden area for residents to freely use. It is highly recommended that domestic staff are adequetely deployed at weekends. The staffing levels for qualified nurses and care staff should be regularly reviewed to ensure the residents assessed needs are met at all times. Bewick Lodge B53-B03 S419 Bewick Lodge V223121 200605 Stage4.doc Version 1.30 Page 28 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR 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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