Inspection on 16/03/10 for Branthwaite Nursing Home

This inspection was carried out on 16th March 2010.

CQC found this care home to be providing an Poor 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Branthwaite Nursing Home 04/05/10

Branthwaite Nursing Home 15/01/10

Branthwaite Nursing Home 14/04/09

Branthwaite Nursing Home 29/04/08

Branthwaite Nursing Home 02/11/07

Branthwaite Nursing Home 05/07/07

Branthwaite Nursing Home 03/07/06

Branthwaite Nursing Home 03/01/06

Branthwaite Nursing Home 05/07/05

Branthwaite Nursing Home 14/10/04

Branthwaite Nursing Home 14/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nancy Saich     Date: 1 6 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 44 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 44 Information about the care home Name of care home: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS 0190067111 0190068339 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aspenframe Ltd Name of registered manager (if applicable) Mrs Margaret Rose Visick Type of registration: Number of places registered: care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD Mental disorder, excluding learning disability or dementia - Code MD Dementia - Code DE The maximum number of people who can be accommodated is: 57 Date of last inspection 1 4 0 4 2 0 0 9 57 57 0 57 Over 65 0 0 57 0 Care Homes for Older People Page 4 of 44 Brief description of the care home Branthwaite Care Home is situated on the outskirts of Workington. The home is a care home that can provide nursing care for 57 people in the above categories. There are three distinct areas in the home - the general nursing unit, a memory care unit for people with dementia and the Harrington Unit that helps people who have complex mental health needs including challenging behaviour. All of the bedrooms are single occupancy and have en suite facilities. There are pleasant communal areas in all three units. Outside, there are raised gardens at the rear, and to the front and side of the home are paved areas. Information about the service is made available in a statement of purpose and service user guide that is on display in the foyer along with inspection reports. The fees currently charged by the services range from £398 to £945 per week and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Care Homes for Older People Page 5 of 44 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: zero star poor 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: This was the main or key inspection for this service for this year. We had also undertaken a random inspection on 15/01/10 and the report for this can be found on the Internet or a copy obtained from our helpline. We sent the manager a form called the Annual Quality Assurance Assessment (the AQAA). This asks for information about the service in the last 12 months and for information about future planning. This was returned to us before the due date. It contained relevant information about how the service is operating, however the document would have benefited from a little more detail in relation to the requirements and recommendations we made at the random visit. We also sent fifty postal questionnaires to service users; 30 of these surveys to staff and a number of surveys to local health care professionals and to people who work for social services. We received eleven residents surveys and two staff surveys. We had Care Homes for Older People Page 6 of 44 feedback from health and social care professionals through these and from other information we received. We quote from some of the surveys that were returned to us. The lead inspector, Nancy Saich then undertook an unannounced visit to the home on Tuesday, 16 March 2010. She was accompanied by Ray Mowat, Regulatory Inspector and by Marian Whittam who is also a Regulatory Inspector. We were in the home from around 9.30 a.m until late afternoon. We spoke to people who live in the home, relatives and staff. We met with the manager and senior people from the parent company. We read a range of documents in the service, walked around the building and observed how things were in the home. Care Homes for Older People Page 7 of 44 What the care home does well: The home has a well laid out service user guide and information about the company who own the home. We learned on the visit and in surveys that some people feel the staff team are kind, caring and respectful. Most staff are pleasant and friendly. Branthwaite has a well led team that provides the caring, happy and homely environment for its residents. Every member of staff is courteous and approachable and laughter can be heard within the home. Their interaction with residents can be likened to a big family get together, they always show respect and never raise their voices in anger. Some people said this would be better if staffing levels were improved: I would just like to say I am very sorry for the good caring staff who do their very best for the residents because of their goodness my loved one is happy and content in herself for that I say a sincere thank you, and I am so very grateful to those concerned. I think it would be a good idea to ask the staff their worries and concerns in a way that they can be completely anonymous, it is very difficult to say what you feel sometimes when it concerns your job, colleagues or your loved one is in the care of others. The specialist unit staff are trained, caring, respectful and welcoming but sadly no where near enough of them to be fair to the patients with all their different degrees and needs of dementia. Staff are friendly despite low morale often and some work too much because others ring in sick. Some people told us they could get up or go to bed when they wished and spend their time as they wanted. People on the general nursing unit told us they enjoyed the trips, parties and entertainments on offer to them. We saw evidence that visitors are made welcome and that local groups are encouraged to visit. This includeds members of the local clergy. We saw nicely prepared meals being served.One of the inspectors sampled lunch and found it to be of a very good standard. People told us they were satisfied with the quality of the meals. I enjoy my dinner and there is always plenty of it. The company help the manager to deal with any formal complaints and people have access to the complaints procedure. The newest parts of the building are of an extremely high standard with large airy Care Homes for Older People Page 8 of 44 rooms and good quality fixtures, decor and furniture. A number of bedrooms in all parts of the home have been personalised and were welcoming and orderly. The laundry is well organised and people were satisfied with the way the laundress looks after their clothes. They keep clothes clean and iron them daily. Some staff have qualifications in care at level II and others are working towards level III National Vocational Qualifications. There is an interim training plan in place for 2010. The manager is trained and experienced in managing residential care homes. What has improved since the last inspection? We had evidence to show that the manager and the company have improved the information they give to people prior to admission and are careful to ensure thorough assessment processes are in place. We could see that some of the written plans of care had improved with more detail and more strategic planning for when people challenged the