Inspection on 03/03/09 for Coxwell Hall and Mews Nursing Home

This inspection was carried out on 3rd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coxwell Hall and Mews Nursing... 20/12/07

Coxwell Hall and Mews Nursing... 08/01/07

Coxwell Hall and Mews Nursing... 23/05/06

Coxwell Hall and Mews Nursing... 27/02/06

Coxwell Hall and Mews Nursing... 16/05/05

Coxwell Hall and Mews Nursing... 08/02/05

Coxwell Hall and Mews Nursing... 30/06/04

Coxwell Hall and Mews Nursing... 19/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Coxwell Hall and Mews Nursing Home Fernham Road Faringdon Oxfordshire SN7 7LB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Lough     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 49 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 49 Information about the care home Name of care home: Address: Coxwell Hall and Mews Nursing Home Fernham Road Faringdon Oxfordshire SN7 7LB 01367242985 01367241594 coxwellcare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sovereign (Coxwell Hall) Limited Name of registered manager (if applicable) Mrs Karen Ruth Wright Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users ot be accommodated is 68 The registered person may provide the following categories of service : Care home with Nursing(N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category : Dementia (DE) Mental Disorder( MD) Date of last inspection Brief description of the care home Coxwell Hall and Mews is registered to provide a service for up to 68 people with a primary need of nursing and care for dementia or a mental disorder. It is set in its own grounds on the outskirts of the market town of Faringdon in Oxfordshire. The homes environment is divided into two separate units linked by a covered ground-floor walkway. The Hall is a 19th century, grade two listed building, that the company limits occupancy to 27 residents, and has flexible accomodation to offer shared rooms, Care Homes for Older People Page 4 of 49 care home 68 Over 65 0 0 68 68 Brief description of the care home should it be required. The Mews is a purpose built 32 bedroom unit, over two floors, and can offer one shared room. All rooms in both parts of the home, except one, provide the basic en suite facilities of a toilet and wash basin. Three rooms in the Mews have full en suites with a bath. There are a variety of communal lounges and dining rooms in each unit. Fees range from £624 to £900 per person per week. Extras include hairdressing, chiropody, newspapers and toiletries. Care Homes for Older People Page 5 of 49 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in December 2007. This inspection process included reviewing information provided by the service before a visit to the home, by two inspectors, over one day. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service were consulted about their opinion of what is provided through surveys and during the period we were in the home. We also spoke to relatives, staff, and visiting professionals. At the time of Care Homes for Older People Page 6 of 49 writing this report fourteen surveys from residents and one staff survey had been returned to the commission. From this visit it was found that there are a considerable number of areas that need to improve as to protect the health and promote the wellbeing of the people they support and sixteen requirements, including an immediate requirement on the day of the inspection, were made to reflect this. The immediate requirement was in regard to fire safety and was rectified before the end of the inspection visit. A small number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: The care planning, delivery of nursing care and personal support should meet the needs of the people they are providing a service to. There should also be good practices in place to ensure that any creams, lotions, or dietary supplements are given as prescribed and accurate records kept. Any shared bedroom accommodation should have adequate screening as to permit the provision of personal care and treatment in privacy. They should ensure that after consultation, the people they support are provided with meaningful activities and occupations that meet with their choices and wishes and their capacity to participate. The people living in the home should be provided with a nutritious diet that meets their needs and choices. They should also provide the assistance and support to obtain their meals and drinks. There should be a process in place to show that they listen and act upon any concerns expressed about the service. Minor concerns should be treated equally as any formal complaints made. The registered manager should ensure that staff are not only given the necessary training and information about safeguarding the people living in the home from possible abuse, they should ensure they have a good understanding of their responsibilities. The physical environment and the use of child safety gates, should not be used as a method of physical restraint. Any form of restricting the movement and decisionmaking that the people they support may wish to make, should only be done after due consideration and risk assessments, are carried out by a suitably qualified person. The environment of the home should be kept in a good, maintained condition, and have the equipment and aids in place to meet the needs of the people who live there. Care Homes for Older People Page 8 of 49 There should also be provided sufficient bed linen and furniture, thats of a reasonable quality and appropriate to the needs and wishes of the people they support. There should be suitable systems in place for the cleaning and sterilizing of bed and commode pans and the practices for good control of infection are effective and do not put the people living in the home at risk. The records for evidencing the recruitment and employment of staff should support that a robust process was carried out and that staff have been provided with the necessary training and knowledge to carry out the roles they have been employed for. The safety of the people living and working in the home must be protected. Fire safety practices need to be robustly put in place and understood by staff. Fire exits must not be blocked by furniture. Further practices for protecting the health, safety, and welfare of the people living in the home should also be managed well. Staff should understand and carry out good practices for the storage and handling of hazardous substances used in the home. There should also be a rigorous risk assessment process to make sure that the environment of the home is safe to live and work in. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 49 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 49 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are needs are assessed thoroughly before they are offered a place in the home. Evidence: A review of the information given to prospective users of the service was carried out to see if it gives sufficient detail about what is on offer before they decide to live in the home. Prospective residents and their families can be provided with a glossy brochure, a copy of the last newsletter(Spring and summer 2008), and the Statement of Purpose and Service User Guide document. Included in the Statement of Purpose and Service User Guide is a chart with the findings from the last quality assurance survey carried out in the home in 2008. However, they had not imparted any comments or views Care Homes for Older People Page 11 of 49 Evidence: about the service made by residents or relatives, as this would be helpful to obtain a better picture of what is like to live in the home. They also provide details of any contractual agreement as to outline the basic terms and conditions of stay in the home. The copy of the latest Statement of Purpose and Service User Guide that was available to read, had been updated in August 2008. Details of the new manager, Karen Wright, who was registered with the commission in January 2009, and her qualifications had been updated. From information provided in the Annual Quality Assurance