Inspection on 16/04/07 for Clarence House

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clarence House 08/03/10

Clarence House 10/11/09

Clarence House 15/10/08

Clarence House 14/02/08

Clarence House 29/08/06

Clarence House 10/04/06

Clarence House 03/11/05

Clarence House 28/04/05

Clarence House 11/01/05

Clarence House 20/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Clarence House Clarence House 42 Warwick New Road Leamington Spa CV32 6AA Lead Inspector Jean Thomas Unannounced Inspection 16th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clarence House DS0000040534.V335810.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. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence House Address Clarence House 42 Warwick New Road Leamington Spa CV32 6AA 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) 01926 832826 01926 882677 Dr Jeyaratha Sivasoruban Mr Kanagasabai Sivasoruban Mr Kanagasabai Sivasoruban Care Home 21 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (16) of places Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Provider shall appoint a suitably qualified and experienced person to manage the care home. Timescale September 2006. 29th August 2006 Date of last inspection Brief Description of the Service: Clarence House is a large Victorian property that was converted from a hotel to a care home in 1984. The home has parking to the front and garden at the rear. There is a ramped access to the front door. The home is situated ¾ of a mile from the town centre with all major facilities readily accessible. The home provides care for 21 older people (including 5 people with dementia care needs) with a wide range of needs, e.g. physical disability, sensory loss, general frailty and other conditions often associated with old age. The accommodation is arranged on three floors, there is a shaft-lift and a chair lift to ensure accessibility. On the ground floor there are two communal lounges with a dining room situated between them. Also on the ground floor there are four single bedrooms and one double bedroom. On the first floor and mezzanine floors, there are seven single and one double bedroom. On the top floor there are a further three bedrooms, one of which is a double room with an ensuite which is currently being refurbished. At the time of the inspection visit the fees charged are in the range £390.00 £485.00 per week and payable in advance by either cheque or standing order. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was a key unannounced inspection visit, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The visit to the service took place on Monday April 16th 2007, commencing at 9:30am and concluding at 3:40pm. Two inspectors carried out the inspection and a separate visit on the same day was made by a pharmacist inspector to look at the management of medication. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. Two people living at the home were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for residents. A tour of the building and several bedrooms was made and observations at a mealtime. Since the last key inspection visit to the service, two random inspection visits were made on Thursday October 26th 2006 and Tuesday March 6th 2007. The visits focused on areas identified for improvement at the last key inspection and showed compliance and improvements in a number of key areas that affect outcomes. A number of shortfalls were also identified and requirements issued to bring about the improvements needed to ensure the continued health, safety and welfare of the people who live at the home. This report uses information and evidence gathered during the random inspection and key inspection process, which involved fieldwork visits to the home and looking at a range of other information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The inspectors had the opportunity to meet most of the residents by spending time in the communal lounge and talked to several of them about their experience of the home. Some of the residents found it difficult to engage in conversation due to cognitive impairments. General conversation was held with other residents along with observation of working practices and staff Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 6 interaction with the people living in the home. We talked to health and social care professionals who visit the home. A relative of a resident, five staff members, the registered manager and the newly appointed manager were spoken to and at the end of the inspection; feedback was given to the registered manager and the newly appointed manager. 10 comment cards were sent to residents and 10 to relatives or visitors to the home. At the time of writing the report, five residents and nine relatives had responded. An audit of residents’ comment cards shows satisfaction with the service provided. For example: residents receive the care and support they need and know who to speak to if they are unhappy. Staff members listen and act on what residents say and are available when residents’ need them. Comments noted include: “This home received a bad report this year and I am still happy at the care given here”. An audit of relatives’ comment cards also shows satisfaction with the overall standard of care provided. Comments noted include: “My Mother has dementia and has been in Clarence House for nearly four years. I feel all her needs are met. She is happy, clean, warm and well fed”. “Clarence House is very family orientated and that is what I liked about it from the very first time I went through the door, staff are always friendly and very kind to all patients. I would definitely recommend to it to anyone looking for somewhere to place a relative”. Since the last key inspection visit, there have been no complaints or allegations of abuse made to the commission or to the home. Since the last key inspection, a new manager had been appointed but had not yet submitted an application for registration. If the manager’s application is successful, they will take over from the current registered manager and assume full responsibility for the management of the home and comply with the conditions placed on the registration of the service. The owners must take action to ensure an application is submitted so that they can be sure an experienced and qualified person is managing the care home. The registered manager and the person appointed to take over from the registered manager were present throughout the duration of the inspection. The inspector would like to thank residents, staff and visitors to the home for their cooperation and hospitality during the inspection visit. What the service does well: The menu is nutritious and well balanced and the food nicely cooked. People living in the home are happy and comfortable and are satisfied with the staff that support them. They were smart in their appearance, with clothes looking Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 7 fresh and clean. Bedrooms were neat and tidy and people are encouraged to bring in their own possessions when they move into the home. What has improved since the last inspection? What they could do better: The systems for the management of medicines in the home must be improved to reduce the risk of harm to residents. Due to the severity of the issues found during the inspection a statutory requirement notice was issued to ensure compliance with the notice. Failure to meet the statutory requirement notice may result in prosecution. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 8 The management of health and social care consultations and health care treatments must be improved so that the residents’ right to privacy, dignity and confidentiality is respected and maintained. People requiring support with their intimate personal care needs should be consulted about whether they prefer to have a male or female carer to support them with this task and their preferences acknowledged and respected. The activity programme within the home requires revising so that all people in the home irrespective of their needs are given equal opportunities for stimulation through leisure and recreational activities, which match their cultural preference. Make sure rigorous staff recruitment policies and procedures are in place and consistently used when appointing new staff so that the home can be sure that those staff appointed are suitable and the people living in the home are not placed at risk. The workforce are all female therefore greater effort should be made by management to employ male carers so that the home can be sure that any gender needs identified can be met. Make sure there are clear lines of management responsibility and accountability in the home and regular audits carried out so that people living in the home are always confident that their needs will be met. The management of monies belonging to people living in the home and being held by the home for safekeeping must be improved to reduce the risk of financial abuse. The registered manager must access training in the management of health and safety in the workplace so he can be sure that health and safety policy and practice in the home is compliant with current legislation and good practice. Make sure staff are appropriately trained to use the transfer hoist and safe moving and handling methods must adopted so that people who need help to transfer are not placed at risk. An annual quality audit seeking the views and opinions of the people living in the home, their relatives and other stakeholders must be carried out and an internal audit used to address any gaps in service delivery. A copy of the findings should be distributed and displayed in the home. The environment should take into account and reflect the individual needs of people living in the home and display signage and picture images to promote independence and assist with orientation. Where bedrooms are shared by two people the impact of any individual changed need must be considered for each person sharing the bedroom, for example, changed mobility needs that require the use of a hoist for transfer to bed. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 9 Make sure staff understand the needs of people requiring specialist dementia care and make suitable provision for social and therapeutic activities for those individuals with specialist care needs so that the home can be sure individual needs are met. 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. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 10 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 Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 11 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): 1,2,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed and have access to information necessary to make informed choices so that they can be sure the home can meet their needs. Standard 6 is not included in this judgement, as the home does not provide intermediate care. EVIDENCE: The registered manager talked about the admission process and said he visits prospective residents and assesses their needs before they move into the home. Examination of documentation held in respect of two new residents showed that records of the initial care needs assessment were held and that information necessary to determine whether the home was able to meet the resident’s needs had been secured. For example, details of previous medical history, mental capacity, personal care needs and some life history that includes past hobbies or interests. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 12 Inspectors were advised that care plans were devised shortly after the person moved into the home and that the care plan was based on the information secured during the initial care needs assessment. Pre admission information was also provided by professional health and social care agencies and used to inform care planning. An audit of resident and relatives’ surveys showed that sufficient information had been supplied by the home to enable individuals to decide if this was the right place for them and residents are issued with terms and conditions. An inspector visited one resident in their room and talked to them about the admission process. The resident had some cognitive impairment and could not remember when they moved into the home or whether someone from the home visited them before they moved in. A visiting family member was spoken to and confirmed that the registered manager had visited the resident to discuss their care needs before they moved into the home. A visiting social care professional spoken to said that family members had been given written information about the home including the cost of the service and were very pleased with the assessment process as the registered manager had provided transport for them to visit the home and to spend some time there which included having a meal. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have a plan of care, access to health care services and are treated respectfully. The absence or use of risk assessments fails to protect residents. Medication and health care is unsafe and place residents at risk. EVIDENCE: A number of care plans were selected and examined at length and findings show general improvements in the range and quality of information held. Some of the information held was detailed and informative and was sufficient for staff to make sure residents’ needs were met. For example: • Sensitive information was held about a resident’s emotional attachment for another consenting resident and of the desire for romance and companionship. The records include: how the relationship between the two individuals has developed, staff guidance on how to respect the resident’s privacy and if the resident ever expresses through action or gesture to take the relationship further, staff are to ensure the individual’s sexual needs are addressed through appropriate consultation DS0000040534.V335810.R01.S.doc Version 5.2 Page 14 Clarence House and guidelines. Staff are informed on how to ensure individual rights are promoted and residents’ not placed at risk of harm or injury. There were however, a number of discrepancies identified in care planning and gaps in monitoring and recording, which may result in unmet needs. For example: • Daily monitoring records showed that staff checked the resident every three hours during the night but records failed to identify a risk to the resident or show why this was necessary. Residents who are not assessed as requiring and who have not requested regular night checks may find this practice intrusive and could be woken up by the staff regularly entering their room. Regular bathing was to be provided to meet the resident’s personal hygiene needs but daily monitoring records failed to show whether this occurred. The resident had a diagnosis of dementia and was unable to say whether they had a bath. There was no risk assessment for the use of the bath or shower and the absence of detailed information necessary to inform staff of what support was required is unsafe and may place the resident at risk. None of the care plans or daily records seen included information about how oral hygiene needs were to be met or of any action taken by