service or when they were unwell. Some staff have started to help people write life stories that will help staff see the whole person. We could see that there had been some improvements for some individuals where in the past there had been problems delivering personal care. The manager and senior people from the company were monitoring this. One or two people who live in the specialist units had become more involved in the general activities and outings. A further part time activities organiser had been taken on. Some plans were ongoing to increase activities and stimulation for people with dementia. A social worker told us that she could see some improvement. On my last visit I thought my client looked brighter and her grooming was improved. Changes had taken place in her care plan.... Some effort had been put in to ensure that staff felt more able to disclose anything that worried them and that senior staff were reporting any possible matters of adult safeguarding in a more effectual way. I feel more able to speak up and hope that when I have concerns they will be dealt with.Things are changing. The company has repaired the roof and purchased some new floor coverings and new furniture for some parts of the home. We had evidence to show that the manager had been making good efforts to ensure that all shifts were covered in the home on most days. Care Homes for Older People Page 9 of 44 The manager had arranged for a number of people to update some aspects of their training. The company has arranged a number of training sessions and some staff have been keen to attend these. What they could do better: We want the manager to keep the statement of purpose and service user guide under review so that people get up to date information about what the service can provide. We also want them to make sure they have full information about people new to the service so that they are sure they can meet complex social and nursing needs. We want the company to continue to support the manager and team to keep on improving the care plans. We also want the company to help everyone in the home to focus this work by looking at a person centred approach to care planning. The company need to undertake a review of how medicines are managed so that they are stored, administered and disposed of appropriately. We also want them to continue to make sure that people have good plans in place that support them with health care needs. This includes good nutritional planning and specific monitoring and planning of things like skin care, medication and behavioural work. We had some surveys and some evidence on the day to show that some staff need help to give people the kind of dignity and autonomy that they want. Some staff need more awareness of the effects mental ill health can have on people. Residents need to look more cared for. Very often they have stained clothes, maybe a jumper or cardigan with no clothes or top underneath, hair not combed... Often they just look wasted. I am sorry for the good caring staff who do their very best... To be fair there are sometimes not enough staff to deal with the different needs of people in the home. I have great difficulty in communication and I feel that carers are now taking advantage of this fact.I ... cannot get my point across so I get ignored as a consequence. We judged that a person centred thinking approach might be beneficial and we recommend that this is considered. We want the company to make sure that there are a suitable individual and group activities in place for every person who lives in the home. This needs to take into account the individuals needs and wishes and any behavioural or therapeutic approaches that are needed to help the person have a fulfilled life. Nursing is very good. Care could be better. Interest in personal things could be improved. Better activities. Should be more activities and someone to spend time with residents in bed as well as the others. Care Homes for Older People Page 10 of 44 We want all the staff to have updates to their training on recognising and reporting any actual or potential abuse and, where appropriate, are trained in how to manage safeguarding. We want the company to write to us when they have completed all the necessary repair, redecoration and fire safety work with details of the completed refurbishments because some parts of the home need to be improved.We had some evidence to show that sometimes residents and visitors judged that the home could be cleaner and tidier. Some household linens need to be replaced. Rooms a bit scruffy in places, walls and doors need painting. A little money spent on painting and decorating. People who havent visited before find it a little dull. Beds and bedding very poor linens are old, thin and faded. Ive thrown better out. Cleanliness of the home needs addressing in Memory unit, bedrooms, toilets, lounges, and eating areas, dirty stains on seats. Food left on the floor and tables not being cleaned. Windows and paths are not being cleaned outside...The home has a lovely courtyard for residents and relatives to sit in. We asked for seats last summer and there still is none. Asked for hand gel on unit many times theres still none. We carry our own. The outside of the home also looks uncared for with windows and doors never cleaned, such a great shame especially that beautiful new end of the Harrington unit. That is what could be a lovely little patio leading out from the dining room. Last summer we could not sit there amid weeds and dirt on the patio, it could bring much joy to these poor old folks trapped inside most of the time, to sit in a lovely, well-kept garden filled with flowers. Surely at this end of their lives is not a lot to ask. Some residents dont have a family who are able or maybe they themselves are not able to be taken out for fresh air, and sunshine. I hope this could be brought to the attention of owners. We want the company to ensure that these mattters are dealt with. We want the manager to make sure that there are always sufficient trained and experienced staff on shift so that people in the different units will have suitably qualified and trained staff caring for them. She needs to consider the mix of skills and experience when she compiles rosters. Several surveys questioned staffing arrangements: It is fine when the usual staff are on.... Maybe a little more staff on duty but they do very well! Need more staff, always short. Have more staff. Staff have forgotten to give my relative breakfast a couple of times due to carers carrying out other duties because of understaffing . Care Homes for Older People Page 11 of 44 We judged that there were usually enough staff but problems may have arisen due to the way they are deployed. This needs to be considered when the manager addresses the issues around skills mix and supervision. The manager needs to ensure that all staff receive the kind of supervision that allows them to carry out their role effectively. This needs to include nurses being supervised when they carry out nursing procedures. The processes for recruitment and induction of new staff must be reviewed and no one should start work without suitable background checks. This has not always happened in the past and must be done so that people are protected from any potential harm. We require that all staff complete the core training sessions that help people to do their jobs. We also recommend that the company pay people or make other arrangements so that staff can attend training that will increase their awareness and keep residents safe and well cared for. I want to learn, I want to go to training but cant do it on my days off...