Assessment, seventy-five per cent of the residents are funded, or part funded, by local authorities, only thirteen residents privately fund their own care. Two people who responded to the commissions surveys stated that they did not receive enough information about the home before they moved in. However, both surveys indicated that the families of the people concerned had been involved with the decision to use the service. The service accommodates people to visit and have trial periods of stay in the home before a decision is made to permanently live there. We met one gentleman during the day of the inspection who was staying in the home for a respite period to see how he liked the experience. He appeared anxious and worried and expressed that he wanted to go home. Staff were supportive and assisted him to speak to his relatives who later collected him and took him home. Assessments of peoples needs are undertaken before a decision is made to admit them to the home. From the records seen, information is obtained from the referring social services if there is one, and from the individual and relatives should they have them. Any specialist health care professionals, such as psychiatric or occupational therapists also contribute to the information obtained to make a judgement as to the service being able to meet their needs. Care Homes for Older People Page 12 of 49 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home cannot be sure that their health and personal care needs will be met. Evidence: Comments made in the surveys returned to the commission, by residents or their representatives, gave the impression that generally people thought that their needs were being met. One person put that they thought that they sometimes received the care and support that they need. Another person put; Very well looked after. Before reviewing the care records and medication practices we undertook a tour of the building with the manager to meet residents and staff and observe care practices going on in the home. From this tour of the service we identified a number of residents care records that could be reviewed as to establish if the service is meeting the individuals needs and matched what we observed the outcomes for individuals actually Care Homes for Older People Page 13 of 49 Evidence: were. From this tour a number of concerns were raised and indicated that a review of some of the residents care planning was paramount as to assess if the were receiving the care and support they needed. Five residents records were selected as to establish if the concerns were through weak care planning or the actual delivery of support. The main areas of concerns were, the provision of personal care, the quality and provision of food and nutrition and the support given to residents by staff to obtain them. Other areas of concern were in regard to safety and the provision of adequate facilities and equipment to maintain the comfort and well being of the people concerned. These other concerns will be further examined later in the report. The concerns were not specifically identified to residents living in one area of the home they were equally across the ground and first floor of the Mews, managed as two units, and the Hall, which is managed as one. The care records selected that the residents were a mixture of those who had recently been admitted to the home and those who had been resident since at least 2000. The care plans had been divided up into separate topics, such as personal care, communication, elimination, and mobility. It was clear that the detail summarising the individuals need was sufficient at the time they were created for staff to follow. It was evident that the planned care was reviewed and the changes in circumstances were identified on the rear of the page. However the plans had not been amended to reflect this fully. For some this meant the dramatic changes in need seen from their original needs, such as semi mobile, continent, almost self caring, to their current needs of nursed in bed, doubly incontinent and full dependency is not clearly set out for staff to follow. Additionally monitoring tools are used in the care records, such as a falls risk assessment, dependency level, nutritional assessment and weight, and pressure area risk assessment. Wound monitoring and body maps are also available to use should they be required. From the sampled care plans the majority of these documents have been reviewed and updated. However, there were a few that had not been used effectively, such as the body maps, or nutritional assessment, and weight that should trigger changes in the planned care and nursing care provided. The manager indicated that there were only a small number of people living in the home that were originally admitted with a primary need for ill health and frailty. The majority have a primary need for care for dementia and mental health needs. From Care Homes for Older People Page 14 of 49 Evidence: reviewing the sampled care plans this was not significantly apparent as they did not show detailed behaviour management, mental health monitoring or individualised activities geared to people with these specific mental health needs. For the delivery of support, the care staff use records kept separately to the main care plans which include a brief summary of the persons needs, and monitoring tools, using tick boxes not text, to note that their basic needs have been achieved. These topics covered personal hygiene, activities of daily living and night care. It was difficult to establish how the information about the personal care and support provided, the general well being of the individuals, and the outcomes from their day, actually feeds back to the daily records or care planning written by the registered nurses. We were informed this is usually carried out verbally. It was also difficult to identify that the care plans were used by the care workers to provide the necessary support that each person needs as the brief summaries seen, were not descriptive enough. One resident was being nursed as having an MRSA infection, however this was not clearly set out in their care plan, and so staff may not been following recognised control of infection practices as to protect the individual concerned, themselves or others in the home. Some of the nursing staff are not recording in the care plans their full names to acknowledge their responsibility for creating or changing them. Comments from the completed surveys indicated that people generally though they received the medical help they needed. One person put, Not really. The information and practices for medication administration were looked at as to see if they are safe and protect the people living in the home. A small sample of MAR(Medication Administration Record) records were reviewed in conjunction with the detail given in the care records for individuals. During assessment the medication needs of the person concerned are noted. However, this information is not transferred into the planned care for staff to deliver, and only some of changes to medication are noted in some of the daily records, and those made by the visiting Dr. There is no overall picture of the medication individuals are prescribed apart from the current MAR(Medication Administration Record) chart. From the sampled MAR(Medication Administration Record) records prescribed items such as creams, lotions, and dietary supplements are not being recorded as given. Care staff do not receive instruction in the care planning records that were seen, as to these being applied or given, this was in reference to the use of specialist shampoo Care Homes for Older People Page 15 of 49 Evidence: and dietary thickener, and creams. An additional random selection of MAR(Medication Administration Record) charts were sample indicated this was consistently not done throughout the home. So it is uncertain that the prescribed treatments are being given to individuals living in the home. The home has three areas that it stored medication for the residents, one for the Hall overall and two, ground floor and first floor of the Mews. The