Inspection on 03/11/09 for Comberton Nursing Home

This inspection was carried out on 3rd November 2009.

CQC found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Comberton Nursing Home 22/03/10

Comberton Nursing Home 11/09/08

Comberton Nursing Home 15/05/06

Comberton Nursing Home 06/02/06

Comberton Nursing Home 09/08/05

Comberton Nursing Home 24/01/05

Comberton Nursing Home 06/09/04

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Comberton Nursing Home King William Street Amblecote Stourbridge West Midlands DY8 4EP Lead Inspector Ann Farrell Key Unannounced Inspection 11:40 3rd November 2009 DS0000060514.V378112.R02.S.doc Version 5.3 Page 1 This report is a review of the 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. 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. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Comberton Nursing Home Address King William Street Amblecote Stourbridge West Midlands DY8 4EP 01384 262027 01384 76943 comberton@hotmail.co.uk 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) Mr. Jayantilal James Bhikhabhai Patel Vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (36) of places Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 36 Old age, not falling within any other category (OP) 36 The maximum number of service users who can be accommodated is: 36 11th September 2008 2. Date of last inspection Brief Description of the Service: Comberton Nursing Home is located near to Stourbridge town centre in an attractive residential area. The home is registered to provide care to a maximum of 36 people who have nursing needs. The home is a large detached property that has been converted and extended to its present form, a 36 bedded nursing home. It comprises of three storeys and bedrooms are located on the ground and first floors. The main living areas, kitchen, offices, laundry and a shower room are on the ground floor, further bedrooms, the bathroom, toilets and the treatment room on the first floor. The lower ground floor accommodates the office and staff room. The home has well maintained gardens to the front and rear and a good sized car park at the front. Fees for the home are from £460 per week. Up to date information about fees the reader is advised to speak to the manager at the time of making enquiries. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 11th September 2008 when they were given a two star rating. Concerns were raised with us and they were looked at during the key inspection. This inspection found a number of areas that require attention to ensure good outcomes for people living in the home and they are outlined in the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken within 6 months. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). The AQAA is a questionnaire that is completed by the manager and it gives us information about the home, staff, people who live there, any developments sine the last inspection and their plans for the future. Surveys were also forwarded to staff, people who live in the home, their relatives and health professionals. One inspector undertook the fieldwork visit over two days. The manager was available for the duration of the inspection. The home did not know that we were visiting on the first day of inspection. At the time of inspection it was stated there were thirty one people living in the home. Information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.2 Page 6 Staff files, training records and health and safety files were also examined. At the time of inspection six people who live in the home, three visitors and four staff were spoken with in order to gain comments. What the service does well: There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. The home had a service user guide which was available in large print and provided people with information about the services and facilities in the home. Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Pre-admission assessments are completed, so staff can determine if peoples needs can be met. The arrangements for handling peoples personal finances are good ensuring their money is protected. What has improved since the last inspection? What they could do better: The assessment and admission process needs to be developed further to ensure people are not admitted to the home who are outside their category of registration, to ensure needs can be met effectively. A letter should be forwarded to people following assessment advising them of the outcome of the assessment. Also a review should be held at the end of the trial period to determine if people are satisfied with the care or if any changes are required. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.2 Page 7 A review of all risk assessments should be undertaken with appropriate follow up action and referral to health professionals where necessary where any concerns are identified, to ensure peoples well being is maintained. The care planning system needs to be developed further in order to provide a comprehensive plan of care for each person and record of any changes, so staff have up to date information about the support people need, so peoples needs are met effectively. Daily records should clearly give details of peoples physical, psychological and social well being in addition to follow up of any concerns, so their conditions can be monitored effectively. Robust systems must be in place to ensure peoples health and welfare including prevention of pressure sores, provision of adequate diet/fluids and nutritional supplements where they re prescribed. Also where any bruising is noted records must be maintained and there must be appropriate follow up to reduce the risk of further occurrences. Communication systems should be reviewed and action taken to ensure effective communication between staff in the home to maintain peoples well being. The medication system needs to be more robust to ensure the safe storage, administration and recording of medication, so people receive the medication prescribed for them Updated training should be provided in manual handling and fire prevention. Also training should be given to staff in respect of dementia, tissue viability, the Mental Capacity Act and Deprivation of Liberty Safeguards, so they have the appropriate skills and knowledge to care for people. Also a review of the training arrangements should be undertaken to ensure training is effective and benefits the people living in the home and there are improved outcomes. The manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure to ensure peoples well being. A review of the arrangements for recording and follow up of any comments/concerns/complaints should be undertaken and action taken to ensure a pro active approach with continued improvement and learning, so people are safeguarded and further re-occurrences prevented. The arrangements for activities should be reviewed to ensure they meet peoples references and interests. A review of the meals should be undertaken with appropriate action to ensure people receive meals that meets their needs and preferences. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 8 A review of staffing levels must be undertaken and action taken to ensure the appropriate deployment and number of staff are on duty at all times to meet peoples needs in a timely and person centred manner. Consideration should be given to the communal space, so that people have room to walk around and the opportunity to take meals and the dining table. Also an audit of armchairs should be undertaken with action to ensure everyone has a suitable armchair to meet their needs. The disinfector on the first floor should be repaired or replaced to reduce the risk of cross infection. The clinical waste bin must be kept locked when not in use and cleaning chemicals must be stored securely to reduce the risk to people in the home. The recruitment of new staff must be more robust and ensure all checks are completed before people commence work in the home, so ensure people are protected. The quality assurance process needs to be developed further to obtain feedback from various stakeholders, regular meetings with staff, people living in the home, relatives and management visits to ensure peoples needs are met effectively and continuous improvement is achieved. 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. 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. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 9 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 Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is made available to people before they move into the home, enabling them to make an informed decision about moving into the home. The pre admission assessment process was adequate in providing staff with information about peoples needs to determine if they could be met upon moving into the home. The manager will need to ensure people are not admitted where needs cannot be met. EVIDENCE: Copies of the service user guide were seen in each persons room visited. They were clearly presented in typed format. It was also available in large print and Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 11 it stated the administrative or management team should be contacted for an alternative format. The document gives people information about the services, facilities and fees to enable them to make a decision about moving into the home. Information from the surveys indicated people received enough information to help them decide if the home was the right place for them, before moving in. The home provides care for people who require long term or respite care. People can visit the home before moving in, so they can view the facilities, meet staff and other people who live there, in order to sample what it would be like to live there. The people who were spoken with stated their relatives had visited on their behalf. Documents indicated that staff undertook pre-admission assessments for people before they moved into the home, so they could determine if peoples needs could be met appropriately and this was confirmed on discussion with relatives. On inspection of the records for two people who had moved into the home recently it was found the documents had been completed. The assessment was based on physical needs; gave some information about peoples basic needs and was of an adequate standard. However, it did not indicate who was involved in the process to ensure a person centred approach. There was no evidence on the files seen of a letter confirming the home could meet peoples assessed needs, as part of the admission process. Staff must ensure a letter is forwarded to everyone following assessment to advise them of the outcome of the assessment, so they can be assured their needs can be met when they move into the home. Following admission to the home there is a trial period of one month. This provides an opportunity to discuss whether the person is happy to continue living in the home and if their care needs are being met or any changes are required. Although there was evidence the acting manager had spoken to professionals there was no evidence of a review with the person living in the home, their relatives, staff and professionals to ensure they were satisfied with all areas. This process needs to be followed and records of the reviews retained in peoples records to demonstrate if they are satisfied with the current plan of care or changes are required. The home is registered to care for people for reason of old age and physical disability. Someone had been admitted recently who suffered with a mental health problem. Although the persons nursing needs outweighed the mental diagnosis and that was the primary reason for their admission, the home is not registered to care for people with mental health problems and staff had not received training. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in respect of meeting peoples needs and care planning need to be more robust to ensure a person centred approach where everyones needs are met effectively. The medication system was not sufficiently robust to ensure everyone received the medication prescribed for them. EVIDENCE: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Following admission to the home a short term care plan is drawn up based on the pre admission assessment, which gives staff basic information about peoples needs and the support they require. This allows time for a more comprehensive care plan to be drawn up. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 13 Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling, nutrition, skin etc. for all the files looked at, but no further general assessment was completed. Risk assessments are completed in order to identify any areas of risk to enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being is promoted. Some of the documents did not have the persons name on or were not dated or signed by the member of staff completing them. One of the risk assessments had been calculated inaccurately, so would not provide an accurate reflection of the degree of risk. The full care plans were found to be generally vague, lacking in detail, and they did not include all areas of need. They were based on physical care only and had not been personalised to individuals. Generally it was found that the planning of care was inconsistent and therefore we could not be certain that each person had care plans that were up to date, accurate and addressed their needs. All care plans need to be personalised and provide detail of the action to be taken by staff to support people, as this could result in poor care practices and evaluation of care may not be accurate. On inspection it was found that some people had been losing weight over a period of time. Although risk assessments had been reviewed they did not indicate loss of weight and there was no evidence that any action had been taken to address the issue. There were people who were prescribed nutritional supplements and nurses had signed medication charts to indicate they had been given to people. However, when fluid charts were checked they did not indicate people had actually drunk the full nutritional drink. Also one person had been prescribed a forticreme pudding and nurses had signed to say it was not required. This is not appropriate as people are prescribed nutritional supplements due to a nutritional risk and staff should ensure they receive them. If for some reason they cannot be taken by the person medical staff should be contacted for advice. Whilst reviewing fluid balance charts it was noted a number of people were not receiving an adequate fluid intake on a number of consecutive days. There was no evidence that any action had been taken and on discussion with the acting manager she stated one person was allocated to ensuring people received drinks regularly, but could not explain the reason for the concerns. Staff were monitoring peoples bowel actions. Records indicated that some people who required support for toileting had not had their bowels open for several consecutive days and there was no evidence that any action had been taken. On discussion with the acting manager she did not indicate any action had been taken. Where aspects of care are being monitored by staff appropriate action should be taken when there are issues, to ensure peoples well being Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 14 Whilst viewing some peoples bedrooms it was noted that bed safety rails were in use. In some cases they were of an adequate height, but in one case it was noted they were not sufficiently high enough to protect the person due to the use of pressure relieving equipment. Also some of the risk assessment for bed rails did not clearly indicate the reasons for their use or that alternatives had been explored. The acting manager will need to review all risk assessments where bed rails are in use to determine if there is a need for them or if alternatives can be used. Where it is deemed necessary to use bed safety rails, suitable equipment must be in place to safeguard the person. Records for one person indicated they had challenging behaviour. There was no appropriate care plan for dealing with this, there was no clear record of any triggers and staff had not received any training in this area to ensure they were suitably qualified to manage the situation. Care plans in respect of diabetes were not comprehensive and did not give guidance to staff on the optimal blood glucose range for each person to ensure their well being. One care plan stated if the blood sugar was low staff should give a milky drink and if it was very low to give hypo stat. The same care plan in one area stated to monitor blood sugar twice daily and in another area once daily. On checking the medication there was no hypo stat in the home prescribed for this person. Action will need to be taken to ensure more robust systems for meeting the needs of people with diabetes. There was evidence that pressure relieving mattresses were in use for people who were at risk of pressure sores, but we did not observe pressure relieving cushions consistently in use. Some people at risk of developing pressure sores had charts in place in order to demonstrate they were receiving regular pressure relief. However, some of the records indicated people had remained in the same position for several hours without any pressure relief. This does raise some concerns about the practices in this area and there was no evidence that care staff had received any update or refresher training in relation to pressure area care or related issues. There were separate charts to evaluate wounds and to record the dressings used. Care plans were not consistently in place for people who had wounds. This was raised with the acting manager, who checked the document and confirmed the findings. The manger stated they do not refer people with wounds to the tissue viability nurse unless they find wounds are not responding to the dressings they use. Three people had just been referred to the tissue viability nurse for advice about wound dressings. On the day of the inspection it was noted that one person had sustained severe bruising as a result of a fall. The fall had been recorded and a photograph had been taken but was awaiting printing. At the conclusion of the inspection a body map chart had not been completed and the falls risk assessment had not been reviewed – however, the provider gave assurance after the inspection Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 15 that these were completed. On discussion with care staff they stated they would inform the nurse of any bruising noted, so that it could be recorded and followed up. A safeguarding referral had been made by a family as their relative had been found to have a number of bruises following discharge from the home. This case is being investigated and is still open. Systems must be reviewed in the home for reporting and recording all incidents of bruising, determine the cause of the bruising and take appropriate action with referral under the safeguarding procedures if causes cannot be identified. Staff record daily records and it was identified that some areas of concern had been identified in them, but there was no evidence of any follow up or resolution of the concern. There were two people in the home with artificial (PEG) feeding tubes. Records indicated one had been turned regularly to prevent complications, but there was no record of this for the other person. Everyone living in the home was registered with a local General Practitioner (GP) who visits the home. People moving into the home have the option of retaining their own GP. (If the GP is in agreement). There was some evidence of visits by Health and Social Care professionals such as chiropodist and optician. There was no evidence available in files to demonstrate monitoring of chronic diseases by health professionals such as diabetes, high blood pressure, asthma etc. Such follow up ensures peoples health and well-being. Advice will need to be sought from health professionals about such monitoring and clear records should be kept in the home to demonstrate this is occurring. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. Medication was stored in locked trolleys in the lounge, but they had no been secured to the wall and a sharps box was on the floor. This poses a risk to people and the nurse was advised to remove the sharps box to another area for safe storage and secure the medication trolleys. Other medication was stored in a locked treatment room. An inspection of the current months medication was undertaken with the nurse on duty. It was found that audits for blistered medication were satisfactory. The audits of boxed medication were not correct or could not be audited in some cases, as there was no record of the amount of medication at the beginning of the month. Other findings included; • Cream had been opened and there was no date of opening. Creams should be dated on opening and discarded within specified timescales to reduce the risk of infection. • Staff had not recorded the amount of medication administered where variable doses had been prescribed. • Oxygen was not prescribed and had not been secured safely. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 16 • • • • Medication for disposal had not been stored in a locked cupboard. The minimum and maximum fridge temperature was not being recorded. This needs to be implemented to ensure medication stored in the fridge is kept at the correct temperature at all times. One person was prescribed promazine PRN and there was no care plan or instructions of how/when it should be used. Staff had recorded that some nutritional supplements were not required. Staff were observed to assist people and they were fairly well supported in respect of personal care and choosing clothing appropriate for the time of year, which reflected their individual culture, gender and personal preferences. We were informed by people that they had to wait a long time for assistance to the toilet. There were twenty three people who required the assistance of two staff and many of the people appeared to have high dependency needs. This may be related to an inadequate number of staff on duty to meet peoples needs and a review of staffing levels is required to ensure peoples needs are met effectively. Bedroom doors did not have locks in place. Residents are asked to sign a consent form for a lockable door on admission if they require one. Lockable facilities were available in bedrooms to store valuables/medication if required. There was a hands free telephone in reception, but no indication in the service user guide about arrangements for people wishing to make or receive calls in private. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 visiting the home were flexible, so people were able to maintain important relationships. Arrangements in respect of activities and meals should be reviewed and appropriate action taken to ensure peoples needs are being met effectively. EVIDENCE: There was no evidence of any rigid rules in the home at the time of inspection. People who live in the home can go outside on their own or with friends and family as they choose, depending on their abilities. On discussion with people living in the home they stated they could get up/go to bed when they wanted. People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 18 The home employs an activities co-coordinator who works four to six hours four days per week. There is a range of activities for people to take part in if they wish. For example, bingo, quiz time, manicures, art and craft work, exercise to music, poetry corner, hand and face massage. Time is set aside for ‘one to one sessions’ for people who do not take part in the other activities such as people who stay in their rooms or people who prefer not to join in larger group activities. They also have some outside entertainers visit, there had been a firework display recently and plans were being made for Christmas. Half of the surveys indicated the home sometimes arranged activities they could take part in. It is recommended that this area be reviewed to ensure everyones preferences are considered in developing the plan of activities. There are two lounges and both have televisions, but the television in the large lounge is positioned so that it can only be seen by a small group of people. The home provides the opportunity for people to follow their own religion ensuring their religious needs are met and a religious service is held in the home regularly. There was a three week rotating menu that was drawn up at the beginning of the year and provided a choice of meal for lunch and evening meal. On discussion with the cook they stated a jacket potato, chicken nuggets or fish fingers could be provided as an alternative, if people did not like the main meal. On discussion people they confirmed they were consulted about choices each day. One person stated they did not like the meals the previous two days and had fish on both occasions. At the time of inspection we were informed by people living in the home the meals were good. Feedback in surveys was very mixed with some telling us they always liked the meals, whilst others told us they sometimes liked the meals or never liked the meals and one was left blank in respect of meals. At the last inspection a recommendation was made in respect of keeping menus under review and ensuring peoples wishes were incorporated into the choices. It is strongly recommended the menus are reviewed, changed seasonally and alternative options are made available for people who do not want or like the main choices on the menu. Dining facilities consisted of two dining tables in the large lounge, so a maximum of eight people could dine at the tables. A third table was available, but was not used by people living in the home during the inspection. Everyone else had their meals sitting in the lounge chair where they had been sitting most of the day or in their bedroom. The lack of dining space means that people do not have the option of taking their meals at the dining table and miss out on the social aspects of dining. It is recommended this area be reviewed to enhance peoples dining experience. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for dealing with complaints. Recording and follow up of complaints and concerns were not sufficiently robust to ensure people were adequately protected. EVIDENCE: The complaints procedure was included in the homes statement of purpose and a copy was available in the entrance of the home. It is recommended that a copy of the complaints procedure is included in the service user guide, so people have the information available if they wish to make a complaint. Information from the home in the AQAA stated there had been thirteen complaints, which were all upheld. Some had been recorded in the complaint book and others were in a separate file. On inspection it was noted that a number of them were about aspects of care and staff responses to people. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 20 On discussion with one person living in the home they stated they had raised concerns, but there was no record of their concerns or the action taken to address the issues. Management will need to ensure a robust system to record all formal and informal complaints/concerns clearly, include the investigation, outcome and feedback to the complainant to demonstrate and open approach and continuous improvement. Also systems need to be put into place to ensure there is learning from issues in order to prevent re-occurrences. The Care Quality Commission received an anonymous complaint about staffing levels, people not receiving regular pressure relief or being supervised, poor manual handling procedures and staff morale. These areas were looked at during the inspection and a number of shortfalls were identified as outlined in the Health and Personal Care Section. Additionally, we found regular staff meetings and supervision had not occurred and the minutes of a staff meeting indicated there were low levels of team work. . The management had made two referrals to the Local Authority in respect of possible abuse under the safeguarding procedures, which had been investigated. A third referral was made by family in respect of a person who had sustained bruising. This case is being investigated and is still open. Whilst reviewing the complaints book it was noted there was an incident where one person living in the home had hit another person. There was no evidence the acting manager or staff had informed the social worker or made a referral under the safeguarding procedures about this, as required. There was evidence of a telephone discussion with the social worker and a review at a later date, but again there was no evidence that this matter was discussed. This is concerning as it suggests that issues are not being addressed appropriate by management. The AQAA stated there had been two incidents of restraint in the home. When the manager was asked about them she was unable to provide details or any records. A record of an incident indicated that one person had bed rails in place and they did not require them, which constitutes restraint. It was concerning that the acting manager was unable to provide us with appropriate details. No person should be subject to physical restraint unless it is the only practicable method of ensuring the welfare of the person. Where it is considered necessary to restrain anyone clear records must be kept and the Local Authority contacted for assessment under the Deprivation of Liberty Safeguards. The training matrix showed that nearly all staff had received training in safeguarding procedures last year. This should ensure they know what to do in the event of an incident or allegation of abuse being made, to ensure people are safe. Staff spoken with on the day of our inspection could give examples Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 21 of forms of abuse and what they would do if they witnessed abuse within the home. This shows that staff at the home have the knowledge to protect people from harm. There was no evidence that staff had received training in respect of the Mental Capacity Act or the Deprivation of Liberty safeguards. Training will need to be provided to all staff in these areas to ensure they are aware of their responsibilities in supporting people who lack capacity to make decisions. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and comfortable environment. EVIDENCE: The building is a large, detached, three storey home for older people located in a residential area close to Stourbridge. There is off road parking and access to the front of the home is by a number of steps. Level access to the building for wheelchair users is towards the back of the building. The garden to the rear is well maintained and a pleasant area for people to sit when the weather permits. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 23 A partial tour of the home was undertaken and it was found to be warm, clean and maintained to a good standard. Communal areas were looked at and a sample of some of the bedrooms and bathing facilities relevant to people we case tracked. Feedback from surveys indicated the home was always clean and there was never any odour of urine, but some parts were looking tired. The home has one small lounge and a large lounge that has three dining tables incorporated into it. The AQAA indicated new dining furniture and lounge tables had been purchased. In the larger lounge there was a plasma type television, but its position resulted in only a small number of people being able to watch it. The number of dining tables did not provide opportunity for everyone to sit at the table for meals and many of them had their meals on small tables in the lounge chairs where they sat all day. Generally people appeared very crowded in the lounges and there was a lack of space to move around. It is suggested consideration be given to providing extra communal space for people. One person was seen sitting in a wheelchair all day, the provider submitted evidence which demonstrated that this arrangement was at the direction of the physiotherapist, however, the service user had not been reviewed since September. Feedback in surveys about what could be improved was better arm chairs. An audit of all arm chairs must be undertaken and action taken to ensure everyone has an appropriate arm chair to meet their individual needs. There are twenty single bedrooms and eight double bedrooms. All are provided with wash hand basin and call bell, so people can call for assistance if required. People are encouraged to bring in their own possessions in order to have familiar items around them to make their bedrooms more homely. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. There is a bathroom on each floor with assisted bathing facilities, so people have a choice of bathing facilities. Toilets are strategically placed around the home. Cleaning chemicals were stored in some bathrooms and toilets and in some cases they were within easy reach of people living in the home. These could pose a danger and risk assessments must be completed and appropriate action taken to ensure the safety of people living in the home. A passenger lift enables people to access all areas of the home and the home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails etc. The main kitchen was clean, well organised and adequately equipped for its purpose Sluice facilities were available in each floor with a sluicing disinfector. The extractor fan in the ground floor sluice was not working and the disinfector in Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 24 the first floor sluice had been out of order for some time. The manager stated staff were sluicing items manually and taking them to the ground floor disinfector. This is not appropriate due to the risk of cross infection. The disinfector on the first floor will have to be repaired or replaced. Whilst touring the home it was noted that wash bowls in peoples bedrooms were stored on the floor, which is not appropriate in respect of infection control. The acting manager removed them from the floor on the second day of inspection. Systems must be in place to ensure equipment is not stored on the floor in future. It was also noted the large bins outside the home for the storage of clinical waste were not locked. This is a risk and they must be kept locked at all times when not in use to ensure safe storage and reduce the risk of infection. The laundry had processes to prevent cross infection. Laundry equipment was adequate to allow sluice and pre-wash cycles. Liquid soap, paper towels, gloves and aprons were seen in all high risk areas. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels and action taken to ensure there is adequate staff on duty at all times to meet peoples needs. Staff require further training to ensure they have the knowledge and skills to meet peoples needs. EVIDENCE: The acting manager stated there was one nurse and six care staff on duty during the morning; one nurse and five care staff in the evening plus one nurse and three care staff overnight. In addition, there were support workers who worked early morning and evening to support people with meals at meal times. From the rotas seen it was noted the managers working hours were not recorded and these staffing levels were usually achieved with the use of agency staff on some occasions. At the last inspection there were two nurses on duty during the day. When the manager was asked why there had been a reduction in the number of staff she stated the proprietor had reduced them due to finances. The dependency of people was high and there did not appear to be adequate staff on duty to meet their needs. Ancillary staff such as domestic, laundry, catering, administration and maintenance staff support the care staff. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 26 At the time of visiting there were thirty one people in the home and staff stated they had recently had up to thirty four people. On discussion with staff it was stated there were eight people who only required one member of staff and the remainder required at least two staff for assistance. During the inspection it was noted that a number of people had high dependency needs and required a considerable amount of assistance with meeting needs, some people were losing weight, some were not receiving an adequate fluid/food intake some were not receiving regular pressure relief. Some people stated they had to wait a long time for assistance to the toilet. Feedback in surveys indicated staff are usually/sometimes available. Comments included; More staff in the lounge at certain times (tea time most definitely) Make somebody more available for help/assistance during meal times Take us to the toilet. Staffing levels must be reviewed and set at levels appropriate for the assessed dependency levels of service users. Action should be taken to ensure that there is appropriate deployment and numbers of staff on duty at all times to meet peoples needs effectively in a person centred manner. The information provided by the home indicated six staff had left employment over the past twelve months. Inspection of a sample of recruitment files demonstrated that one person had commenced working in the home before a Criminal Record Bureau (CRB) Check had been received and there was no evidence of a POVA (Protection of Vulnerable Adults) first check. The other two files were adequate, but references had not been taken up with the last employer for one and there was no evidence of any notes from interview in both cases. Management will need to review the recruitment procedure and take action to ensure a more robust procedure and people are protected. There was evidence that the home had an induction training package for staff and the sample seen had not been completed. The acting manager stated staff also complete the Social Skills Council induction training package. The homes training matrix demonstrated that the majority of staff had completed mandatory training in fire prevention, moving and handling, infection control, abuse, health and safety and first aid last year. However, less than half the staff had received updated training in respect of fire prevention and fire drills this year. On discussion with the acting manager she stated although she was a manual handling trainer staff had completed the training with an outside organisation, but she was not aware of the persons qualifications. She stated another manager provided the training in respect of infection control, health and safety and food hygiene with the use of a video and questionnaire. These videos are designed to be used as part of a training session lasting approximately three hours in total and followed up with questionnaires. This area will need to be reviewed to ensure effective staff training. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 27 Records indicated that nineteen of the thirty three care staff had completed National Vocational Training (NVQ) Level 2 or above in care. Where basic mandatory training has not been updated action will need to be taken to ensure all staff receive updated training. As identified in other parts of the report training is required in some areas to develop staff knowledge and skills, so they are better equipped to meet peoples needs effectively. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More robust management systems are required to ensure the health, welfare, safety and protection of people living in the home plus the support of staff. EVIDENCE: Currently there is an acting manager taking day to day responsibility of the home. She is a registered nurse with many years experience in nursing. The proprietor stated they will be recruiting for a manager to take control of the home. The home does not act as appointee/agent for people but assists with personal allowances. Individual records are maintained for people where the home Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 29 holds personal monies. Receipts were available to confirm all expenditure on peoples accounts. The balance of monies checked was found to be correct, with two signatures for all entries. This should ensure people’s monies are held safely. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home in order to gain information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home. It provided some of the information required, but would have benefited from more detail. The home has a quality assurance process that consists of audits for some areas. Some of the audits had identified areas of improvement, but it was not clear what action had been taken to address them. Questionnaires had recently been forwarded to relatives for feedback and the acting manager had developed a graph of the feedback, but there was no development plan for areas of improvement. Also there was no evidence of feedback from other stakeholders such as people who live in the home, staff and visiting professionals. The quality assurance system will need to be further developed to gain feedback and develop plans to ensure continuous improvement. There had been one meeting with care staff and one with nurses since the acting manager took up post earlier in the year and the minutes were available for inspection. These indicated there were issues in relation to a lack of team work. Records of staff supervision were lacking in detail and did not demonstrate formal supervision sessions were held with individual staff. There was evidence that a senior manager had visited the home between January and July 2009, but there were no records of visits taking place since then and the acting manager stated she was not aware of any. Throughout the inspection shortfalls were identified in care planning, risk assessments, medication, meeting needs, communication, staffing availability, restraint, referral of issues to appropriate professionals and team working etc. A number of areas need development, to ensure everyone receives a consistent standard of care that meets their needs in a person centred manner. It is recommended that a review of all areas is undertaken and positive action taken with appropriate support for the acting manager to ensure effective systems are developed and put in place to ensure the well being of everyone living in the home. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was safe and in full working order. These were found to be generally satisfactory with the exception of the electrical wiring that was completed in 2008. It highlighted a number of areas that needed attention and there was no evidence that they had been addressed. The acting manager provided us with information following the Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 30 inspection to demonstrate remedial action had been taken. Checks were completed on the fire system regularly and this should ensure people are safe in the event of a fire. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 31 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 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 12(1) Requirement The manager must not admit anyone outside the homes category of registration in line with the current legislation. A review of everyones individual risk assessments must be undertaken to ensure they accurately reflect risks related people living in the home. Where a risk is identified appropriate action must be taken to reduce the risk with referrals to health professionals where necessary. Care plans must include all areas of need and outline in detail the action required by staff to meet peoples needs effectively. A review of all risk assessments in respect of bed rails must be undertaken. Where it is deemed that a person is a risk of falling out of bed alternative options should be considered to safeguard them. If bed rails are deemed the most appropriate method of protecting them suitable bed rails must be put in place. Robust systems must be put in place to reduce the risk of DS0000060514.V378112.R02.S.doc Timescale for action 03/11/09 2 OP7 13(4) 03/12/09 3 OP7 12(1) 03/02/10 4 OP8 13(4) 03/12/09 5 OP8 12(1) 03/12/09 Comberton Nursing Home Version 5.3 Page 33 6 OP8 12(1) 7 OP8 12(1) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 11 12 13 OP9 OP9 OP9 13(2) 13(2) 13(2) 14 OP9 13(2) pressure sores with appropriate equipment and regular pressure relief. Robust systems must be in place to ensure people receive an adequate diet/fluid intake and nutritional supplements where they are prescribed. Where this is not occurring medical advise should be sought to ensure peoples well being. Staff must record all incidents of bruising and there must be appropriate follow up with an investigation of the cause and referral under the safeguarding procedures where necessary to ensure peoples well being. Robust systems must be in place to ensure the correct administration and recording of medication. To ensure everyone receives the medication prescribed to them. Staff must record the amount of medication administered where variable doses are prescribed to ensure the correct administration of medication to people. Medication trolleys must be secured to the wall when not in use to ensure the safe storage of medication. Sharps boxes must be stored safely, to reduce the risk of accidents. Oxygen must be prescribed for individuals and must be stored safely to reduce risks. There must be clear instruction in place for the use of PRN medication, to ensure consistency in its use. The date creams are opened must be recorded and they must be disposed of within certain timescales to reduce the risk of cross infection. DS0000060514.V378112.R02.S.doc 03/12/09 03/12/09 03/12/09 03/12/09 03/12/09 03/12/09 03/12/09 03/12/09 03/12/09 Comberton Nursing Home Version 5.3 Page 34 14 OP9 13(2) 15 OP9 13(2) 16 OP18 13 17 OP18 13 18 OP26 13(2) 19 OP26 13(3) 20 OP26 13(3) 21 OP27 18(1), 12(1) The minimum