[for personal and financial reasons] If I were paid I would. We want the company to repeat their quality auditing process to make sure they have the true opinions of residents and staff and other stakeholders. We want them to provide more details in their development plan showing they have taken peoples opinion on board. At least one survey suggested that more attention needs to be paid to the opinions of residents and relatives. Management side very poor. You can complain or suggest things but find nothing is done or its only half done. I find that the home is like two separate homes as one side seems to run better than the other. It is recommended that money raised on behalf of residents is paid into an account and that residents (or their relatives)are included in the processes used to decide how to spend this money. The registered person needs to make sure that the service meets the requirements contained in the enforcement notice served by the fire service. This must include fire safety and staff training and instruction. All staff must attend training in manual handling and suitable checks made on their competence. Food hygiene and food safety matters must be improved. The kitchen needs to be cleaned and some repairs and improvements undertaken so that the catering operation protects people from possible harm. 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 on page 4. Care Homes for Older People Page 12 of 44 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 13 of 44 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 14 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for giving and receiving information prior to admission were satisfactory and will improve with some minor improvements that reflect the homes ability to meet peoples needs. Evidence: On the day of the visit we were given copies of the most up-to-date Statement of Purpose and Service User Guide. These were detailed and well laid out so people could understand the aims and objectives of the service. We did note that some claims in these documents about staff training have yet to be met so we recommend that any statements are reviewed to reflect the current acheivements in training and staff development. There have been no new residents admitted since the random inspection so it is difficult to measure whether they have met the requirement made in January. However we saw a number of quite in-depth assessments on file and saw that where Care Homes for Older People Page 15 of 44 Evidence: there had previously been gaps these had been filled with up to date social work reviews. We also learned from the manager that they were being much more careful about planning any admissions. We judged that the requirement has been met but we want the manager to continue to make full assessments prior to admissions, involving trained nurses especially when people may require complex nursing. Care Homes for Older People Page 16 of 44 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. We consider that some improvement has been made in the delivery of personal, health and nursing care but the company now need to ensure that this continues for every individual and that the improvements are consolidated. Evidence: We read a number of the written plans of care that help people get the right kind of support. We read some of these in great depth and met with the people involved. We judged that the manager and her deputy had reviewed the plans. Some of this had been done with social workers who had undertaken reviews of all of the individuals who live in the service. We saw some improvements to some plans where social work intervention was evident. We also saw some considerable improvement to the details of plans in the specialist units and these were completed by the deputy for this unit. We saw examples of some very focussed planning with people who have behavioural difficulties. We judged that the requirement to review care plans has been met. Throughout the building we saw that everyone had a care plan and that each persons plan covered a number of areas. Some were still not up to date as they did not reflect Care Homes for Older People Page 17 of 44 Evidence: the changes noted in monthly evaluations.Plans were in place for some people even when they did not have specific needs. Other plans still lacked detail and we would have liked to see plans being more specific to the person. For example we read plans that talked about communication or distraction but not all of them gave details of how to communicate with individual people or what kind of things might distract that particular person. All three inspectors judged that the care planning process in the home would benefit from staff at all levels understanding person centred thinking and person centred planning as we judged that the process needs to be more focussed on the whole person. Some people could be much more involved with compiling their own plans. A number of plans did not reflect the specific needs of the individual. One plan for a person with complex nursing needs was not robust enough to ensure good care delivery. We discussed this with the manager and with senior officers from the company and we were assured that one of these senior people would undertake yet more practical, inhouse training for people who write care plans. We made a new requirement that all care plans be updated and reflect the needs and wishes of individuals. We read the daily notes and records of GP and district nurse visits. We saw that medical professionals were called out when necessary. We also had evidence to show that nurses in the home were asking for more specialist help for some people. In the specialist units we did see some health action plans for people who may challenge the service and we saw the promise of these contingency plans continuing to develop into good strategies to help when people had periods of mental ill health. We judged that the input from social workers and health care practitioners, along with a willingness on the part of the service, had helped things to improve somewhat in terms of the delivery of personal and nursing care. We judged that this needs to continue and be sustained. The original requirement about health care contingency planning had been met but we made a new requirement about meeting healthcare needs. We found some areas where we judged that health and nursing care need to improve. The service uses two different formats to calculate a persons risk of developing pressure sores. We had already told the company that we believe this can cause confusion. Some people on the specialist units had behaviour monitoring charts that had not been filled in consistently and were still awaiting evaluation. Specific plans for nursing interventions could be more robust. Some people had been assessed as needing support with taking fluids and maintaining a good diet. Fluid charts were not always being filled out during the night and when they were completed the specific Care Homes for Older People Page 18 of 44 Evidence: amounts taken were not recorded. We also saw an assessment form that should help to prevent malnourishment where the person had not been weighed. We looked at other files where people may have needed more careful dietary