storage facilities for the Hall were reviewed and showed that medications are kept locked securely in a room designated for this purpose. There were suitable facilities for the storage and recording of any control drugs should they have them. There was a designated drug fridge where the temperature is checked regularly. Medications are supplied by a local pharmacy in a recognised MDS(Monitored Dosage System) with additional liquids and specialist medications dispensed separately. From what could be seen and from the description given by the registered nurse on duty during the day, the current medication trolleys do not hold all the required drugs for whole day and some have to be transferred over before medication rounds are carried out. The nurse was unable to provide information that medications are checked in and out of the home other than noting the receipt on the individuals MAR(Medication Administration Record) chart. The dispensing pharmacy had carried out a recent audit of the medication practices in the home and had not found significant causes for concerns. In surveys returned to the commission three respondents put that they thought that the staff did not listen and act upon what they requested. Further comments were made: Not always. Sometimes have to wait. Not always Most of the residents suffer from dementia and other similar defects. I tend to be judged similarly. During the processes for reviewing the premises facilities and observing the interactions of staff with residents, we looked at the practices in place to protect and support individuals privacy and dignity. The care planning that was reviewed did support that staff were instructed about respecting privacy and choice, however as previously identified these records, may not Care Homes for Older People Page 16 of 49 Evidence: be as current as they should be. We looked at what they have in place for privacy in the shared accommodation, and although it a very positive step to ensure that couples can remain living together, it was identified that insufficient care had been put in place for protecting their privacy. This was in respect to the inadequate screening between beds in the rooms. We were informed that mobile screens were shared between the two occupied double rooms in the Hall, as there are no permanent screens in place. Care Homes for Older People Page 17 of 49 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service may not experience the lifestyle they choose or be supported to continue with their interests or activities within the limits of their capabilities. The meals and provision of diet may compromise their health and wellbeing and the processes of ensuring they have the support for obtaining them is poor. Evidence: Throughout the day of inspection we were observing the outcomes for the daily lives of the people living in the home. From information given in the Annual Quality Assurance Assessment, a small number of residents are nursed in bed, the rest range from fully mobile to wheel chair users and nearly all have a primary need of care for dementia. Also in this document the manager put forward the improvements the have put in place in the last twelve months to enhance the experiences of the people living there. These included a planned activities programme for the year ahead, an ice machine in the kitchen for cool drinks when required, increased staffing levels, and the provision of a sensory room. Care Homes for Older People Page 18 of 49 Evidence: The records, in the care plans reviewed, for evidencing that staff are providing support that meet individuals choices and preferences of daily living, leisure and cultural interests, and any religious observance were also assessed to see what is planned and put in place for the person concerned. From the records seen it was evident that staff take time with the support of the resident and their relatives, where possible to seek some personal history, and information about their choices of how they like to live, when they arrive in the home. What was also obvious is that interests for hobbies and social activities are outlined in a document incorporated in the overall care planning records. However, what was not evident that there was a planned programme of interaction and support given by staff to meet individuals needs or wishes. This is particularly important to people with dementia or short-term memory loss as to provide meaningful activities that they can participate in within their capabilities. The reviews of the information for activities and social interaction for individuals did not reflect what was observed going on in the home or their changed health needs. From what was on display on notice boards there was a planned programme of activities that are based around communal events such as on the day of the inspection a musical performer, visits by the pat a dog scheme, creative arts and craft activities and celebrations for calendar events. Visits by the hairdresser, chiropodist, and mobile library are also planned into this schedule. Residents are also given a broad list of entertainment that they could possibly expect should they choose to live there, in the Statement of Purpose and Service User Guide. The list highlighted a number of external activities to the home that they may be able to participate in, although it was difficult to establish if these aims had been achieved when reading some of the care records that were reviewed. Observing residents in their rooms and communal areas, including the sensory room it was difficult to establish if they were obtaining sufficient stimulus and occupation they required. A number of residents in both parts of the home wandered around the home, without purpose and appeared very rarely to settle. Others were sat in communal rooms or in their bedrooms with nothing to occupy them, such as magazines, newspapers, books, or their handbags. In some parts of the home TVs were on, but it was uncertain that care had been taken to see if the residents in the vicinity were interested in what was being broadcast. It was also difficult see what stimulus or interaction those residents obtained if they remained in their rooms apart from the visits to carry out tasks by the care and nursing staff. This was because the majority had been left with nothing to focus on or been given the chance to call for assistance as the call bell system was not fully Care Homes for Older People Page 19 of 49 Evidence: operational. The specifically employed activities organisers were in the home during the day and it was difficult again to assess if they designated exclusive time to individuals for one-to-one stimulation as this was not seen and there was nil of note recording in the care plans that were reviewed. We looked at the specifically named Sensory room and found that when the musical entertainment was not taking place, residents were just sitting unoccupied. Service users in several lounges/ bedrooms were observed calling out for attention or seeking reassurance. We noted that in one lounge, a resident required assistance, due to being incontinent of faeces. This was brought to the attention of staff present although it must have been obvious to them. An observation of the home in general indicated that there was very little stimulus in the environment. It is now recognised that people with dementia and other like disorders, take pleasure from tactile objects and little activities they can carry out, such as moving and carrying items around. A positive step is the employment of four members of staff to take the lead in providing activities in the home. However, the majority of the hours that they are present, are between 8am and 4pm during the week, a total of 60 hours. There is no apparent support for activities, other then provided by the care and nursing staff, during the evening or weekends. Comments from the returned surveys indicated that the were a number of residents who the family felt were unable to join in with any activities and three people who expressed that there were not always something that they could participate with. Additional