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Inspection on 26/02/07 for Brackley Cottage Hospital

Also see our care home review for Brackley Cottage Hospital for more information

This inspection was carried out on 26th February 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home had a happy, friendly atmosphere and residents spoken to stated that the staff were very kind and caring. They said that the standard of food was very good although no choices were offered. Staff recruitment practices protect residents from potential harm, and include the necessary checks from the Criminal Records Bureau.

What has improved since the last inspection?

Procedures for the recruitment of volunteers have been improved and individual records of these people are now kept in the home.

What the care home could do better:

The environment of the home is very clinical and little effort has been made to provide a more homely place for the residents to live. Some rooms are multioccupancy and do not meet the National Minimum Standard. There have been plans to replace the building for several years but these are now on hold owing to transfer of the home to a new NHS trust area. The standard of record keeping in the home is poor, and staff have no written guidance concerning the care needs of residents, nor plans for how these needs may be met. Improvement to the provision of these records was recommended at the last inspection, but no action has been taken. Residents admitted for intermediate care have no plans for their rehabilitation, or intended ongoing care. Two residents spoken to in this category were not aware of any planned discharge date. There was no evidence of any rehabilitation facilities, or provision for this group to regain daily living skills. One resident in the intermediate care area of the home, had palliative care needs, which is in contravention of the conditions of registration. Records of "activities" were available for the residents in long stay beds but this consisted mainly of watching Television. There were no records of activities provided to intermediate care residents, and those spoken to stated that they were not offered any and just chatted or watched Television. In discussion, the administrator said that activities are offered but that residents don`t wish to join in. There was no evidence that this was the case or of the type of activity offered, and no evidence that residents preferred hobbies and interests was taken into account when activities were planned. This was a requirement at the last two inspections and remains outstanding. One resident had chosen to continue to administer her own medication. There was no risk assessment in place for this and her medication was kept in a plastic box on her bed table. No lockable facility had been provided for these, putting other residents and visitors at risk of accidental ingestion. An immediate requirement was made that these medicines should be stored safely. Residents had bedrails fixed to their beds without the necessary risk assessments and consent to restraint being in place. Three out of the four residents monitored did not have bumpers fixed to these to prevent the residents from becoming entrapped in the rails. Residents assessed as being at risk of developing pressure ulcers did not always have the necessary pressure relieving equipment in place.

