Inspection on 12/12/08 for Bluebell Court

This inspection was carried out on 12th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bluebell Court 16/04/09

Bluebell Court 11/06/08

Bluebell Court 21/06/07

Bluebell Court 14/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bluebell Court Stanley Road Grays Thurrock Essex RM17 6QY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Bluebell Court Stanley Road Grays Thurrock Essex RM17 6QY 01375369318 01375369346 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Primrose Care Home Limited Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Bluebell Court is a purpose built three storey care home with Nursing for older people who have physical disabilities and dementia and is registered with Commission for Social Care for the continuing care of 80 residents in total. The Home is located centrally in the town of Grays within walking distance of local amenities. The M25, the A13 and Grays railway station are in close proximity. The building has been adapted to provide three purpose built floors, to provide a homely atmosphere for the service users and families. Trained nursing staff and carers are available for the provision of personal and nursing care. Parking is available to the front of the building. The home Care Homes for Older People Page 4 of 29 Over 65 30 80 10 0 0 0 Brief description of the care home was registered in July 2006. At the time of the site visit the manager confirmed that the fees ranged from £395.43 to £575.00 per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was undertaken over a 10 hour period, over two days, as part of the routine key inspection. It was possible to meet with two senior managers from the company, who had been covering the management of the home until a new manager starts in 2009. An Annual Quality Assurance Assessment, that details their own assessment of what they do well, what could be done better and what needs improving was not requested for this inspection as one has already been submitted earlier in the year and used for a previous inspection. Prior to the site visit, the management was sent a variety of surveys to distribute, that Care Homes for Older People Page 6 of 29 asked questions that were relevant for each group, such as for people who use the service and relatives. Six responses was received from people who use the service and seven from relatives/carers. During the visit to the home, it was possible to speak to 5 residents and 4 staff in addition to the management team. It was also possible to speak to one relative. A tour of the home was undertaken and a range of records relating to the home and the services offered were reviewed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that their needs will be properly assessed prior to coming into the home and that they will have sufficient information on which to base a decision. Evidence: The management of the home have a service users guide in place and this can be found in the main reception area of the home and residents may have a copy if they wish. The guide contains all the required information and is printed in a large font, with some pictures. Consideration could be given to developing the format further, in relation to the needs of the service users in the home and personalising it to the home itself with the use of more pictures. It may also be of value to have it more freely available, for example in lounges etc. One resident and their family confirmed that they had asked for a copy and been given one another residents spoken to said that I did not seen a guide when admitted. The covering manager for the home was seen to Care Homes for Older People Page 10 of 29 Evidence: be updating residents contracts/terms and conditions and confirmed that letters are now sent out to prospective residents telling them, after assessment, whether the home would be able to meet their needs or not. Residents had commented in surveys that they had not received contracts so it was positive to see that this was being addressed. The management have a pre-admission assessment system in place for prospective new residents to the home. The most recent assessments were reviewed and these were sufficiently detailed to enable the assessor to make an informed decision about the suitability of the home for the resident. The assessments were also backed up, where appropriate, by information from referring authorities. The assessment tool itself could be developed to have a more person centered approach, leading to a person centered approach to care planning. Records did show that residents preferences were listed in some areas but this could be improved upon. In surveys residents commented that they had visited the home twice before admission and that overall, those who responded said that they had enough information about the home prior to admission. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their basic care needs met but more personal preferences and detailed needs may not be taken into account. Evidence: Since the last inspection the management team working at the home have revisited the care planning system, including auditing and reviewing 73 care plans and they have worked to improve the recording of and care management in the home. Evidence of the audits were seen and the comments noted were seen to be objective. 3 full care plans, from the nursing and residential units were reviewed along with 6 further care plans and care records for specific cross checking. Overall the care plans were adequate, up to date and were in place for the majority of identified needs. In some areas they need to contain more detail and be less generalised, in order to sufficiently guide staff and be more person centered, to reflect the individuals choices and lifestyle. Care plans on the residential floor did contain more person centered information but still require further development. It was also noted that key information identified on pre-admission assessments, for example on skin conditions Care Homes for Older People Page 12 of 29 Evidence: and important medication history, was not always reflected in the current care plan and therefore potentially lost to care staff. Care plans also need to be in place that detail the management of residents who experience ongoing pain and how this affects their daily life. The management team at the home are planning to introduce a very person centered care plan for residents with dementia in the home and it was possible to see an outline of this, which looked very positive and resident led. Staff need more skills and information when dealing with residents with dementia as they were observed to be