Inspection on 31/01/07 for Deer Park Nursing Home

This inspection was carried out on 31st January 2007.

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

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

Other inspections for this house

Deer Park Nursing Home 22/05/08

Deer Park Nursing Home 13/11/07

Deer Park Nursing Home 18/07/07

Deer Park Nursing Home 14/03/06

Deer Park Nursing Home 10/10/05

Deer Park Nursing Home 04/03/05

Deer Park Nursing Home 07/09/04

Deer Park Nursing Home 08/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Deer Park Nursing Home Rydon Road Holsworthy North Devon EX22 6HZ Lead Inspector Clare Medlock Unannounced Inspection 31st January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Deer Park Nursing Home Address Rydon Road Holsworthy North Devon EX22 6HZ 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) 01409 254444 01409 254448 deerpark@rydonroad.fsbusiness.co.uk Mr Andrew Gordon Orchard Ruth Hatcher Care Home with Nursing 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (56) of places Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for 56 - Adult/Elderly General Nursing Care Registered for 3 Elderly Residents Date of last inspection Brief Description of the Service: Deer Park Nursing Home is a purpose built care home situated on the edge of Holsworthy, a market town in North Devon. The home is privately owned; the Registered Manager is a qualified nurse and oversees the day-to-day management of the service. The service is currently registered to provide care for 56 people. Residents are provided with care that is overseen by qualified nurses. Residents also have access to other health services and are escorted to attend hospital appointments when necessary. Additional health service personnel that visit the home include, the chiropodist, dentist, speech and language therapist and an audiologist. Care staff undertake activities with residents in the afternoons and there is also visiting entertainment from time to time. The service has a minibus, which is used for hospital appointments, transporting day care Service Users and conducting twice weekly trips. Visitors are welcome into the home at any time. Meals are cooked on site and a doctor visits the home weekly. In addition there is a weekly ‘ trolley - shop’ and a hairdresser comes to the home twice a week. Although the home is large, it does have homely and comfortable atmosphere. Fees vary and range from £ 481 to £ 550. Extra costs are charged. These include: Hairdresser £4-£18, Chiropody £7 per visit, Toiletries- At cost, Newspapers and Magazines- At cost with no delivery charge. The Statement of Purpose, Service User Guide and recent inspection reports can be found in the entrance hall to the home or from the Matron. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and the visit to the home took place on Wednesday 31st January 2007. Prior to the inspection questionnaires were sent to residents, relatives, health care professionals who visit the home, care managers who use the home for their residents, and staff. Twenty resident, 32 Relative/visitor, 3 Care managers, 11 Healthcare professional and 32 staff questionnaires were received. Three inspectors also spent a day at the home. This visit consisted of a full tour of the building, speaking with residents, relatives, staff and the Providers. Records, Care Plans and other documents were inspected. ‘Case tracking’ was performed on five residents. This is where the records and care of randomly selected residents is looked at in detail. What the service does well: Deer Park Nursing Home continues to provide personal and nursing care to all residents including highly dependent residents and to those who are unable to express their needs. Residents are able to wear their own clothes, be called by their chosen name and bring personal items to decorate their rooms. The home provide a stable level of staff. Nursing and personal care provided at the home is generally good. Staff at the home access a range of services including; General Practitioner, District Nurse, dentist, optician, chiropodist, out patient appointments as well as NHS Services. The home has many adaptations to help Residents keep as independent as possible and ensure they are able to access all parts of the building. The home is situated in a rural community where many staff live and residents have lived. This provides a sense of community atmosphere inside the home as well as outside the home. Relatives and visitors have access to the home at all times and are welcomed by staff. The residents enjoy the varied activities programme and residents praise the standard of food provided. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Manager must now ensure the records in the home are used to support the care that is given and improve communication at the home. This record keeping should begin before the resident comes to the home with a thorough assessment. The home should use a form that is a reminder to ask all the questions recommended. This will mean the staff will be able to see whether they can meet all the needs of the resident. This assessment can then be used to form the basis of the care plan, which can be used to communicate the needs to all staff. The current method of verbal communication works sometimes but not at another times and places residents at risk of either having care missed or given in an incorrect way. The improved communication will also show the standard of care that is given. Once the care plans are used they should be reviewed and written in such a way that any changes can be identified. The current method of recording some information means that changes in condition are missed. Any changes in care should remind staff to write a new plan of care that is detailed enough for staff to follow on a daily basis and would mean care would Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 7 not be missed and staff who have been away for a few days know what care they should give. The management of medication should also improve in the home. Registered nurses should be reminded of the Nursing and Midwifery Council administration of medicines Code of Practice. This would remind them that it is their responsibility to accurately record what medicines have been given and who is responsible for the administration. The storage of medicines should also be reviewed to ensure eye drops are stored at the correct temperature. Photos for all residents would assist agency staff or new staff in recognising residents to ensure the correct resident gets the right medicines. Nurses should also respond promptly to residents who request pain relief or other as needed medication. The environment needs particular attention to ensure that it is a safe, hygienic and pleasant place for residents to live, staff to work and visitors to visit. Obtaining more hoists and ensuring the ones used are safe, clean and free from fault will promote residents and staff safety. Infection can be reduced by ensuring staff are aware of the appropriate use of gloves and aprons, use of plates for cake, and appropriate access to the kitchen. Disinfecting sluices are required for care homes that provide nursing. The previously set timescale for this is soon to expire. Providing a disinfecting sluice would minimise the spread of infection and prevent enforcement action from the Commission for Social Care Inspection. Hygiene and infection spread could also be improved by ensuring the leaking washing machine is replaced with a machine that has a programme that reaches appropriate temperatures to control the risk of infection. This would protect staff from splashes when hand sluicing soiled linen and laundry. Staff should also be provided with hand washing facilities to ensure hands can be cleaned following the handling of infected material or clinical waste. Cleaning at the home is generally good but this is restricted to weekdays where cleaning staff are