monitoring. We looked at the medicines on all three units. We had evidence from a health care practitioner to show that in the past a regime prescribed by a specialist had not been followed correctly.We had evidence on the day to show that the storage of some controlled drugs needs to be improved;some liquid medication was not stored in the fridge and that instructions for as required medicines needs to be recorded in a more robust manner.The current records were satisfactory for administration but we saw that there were some gaps in recording in previous months. Some people do not have a photograph on their medication file so that staff can be sure they are giving medicines correctly.Some people might benefit from having their medication reviewed by a medical practitioner. One drug that needs to be carefully administered needed more instruction on the charts.Some records of disposal of drugs were imprecise. We informed the manager and the company that we would require them to review their arrangements for medication and that a specialist inspector would visit in the future to ensure they had suitable arrangements in place for managing medication. On the day of our visit and at the random visit we saw some very nice interactions between staff and residents. We had evidence to show that some, but not all, staff had received training in privacy, dignity and resident rights along with safeguarding training. These are in-house sessions lasting two and a half hours. Staff on the day could talk about treating people in a dignified manner. There have been some allegations made that some staff do not always follow these guidelines and that some residents are not always treated with the dignity that they should be afforded.This is discussed further under safeguarding (Standard 18). Most residents we spoke to were happy with the way most of the staff treated them. We saw that some peoples care and personal grooming were improved from the way it was being managed at the random inspection. However we saw one example of undignified care and a senior manager from the company asked staff to deal with this straight away. We saw one or two entries in the daily notes that were somewhat subjective. Again senior managers said they had spoken to staff about this and would continue to train and develop staff to do this in a professional and objective way. We see the promise of improvements to the way staff deliver care and we think staff would benefit from learning about the person centered approach to care. We made a good practice recommendation about this. Care Homes for Older People Page 19 of 44 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. Further improvements need to be made so that each individual has the kind of lifestyle that they want and need. Evidence: The three inspectors arrived around 9.30 and found that some people had been up for some time and others were still being helped to get up. People told us they could have a lie-in if they wanted and some people who were feeling unwell had gone back to bed. Some people took their meals in the dining rooms in the home but others spent a lot of time in their rooms. This was, in some cases, their own choice. People in the general nursing unit told us that there were activities on offer and that they enjoyed these. The activities organiser has now been joined by another part time worker and they were working together on ideas for entertaiments and activities. They showed us a programme for the week and this was mainly for people in the general unit. There is also a monthly trip out Some people on the specialist units do join in these activities where possible but some people are unable to do this and they have specific risk assessments that would prevent this happening. We were not provided with a specific activities programme for people on the specialist Care Homes for Older People Page 20 of 44 Evidence: units and the activities organisers had not received training on special activities for people who may be damaged by the symptoms of mental ill health. The deputy on this unit said she was trying to develop appropriate activities and that she was starting with life story plans. On the table at the entrance we saw these blank formats with a notice asking families to fill these in. One or two had been completed. Staff said they hadnt had time to do much of this life story work. One of the company directors said that once they had redecorated they were going to create special areas in the Memory Care unit where interesting pictures and objects could be found by people who felt restless. We looked at individual records of activities for people on this unit and the Harrington Unit and we did not see specific, planned activities. We found very little therapeutic intervention. We still require the service to make sure they devise both group and individual plans of activities and entertainments for everyone in the home, no matter the challenges their illnesses and disabilities give them.These do need to meet individual needs and abilities and stay in line with risk assessments made for people who may challenge staff and other residents. The visitors book showed that some relatives and friends are frequent visitors. We also saw some evidence of local community groups being involved and people going to local entertainments. These include church based activities. We learned from people in the service and from staff that people who live here are asked about lifestyle choices. We also learned that sometimes staff found it difficult to deal with people who make inappropriate choices due to dementia. We judged that more work needs to be done with staff in terms of rights and risks, choice and behavioural approaches. We also noted that some personal information about lifestyle choices was on view in peoples rooms (and in one case outside the bedroom door). Residents were unsure if they could remove these. We didnt meet anyone who had read their own care plan although a few people said they had been asked about their needs. Some people could have written their own life story plan with some help but had yet to do so. We noted that in some dining areas people werent encouraged to help themselves to vegetables, drinks or condiments. We recommend that ways are found to give people more choice and independence where possible but that this is done within a risk assessment framework and that where people have mental health needs this is done in their best interest. We observed staff serving up a very appetising main meal at lunchtime and we had surveys saying the food was more than acceptable. We could find no record of meals taken in the kitchen and easier access to menu choices would be good. The head cook Care Homes for Older People Page 21 of 44 Evidence: said she was going to ask people about their preferences when she updated the menus. We judged that taking a person centred approach to meals and meal times will help people have even more choice than at present. Care Homes for Older People Page 22 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We judge that the way the service deals with complaints, concerns and allegations has improved recently but we want the service to be much more robust in their recruitment and training of staff. Evidence: We looked at the records of complaints and matters of concern reported in this service. The manager had made us aware of most of the matters contained within these two records. We had evidence