talking to them, not unkindly, but inappropriately when trying to get them to do something and not thinking about different ways to approach the issue. Residents who commented said the carers are busy but they do make the effort and they make time to do things for you, my baths are very quick, in and out, no time to soak your feet and staff are polite and caring but not all have the experience they need to do the job. From the managers internal audit, of 35 questionnaires returned, 93 were happy with the overall care provided in the home. Discussion with staff showed that they knew the residents quite well but the information they held was not generally reflected in the care plans. Risk assessments had been completed for a range of issues such as nutrition, manual handling, risk of falls, pressures sores and the use of bed rails. It was noted that on the nursing floor bed rails were being used without protective bumpers and staff on that floor had not noticed this and therefore not followed their own risk assessment. Issues identified in the risk assessments need to be, where appropriate, linked to the care plan to ensure that management issues are not overlooked. For example, risks identified associated with falling were not reflected in care plans for mobility. It was also noted that one resident had two manual handling assessments in place, completed the same month containing different information. This needs to be addressed so as to ensure the correct management of a residents needs. It is also recommended that the risk assessment for the use of bed rails is reviewed to ensure that this is a more robust assessment of risk. This was discussed with the covering manager. The use of fluid monitoring charts was reviewed and these were found to be inconsistently completed therefore limiting their value. Charts were seen to be more efficiently completed in the morning, giving a reasonably accurate picture, but during the afternoon and evening, recording dropped off making the chart of limited use. A review of the use of these charts is needed to ensure that they are a valuable tool to aid the management of residents care. Records on fluid charts were also noted to not tie in with what staff had recorded in the daily records regarding food and fluid intake. Records showed that residents were seeing their GPs in a timely manner and they also had access to regular chiropody and eye tests etc. At the time of the inspection there were no residents with pressure sores in the home and the nursing staff were not Care Homes for Older People Page 13 of 29 Evidence: undertaking any wound management. Care records showed that where staff were having difficulty meeting residents specific needs, they had been referred to the appropriate professional for either reassessment or guidance. Medication systems were checked on the nursing floor of the home and were found to be in good order. Medication is checked into the home and recorded properly. The medication administration sheets were clear and signing the charts and the use of omission codes was good. Controlled medications are appropriately managed but staff do need to ensure that any controlled medications no longer in use are disposed of within guidelines. New protocols have been put in place to guide staff when giving as and when medications and there was evidence on the records that residents were having their medication reviewed appropriately. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst outcomes for residents are generally good with regard to mealtimes and activities, the task/staff led approach to care management may mean that choices and flexibility are limited at times. Evidence: From care plans, records, discussion with staff and residents it is clear that there are efforts to make the routines of the day resident led but this has yet to be fully achieved. Staff spoken to outlined a generally task led routine listed on the daily allocation sheet and said that we interact with residents, play dominoes etc. between 11- 11.30 after all the other jobs have been done and we do pad changes at 10.30. Residents who commented said that I do generally get a choice as to who helps me have a bath, I am always asked if I want to go to activities, I can choose, I dont know who my key worker is, I dont have a lot of choice but what I do have staff adhere to and I dont particularly get a choice in the mornings as I need staff to help me. Social care plans were in place for residents but these were seen to need more detail as they just contained general information and no resident preferences for care staff to refer to or goals, for example, to promote independence, retain skills and maintain self worth. For example, care plans identified that residents needed to Care Homes for Older People Page 15 of 29 Evidence: maintain their social skills but did not give staff any guidance on how this would be achieved. Life histories were in place for some residents but not for others. Key information from these records had not always been used in the social care plans. Two activity officers are employed at the home and they also have access to an additional helper for outings etc. Both officers are able to drive the large minibus which the residents benefit from. The activity officers do have information on residents preferences regarding hobbies and pastimes. Some of these may need review as they were dated 2007 and ideally they should be linked to the social care plan that care staff also use. Records are kept of activities offered and these include minibus outings to shops and places of interest or just drives out, bingo, coffee mornings at the local church, personal shopping trips, nail care, pat dog, gentle exercises, library trips, crafts, music, entertainers, reminiscence and memory games. Residents who commented said I have attended the carol concerts and the activitys officer comes and sits with me and does my nails, the hairdresser is good, theres a nice salon and you get lots of fuss and I am quite content in my room but they do always tell me what activities are on. The home benefits from active input from a relatives group that puts on events in the home to raise money for residents activities etc. Minutes of residents meetings show that residents are consulted and able to make comments. A recent feedback questionnaire showed that 82 of residents felt that there were sufficient activities. The meals service at the home was reviewed and lunchtime observed on all three floors. Meals times were seen to be relaxed and residents were not kept waiting for their meals even if they had chosen to eat in their rooms. Some non-care staff were seen to be helping