comments were: Dont always feel like participating. The choice is orientated around disabled patients. A permanent person acting as an independent Advocate within the home is funded by a charity to support the residents living there. The full capacity of this role and the impact on residents was not fully explored during this inspection. We looked at the provision of meals and mealtimes, as to see if it meets the needs of the people living there, and is provided in a pleasant atmoshphere and at times convenient to them. The concerns raised by observing the frailty, isolation, and lack of provision for fluids Care Homes for Older People Page 20 of 49 Evidence: for some of the residents gave indication that the care planning and support for nutrition and meal provision should be reviewed in greater depth. Another indicator was that there were a number of residents with poor or compromised nutrition with the volume (at least 7 different residents) of dietary supplement drinks obtained through prescription, that were seen to be held in one of the clinical rooms(Hall). Information in the Annual Quality Assurance Assessment, completed in September 2008 identified that thirty-five of the residents at that time needed help, supervision, or full support with their meals. The manager confirmed during this inspection visit that there remained a significant number of residents that need full support with their meals. The care records seen did not indicate that there was a considerable number of the residents with compromised nutrition or fluid balance as there were very few monitoring tools in place for staff to ensure that they were meeting individuals needs. The manager provided a copy of the planned menu schedule in place. Evidence was seen around the home that copies of the daily meals, on offer, are put on display for residents to read. From examination of the written menus, it appears that there are a variety of meals provided over a four weekly rotational programme. From this it also indicated, that residents can anticipate they will have a choice of cooked breakfasts, six days a week, and a variety of cereals, toast, and fruit to accompany them. At the midday meal, a choice of two main courses, and a selection of sweets. The evening meal is noted as soups, sandwiches, or a hot snack. From some of the sampled daily menu choices records and information provided from staff, the menu plans do not necessarily match what is actually provided. Through discussion with the manager it was stated that all the meals for every resident are now fortified as it became difficult to ensure that those who needed it, obtained the necessary nutriments to meet their needs. We sampled the evening meal to see what residents are provided with and reviewed the records for choices of meals for that day. We were informed that staff assist residents to select where possible their selection of meals for the next day. The choices are recorded, with indicators of any alternatives noted. From the records it could be seen that thirteen residents in the Mews and six in the Hall required a pureed diet. However, for all nineteen there was no indication of what this would consist of or choices noted for either the poached fish or chicken Care Homes for Older People Page 21 of 49 Evidence: supreme which were the options of the meal at midday. At least nineteen of the other residents were indicated as requiring MP which we were informed was mashed potato. The sampled evening meal consisted of three squares of white bread sandwiches, two cold fish fingers, a bowl of thickened over sweet, mushroom soup and a cup of milky tea. Jam was at least one of the fillings for the sandwiches. The fish fingers were of a very poor quality. Baked beans were also on the menu to accompany the fish finger, although the quality of the baked beans was not sampled. The records for the menu choices for the suppers in the Hall part of the home indicated that at least three residents were having Ready Brek for their supper, nothing else for two, one was having MP(mashed potato). Also at least two residents were having mashed potato and soup for their meals. Further concerns about residents obtaining their meals as planned were raised when at 7pm it was observed that one person still had their meal tray in their room and had not been supported their food. The individual concerned we met in the corridor outside, who stated to us that she was looking for her bedroom. She declined the meal when shown by a member of staff. It was unclear that she was offered an alternative to supplement the meal that was missed. (the meal was three sandwiches and two fish fingers and a cup of tea) During the day we looked at the facilities and support in place for snacks and supplements for residents who are unable to linger long enough to eat a whole meal in one sitting. This is area that is now recognised as a concern for those people with a significant level of dementia and that strategies should be put in place to ensure that they are able to achieve their required level of nutrition. It is usually recommended that snack or finger foods are made available at all times of the day to enable them to eat as they wish. There was no evidence of a speech and language therapy or dietitian being involved with provision of food in the home, or within the sampled care plans. From what we were informed by staff, food for snacks could be obtained from the main kitchen for this purpose. However, nil of note was observed in the home, both in the Mews or the Hall for those people who were not able to eat a whole meal in one sitting. The facilities in the separate kitchen area of the Mews did not support that there were snacks or the basics for them readily available for staff to provide sandwiches, toast or other items, should a resident need them. This is particularly pertinent during evenings and at night when staff would have to leave the building to obtain snacks for residents and this would reduce the number present in this area of Care Homes for Older People Page 22 of 49 Evidence: the home. Comments from residents included that two always, three usually and five sometimes liked the meals provided. Additional comments were: Boring meals. Eat because theyre put in front of me. Eat because I must. Always something to enjoy. Care Homes for Older People Page 23 of 49 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and their relatives cannot be confident that their concerns will be listened to and acted upon or that all the staff working in the home have the confidence and the ability to ensure that residents are protected from possible abuse or harm. Evidence: Comments from some of the respondents to the commissions survey indicated that that there were mixed opinions of the management of the complaints process in the home. One person put that they never know who to speak to if they are not happy and three stated that they did not know how to make a complaint. Additional comments were: Nobody listens. I tell my family. My family would complain. My family would complain on my behalf Care Homes for Older People Page 24 of 49 Evidence: Yes, but my avenues get to be lost by the management. From information in the Annual Quality Assurance Assessment, Statement of Purpose, and Service User Guide, residents are provided with a copy of the complaints procedure when they arrive in the home. There are copies put on display in various parts of the home. The copy of the procedure included in the Service User Guide that was reviewed for this inspection purpose did support that the complainant is given the necessary information, including the most up to date contact details of the commission. However, this was not reflected in some of those seen on display in the home. This omission was pointed out to the manager during the day, who promptly remedied the information to the correct details. It was unclear if the complaints procedure is provided in an easier to read format. The manager provided information that they had been in receipt of two written formal complaints during the last twelve months and the records and