to show that the company respond to complaints and that the registered manager and her line manager had looked into a number of issues. Full details of these complaints investigations were recorded and we judged that the complaints and concerns received had been looked at in a satisfactory way. We spoke to residents about making complaints and most people we spoke to said they would go to a member of staff or to the manager. There was suitable information available by the entrances of the home and people had copies of the complaints procedures in their bedrooms. We had plenty of evidence to show that this service has become much more efficient in reporting and dealing with any matters of adult protection. Since the start of the year the manager has made sure that safeguarding matters have been reported promptly and correctly. The record showed how these issues were dealt with by the appropriate external agencies working with the company. Care Homes for Older People Page 23 of 44 Evidence: The manager continues to train people in matters of safeguarding, dignity and respect. When we visited in January 2010 we noted that a number of members of staff had not completed this training. The inspectors were given copies of the most up-todate training records and we could see that some people have now completed this training. Staff spoken to on the day could give a good account of what was abusive and we have evidence to prove that staff are now much more ready to speak up if anything concerns them.However there still remains a number of staff who appeared from this record not to have completed this important training and a number of other people who have not had it updated since 2007. We repeat the requirement made in January and extend the timescale to allow the company to ensure that every person who works for them in this service understands what is abusive and understands how to prevent, report and where appropriate help manage any incidents or allegations of harm, neglect or a possible abuse. We also noted when we looked at staff files that there were some staff whose background checks had not been completed before they started to work with vulnerable people. We discuss this further under staffing. Incomplete background checks can be a potential safeguarding problem, especially in a service that has difficulties maintaining supervision and training. We also spoke to management about access to the building through the specialist unit entrance and they agreed to look at this security matter as it too could compromise safety. Care Homes for Older People Page 24 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment and the fixtures and fittings need some improvements and staff need to be reminded of their responsibilities so that people can have a safe, clean and relaxed home. Evidence: The home is situated in a semi rural location some ten minutes drive from the centre of Workington. The home is served by public transport and there is a very large area for parking at the front and side of the property. There are small enclosed courtyard garden areas for each unit. Branthwaite Nursing home has three separate units -- the general nursing unit, the memory care unit for people with dementia and the Harrington unit which caters for people with complex mental health and challenging behaviour needs. The original building has served different purposes over the years but now accommodates people in mainly single ensuite rooms. The general nursing area (called the Branthwaite Unit) is in this older part of the building as is part of the dementia care unit and most of the ancillary services.There are large lounge and dining areas and a conservatory in this unit. This is the oldest part of the property and during our visit we noticed that although some refurbishment work was ongoing in this unit, some redecoration and replacement of furniture and fittings is now necessary. A Care Homes for Older People Page 25 of 44 Evidence: number of residents and relatives commented on this in surveys. Part of the Memory Care unit is also the original part of the building. Some areas of this unit now need some work to lighten and refresh the decor and the fixtures and fittings. Outside the courtyard garden areas also needed some attention. The company showed us their plans to deal with some of these environmental issues. They have already repaired the roof and purchased some new furniture and floor coverings. One part of the Memory Care unit and the Harrington unit are new build extensions to the property and are of an extremely high standard. We visited a number of people in their own bedrooms and we could see that these rooms exceed the National Minimum Standard for room sizes, were nicely furnished and fitted out and that staff had helped people to personalise these rooms. The second lounge and the dining room in the memory care unit are also of a very high standard. These areas are under used and staff told us that people prefer to use the original lounge and conservatory.We would encourage the staff team to help people use different areas so that they can feel safe and relaxed in their environment. There are enough bathrooms and lavatories around the building. Again the company is aware that some of these older facilities now need to be improved on to provide more suitable facilities. These are included in their development plans. The company showed us a plan that stated that a repair and replacement project would be undertaken in the spring of 2010.This work includes the replacement of patio doors, redecoration, refurbishment of older areas and some fire safety work. On the day of our visit a team of workmen employed by the parent company were on site and were adjusting fire doors around the property. We were assured by a senior person in this company that this work would continue for a number of weeks until their plan for improvement was completed. We asked the company to make sure that they send us a detailed report of this work once it is finished. The new part of the property has modern adaptations and fixed equipment and we had evidence to show that the company is in the process of ensuring that the older part of the property also has suitable adaptations that will help with the care and nursing needed. For example we were told that a new sluicing disinfector was to be installed. A number of people told us in surveys that they were not always happy with the cleanliness of the building. On the day of our visit the home was fairly clean and orderly but again surveys said that this depended on time of day and who was on duty. We saw a number of work records for care and ancillary staff and we ask that Care Homes for Older People Page 26 of 44 Evidence: the company audit these standards when they look at an overall picture of quality in the service. The home states that it is a non-smoking home but a room in the Harrington Unit was being used for smoking and needed improved ventilation. The men on the unit said they were happy to smoke outside but couldnt get out as the patio doors were broken. We saw some cleaning materials that needed to be locked away or stored securely and some personal toiletries that had been left in shared bathrooms. We talk about training in health and safety and hazardous substances in the section entitled Staffing. Our comments about person centred thinking apply to peoples possessions and right to privacy and security. The main kitchen was not as clean