staff to show needs were being met. • • Observations during the key inspection visit found that residents looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. Residents were well presented and wore clothes that were suited to the time of year. Garments were clean and well maintained. Documentation seen showed that care plans were being reviewed and updated by staff in the home but the information held failed to show whether residents or if appropriate, their representatives were consulted about their care plans. Two residents spoken with said they were not aware of their care plan. Records viewed also showed that staff from Adult Health and Community Services carried out regular care reviews. Resident surveys showed that residents feel they receive the care and support they need and that staff listen and act on what they say. Two residents spoken to also said they were well cared for and described the staff as “kind and helpful” and “they look after me alright”. One resident spoken with said, “ I have a shower or a wash down I don’t need any help, I would feel embarrassed”. Examination of the resident’s care profile failed to include a risk assessment for the shower or include sufficient information about how personal care needs were being met. Gender issues Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 15 should be discussed with residents’ requiring help with intimate personal care and their preferences recorded and respected. A number of risk assessments have been completed for activities that may pose a risk and include, moving and handling and the prevention of falls. One risk assessment read indicated that the resident may be at risk of falling at night and identified the need for staff to make regular checks. Records show the outcome of the risk assessment had been discussed with the resident who in response had signed a disclaimer to make sure staff didnt make regular checks because the resident felt it was an intrusion and didnt want it. Risk management strategies were found on one care plan looked at for the management of a residents epilepsy. The strategy was specific and clear, which would enable staff to have a good understanding of how to keep people safe. The risk assessment included the management of risk of aspiration when lying in bed and informed carers that there should be a two hour lapse between the resident’s last meal and retiring to bed. Daily records looked at for this resident showed they were going to bed between six oclock and seven oclock in the evening, which is only one hour after the evening meal. This suggests that staff are not fully aware of the risk assessment strategy in place and are placing the resident at risk. A number of risk assessments were found to be the same or very similar and were not personalised to take into account, the individuals capacity for independence or their ability to understand any limitations that may be imposed. An absence of accurate information was also identified for example, A risk assessment for bathing a resident who was unable to stand included encourage xxxxx to hold the bath rails when standing. Examination of the care plans, daily records and other documentation showed that residents have regular access to GPs, community nurses, optician, chiropodist and dentist. Advice on continence management is sought from the community continence adviser who also provides any necessary continence aids. Advice on how to meet the needs of some residents with a cognitive impairment is sought from a consultant psychiatrist and the information used to inform care planning. The new manager talked about care planning and risk assessments and said she had started to review and where necessary revise care plans and risk assessments so that she can be sure all the information held accurately reflects residents’ needs and is sufficiently detailed to provide staff with the information they need to make sure individual needs are being met. We talked to a health care professional who visits the home about the care given to residents. Comments noted include: Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 16 “There have been some improvements in care and the home is cleaner” “Its better than it had been.” In response to shortfalls identified during the last key inspection new sit on weighing scales have been purchased. Information held on residents’ records showed that not all residents have their weight monitored therefore greater effort is required so that staff can be sure nutritional needs are being met. For example, a resident who had recently moved into the home and who was assessed as being at risk of not having their nutritional need met had not had their weight recorded when they moved into the home so staff could not be sure nutritional needs were being met. The new manager talked about the arrangements for promoting privacy and dignity and said the practice of using a designated resident’s bedroom to provide health care consultations or treatments had stopped. Consultations and treatments now usually take place in the lounge or dining room because visiting health care professionals would not wait for residents to return to their room. The management of health care consultations and treatments should be improved so that the residents’ right to privacy, dignity and confidentiality is respected and maintained. The new manager demonstrated a commitment to making sure that residents have their health care needs met in private. This will be looked at again during the next inspection visit to the service. Observations throughout the duration of the inspection visit showed that residents were treated with respect and had their dignity maintained. For example, personal care was provided in private and staff generally interacted with residents in a respectful and meaningful manner. One staff member was considered ’sharp’ in her tone when talking to residents and was observed to instruct a resident several times to “sit down”. This was brought to the attention of the registered manager and new manger who were aware of how the staff member may have appeared and would raise the matter with the worker. The pharmacist inspector visited the home to inspect the medicine management the service provides. The inspection took two hours. Six residents medicines charts and medication were randomly selected to audit together with some care plans. The medicine management was poor. Concern was expressed that residents’ went without their prescribed medication on entry to the home. There was no system to check with the resident’s doctor to confirm their current prescribed medicine regime. This resulted in one resident not having any prescribed medication for nine days. The staff said the relative did not bring in any medication and only when she bought in some repeat prescription slips did they think to order the medication. A lack of understanding of the severity of this was apparent during the inspection despite staff undertaking and successfully completing accredited training in the safe handling of medicines. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 17 The staff also failed to anticipate when a supply of medicines would run out. One resident had no prescribed medication for 10 days. The staff said the doctor had discontinued the medication but this was not supported in the care plans or a medication protocol issued by the doctor. A photocopy of an additional supply was found that had been written six days after the supply had ran out. This is of serious concern. An immediate requirement notice was left in the home to ensure that all residents’ have their prescribed medication available to administer at all times. Medicines that were regularly ordered and supplied in 28 day packs had been administered as prescribed but some gaps were seen when the medicine either had not been administered and the reasons for non-administration not recorded or administered and not recorded as such. On the day of the inspection the residents were up late and the medication round started and finished late. This resulted in an inadequate time between the next drug round which may increase possible side effects and risk of overdose. Staff appeared unaware of these risks. Two new medication trolleys had been purchased and the medicines stored under each residents name and were clean and tidy. Hand written medicine charts were poor in some instances. Dose changes recorded by the doctor on the chart had not been fully adhered to. In one instance staff had signed that they had administered one medicine twice and then crossed out the error due to failing to adequately record the new dose change. The morning dose that was no longer required was still left in the medication trolley increasing the risk of administration in error. This is of serious concern. Some medicines had been prescribed on a “when required (or prn)” basis. These did not always have fully supporting “prn” protocols detailing their use resulting in them being administered routinely. Medicines were found in the trolley that had not been recorded on the medicine chart. This included an ointment and an injection the district nurse administered that was not labelled. Confirmation that it actually belonged to the resident or a new supply sought had not occurred. All medicines must be recorded on the medicine charts so the home has a full up to date list of all prescribed medication and be administered from a pharmacy labelled container. One medicine was also found in the surplus medication trolley that had not been recorded on the medicine chart dispensed on 13/03/07. It could not be confirmed whether this medication had been discontinued by the doctor or not. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 18 Medicines are not always returned at the end of the 28 day cycle and were carried over for the following month. Staff failed to record the “carry over” balance so audits could not be undertaken to demonstrate that the had been administered as prescribed. Staff were unsure as to what they could or could not carry over the following month and do not appear to implement the training undertaken. One care staff said the training did not include how to write on the medicine charts. Training had not been sought from the community pharmacist who provides these charts. One member of staff had taken the label off one medicine box and stuck it over the pharmacy label of the old dispensed item the previous month and transferred the contents. This is considered poor practice as it increases the risk of error. The reasons why she did this was unclear and was either because the second dispensed box was too small or it had another name on it and may have caused confusion. Staff should be reading the dispensed label and not selecting medication according to packaging or colour. The staff had purchased some homely remedies to administer to the residents for minor illnesses. No homely remedy policy was found to support their use. Due to the severity of the issues found during the inspection a statutory requirement notice was issued to ensure compliance with the notice. Failure to meet the statutory requirement notice may result in prosecution. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not encouraged to participate in social and cultural events but can maintain contact with family and friends. Food is nutritious and plentiful but specialist dietary needs not met. EVIDENCE: A part time activities organiser is employed and is used to support care staff. For example, on the day of the key inspection there were no activities taking place as the activities organiser said she had to escort a resident to the hospital to attend an out patient appointment. We were told that activities included visits to Victoria Park and to Tesco’s supermarket. Staff spoken with did not know whether risk assessments had been carried out and were not aware of any risks to residents. Foot spas were provided and were popular with residents. Board games and some group activities such as ball games and singing along to wartime favourites were also popular with some residents. The activities organiser said she had attended two training courses on dementia care and was enthusiastic to learn more about the needs of people with dementia and of how to provide social and therapeutic stimulation. The inspection found no evidence to suggest that the needs of people with dementia were considered when Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 20 planning activities; this was because most of the activities provided required a level of concentration and memory recall that people with dementia often no longer have. For example, board games, cards or dominoes. Staff spoken with were unaware of when or if it reality orientation should be used or of the benefits to be gained by the introduction of tactile boards and other items that may engage residents, provide stimulation and help to maintain mental agility and finer dexterity skills. Music is sometimes played during the day and residents spoken with were happy with the selection being played. Residents said that they could access the church service, which is held in the home each month, if they wish. Staff said that a physical activity programme, (Mr Activator), took place on a weekly basis and a resident spoken with said that they find this activity supports their mobility. Residents also said that more activities could be planned for on a daily basis, especially for people dependent on staff support for encouragement and motivation with their leisure time. A number of resident were asked about activities comments noted include: “ I have a magazine but I sometimes get bored” “I like looking out of the window” and “ I like the exercises when the man comes in”. Comments on resident and relatives surveys include: “Activities tend to be concentrated around the more mobile and mentally alert residents, rather than trying to stimulate less mobile less mentally alert residents. A dedicated activities organiser is really needed” and “I feel that my xxxx is quite contented with the way of things, he is able to move around the home as he wishes”. Daily records completed for residents did not fully account for the activities the person had participated in. For example entries made include, shopping activity and nails done and did not include the resident’s views on the activity and whether they enjoyed this or were satisfied with the outcome. One resident talked about enjoying some independence in their lifestyle activities by being able to walk into the town of Leamington Spa and potter about in the garden in warmer weather. They said they could access library books and could go to their room if they wanted some quiet time”. One care plan seen included how the resident liked to spend time and how needs are to be met for instance, “attends services at the local church and is to be encouraged to attend services at the home”. The resident is also to be made aware of when ‘songs of praise’ is being shown on the television. Daily records seen failed to show whether this always occurred. Consultation with people in the home showed that visiting is flexible and takes into account the needs and wishes of residents. Two residents spoken with said they could have visitors at any time and they were always made to feel welcome. An audit of relatives and friends surveys confirmed this occurred. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 21 Comments noted include, “I liked it from the very first time I walked through the door, staff are always friendly and very kind to all patients”. Surveys also showed that the home helps residents to keep in touch with family and friends. The dining room has been established at the front of the house and this has greatly improved the dining facilities. The room is bright and cheerful and residents, and staff, said they liked new arrangement very much. By establishing the dining area at the front of the house, this has now provided a lounge area that is more spacious and enables easier movement for staff and residents. Residents appeared comfortable with the seating provision in the lounge and there is evidence that individual assessed need for the provision of specialist seating is being looked at and some new furniture has been purchased. One resident now has a reclining chair which meets their needs and staff said that moving and handling for this person had greatly improved following the provision of this equipment. The new manager was aware residents were not routinely offered a key to their room and demonstrated a commitment to making sure they are offered a key unless their risk assessment suggests otherwise. The outcome of any consultation with either the resident or if appropriate their relative or representative will be recorded on the care plan to confirm they have been consulted and what has been agreed. Observations in bedrooms, toilets and bathrooms found that residents did not always have easy and safe access to a call alarm. For example, the call alarm in the new bathroom and a bedroom that had been re-arranged to meet a change in the needs of the occupant. A call alarm must be accessible to residents or staff should they require assistance. Since the last key inspection, improvements have been made to the arrangements for the provision of meals. For example, a four week menu had been devised and a menu board purchased and displayed in a prominent position so that residents could see what alternatives were available. Although there is an alternative to the main meal, this remains the same all week. For example Jacket potatoes with cheese or beans is the alternative from Monday to Sunday. It is recommended that the alternative meal offered be varied so that residents have informed choice. Observations showed the cook consulting residents about the choices available and a record was held of each resident’s preference and used to provide the main meal. On the day of the key inspection visit residents were served sausage, chips and peas or omelette and salad. Observations showed that staff were not always aware of the individual dietary needs of residents as one resident assessed as requiring a soft diet was given sausage, chips and peas. This same resident was also considered to be at risk Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 22 of not having their nutritional needs met and as preferring to be with others at meal times. Observations showed that the resident remained in the sitting room for their main meal and did not eat any of the food placed in front of them. Staff did not spend time with the resident, offer an alternative or encourage them to eat their food. The resident spent most of the mealtime asleep in the chair. The absence of support from staff was discussed with the new manager who said that a visit from the doctor had been requested as the resident had recently been prescribed night sedation and it was felt that this was why they was spending so much time sleeping. Information held on the care plan of one resident failed to identify that the resident had developed a wheat allergy and that hospital staff advised that a gluten free diet should be encouraged. All the residents spoken to said how much they enjoyed the food, which they found varied and plentiful. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 23 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints and safeguarding adult’s policy and procedure and have staff that know how to safeguard residents. EVIDENCE: Since the last inspection there have not been any complaints, incidents or reports of alleged abuse made to the home or to the Commission for Social Care Inspection (CSCI). A complaint was made to the Environmental Health Food Safety Team in September 2006. (Further information is included under the outcome group ‘Management and Administration’). The home had revised the complaints procedure, which was displayed in the entrance hall. This ensures that residents know their concerns are taken seriously and responded to appropriately. As there were no recorded complaints held at the home since the last key inspection we were unable to look at how well complaints were managed. Three residents spoken to said they would talk to the owner if they were unhappy. Comments noted include “ I am satisfied and would talk to xxxx if I had any problems”. The home had policy and procedure for safe guarding adults that included ‘Whistle blowing’. Staff spoken to were aware of what actions may constitute abuse and aware of the main principles of the ‘Whistle blowing’ policy and procedure and would raise any issues or concerns with the management. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 24 In response to shortfalls identified during the last key inspection documentation showed that 12 staff members had attended training on 26/09/06 on ‘Adult Abuse in the Elderly’ and on 13/10/06 a further 11 staff members had received training on ‘Challenging Behaviours.’ Information received before the key inspection showed that further training is planned and includes ‘Action on Elder Abuse and Dementia Awareness. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 25 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): 19,22 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from living in a safe and well maintained environment. EVIDENCE: Improvements required concerning systems to prevent or minimise risk of infection regarding the effective disposal of clinical waste and used incontinence pads have been met An inspection of the laundry area, which is located in the basement of the home found that since the last key inspection the washing machine had been repaired and clothing and linen were now being washed on the premises. There was evidence that robust systems were not in place to control the spread of infection. For example there were no hand washing facilities, i.e. soap and paper towels, the container for disposal of waste did not have a flip top lid, mops and buckets were not colour-coded for designated use and a mop bucket had been left full of dirty water. A number of items not required for the laundry were stored in this area. There was no identifiable dirty to clean flow Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 26 of laundry. The new manager talked about the arrangements for infection control and said that soiled linen was taken to the laundry in red alginate bags. Observations in the laundry room showed there were no bags available. Although appropriate action has been taken since the last key inspection the management of the prevention and control of infection still presents some risk to residents. The last key inspection identified that commodes provided in some bedrooms were in poor condition with ‘bowls’ being heavily stained. Observations showed that although new commode bowls had been purchased there was no clear procedure for emptying commodes