information for these were reviewed as to establish if the process is carried out effectively. From what could be seen the concerns are explored and actions taken to rectify them. Copies of correspondence, meetings, and actions taken are kept. What was concerning was that although the manager expresses that there is an Open Door policy to communication within the home. Very little is noted about the minor concerns and comments that residents, relatives, visitors, and staff make during course of providing the service. This is not good practice. The manager should have a formal process for noting comments to be recorded, monitored and the actions taken to rectify the concerns. Using a log to note these down would support an effective monitoring of what is provided and alert the manager and staff to any deficits before they become a formal complaint. Residents and relatives would have greater confidence that their concerns are listened to and acted upon. The systems and processes for safeguarding adults from possible abuse was only briefly reviewed during this inspection as the home has evidenced previously that they have provided staff with the necessary information and procedures for this. We took the opportunity to discuss with a small number of staff their understanding and from this we were made aware that some may be as not as confident about reporting and seeking assistance should they have concerns. We also had difficultly confirming that through problems with language that all staff had a good understanding of their responsibilities. Care Homes for Older People Page 25 of 49 Evidence: Not all staff, spoken to were clear about the procedure for whistle blowing (Public Interest Disclosure Act 1998) or that the Local Authority Social Services Department, took the lead in investigating allegations of abuse. Throughout the review of the facilities of the home we observed eleven residents bedroom doors with child safety gates in situ. As previously identified in reviewing the sampled care planning documents, the evidence did not signify sufficient attention had been made to putting these in place with the best interests of the people concerned. The initial safety issue for fire will be examined later. Of considerable concern is the use of these to possibly restrict residents movement around the home. Concerns around this issue of possible restraint were referred to the Oxfordshire Social Services as a Safeguarding Alert. Care Homes for Older People Page 26 of 49 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are not provided with an environment that is suitable to meet their needs and maintained in their best interests. Evidence: The home provides good-sized accommodation for individuals and plenty of communal spaces for them to enjoy. It was evident in parts of the home that there is a programme of refurbishment and renewal, with new carpeting and redecoration carried out. However, there are some areas of great concern that the facilities do not meet the needs of the people living there or are fit for the purpose for which, they are registered for. We looked at the general appearance, upkeep, and facilities in the home, focussing on those areas that have immediate impact on the people the service supports and those areas that protect them from possible harm. The home has a good number of communal spaces, a variety of small lounges, dining rooms, and a good-sized conservatory in the Hall part of the home. The staff have made a specific area as a designated activities room for residents to use in small groups. Care Homes for Older People Page 27 of 49 Evidence: The garden, we were told, is secure and from what could be seen is able to offer seating and patio areas when the weather is warmer. The home has for all, but one, provided en suite facilities of toilet and wash basin, three of the en suites have baths. There are a number of assisted shower and bathrooms in each area of the home. Some of the shower rooms showed that although tiles and wall coverings had been refurbished, there were also areas with some missing and paint chipped at the base of the floor fixing for one assisted bath in the Hall. This same bathroom had a very dirty plastic shower hose, which was for attaching to the taps, and a wooden chair that appeared to be used to sit residents to prepare for and redress after, their bath. Karen Wright was reminded about managing cleanliness and the control of infection in regard to the plastic hose and the ability to keep clean and hygienic items made of wood. The shower hose was immediately disposed of, and the manager provided information that the chair would be removed. In the Annual Quality Assurance Assessment it is noted that the service has the appropriate aids and equipment to meet the needs of the people living there and for residents to remain and independent as possible for as long as possible. However, it was very evident that a good number of toilets were not fitted with aids and adaptations to meet the needs of residents. Hand rails not in place around toilets, bedroom commodes placed as an assisted toilet seat. It was unclear if the home had utilised the profession knowledge of an Occupational Therapist to ensure that they have the necessary equipment and facilities to meet the needs of the residents they care for. Further information was submitted in the Annual Quality Assurance Assessment, selfassessment document completed by the manager clearly states that, There is an effective nurse call system in use in all rooms which can be used by resident in the home summon assistance as required. This is clearly not so as the majority of the bedrooms and en suites had the cords removed from the room and at least four residents had been left without the ability to summon help. We looked at the furnishings, fittings, and facilities for individual rooms and if residents are assisted to personalise their accommodation as they wish. A good number of the bedrooms that were reviewed evidenced that the quality and provision of furniture and furnishings was either worn or missing. A number of rooms did not have the recognised furniture, such as soft chairs, bedside tables, or a table to sit at. Care Homes for Older People Page 28 of 49 Evidence: Many did not appear homely or welcoming. It was difficult to establish if this was personal choice of the individual concerned as little was recorded in the care plans that we reviewed as to supporting evidence for this. Although, inventories of personal possessions had been taken when individuals came to live in the home it was difficult to assess with the sampled records if any of the furniture in some of these rooms were items belonging to the individuals concerned or provided by the service. The condition and volume of the bed linen and pillows provided in the bedrooms that were viewed was concerning. A high number showed that many of the sheets were worn and thin and a good number of the plastic covered mattresses did not have a sufficient covering over them to minimise the uncomfortable experience of sleeping on it. Most beds appeared to have the minimum of a blanket, bedspread, and one pillow. When the question of the condition of the bed linen was raised with the manager, we were informed that new linen was already on order. However, the overall condition of the linen that was seen did not support that there was an ongoing programme of replacement. Residents are not provided with a lock to their bedroom doors should they wish or required them. The home appeared to be kept, very warm and the majority of the radiators had been fitted with guarding. What was apparent was the variety of temperatures in individuals rooms, some were far too hot with temperatures of 80F, 30C. From what could be seen the heating in some of the home, is provided by storage heaters other parts it was unclear whether this is the same. Information given in the Annual Quality Assurance Assessment stated that the last service check on this was carried out in 2004 and All rooms are centrally heated with controllable covered radiators that enable resident to choose their ambient room