and maximum temperature of the medication fridge must be recorded to ensure medication is stored at the correct temperature. Medication for disposal must be stored in locked cupboards to ensure the safe storage of medication. Effective systems must be implemented to ensure all safeguarding issues are referred to the Local Authority safeguarding unit. To ensure people are effectively safeguarded. No one living in the home should be subject to restraint unless it is the only way of ensuring their welfare. If any type of restraint is required the Local Authority should be contacted for an assessment under the Deprivation of Liberty Safeguards legislation. A risk assessment must be undertaken in respect of cleaning chemicals that are stored in bathrooms/toilets and appropriate action to ensure people living in the home are not at risk. The clinical waste bin to the rear of the home must be kept locked when not in use to ensure clinical waste if stored safely and reduce the risk of infection. The disinfector on the first floor must be repaired or replaced in order to reduce the risk of cross infection. A review of the number and deployment of staff should be undertaken and appropriate action taken to ensure there are sufficient staff on duty at all times to meet the needs of the current number and dependency DS0000060514.V378112.R02.S.doc 03/12/09 03/12/09 03/12/09 24/11/09 15/11/09 15/11/09 03/12/09 03/12/09 Comberton Nursing Home Version 5.3 Page 35 22 OP29 19 23 OP30 23(4) 24 OP31 8 of people living in the home. The manager must ensure all checks are completed for newly employed staff before they commence working in the home, to ensure people are safeguarded. All staff should receive updated training in respect of fire prevention to ensure staff skills remain up to date, they have knowledge of current good practice and people are safeguarded in the event of a fire. The proprietor must ensure a manager is registered with the Commission to ensure effective leadership and management systems are implemented in the home to safeguard people. 03/12/09 03/12/09 28/02/10 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 OP3 Good Practice Recommendations A letter should be forwarded to people following the pre admission assessment advising them of the outcome of the assessment. This enables people to make arrangements and gives them confidence their needs will be met upon moving into the home The manager should ensure a formal review is undertaken at the end of the trial period with the person living in the home, family, staff and professionals to determine if everyone is satisfied with arrangements or any changes are needed and records must be retained. Documents relating to people living in the care home should include the name of the person, date and name of staff completing it, so that care can be monitored. Daily records should indicate follow up to any concerns to demonstrate peoples needs are met effectively. Records in relation to PEG tubes must clearly indicate the DS0000060514.V378112.R02.S.doc Version 5.3 Page 36 2. OP7 3 4 5 OP7 OP7 OP8 Comberton Nursing Home 6 OP8 7 8 9 10 OP8 OP10 OP12 OP15 11 OP16 12 13 OP16 OP18 14 15 16 17 18 19 OP19 OP19 OP27 OP29 OP29 OP30 care of the tube to reduce the risk of complications. Staff should liaise with the GP surgery regarding the monitoring of chronic diseases such as diabetes, high blood pressure, asthma etc. to ensure peoples well being. Records of all checks should be retained in the home. A review of communication systems should be undertaken and action taken to ensure effective communication in the home to ensure peoples well being. People living in the home should be advised about the arrangements for making and receiving phone calls in private. It is recommended that a review of the activity programme is undertaken with people to ensure it meets peoples preferences and interests. A review of the menus should be undertaken to ensure meals meet peoples needs and preferences, it should be changed seasonally and alternative options should be available for people who do not like or want the choices on the menu. The manager must ensure robust procedures are in place for recording and dealing with all informal complaints and concerns and systems put in place to reduce the risk of reoccurrences. It is recommended the complaints procedure be included in the service user guide to ensure everyone is aware of the procedure in the event of any concerns. Staff should be provided with training in respect of the Mental Capacity Act and the Deprivation of Liberty Safeguards, commensurate with their position in the home, to ensure they are aware of their responsibilities in respect of supporting people who lack capacity to make decisions. Consideration should be given to developing the communal areas, so people have sufficient space to move around and the opportunity to take their meals at the dining table. Review all armchairs and take appropriate action to ensure everyone has a suitable armchair to meet their needs. The managers hours should be recorded on the duty rota, so that it is known when they are available in the home. A reference should be obtained from applications most recent employer to ensure a robust recruitment process. It is recommended that notes be recorded at the time of interviews for prospective staff to ensure a robust recruitment procedure. Staff should be provided with training specific to meeting peoples needs such as dementia, managing challenging behaviour, tissue viability etc to ensure they are trained in DS0000060514.V378112.R02.S.doc Version 5.3 Page 37 Comberton Nursing Home 20 OP33 21 22 OP33 OP33 23 OP33 meeting peoples needs. It is recommended the quality assurance process is further developed and an annual development plan is drawn up indicating planned areas of improvement to ensure continuous development. It is recommended staff meetings are held on a regular basis to aid communication plus provide support and guidance for staff. It is recommended regular meeting are held with people living in the home and their relatives to provide opportunities for feedback and further development within the home. It is recommended regular visits are undertaken by the proprietor or their representative to assess the quality of the home. A report should be written following visits and made available in the home for inspection. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 38 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Comberton Nursing Home DS0000060514.V378112.R02.S.doc Version 5.3 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!