as it should have been and we discuss this again under the management section of this report. We also checked the laundry and we found this to be well-managed, clean and orderly, despite being in the older part of the building. It would benefit from some redecoration and refurbishment work and we were again told that this would be done in due course. Some surveys commented on the linens in the home. We did see some sheets that needed replacing and a senior person from the company agreed to purchase new linens as soon as possible. Care Homes for Older People Page 27 of 44 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The company needs to ensure that staff are recruited, deployed and trained properly so that people receive the best possible nursing, care and attention. Evidence: We looked at four weeks worth of rosters given to us on the day of our visit. These records were somewhat confusing and did not always give a true record of who was working. We mentioned this in the next section under records. A number of surveys we received queried the staffing levels, especially where people had complex needs. However we were able to see that most shifts were now adequately covered. There were one or two occasions when, usually due to ill-health, shifts were a little low on staff. We judged that the requirement on staff numbers has been met but want the registered person to continue to monitor staffing levels. We looked at the skills mix for some shifts picked at random and found that sometimes the specialist units were covered by a nurse who did not have a special training in mental health and that sometimes the group of staff on duty had gaps in their experience and training. We judged that good efforts were made to have enough staff on duty but that sometimes this compromised a good mix of experience and competence. We make a new requirement about staffing. We checked on recent recruits to the home. We found that people completed suitable Care Homes for Older People Page 28 of 44 Evidence: application forms and there were acceptable records of interviews that had taken place. We found evidence to show that the manager had started some people without all the necessary background checks. At least one person had been working for some months and we could find no evidence of completed checks.We also found other people who were waiting for Criminal Records Bureau checks. A senior person from the company followed up this missing information by telephone with the Human Resources Department but was unable to confirm that these had been received. We now require that all new members of staff have two suitable references, have their names checked against the Protection of Vulnerable Adults List and have an up-todate Criminal Records Bureau check before they start to work with vulnerable people. This service has a good number of people who have National Vocational Qualifications at level II. Some people are undertaking further qualifications at a higher level and other staff are working toward this. Many of these candidates attend training when it is offered. We asked for a copy of the most up-to-date training plan and we saw that the manager had developed a new plan for 2010. This covered some of the core training targets that the company set out for the team. Some of this is done by the manager herself and some by trainers employed by the company. Two of the care staff are attending study sessions in a variety of issues at West Cumbria Hospital. We spoke to staff about their training and received surveys where people told us that they found it very difficult to attend training when they were not paid for this. Nurses told us they kept up their clinical practice in their own time. We asked for a record of training undertaken by staff and we received the most up-todate copy.We saw from the training matrix that a number of people have updated their training since our visit in January and on the day of this key inspection there was a trainer from the company trying to update as many people as possible. Some individual members of staff had attended most of the training but we also saw that some people (including nurses who had been working recently and were in charge of the home) had not attended important training like moving and handling and fire training. We found that there were still significant gaps in training for some nurses and some carers in the following areas ; moving and handling, fire training, basic food awareness, health and safety and control of hazardous substances, first aid, infection control, dementia awareness and challenging behaviour. We talk about this again under management. Care Homes for Older People Page 29 of 44 Evidence: Despite the fact that the service claim to have a speciality in dementia and challenging behaviour the uptake of dementia awareness and challenging behaviour training has been very poor. When we analysed the rosters we found that on some shifts the staff lacked both training and experience. This training deficit and poor skills mix might increase risks for residents and for people who were working in the home.We are concerned that the lack of paid training is preventing staff from being appropriately skilled to deal with peoples needs. We made a general requirement about induction, supervision and training in January 2010. We now make a specific requirement about training.We also make a good practice recommendation that all staff are paid for a minimum of three days and that nurses are given suitable time off to maintain their clinical practice. We make a further good practice recommendation about training in understanding the needs of people with mental health problems. Care Homes for Older People Page 30 of 44 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A more co-ordinated approach needs to be taken so that the overall management of the home allows for an efficient and safe operation for residents and for people who work in the building. Evidence: The manager of the home is registered with the Care Quality Commission and has had experience of running residential homes in the past. She is trained to NVQ level 4 in home management. She is the general manager for the home and has two deputies who take the general and specialist nursing clinical leads for the service because the manager does not have nurse training. They in turn have clinical support from senior officers of the company. Evidence of this support was seen during the inspection. The deputy who leads the general and nursing unit has not been at work for some months and the deputy for the specialist units has been trying to cover clinical supervision for all three units during her leave. This has proven to be a challenge and we were told that clinical supervision has suffered somewhat. We also queried whether Care Homes for Older People Page 31 of 44 Evidence: the deputy for the specialist units has had enough time to develop care, treatment and therapeutic programmes for these largely newly established units On the day of our visit there were three senior members of the company on site. They were supporting the management team to deal with a number of issues. These included records, training,maintenance and management systems. We were told that they had been in the home for some days and that the operations manager is a regular visitor who staff and residents can talk to. We were told in the AQAA that the home has a quality monitoring process and that they