temperature. However it was difficult to identify that the intense heat in some of the rooms we sampled were the choices of the people who live there. The quality of the cleanliness around the home was variable. Some of the carpets were clean and fresh others were considerably marked with spills and in particular the upstairs dining room in the Mews, smelt of sour milk, which must make very unpleasant for residents to eat their meals in this environment. The manager did make it clear that the matter was in hand and the carpet was due to be cleaned later that day. Some of the other areas of the home did have a variable level of odour of stale urine, particularly with some of the carpeting in bedrooms. Care Homes for Older People Page 29 of 49 Evidence: In bathrooms, toilets and sluices, liquid hand soap and paper towels were provided for staff and others to wash their hands. Through the Annual Quality Assurance Assessment, we were informed that all staff had been provided with the necessary training control of infection and follow the procedures for this. There are sluice rooms on each floor of the two areas of the home. None of which, we were informed by the manager, have the mechanical cleaning and sterilizing equipment for bed or commode pans or urinals. We looked at the facilities in two of these areas, in the Hall, and found that one had an odour of dampness, and items that should be held in accordance to Control of Substances Hazardous to Health Regulations (COSHH) left out, unsecured. The other gave limited access to the sluicing facility, as a clinical bin was placed in front of it and the pan was use as a storage facility for the replacement bags. The laundry area of the home is on the ground floor of the Mews. The door to the laundry room was unlocked and the room was unattended when we visited this area of the home. There were the necessary pieces of equipment for the laundering of personal and household linens. However, the cleanliness of the room was not of a high standard and items that should be kept within Control of Substances Hazardous to Health Regulations (COSHH) were left on display. Residents would not normally have access to this room as the area is protected by a key coded access, although on this occasion the external fire door to the grounds where residents could have access too, had been left open. Information in the Annual Quality Assurance Assessment, and given by the manager, that there is a regular audit for the environment of the home to identify any deficits and ensure that there is a planned programme of renewal, refurbishment, and repair. However, it was difficult to identify that the current practices for this have been effective in doing this. The deficits in the provision of equipment and aids for residents, the lack of an effective call bell system, and poor state of some of the bed linen do not support that the service is focussed on the provision of a comfortable suitable environment for people to live in. Comments from residents included: I do my own cleaning by choice, in my opinion it is better. I have a comfortable room. No bell pull. I dont like the bed. Care Homes for Older People Page 30 of 49 Care Homes for Older People Page 31 of 49 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service cannot be confident that the staff working in the home, have had the necessary checks carried out to establish they are suitable to work with them. They also cannot be confident that all the staff have the knowledge and understanding to carry out their roles ensuring that their health, safety, and welfare is protected. Evidence: During the last inspection process in December 2007 it was identified that there were some concerns about the number and skills of the staff employed in the home. The staffing rotas and observing the activities going on in the home were used to assess the current levels of staff meet the needs of the service and the people they support. The Annual Quality Assurance Assessment, self-assessment document clearly states that the staffing level in the home is based on the dependency needs of the people living there. We could see in the care plans that individuals dependency needs were assessed, although it was unclear from discussion with the nursing staff how this information is used overall to adjust to the needs of the residents in the various parts of the home. From the copies of the planned duty rotas that were reviewed, the information Care Homes for Older People Page 32 of 49 Evidence: supported that there are usually three registered nurses on duty during the day and two at night for the whole home. There is usually four to five care staff on each shift during the day, two to three at night in each unit, with most staff working long days of twelve hours. The staffing is managed with two staff teams, one for the Hall, and one for the Mews. The majority of the staff are assigned to working regularly in one area, a small number of care staff work flexibly across both parts of the home. Some of the care staff also spend part of their working week, providing duties for domestic, laundry, and activities. In addition to the care and nursing staff there is a small team of domestic and catering staff. Comments from the completed surveys indicated that there were usually staff available when residents needed them. Additional comments were; Not always. Often understaffed. Help always at hand. Two people put that the service could be improved with, More staff. One respondent stated, The staff do what they can We observed during the day that staff were often not in the vicinity of some of the lounges and communal areas where residents were sitting. At times staff were seen to be supporting two or three of the busy residents in the corridors as they wandered around and were unable to settle. This must be incredibly difficult to ensure that all residents have equitable support, especially at meal times or when peak care activities are going on. From the information included in the duty rota there are two Registered Mental Nurses working full time in the home. One is assigned to the Hall, the other to the Mews. The other nursing staff appear to come from a general nursing background, one nurse we spoke to was an experienced renal nurse. The manager provided information prior to the inspection that one of the nurses had completed training in dementia care and that a further two had commenced the same course. It was unclear if the nurses had completed this at the time of the inspection. Ensuring staff have the necessary knowledge in regard to dementia is a positive step to meet the sometimes complex and challenging needs of individuals with this condition. Care Homes for Older People Page 33 of 49 Evidence: The figures giving in the information provided in September 2008 were that eleven of the thirty care staff working in the home had obtained an NVQ 2 or above in care. Four further carers employed were working towards this. One senior carer has recently completed an NVQ 3. The practices for recruitment and employment were reviewed to see if the processes are robust enough and protect the people living in the home from inappropriate staff working with them. A sample of three staff recruitment records were assessed and showed that the quality of the process has been variable, the most recently employed supporting that the majority of the required information is obtained. One applicant had not provided their full work history but the other application forms did support that the others had. Relevant personal details and two referees are required to be completed. Copies of proof of their identity had been taken for all three applicants and records were available supporting that Criminal Records Bureau and Protection of Vulnerable Adults list checks had been carried out. Of the three records reviewed only the most recently employed member of staff was used as an assessment of the practices carried out. This individual had been recruited during the last few months and had started in the home with a Protection of Vulnerable Adults list check for ten days before the full enhanced