CARE HOMES FOR OLDER PEOPLE Brackley Cottage Hospital Pebble Lane Brackley Northants NN13 7DA Lead Inspector Linda Preen Key Unannounced Inspection 26th February 2007 10:00 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 Brackley Cottage Hospital DS0000012602.V329382.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. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brackley Cottage Hospital Address Pebble Lane Brackley Northants NN13 7DA 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) 01280 702388 01280 700329 Brackley Hospital Trust Claire Mansfield Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of service users must not exceed 14. The 14 service users will be in the category of OP No-one falling within the category of intermediate care may be admitted to the home when there are 9 persons in this category already accommodated within the home. No-one falling within the category of OP receiving nursing care and not intermediate care may be admitted to the home when there are 5 persons in this category already accommodated within the home. The beds located in the multi bed rooms must only be used for service users receiving intermediate care for rehabilitation, and must not be used for any other category, including palliative care. Service users whose anticipated stay exceeds 8 weeks may not be admitted into the intermediate beds. 3rd May 2006 4. 5. 6. Date of last inspection Brief Description of the Service: Brackley Cottage Hospital provides nursing and intermediate care to 14 service users. It is situated close to a park, and close to amenities in the market town of Brackley. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two hours were spent prior to the inspection reviewing previous requirements and recommendations and collating information provided by the service. The inspection took place over a period of five hours as part of the statutory inspection programme. Four residents were chosen in order that their experience in the home could be assessed. The method used was “Case Tracking”. This involved looking at their records, talking to them and also to the staff concerning the care received. In addition to this staff rotas and medication records were seen. Information was also available from a questionnaire completed by the providers of the service. Fees range from £2535 for a shared room to £2600 for a single room per month. What the service does well: What has improved since the last inspection? Procedures for the recruitment of volunteers have been improved and individual records of these people are now kept in the home. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 6 What they could do better: The environment of the home is very clinical and little effort has been made to provide a more homely place for the residents to live. Some rooms are multioccupancy and do not meet the National Minimum Standard. There have been plans to replace the building for several years but these are now on hold owing to transfer of the home to a new NHS trust area. The standard of record keeping in the home is poor, and staff have no written guidance concerning the care needs of residents, nor plans for how these needs may be met. Improvement to the provision of these records was recommended at the last inspection, but no action has been taken. Residents admitted for intermediate care have no plans for their rehabilitation, or intended ongoing care. Two residents spoken to in this category were not aware of any planned discharge date. There was no evidence of any rehabilitation facilities, or provision for this group to regain daily living skills. One resident in the intermediate care area of the home, had palliative care needs, which is in contravention of the conditions of registration. Records of “activities” were available for the residents in long stay beds but this consisted mainly of watching Television. There were no records of activities provided to intermediate care residents, and those spoken to stated that they were not offered any and just chatted or watched Television. In discussion, the administrator said that activities are offered but that residents don’t wish to join in. There was no evidence that this was the case or of the type of activity offered, and no evidence that residents preferred hobbies and interests was taken into account when activities were planned. This was a requirement at the last two inspections and remains outstanding. One resident had chosen to continue to administer her own medication. There was no risk assessment in place for this and her medication was kept in a plastic box on her bed table. No lockable facility had been provided for these, putting other residents and visitors at risk of accidental ingestion. An immediate requirement was made that these medicines should be stored safely. Residents had bedrails fixed to their beds without the necessary risk assessments and consent to restraint being in place. Three out of the four residents monitored did not have bumpers fixed to these to prevent the residents from becoming entrapped in the rails. Residents assessed as being at risk of developing pressure ulcers did not always have the necessary pressure relieving equipment in place. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 7 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. Brackley Cottage Hospital DS0000012602.V329382.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 Brackley Cottage Hospital DS0000012602.V329382.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, 4 and 6 Quality in this outcome area is poor. Needs assessments are general and not specific to the individual so that the home may assess if individual needs may be met. There is no evidence of residents admitted for intermediate care being helped to maximise their independence and return home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some assessments of daily need were available in the files seen, but in two cases, the contact/referral forms had been received one to two weeks after admission. A requirement was made in this respect. One resident in an intermediate care bed, had been admitted requiring palliative care, which is specifically excluded in the conditions of registration. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 10 An entry in this persons records states that staff are unable to meet her emotional needs. In addition to this notifications had been received of three other residents who had died from malignant disease in a two-month period at the end of last year. The General Manager was strongly reminded that residents must not be admitted out of category. A requirement was made in this respect. There was no evidence that residents admitted for intermediate care were helped to maximise their independence in order to return home. There were no plans in place for their rehabilitation and no specialist facilities provided to assist in this area of care. Residents spoken to were unaware of any planned discharge arrangements, although one lady was hoping to return home, when her current condition had improved. A Requirement was made in this respect. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is poor. 7, 8, 9 and 10. No guidance is available for staff on how to meet resident’s needs in the home. Unsafe systems are in place for the control of medication in the home. Residents are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents receiving intermediate care and one receiving long term nursing care were chosen to assess. This involved looking at their records, talking to them and the staff and observing the care provided. Records for all four of these residents were inadequate, with little or no evidence of care planning in order to guide staff having taken place. Two of these residents had no care plans at all in place, one had a document used for care planning in place, but this just had the generalised statement which instructed staff “For pain and symptoms to be under control and emotional needs addressed” and the fourth, although care plans were in place, Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 12 were totally inadequate. For example the care plans for catheter care and tube feeding had no instruction concerning the care of these items. This resident was fed by a PEG (Percutaneous Endoscopic Gastrostomy), which involves a tube being inserted directly into the stomach through the abdominal wall in order that liquid nutrition can be given. There are important care needs for these tubes and although the staff nurse on duty was aware of these needs, there was no instruction for less familiar staff or records that these procedures had been followed. Three residents had forms for recording Moving and Handling needs but these had not been completed. The fourth had a moving and handling assessment but this was not dated. One of the three without a moving and handling assessment was wheelchair dependant and required assistance with transfers to and from her chair. Pressure risk assessments were available but one of the residents assessed as being at medium risk and requiring a pressure relieving mattress and cushion, did not have these in place. One resident had no nutritional assessment or care plan despite a record on admission stating that she was “hardly eating”. Residents had bedrails in place with no consent, risk assessment or review in place. Three out of the four residents had unprotected bedrails, leaving them at risk from entrapment. One of the residents had an additional diagnosis of dementia, and while it is acknowledged that his physical care needs outweigh his mental health needs, there was no care plan in place for his dementia to guide staff concerning his remaining abilities or coping strategies for any behavioural problems which may present. Systems for the ordering, storing, recording, administration and disposal of medication were seen and found to be satisfactory for those medicines being administered by staff, however in the case of one resident who had chosen to self administer her own medication, safe systems were not in place. There was no evidence that a risk assessment had been completed and there was no provision for the safe storage of these medicines. In fact the resident had them in a plastic container on her bed table where they were accessible to anyone either sharing the four- bedded room or entering it from another area. An Immediate requirement was made concerning this. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. There is no evidence to support that arrangements for social activities and food take individual residents preferences into account. Visitors are welcome in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to expressed their satisfaction with the food provided and confimed that it was of a very high quality, however they stated that no choice is offered. In discussion, the administrator stated that the cook goes round every day to see what residents would like, but there was no evidence to support this or records of likes and dislikes in the files seen. The administrator later informed the inspector that lists of resident’s likes and dislikes are available in the kitchen. There are no facilities for communal dining and residents eat at small bedside tables in their rooms. There was no evidence of any activities being provided to provide stimulation for residents, apart from a weekly church service. There were no records of residents preferred hobbies and interests and although board games etc were Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 14 available, there was no evidence of any participation in these. Residents spoken to stated that there were no activities and that they just watched Television or chatted to others. A daily diary of activities for the long stay residents had been commenced but this just recorded watching television and not if any other activity had been offered. A small communal lounge is available, but residents were reported to prefer sitting in their own rooms. This lounge was not homely, and although there were armchairs and a television, one corner was stacked with overflowing boxes donated items, and an unused pressure relieving mattress and machine were piled on a table in another corner. This does not provide a welcoming place to sit. Visitors are welcome at any time and a group of volunteers also come into the home to see the residents. There were no records of residents choices concerning times of rising and retiring or daily routine or of their preferred night time routine although the daily statement for one gentleman did record that he sometimes chose to stay in bed. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Systems are in place to deal with complaints and to protect residents from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is available within the home. No complaints have been received by the home, and none reported to the Commission for Social Care Inspection since the last inspection. One resident spoken to said she did not know what the complaints procedure was but that she had no cause to complain and could find out if she needed. Staff records demonstrated that all staff hold a current Criminal Records Bureau clearance and that references are obtained prior to employment. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 and 26. Quality in this outcome area is adequate. The environment is institutional in nature and does not provide a homely place in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a long standing cottage hospital and the environment is not suited to long-term care. There have been plans for some years to replace this with a purpose built home to improve facilities but these are currently on hold owing to a change in the Strategic Health Authority with responsibility for the area. There are currently two four bedded wards being used for intermediate care residents, and these rooms do not meet the National Minimum Standards. Facilities are provided as for a hospital ward and are very institutional with no opportunity for individual personalisation. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 17 Some of the residents in long- term care beds have their own rooms and these are more personalised to the individual, however a shared room in this area is again reminiscent of a hospital ward with “safety flooring” similar in appearance to vinyl, and hospital type beds. As stated earlier, there is little communal space, and that which is provided is cluttered and not homely. There is no provision for residents to sit outside if the weather permits. The home was clean and tidy but had an overpowering odour of disinfectant, which only added to the impression of a clinical building and not a home. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 good. Staff are provided in sufficient numbers and the trust has a commitment to staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were three care staff and one registered nurse at the time of the inspection. The nurse in charge confirmed that they still provide a treatment room service to local residents but that this is usually at weekends when community nurses are unavailable to do dressings. She stated that these patients are seen by appointment and are arranged for the overlap period in the middle of the day, when two Registered Nurses are in the building. Despite there being no care plans in place, staff on duty were aware of residents needs and residents expressed satisfaction with the care provided. The pre-inspection questionnaire completed by the provider, states that 50 of care staff currently hold a National Vocational qualification in care, to guide them on meeting the basic care needs of residents. In addition to this, there is an ongoing programme of training and refreshers in Moving and Handling, Fire, Basic life support, Health and Safety, and Control of Substances Hazardous to Health. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 19 A selection of staff files was sampled. This demonstrated that recruitment systems are in place to protect residents from potential harm, and include the taking up of references and Criminal Records Bureau checks. An equal opportunities policy is in place but the staff reflect the local community and are mainly white, British. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 20 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. Management systems in place do not ensure that adequate care records are in place to ensure that all resident’s needs are met in a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is a first level registered Nurse who with the General Manager is responsible for the day- to- day service provided within the home. The home is run on the lines of a hospital and there is no evidence that individual residents needs are considered in daily routines or care practices. There was however evidence of a resident satisfaction survey having been completed, and those who had responded were positive in their comments. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 21 Such things as “The staff were consistently cheerful and willing” and “Meals have been super” were recorded. There was no evidence that the Registered Manager conducts any other form of quality assurance in order to monitor the service provided. The General Manager stated that residents handle their own finances and that the home does not have any involvement in this part of their lives. Maintenance records for equipment in the home were available and records of the testing of fire alarms and emergency lighting were found to be satisfactory. Requirements had been made following a recent fire officer’s visit, and the administrator confirmed that action had been taken in response to this. As stated above, three out of four residents chosen, did not have moving and handling assessments in place to protect both them and staff from potential harm. Residents with bedrails in place did not have risk assessments, care plans or protective padding in place to protect them from entrapment. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 22 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 2 X 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X 1 1 Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14(1) a, b and c Requirement All residents must have an assessment of needs, which includes input from them, their carers and any other agencies involved, prior to them being admitted to the home in order that an assessment may be made to ensure their needs may be met in the home. Residents must not be admitted to the home outside the registered categories of care. Residents admitted for intermediate care must have facilities in place to maximise their independence and facilitate their return home. All residents must have clear, individual care plans in place to guide staff concerning how their needs may be met. These should be signed by the resident or their advocate and regularly reviewed to ensure that the information is up to date. Moving and handling assessments must be in place for all residents in order to protect both them and staff from DS0000012602.V329382.R01.S.doc Timescale for action 01/04/07 2 3 OP4 OP6 4(b) 16 01/04/07 01/04/07 4 OP7 15 (1) &(2) 01/04/07 5 OP38 13(5) 01/04/07 Brackley Cottage Hospital Version 5.2 Page 24 6 OP8 12(1) a 7 OP8 13(7) 8 OP18 13(8) 9 OP9 13(2) 10 OP12 16 potential harm. Where residents are assessed as being at risk of developing pressure ulcers, suitable pressure relieving equipment must be provided to reduce the risk of this occurring. Risk assessments must be in place for all residents using bedrails. These assessments must be regularly reviewed. All bedrails must be provided with bumpers to prevent residents becoming entrapped in the rails. Consent to the use of any restraint including bedrails must be obtained before they are put in place. A lockable storage facility must be provided for all residents who self medicate. (An immediate requirement was issued concerning this.) Service users social needs must be met by the provision of regular, planned and meaningful activities. Records must be held of activities offered to or undertaken by service users. This requirement was made previously with timescales of 15.2.06 and 10/06/06 and remains unmet. In view of the continued delay in replacing the building, further efforts must be made to provide a more homely setting in which the residents may enjoy their daily lives. A robust quality assurance system must be introduced in order to ensure that all areas of the home and its management are regularly audited to ensure that resident’s needs are foremost in the home. DS0000012602.V329382.R01.S.doc 01/04/07 01/04/07 01/04/07 26/02/07 01/04/07 11 OP19 16 01/05/07 12 OP33 24(1) a and b 01/05/07 Brackley Cottage Hospital Version 5.2 Page 25 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 OP14 OP3 Good Practice Recommendations Service users should be offered choices at mealtimes. A nutritional assessment should be completed for all residents and referrals made to the necessary health care professional where a deficit is identified. Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 © 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 Brackley Cottage Hospital DS0000012602.V329382.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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