after use as staff were unclear about who was responsible for this task. For example, a commode was not emptied and cleaned for four hours after use despite three staff being aware that this should happen. Documentation received before the key inspection visit showed that following a request by the new manager a lead Occupational Therapist from Adult Health and Community Services visited four residents to assess them with regard to manual handling difficulties. Details of the outcome of the assessment also include the methods to be used when assisting each resident to transfer. Some of the residents assessed had recently moved in to single rooms to enable them to have enough space to be assisted with transferring from bed/chair/commode etc. It was felt that some of the rooms would still benefit from removal of furniture that is not used, as this would provide extra space either side of their armchairs for staff to be able to stand either side. Bedrooms looked at were generally in good condition, clean and tidy. A shared bedroom however was not to the same standard and some refurbishment and redecoration was required. For example there were water stains on the ceiling which, the manager had said, was as a result of a water leak in the room above, the carpet was heavily stained and there was no armchair seating in the room. There were two chest of drawers in the bedroom, one for each resident, however one of these was a small three draw chest of drawers and may not have been sufficient for the resident’s needs. The mobility needs for one of the residents sharing the room had changed and they now required a hoist to assist with transferring from their reclining chair into bed. In order to provide sufficient room for this activity to take place safely the bedroom had been re-arranged and this had necessitated the removal of separate seating and furniture that was being used for storing clothes. These changes to meet one residents needs had made a significant impact on the other person sharing the room and the risk assessment and care planning did not demonstrate that this had been taken into account. For example insuffiect storage space for clothes no bedside call alarm, no armchair for the resident or for their visitors to use. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 27 Adult Health and Community Services have supplied the standard equipment to meet the needs of the residents for a short period until that equipment is purchased by the home and will only provide ‘specialist equipment’ to be used by the assessed resident. The four residents assessed required standard equipment. Three residents were referred to Warwickshire wheelchair services for an assessment. The registered provider talked about the arrangements for replacing the equipment loaned to the home and said that he planned to purchase two mechanical hoists one for use on each floor and is also looking at buying a tracking hoist to be fitted in one resident’s room. A new sling for the hoist and some slide sheets had been purchased to support residents to transfer safely. Observations showed that when residents required help to transfer, staff gave reassurance and explained what they were doing so that residents were aware of what was going to happen and why. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 28 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff available but residents do not benefit from having their needs met by a qualified workforce. Staff recruitment practices are unsafe and place residents at risk. EVIDENCE: The registered manager said there were 16 residents being accommodated at the home and a staff complement comprising of the registered manager, and the new manager, a senior carer, three carers, a domestic assistant, activities organiser, cook and kitchen assistant. It was the registered manager’s assessment that four residents required specialist dementia care and a number were physically frail or had cognitive impairments. Four residents were at risk of developing pressure sores and one resident was having a tissue wound treated by the community nurse. None of the residents were assessed as having challenging behaviours. The registered manager talked about the staffing arrangements and said there were usually four carers on duty in the mornings, three in the evenings and two at night. Four weeks staffing rotas were seen and showed that an agency worker had been working at the home for the two weeks before the key inspection visit and was being used to fill any identified gaps in the rota. Rotas also showed that sometimes staff numbers in the evenings reduced to two and that the registered manager had been on the night rota as well as working during the day. It is recommended that staff rotas be revised include the designation of staff and the number of hours worked by the night staff so that Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 29 the home can be sure there are always sufficient numbers of suitably qualified and experienced staff on duty to meet the needs of the residents. A number of residents were asked about the availability of staff and all those spoken to said that staff were available when they needed them. An audit of residents’ surveys also showed that residents received the care and support they need and staff listen and act on what they say. Relatives’ surveys showed that the home gives the support or care to their relative or friend that they expected. Additional comments noted include, “They are very kind and caring to all the patients”. Relatives or friends also felt that the care service meets the different needs of people living in the home. Additional comments include, “They don’t consider any patient any worse or better than the other, they are always treated very well”. Three staff spoken with said sufficient staff were available and that staff at the home generally filled any gaps identified in the rota. Inspectors noted that one care worker had difficulty speaking and understanding English. The registered manager said the worker was attending English language classes and that the worker’s ability to understand and to communicate in English had improved. Information supplied before the key inspection visit showed that 36 of the care staff were qualified to NVQ Level two or equivalent. This falls below the standard expected that required 50 of care staff be qualified by 2005. The registered manager must take action to address the shortfall so that the home can be sure that residents benefit form having their needs met by suitably qualified staff. During a random inspection visit to the service on March 6th 2007, we looked at staff recruitment and training records for evidence of sound and safe recruitment practices and to see if new workers were having an induction appropriate to their role. The recruitment records for three new staff were looked at showed that there were two staff working in the home before the outcome a check made against the Protection of Vulnerable Adult (PoVA) register or Criminal Record Bureau (CRB) disclosure was known. This resulted in an immediate requirement notice being issued to make sure residents’ safety was not being compromised and staff did not work with residents before the outcome of a PoVA first check or CRB disclosure was known. Evidence that these checks had been made was seen and the registered manager said that rigorous staff recruitment practices were now being followed. This will be looked at again for compliance during the next inspection visit to the home. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 30 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 poor. This judgement has been made using available evidence including a visit to this service. The home is not well managed and does not have quality assurance and monitoring systems developed by a qualified, competent manager. EVIDENCE: The registered manager is not qualified, has only basic management skills and minimum experience to run a care home. It has been agreed with the owners that the registered manager be replaced by a qualified and experienced person to manage the care home. A new manager was appointed January 2007 and at the time of writing this report had not submitted a manager’s application to the commission for registration. The new manager advised inspectors that the application had been completed and would be submitted when the CRB disclosure was received. Following the registration of a suitable person to manage the care Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 31 home the registered manager, who is also the owner, plans to continue working in the home but will not have day-to-day responsibility for the operational management of the home. In response to concerns about the financial viability of the home identified when the owners failed to pay their annual registration fees the owners have now supplied the financial information and documentation as required by the Care Homes Regulations (2001). Health and safety is not always well managed for example, observations showed that on one occasion staff used what is considered an unsafe method of moving and handling and known as a ‘draglift’. We asked whether staff have been trained to use the hoist and were informed that not all staff have been trained in how to use the equipment. One staff member spoken to said they did not feel confident in using the manual handling equipment and that they had had little training. The new manager said she would make sure that staff adopt appropriate methods of moving and handling and will make sure that staff who use moving and handling equipment receive appropriate training to make sure residents are not placed at risk and the home complies with the Manual Handling Operations Regulations (1992). In response to shortfalls identified during the last key inspection visit inspectors were told that the home’s policies and procedures were being reviewed and updated and observations showed that residents personal’ records were now held in secure cabinets and not left unsupervised when in use. Documentation requested for the purpose of the inspection was made available to inspectors and records seen were generally well maintained. The registered manager informed us that that independent professional advocacy services support two residents with managing their finances and information received from the home before the key inspection visit showed that twelve residents were subject to Power of attorney arrangements. The remaining residents either managed their finances independently or were supported in doing so by family members. The registered manager did not act as appointee for any residents’ benefits or manage any savings. One care plan looked at showed the resident had no conception of money and that Advocacy Alliance supports the resident to manage their finances. The home does not have a written policy or procedure for safeguarding residents’ finances. The records of financial transactions and monies held on behalf of three residents for safe keeping were looked at and showed that improvements identified during the last key inspection visit had not been sustained as receipts for items purchased on behalf of residents were not always held and a number of financial discrepancies were identified. For example, £12.00 was paid to the hairdresser but there was not a receipt held to confirm expenditure. Records showed there should have been £25.67 belonging to a resident but when checked it was found that £15.47 was being Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 32 held. According to the records, a resident should have had £43.50 and not the £25.00 being held. Records of financial transactions showed that withdrawals of £5 and £10 had been made for two residents to purchase ‘toiletries’ receipts confirming purchases were not available for inspection. This report includes a requirement that action is taken by management to make sure residents’ finances are safeguarded and residents are not placed at risk of financial abuse. This will be looked at again during the next inspection visit to the home. There was no evidence to suggest that quality assurance and quality monitoring systems, based on seeking the views of residents, was in place to measure success in meeting the aims, objectives and statement of purpose of the home. We obtain information before inspections. This information includes confirmation that all necessary policies and procedures are in place and are upto-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Information about staff training received for the home before the key inspection showed that staff training in 2006 included, First Aid Awareness, Manual Handling, Medication, Fire awareness and infection control. Training planned for this year includes’ First Aid, Infection Control and Medication. Weekly fire alarm tests are carried out and the staff attend monthly fire practice. The most recent water temperature check for compliance with Legionella took place on January 24 2007. In response to shortfalls identified during the last key inspection the home now inform the commission of any accidents or incidents that affect the health, safety or welfare of residents and in accordance with regulation 37 of the Care Home Regulations (2001). In September 2006, we were advised that the Environmental Health Food Safety Team had received a complaint regarding poor standards of hygiene. A visit to the home by the Food safety Team found shortfalls in standards and notices for compliance by October 10th 2006 were issued. On November 11th 2006, the Food Safety Team advised us that the service had complied with the notices but there were still concerns about the management. The most recent monitoring visit took place on January 12 2007. We talked to the registered manager about the issues identified during the visits and we were made aware of the progress that had been made including the purchase of a new dishwasher. In order to make the improvements required by the Food Safety Team refurbishment of the kitchen is planned. We were informed that the next visit by the Food Safety Team was due to take place on April 19 2007. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 33 The registered manager said he hoped to postpone the visit until all the work had been completed. A visit to the kitchen found the food preparation area clean and tidy. Food that had been opened or prepared in the kitchen and stored in the fridge had the date of opening or preparation attached so that staff could be sure food offered to residents was not passed its use by date. Staff working in the kitchen wore protective clothing but to further reduce the risk of cross contamination staff should cover their hair. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 34 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x 2 x 2 x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 1 x x 2 Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 36 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(4) Requirement Staff must be aware of the outcome of any risk assessment and use this information to make sure residents are not placed at risk. Make sure care staff order medicine that the residents require in time to ensure that there is enough medicine to administer as prescribed. Timescale for action 14/05/07 2. OP9 13(2) 14/05/07 3. OP9 13(2) 4. OP9 13(2) Not met. Timescale for compliance 30/09/06. Make sure that all new residents 14/05/07 who come to live in the home have their medicines checked with their doctor and new supplies sought when necessary in a timely manner. Ensure any when required 14/05/07 medicine must be supported by a prn protocol written with the support of a clinician. Not met. Timescale for compliance 30/09/06. Make sure that the right 14/05/07 medicine is administered from the right pharmacy labelled container at the right time and right dose and records accurately reflect practice. Make sure that all quantities of 14/05/07 medicines carried over from DS0000040534.V335810.R01.S.doc Version 5.2 Page 37 5. OP9 13(2) 6. OP9 13(2) Clarence House 7. OP9 13(2) 8. OP9 13(2) previous cycles are accurately recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. All medicines are administered 07/05/07 from a pharmacy labelled container and all secondary dispensing ceases immediately. All care staff that handle 14/05/07 medicines must undertake an accredited course in the safe handling of medicines that meets the needs of the staff and residents and staff implement good practice learnt. Time scale of 06/07/06 partially met. All policies and procedures 14/06/07 regarding medication are written and staff are trained to adhere to these policies. 16/04/07 The medicine refrigerators maximum, minimum and current temperatures be read daily and must lie between 2°C and 8°C at all times to ensure the stability of medicine requiring refrigeration in accordance with their product licences. Appropriate action must be taken if the temperatures fall outside these limits. This requirement was not looked at during this inspection and the timescale for compliance is Jan 2006. Undertake staff drug audits before and after a drug round to confirm staff competence in medicine management. Take appropriate action if these audits indicate that staff are not administering the medicines as prescribed and accurately 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 14/05/07 Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 38 recording the transaction. Not met. Timescale for compliance 30/09/06 Effective procedures must be in place to reduce the risk of infection or cross contamination so that residents are not placed at risk. Not met. Timescale for compliance 21/05/06. An application from a suitable person to register as manager of the care home must be submitted to the commission so that residents can be confident that the home is being managed by someone who is appropriately qualified and experienced. A system for evaluating the quality of the service provided must be introduced and maintained and include consultation with residents their representatives and other stakeholders so that management are aware of and can respond to any shortfalls identified in the service provision. Not met. Timescale for compliance 31/08/05. Accurate records must be held of monies deposited by residents for safekeeping and which is used to make purchases on the residents’ behalf so that residents’ finances are safeguarded and residents are not placed at risk of financial abuse. Staff must be suitably trained in moving and handling people so that the staff understand what methods are to be used and residents are not placed at risk DS0000040534.V335810.R01.S.doc 12. OP26 16(2)(j) 07/05/07 13. OP31 8 14/05/07 14. OP33 24 30/06/07 15. OP35 13(6) 30/04/07 16. OP38 13(5) 30/04/07 Clarence House Version 5.2 Page 39 of harm or injury as a result of unsafe staff practices. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Work already started to review and update care plans should continue so that care plans accurately reflect the care and support needed and staff have access to the information they need to make sure residents needs are met. To make sure residents health, social care and nutritional needs are met accurate monitoring records should be held. Residents or if appropriate their representatives should be consulted during the care planning and review process so that the views and wishes of residents are known and are taken into account and used to inform care planning. Where bedrooms are shared, the impact of any change in an individual’s needs should be considered for each person sharing the bedroom. Gender issues should be discussed with residents or if appropriate, their representative and their views recorded and respected. Work on risk assessments should continue and should take into account the residents capacity for independence to make sure staff are aware of the actions needed to reduce risk and to promote independence and self care. Regular night checks on residents should only be carried out if a risk assessment identifies the need or in response to a request made by the resident. Information about basic personal care needs should be readily available to staff. If the resident agrees, this information could be kept in their room. Information should be made available to demonstrate how oral hygiene needs are met. DS0000040534.V335810.R01.S.doc Version 5.2 Page 41 2. OP8 Clarence House 3. OP10 Regular weight checks should be carried out and accurate records held so that the home can be sure nutritional needs are being met. Residents should have any health care consultations or treatments provided in private so that the residents’ right to privacy, dignity and confidentiality is respected and maintained. Residents should be offered a key to their room unless a risk assessment suggest otherwise. Individual profiles should be further developed and where appropriate used to inform care planning. Staff should be given the necessary time, skills and training needed to carry out reminiscence activity, which has been shown to play a powerful part in maintaining identity in older people, as well as allowing a relationship to develop between residents and staff. Staff should be trained in the provision of specialist dementia care so that they are aware of how to identify the residents’ needs and can provide appropriate social and mental stimulation. Residents should be consulted about a programme of activities that takes into account individual and group needs. Details of planned activities should be displayed in the home so that residents are aware of what is planned for the day and can plan their time accordingly. Daily records should include detail of the activities residents participate in and include a record of the outcome for the resident. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. Alternatives offered to the main meal should vary each day so that residents are not at risk of not having their nutritional needs met. Residents should be encouraged and supported to eat their food. In the event that the resident declines then a suitable alternative should be offered. Staff should be aware of residents dietary needs so that the home can be sure individual needs are met and resident not placed at risk. 4. OP12 5. OP15 Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 42 6. OP28 7. OP38 Greater effort is needed to increase the number of qualified staff to NVQ or equivalent so that residents benefit from having their needs met by a suitably qualified workforce. To reduce the risk of cross contamination staff responsible for food preparation should cover their hair. Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Clarence House DS0000040534.V335810.R01.S.doc Version 5.2 Page 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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