Criminal Records Bureau came through. The manager gave information that the individual was supervised for that interim period. However, there were no records to that effect in the individuals employment file. The records seen show that the standard of ensuring that suitable references are obtained has been weak, examples seen for the member of staff more recently employed evidences that this process has improved. We looked at the records for induction and for all the employees records that we reviewed, the supporting evidence that they had a structure induction, was poor. For the most recent employee, a checklist of the topics covered on the one day of induction, showed that key areas of health and safety are looked at and the new member of staff signs an acknowledgement they have read and understood the key policies and procedures involved. Topics included are health and safety, prevention of cross infection, fire safety and protection of vulnerable adults. Although the individual concerned has been employed for domestic services in the home, it was difficult to assess that the content of the one-day induction had equipped the new member of staff to work alone. There was no supporting evidence that any formal training was Care Homes for Older People Page 34 of 49 Evidence: planned to provide this individual with the full mandatory training they require. Copies of previous training certificates and qualifications are taken on application for employment. But there appears not to be a formal process of identifying individuals training needs. The records reviewed for the two other members of staff showed that there were considerable gaps in ensuring that they had obtained the necessary training and updates for safe working practices. From information given by the manager all staff are provided with a staff handbook and a copy of the General Social Care Council Code of Conduct. Care Homes for Older People Page 35 of 49 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not managed in the full interests of the people they support. Evidence: The service is managed by the registered manager, who has been working in the home for around twenty years in previous roles, the most recent as deputy and acting manager. During her registration with the commission in January 2009, as manager it was identified that she would benefit from attaining an NVQ 4 in Management and seek training applicable to her role in regard to Safeguarding Adults from abuse. From information provided it was clear that she had made a start with further professional development but had been unable to continue as a new training provider was in the process of being sought. Care Homes for Older People Page 36 of 49 Evidence: She is supported by regular visits by the Director of Nursing and is able to access the resources for administration and professional advice from the provider organisation. We looked at the processes in place for consulting with the people who use the service and for the overall monitoring of the quality of what is provided. Information available did support that there were periodical resident and relative meetings and that an annual survey is sent out to residents, relatives, and staff. It was evident that some of the findings had been analysed from the last exercise, June 2008, as a graph of the key results are included in the copy of the Statement of Purpose and Service User Guide, given to residents. The manager could not offer a copy of the full analysis of these findings, but provided the returned surveys for a review. Included in these were a small number of comments, Heating has been troublesome at times and in regard to making improvements. To be able to see through my window as glazed panels are blown. Other comments were Commode in toilet is wobbly and needs replacement, and for improvement needed, To provide safety rails to toilet as to hang on to. There was no information available to support that these concerns or comments had been listened to and acted upon. What is good is the newsletter provided to residents and relatives, giving a snapshot of events and information about the home, and what may be planned in the future. The copy of the latest newsletter from spring and summer 2008 was in the reception area of the home. It was unclear that there was a more recent edition available. Some of the other quality assessment processes that are carried out were reviewed. This included the weekly environmental audit undertaken by the manager. Through this inspection assessment it has been identified that this system is not robust enough, as the areas of concern that have been highlighted, should have been recognised during this process and during the regular provider visits under regulation 26. Other audit processes were stated to be in place according to the information enclosed in the Annual Quality Assurance Assessment submitted to the commission. However, the quality of these, were not reviewed during this inspection visit. The manager confirmed that there had been no changes in the management of any service users monies held on their behalf since the last inspection. As previously identified during the last inspection visit the processes for handling residents money is managed well, this area was not reviewed during this inspection. We looked at some of the documentation and records for the management of safe working practices that are carried out in the home. Care Homes for Older People Page 37 of 49 Evidence: As highlighted earlier in this report, there are some areas of concern about some of the practices carried out that could have a significant impact on the people who live and work in the home. The main areas of concerns were the fire safety practices, infection control, and the management of substances that should held in accordance to Control of Substances Hazardous to Health Regulations (COSHH)1998. The use of child safety gates across doorways to restrict access presents huge fire safety risks, the use of one of these across a fire exit indicates that staff are not fully aware of their responsibilities. Additional to these concerns, it was apparent that other exit routes were not fully accessible in the ground floor of the Hall, through furniture being placed in front of them. Further concerns were seen has staff had placed a spare mattress at the top of a stairway, designated as a fire exit, restricting the access out of the home. An immediate requirement was made as to remove barriers to access to the fire exits. Staffs management of infection control was seen to compromise the safety and well being of the people living and working in the home. As practices carried out are weak and the instruction given to staff is poor. This is with particular reference to the management of an individual with MRSA and the general weak practices preventing cross infection. The lack of proper procedures and facilities to clean and sterilize bed and commode pans further adds to concerns. The gaps in the management of items that should be stored and cared for under Control of Substances Hazardous to Health Regulations (COSHH) 1998, shows that there are improvements to be made to protect the people who live in the home. Items left unattended in unlocked sluices and the laundry room show that staff are not adhering to safe practices. A sample of the risk assessments for the general safe working practices in the home, were reviewed. From the records seen, apart from those included in individuals own, care records, there are a small number of topics assessed. These include Low Windows, Ventilation, Trips and Falls, Individual Glass Panes, Restrictions, Appropriate placement of service user, and Obstructions or hazardous window ledges. All had been acknowledged as reviewed in December 2008. For the Individual Trips and Falls the document states that each room should have an assessment carried out. However, it was not evident that this had been carried out for one en suite as there was a raised drain in the centre of the floor. Karen Wright also confirmed that they had not carried out risk assessments for the baths with bathplugs in place