had sent surveys to stakeholders and that the outcomes were positive. We in turn sent out surveys and had both negative and positive feedback. Adult Social Care told us that they also had mixed feedback about quality when they reviewed everyones care.We had only brief details in the AQAA about steps they were taking where CQC had made requirements or recommendations. We could see evidence in care records and in staff work records that quality audits exist.Quality audits are undertaken by staff from the parent company. We also received a copy of their Annual Development Plan dated February 2010. This plan outlines the services provided and lists improvement made in the last eighteen months. These include improvements to the building and an outline of the changes in the management structure. It then goes on to show their plans for the forthcoming year. This gives reasonable details of improvements to the fabric and fittings of the home. It also states training that will be offered. The last section states that they will be developing the service provided to all users but especially to those in the specialist units. It discusses briefly the development of care plans [that] will be more individualised and person centred... but does not explain how this will be done. We are unsure if this plan was developed after a full audit of the quality monitoring of the home. We have evidence to show that stakeholders of this service have mixed views of the quality of the service provided and we are concerned that the quality auditing process has missed dissatisfaction or gaps in the delivery of care and services. We recommend that a further audit is done of the service and that more details are added to this development plan. We checked on money kept on behalf of residents and we found this to be in order with suitable accounting taking place. We noted that there was a sum of money kept in the safe that staff and relatives had raised for the benefit of the people who live in the service. We judged that this fairly large sum would be better in an account where it could accrue interest and where residents and staff could be involved in making decisions about how it is used. Care Homes for Older People Page 32 of 44 Evidence: We checked on staff supervision records in January and at this visit. We saw that some people had received suitable levels of formal supervision but also had evidence to show that some people had no supervision recorded. Some records needed to be more detailed and for nurses we found gaps in the recording of clinical supervision. We did not receive enough evidence at either visit to show that clinicians had checked that nurses were competent in various nursing procedures. We were given a blank copy of a very good clinical supervision format devised by a senior person in the service. This was yet to be used in this home.We had some evidence to show that some good supervision had taken place and that some staff had been supported during this to discuss some issues that worried them. We want the home to continue to improve both formal, clinical and observational supervision. We looked at a varied selection of records used in the home. We found that there were a number of systems used that should provide good evidence to prove that management and care were working well. However we found that some records were not being maintained correctly. For example some care records were incomplete or lacked precision. Some staff records were difficult to access.Rosters showed incorrect qualifications for one nurse.Records required to ensure that health and safety systems were working correctly were not always up to date. We checked the fire log book and found that drills, instructions and checks on systems were much improved since our last visit some eight weeks before. Prior to this there were significant numbers of staff who needed to attend training, drills and instructions. A senior person from the company was creating a system whereby the records of drills and instruction could be recorded appropriately and everyone included in this. The home has been visited by the fire service who judged that they needed to improve the fire safety arrangements. We recommend that they continue with the actions required by the fire service and make sure that people receive suitable drills and instructions. A number of key people have not had fire training and the fire service want the home to have enough people trained as fire wardens. Again we recommend that these actions are carried out in a timely fashion along with the actions the fire service want them to take in relation to fire equipment and means of escape. We checked on the frequency of training received in manual handling and we discovered that a number of people still needed to have initial manual handling training or have updates to this. We saw that some effort had been made to check staff competencies in this. We extend the requirement made about manual handling Care Homes for Older People Page 33 of 44 Evidence: training for staff because, when we looked at the rostered hours, we found shifts where staff were expected to deal with people who needed help to move around but where a number of staff had not received this training.We judged that this matter may endanger people in the home and staff who work there but are prepared to give a little more time to allow the manager to complete this training and competence checks. We also discovered gaps in the way food safety arrangements were being managed. Recording of things like fridge and freezer and cooked food temperatures had only recently been updated. We visited the kitchen and found the food hygiene standards were not as one would expect in a service that deals with very frail and vulnerable people. The storage of dry goods needs improved, as does the recording of food temperatures. A review of kitchen equipment repair and replacement needs to be done.Some food preparation areas of the kitchen needed a deep clean. The hot locks used to take food around the units had food debris left in them and had not been cleaned. We looked at these matters with a senior officer of the company who agreed that the standards were unacceptable. She started to make improvements on the day and has informed us of further progress.There is a requirement about this. Care Homes for Older People Page 34 of 44 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 A programme of social and 28/05/2010 therapeutic activities must be developed for people with organic mental health problems and for people with functional mental health issues. This should take into account ability and any special needs or requirements. Where necessary individual programmes must be drawn up. This requirement had an original end date of 12/03/2010 and has been extended. This must be done to comply with Regulation 16 of the Care Standards Act 2000 and to combat lack of stimulation, disorientation and challenging behaviours in vulnerable people. 2 18 13 It is required that, through training or by other means, all staff understand their responsibilities and job role in relation to safeguarding vulnerable adults. This requirement had an original end date of 12/03/2010 and has been extended. 28/05/2010 Care Homes for Older People Page 35 of 44 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 This must be done to comply with Regulation 13 of the Care Standards Act 2000 and so that staff understand what is abusive and so that they also understand how to report, or where appropriate, manage any safeguarding issues. 