to feed residents that needed assistance and whist this is good, in order that residents do not have to wait, these staff were seen to be feeding residents who were laying down in bed and they require more guidance before they take on this role, to avoid any risks to residents. Menu choices are not currently displayed in the dining room for residents but the covering manager says that plans are in place to address this. Menu choices show that alternatives are available although not many residents are making use of this option. The covering manager said that they were just about to introduce a nutritional recording chart that would provide a record of what/how much residents actually ate. Residents had good access to drinks between meals and on the morning drinks round they were actively offered fruit by the care staff and this was observed to be popular. Cooked breakfasts are regularly available. Residents who commented on the meals said that there is a lot of mash potato, the chef will take note of some preferences we may have, you do get choices, the food is Care Homes for Older People Page 16 of 29 Evidence: hot enough and there is enough to eat, the meat in pies if often too big and not soft the meals are variable in quality, the food is generally good but I cannot get on with the meat, the food is quite nice, nicely cooked and teatimes I usually have sandwiches, sometimes there are other choices. Minutes of the residents meetings over the past few months show that residents are happier now and not raising concerns as they were regarding lack of fruit etc. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that any concerns they have would be listened to and acted upon and also, as far as possible, they would be protected in the home. Evidence: The management team have a complaints procedure in place and this can be found displayed around the home and it is also in the service users guide. Residents who commented said that if I had a complaint I would see some-one in the office, the staff tell me to raise any concerns I have with them and If I raise anything with a carer I do find that they relay it as the issue gets attended to. Records show that complaints are logged in the home and dealt with thoroughly and appropriately. Any adult safeguarding matters are also appropriately referred and overall the records were good and informative. Complaints logged since our last inspection related to food, laundry services and missing personal items. Minutes of the most recent residents meeting showed that the laundry was not a current cause for concern and none of the residents spoken to raised this with us. The home had many letters of support on file for the home from relatives following our last inspection and also letters of compliment which included such comments as my relative was very happy in your nursing home, my relative received excellent care during her short but happy stay at Bluebell Court and My relative was always treated with the utmost kindness and respect. Care Homes for Older People Page 18 of 29 Evidence: The management of the home have adult safeguarding policies and procedures in place including local guidance. Staff spoken to demonstrated an awareness of these procedures and the correct action to take. Training records showed that there is generally a good level of compliance with staff training in this subject with only a small percentage of the staff team still requiring this training. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in an environment that meets their needs but more attention to detail would improve safety outcomes for them. Evidence: A partial tour of the home was undertaken, with all three floors visited along with all communal areas and a number of bedrooms. The home was seen to be very clean and well maintained. No odours were noted. Records show that there is good compliance with staff attending infection control training. Bedrooms are of a good size and all en suite. Residents had personalised their bedrooms and brought in their own items of furniture etc. Some residents had decorated their rooms for Christmas. The home overlooks, from three sides, a local park, giving many of the residents good outside views. There is a secure, well maintained garden which contained bird tables and garden furniture for the summer months. Signage in the unit for residents with dementia is variable, with some good signs, but this does need more work to promote residents independence. It was noted that domestic staff were decanting chemical cleaning products into containers with insufficient labels for identification and these were stored on the domestic trolley, presenting a potential risk to residents and staff should an accident occur. The manager reported that she had been trying to address this issue and would Care Homes for Older People Page 20 of 29 Evidence: revisit the matter with the domestic team. Residents who commented said that I am happy with my room and its cleaned every day, my room is fine and its always nice and warm and I spend a lot of time in my room and if anything is wrong then the handyman sorts it out quickly. Residents who responded to the managers recent internal satisfaction questionnaire were very satisfied with the environment, the temperature of the home, the security and the cleanliness and tidiness. The manager employs a full time maintenance man. An up to date fire risk assessment has been completed for the home and each resident has an individual risk assessment in place. Good records also show that the alarms and fire systems are regularly tested and staff attend regular fire drills. The maintenance man has records available to show that he carries out regular safety checks of fixtures and systems in the home, such as window restrictors, water temperatures and general safety checks around the home. Reporting systems, where shortfalls are identified, need to be revisited to ensure items that require action are addressed, for example, bed rails with bumpers missing. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable staff team, who need more training in some areas to ensure that they can fully meet their needs. Evidence: The staffing of the home was reviewed and discussed with the covering manager. Staffing levels are generally based upon a ratio of 1:7 for the residential unit, 1:5 for the nursing unit and 1:6 for the dementia unit. At the current time based upon information on staffing rotas the units are staffed at higher ratios and the manager confirmed that this is because of the current levels of dependency. This was reviewed and staffing levels increased recently. The staff team is quite settled, agency use is minimal and there are no day care vacancies, just one senior post vacant for night duty. Staff rotate between the units to gain experience and so that they know the residents should the need arise for cover. Some residents find the staff changes disconcerting and perhaps there should be more explanation given to residents on this and an opportunity given for them to comment. Residents who commented on the staff team said that the carers are very nice, they are busy but they make time to chat to you, If I use the buzzer they come quickly to see you, the care staff are a nice bunch of people but sometimes they are short, they are friendly, the staff are polite and caring and the staff are polite and they do listen Care Homes for Older People Page 22 of 29 Evidence: to what you say. Staff are encouraged to undertake NVQ qualifications and records show that the home has yet to reach the 50 desired standard. It was evident on the day of the inspection that staff are actively undertaking these qualifications as NVQ assessors were visiting staff in the home and on discussion with them, feedback was positive. Three staff files were checked at random to review the recruitment process in the home. The staff files were in good order and contained all the required checks and documentation that should be in place. Staff induction training records show the management team are steadily ensuring that all care staff, where required , have completed their common induction standards through Skills for Care. Discussion with care staff confirmed that they are completing their induction. Nurses professional pin numbers/registrations were also checked and found to be in order. Staff training records show that there are some gaps in staff training that need to be addressed, this included manual handling. Compliance was seen to be better with fire safety, infection control, first aid and health and safety. A new dementia awareness course has been introduced and although some staff have attended this there are still significant gaps, especially as staff move around the home, between units, to work. Records show that staff are attending additional training on catheter care, wound management, person centered care, medication administration, challenging behavior etc. Staff spoken to said that thier was a lot of training on offer and the standard of training given was good. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a reasonably well run home that is steadily improving. Evidence: At the current time there is no permanent manager in post but a new one has been appointed with a view to starting early in the new year. Senior management from the company have been covering the home on a day to day basis and staff spoke positively about the support and help they were receiving. Staff said its a nice environment to work in, people get on well and the atmosphere in the home and the staff moral is much improved and the management cover has been good and helpful. The management of the home have a quality assurance system in place. This comprises of a range on internal audits, for example, medication administration and obtaining feedback from residents and relatives etc. This has recently been undertaken using feedback questionnaires for residents and the results show an overall positive result with percentage scores in the 90s apart from the laundry, 77 and sufficient Care Homes for Older People Page 24 of 29 Evidence: activities 82 . An analysis of the results and subsequent action plan should be developed. The covering management team have started the staff supervision system afresh. Records show that all the staff have had supervision time and now appraisals are being undertaken. The management acknowledge that they will not achieve the desired supervision level this year for their staff team but it is clear that a organised system is now in place, which includes care practice observations. No health and safety issues were noted on touring the home apart form the management of domestic cleaning products and this is outlined in Section 5. Accident records were reviewed and seen to be completed well and followed up where required and compliance with staff training in health and safety is quite good. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 12 16 (2) m & n All people residing at the 01/08/2008 care home must have their social care needs met to ensure they have stimulation to promote their wellbeing. Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Residents care plans must be written in detail and be person centered as far as possible So staff have sufficient guidance to meet the residents needs in the way that they would wish. 14/03/2009 2 8 12 Ensure that risk assessments are correct, followed and linked to the residents care plan. So that risks are minimised by correct management. 14/02/2009 3 12 12 Routines of the day, including the provision of activities from staff, should be resident led and a social care plan need to be in place. So that the care provided is based upon residents needs and preferred routines and that their social care needs are met. 31/03/2009 Care Homes for Older People Page 27 of 29 4 19 13 Keep all parts of the home, as far as possible, free from COSHH hazards. To ensure resident safety. 06/02/2009 5 30 18 Ensure that staff have the training they need to undertake their responsibilities and meet residents needs. Especially in relation to caring for people with dementia. So that residents benefit from a competent staff team. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 3 Consider a review of the service user guide in relation to format and making it available to interested parties. Develop a more person centered pre-admission assessment tool, which would help lead into person centered care planning. It is recommended that the risk assessment for the use of bed rails is reviewed to make it more user friendly and robust. Any staff assisting residents to eat should be given some training in how to do this without putting residents at risk. Ongoing consultation should take place with residents regarding the meal service in the home, so that concerns are addressed. Improve signage for residents in the home, especially in the unit for residents with Dementia. Ensure that lines of reporting for identified maintenance shortfalls are clear. Consult with residents regarding the deployment of staff within the home and the changes between units. Continue to develop the staff supervision programme. Page 28 of 29 3 8 4 5 15 15 6 7 8 9 19 19 27 36 Care Homes for Older People Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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