in regard to the specific Care Homes for Older People Page 38 of 49 Evidence: needs of the people they support. A copy of the most recent environmental health inspection, in January, for food safety in the kitchen, gave an overall rating of satisfactory. Comments from residents about the service in general were: Id like to stay here. A resident comes into my room and tries on my clothes despite there being a gate barrier which worried me. I call for help. Im satisfied. Satisfied with the little I want. Care Homes for Older People Page 39 of 49 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 40 of 49 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 That the registered person shall ensure that proper provision is made to meet the health and welfare needs of the people living in the home. You should ensure that the care planning, delivery of nursing care and personal support meets the needs of the people you are providing a service to. The care planning should reflect accurately what is to be provided and ensure that staff have clear specific instruction of how to carry them out. 02/06/2009 2 9 13 The registered person 03/04/2009 should ensure that there are safe arrangements in the home for the management of medications. You should make sure that the people you support obtain the medications that Care Homes for Older People Page 41 of 49 they are prescribed. You should have good systems in place to ensure that any creams, lotions, or dietary supplements are given as prescribed and accurate records are kept. 3 10 12 The registered person 01/05/2009 should ensure that the home is conducted as to respect individuals privacy and dignity. You should ensure that any shared accommodation has adequate screening as to permit the provision of personal care and treatment in privacy. 4 12 16 The registered person shall ensure that the people they support after consultation, are provided with activities and occupations that meet with their choices and wishes and meet with their capacity to participate. You should ensure that the detailed information obtained about the person when they arrive in the home is used effectively to provide a personal activities programme that meets their individual needs. Staff qualities, quantities, and equipment should be in place to achieve this. 5 15 16 The registered person should provide in adequate quantities, suitable wholesome and nutritious 03/05/2009 30/06/2009 Care Homes for Older People Page 42 of 49 food which is varied and properly prepared and available at such times as may reasonably be required by the people you support. You should ensure that the people you support are provided with a good quality and quantity of fluids and diet. You have a responsibility to ensure that they have the necessary support to obtain this especially in regard to meeting the needs of those with dementia who no longer can make effective decision making or care for themselves. 6 16 17 The registered person should keep a record of any complaints made by the people who use their services, their representatives, or others, about the operation of the care home and the actions taken to rectify them. You have a responsibility to act upon any concerns or complaints made to you about the services you provide. Minor concerns that maybe rectified immediately should still be recorded as to ensure that you can monitor the practices carried out and eliminate any trends of concerns. 7 18 13 The registered person should make suitable 30/04/2009 30/04/2009 Care Homes for Older People Page 43 of 49 arrangements, by the training of staff and other measures, to prevent the people who use the service being put at risk from being harmed or suffering abuse or being place at risk of harm or abuse. You have a responsibility to ensure that staff are not only provided with the necessary information and training in regard to recognising, preventing and acting upon any concerns of possible abuse, that they also have a good understanding of their responsibilities. 8 18 13 The registered person shall ensure that the people who use the service are not subject to physical restraint unless they are the only practical means of securing their safety and welfare or that of others. You should ensure that the measures you put in place to restrict the movement and decision-making that the people you support may wish to make, is done in their best interests. Any restrictions implemented should only be done after due consideration of, and assessment as to the risks to them or others, that are carried out by a suitably qualified person. 31/03/2009 Care Homes for Older People Page 44 of 49 9 19 23 The registered person should not use the premises for the purpose of a care home provision unless it is fit for the purpose and meeting the needs of the people who live there. You should ensure that the premises of the registered service are fit for the purpose of providing accommodation and facilities that the people who live there, need. You should make sure that you have a good programme of routine maintenance, refurbishment, and renewal to ensure that it is kept in good order. 30/04/2009 10 22 23 The registered person should provide the necessary aids and equipment in the bathrooms and toilets for the people living in the home to live as independently as possible. You should ensure that the home is equipped with any adaptations, aids or equipment that can promote and support residents to remain as independent as possible and that the environment is safe for them to use. 30/04/2009 11 24 16 The registered person should provide in rooms occupied by the people who use the service adequate furniture, bedding and furnishings that are suitable 30/05/2009 Care Homes for Older People Page 45 of 49 to their needs and choices of how they wish to live. You have a responsibility to provide a good quality standard of furnishings and bedding to the people living in the home. There should be a robust process of audit and renewal of these to ensure that they can expect to live in a comfortable and pleasant environment. 12 26 23 The registered person 30/08/2009 should ensure that adequate facilities are in place for the cleaning and sterilization of bed and commode pans. You have a responsibility to have good measures in place to manage the control of infection in the home. You should take appropriate advice as to ensuring that you implement the necessary practices to clean and sterilize bed and commode pans that are used in the course of providing nursing and care to the people living in the home. 13 30 18 The registered person shall, having regard to the size of the home and the numbers and needs of the people living there ensure that the persons employed in the home are suitable to work there and have received the appropriate training to do so. 30/07/2009 Care Homes for Older People Page 46 of 49 You have a responsibility to evidence that you have carried out a robust recruitment and employment of the members of staff you employ. You should also ensure that they have been equipped with the necessary training and assessed as competent to carry out their roles. 14 38 13 The registered person should ensure that all unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. You should have a good risk assessment process that is carried out for the environment and reviewed regularly to ensure that the people you support are protected from possible harm. Dangerous flooring and inadequate measures taken in regard to safety in bathrooms puts the vulnerable group of residents you support at risk. 15 38 13 The registered person 30/04/2009 should ensure that all hazards from substances that should be kept secure in accordance to Control of Substances Hazardous to Health Regulations (COSHH) 1988, are eliminated. You should ensure that staff 30/04/2009 Care Homes for Older People Page 47 of 49 adhere to the regulations for the safe handling and storage for clean solutions and other similar products used in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 48 of 49 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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