3 38 13 It is required that all staff attend updates to manual handling training and that their competence in this is checked by persons trained to do so. This outstanding requirment has been extended. This must be done to comply with Regulation 13 of the Care Standards Act 2000 and to ensure that safe manual handling is carried out and that both staff and residents are kept as safe as possible. 28/05/2010 Care Homes for Older People Page 36 of 44 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 15 Individual care plans must 28/05/2010 reflect the needs and wishes of the individual and contain guidance for staff about nursing and care interventions and personal preferences and wishes. This must be done to comply with Regulation 15 of the Care Standards Act 2000 and to ensure that people get the highest possible standards of care. 2 8 12 The registered person must 28/05/2010 ensure that individual health and nursing care needs are met at all times. This must be done to comply with Regulation 12 of the Care Standards Act 2000 and to ensure that good health care planning is in place. This should include nutritional planning, pressure and wound care Care Homes for Older People Page 37 of 44 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 and behaviour managment to ensure people receive high standards of physical and mental health care. 3 9 13 A thorough audit of the arrangements for managing medication must be undertaken. This must be done to comply with Regulation 12 of the Care Standards Act 2000 and to ensure that medicines are managed appropriately. 4 19 23 IT is required that the planned improvements to different areas of the building are completed in a timely fashion and a completion report sent to the Care Quality Commission. This must be done to comply with Regulation 23 of the Care Standards Act and so that people live in a well maintained and comfortable home that has access to outside areas. 5 26 23 IT is required that suitable 28/05/2010 measures are put in place so that all areas of the home are clean and hygienic at all times. 28/05/2010 28/05/2010 Care Homes for Older People Page 38 of 44 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 This must be done to comply with Regulation 23 of the Care Standards Act 2000 and so that peoples health and well being are not compromised and so that staff understand their responsibilities to maintain good hygiene levels when undertaking housekeeping and care tasks. 6 27 18 It is required that there are sufficient staff on each shift who have the skills and knowledge required to meet the needs of residents. This must be done to comply with Regulation 18 of the Care Standards Act 2000 and to ensure that eacg shift has workers on duty who know how to deliver appropriate care and services. 7 29 19 IT is required that any new 28/05/2010 member of staff has two references - ideally with one being the last employer;is checked against the Protection of Vulnerable Adults List and has a Criminal Records Bureau check before they start to work directly with vulnerable people. 28/05/2010 Care Homes for Older People Page 39 of 44 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 The registered person must do this to comply with Regulation 19 of the Care Standards Act 2000 and to ensure that people in the home are protected from potential harm or abuse. 8 30 18 It is required that all staff attend the basic training programme that is set out by the company. This must be done to comply with Regulation 18 of the Care Standards Act 2000 and to ensure that staff are suitably skilled and knowledgeable for the work they perform. 9 36 18 It is required that all staff receive formal supervision and also have their practice observed. This needs to be done to comply with Regulation 18 of the Care Standards Act and to ensure that staff have the opportunity to discuss concerns, training needs and to reflect on practice. Staff competencies need to be checked through observation and formal supervision. 28/05/2010 28/05/2010 Care Homes for Older People Page 40 of 44 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 10 37 17 IT is required that a review is held on the way records are maintained in all areas of the service. This must be done to comply with Regulation 17 of the Care Standards Act 2000 and to ensure that clear and concise information is available that will help the home to function efficiently. 28/05/2010 11 38 37 It is required that the 28/05/2010 registered person ensures that the kitchen is kept in a clean and orderly fashion; that food safety rules are applied; that staff understand how to handle hazardous substances and that records are kept of food temperatures. You must do this to comply with regulation 16 of the Care Standards Act 2000 and to ensure that safe working practices are in place for food safety so that food is stored and prepared correctly in order to lessen the risk to service users. Care Homes for Older People Page 41 of 44 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 1 It is recommended that information contained in the Statement of Purpose reflects the therapeutic care and services provided and gives a true account of training received by staff. It is recommended that staff receive training in person centred thinking and in person centred planning so that the way care is delivered becomes much more focused on individual needs. It is recommended that nutritional planning is reviewed throughout the home so that everyone has suitable arrangements in place to help them maintain or improve their nutrition and hydration status. It is recommended that arrangements for people who smoke are looked at again so that the home meets the smoking legislation and gives people choice about smoke free environments. It is recommended that all staff have a minimum of three paid days training per year and that nurses are given time to update their clinical practice. Again the company ought to arrange for time off from their duties, or pay, for this. It is recommended that all staff who work either directly or indirectly on the specialist units have training in awareness of the needs of people with both organic and function mental illness and are aware of therapeutic techniques and have training in managing challenging behaviour. It is recommended that in this service where the registered manager is not a nurse that there is always suitable dayto-day clinical lead cover for the absence of either deputy. It is recommended that a further quality monitoring excercise takes place seeking views of people who live and work in the home, visitors and professionals and that from this the development plan has more details of the steps that will be taken to meet the legislation and the wishes of stakeholders. It is recommended that an account be opened for money raised on behalf of people who live in the home and that residents or their representatives are involved in the administration of this money. It is recommended that all matters contained in the enforcement notice served by the fire service are acted Page 42 of 44 2 10 3 14 4 19 5 30 6 30 7 31 8 33 9 35 10 38 Care Homes for Older People 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 upon as soon as possible. Care Homes for Older People Page 43 of 44 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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