employed. Cleaning should continue at the weekends in this 24 nursing service. This would enable spillages to be cleaned and the spread of infection to be reduced at weekends. The Manager should ensure recommendations made by the EHO (Environmental Health Officer) are acted on. The worn worktops in the kitchen should be replaced and access to the kitchen by non-kitchen staff should be restricted. The safer food better business workbook should be regularly followed. This would prevent the unlabelled and undated food being found in the fridge. The general décor of the home should be improved. The planned programme of replacement of carpets should continue and worn furniture should be replaced. Plug sockets and light fittings should be regularly checked to make Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 8 sure they are safe. Boiler cupboards should be cleaned and repainted to get rid of mould staining. The manager should be commended for the vast improvement in staff recruitment. This could be improved by ensuring she signs to say she has seen the original form of ID and by ensuring written references are from suitable sources (Ex employers rather than friends) The safety of the home could also be improved: COSHH (Control of Substances hazardous to health) substances and cleaning products should be locked away. Fire exits must not be obstructed, door wedges on fire doors should not be used, and corridors and exits should not be used to store equipment that can be a trip hazard. Stairs that are used as fire exits should be accessible but stairs that do not have a landing should be guarded by a device that resident or staff could not fall over. A taller gate should be considered. The manager should devise a system to see what training gaps are present so mandatory training is complete. Any staff that have not had training in fire safety, moving and handling, food safety, infection control, and adult abuse awareness must be provided with training to ensure they have the skills and knowledge to work in a safe way. The Manager must introduce the programme of supervision to ensure staff are working appropriately and have the appropriate support. The Manager should also keep evidence of the induction training given and include ancillary staff in the induction programme. Resident safety and welfare is the main priority for staff at the home. Staff should look at the practice they use and make sure residents are safe at all times. This includes making sure wheelchair footrests are used when transporting residents. Communication at the home must be improved. Improving communication between staff and residents, their families and other health care professionals would make sure staff initially get all the information they need to fully meet the needs of the resident. Improving written communication would ensure the needs of residents are communicated to all staff and would reduce the reliance of more informal communication. Ensuring care staff and nursing staff communicate more effectively would benefit the care given to residents and improve the morale of staff. The Manager (matron) should also ensure she maintains lines of communication with staff at the home so they feel able to bring new ideas, share concerns and improve residents lives. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 9 The staff, manager and Provider should also look at the way they deal with complaints. Rather than looking at them as a criticism they should be seen as a way of improving care for the residents and working life of staff. The Manager should keep a record of concerns to see if any trends or patterns arise. The Manager should ensure she keeps detailed records of complaints made and show how they have been responded to. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service Users receive sufficient information to make an informed decision about coming to the home. The home do not always obtain enough information for Service Users prior to admission and do not use the assessment for care planning which means that staff may not have all the information needed to care for the Service User appropriately. EVIDENCE: A Statement of Purpose and Service User Guide were produced at this inspection. Both documents contained all the necessary information needed. This helps Residents and their families decide whether Deer park Nursing Home is the right place for them to be. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 12 Resident questionnaires showed that the majority of them had received a contract. Inspection confirmed all the residents that were case tracked all had a contract. The majority of resident questionnaires received showed that enough information was received. Comments included: • I don’t remember having time to decide • I used to come for day care but did not know what it was like full time • I came and looked around the home • My daughter looked at the home and found it suitable • Very little in writing, although the owner was very willing to answer questions and provide staff to show us round • Comprehensive brochures and a tour of the home Residents spoken to on the day of inspection said that they knew of the home before they came in and wanted to come here to be near to their family. Case tracking (closely following the care and looking at their records) showed that assessments for all residents were performed. However these documents showed that this process is inconsistent and did not always form the basis for planning the care residents needed. Documents showed that information is obtained by the home in a variety of ways. This included obtaining details from hospital staff, GP, relatives and social workers. One assessment seen which was not part of the case tracking showed that information had been jotted down on a piece of paper and the care plan issued from social services was performed six months prior to admission. The handwritten notes by staff at the home were not sufficient to show that the residents’ needs had been fully assessed. Discussion with the Matron confirmed that she tries to visit each resident prior to admission where possible and this is only restricted when the resident is moving from another part of the country. There was no evidence that the home use a standard assessment tool that contains all the recommended questions for all residents admitted to the home. Assessments seen were sometimes not dated, signed or reviewed. Discussion with the Matron confirmed health care specialists are consulted regarding the specific needs of Residents. Registered Nurses are appointed as link nurses for advice regarding issues such as continence care, nutrition and tissue viability. Healthcare Representatives come to the home to give educational talks to staff and the Matron ensures all staff attend training to ensure health care needs are met. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 13 Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care Planning does not always reflect the standard of care and is poor in places which means changes in condition is not detected or adequately planned for. The poor care plans rely on the verbal communication of information, which means information can be missed or lost. EVIDENCE: Residents seen on the day of inspection appeared well cared for with the finer details of care being given (Appropriate foot wear, glasses on, hearing aids in and clean nails) Records for the assessment of falls, pressure damage, safe movement and mobility, clinical risk and social living were seen in resident care plans. The majority of these had been reviewed but any changes had not resulted in a new plan of care being made. This means changes in care and condition relies on staff communicating verbally and could result in information not being passed on. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 15 Resident Questionnaires were generally positive about the care they received. The majority of those that replied said they received the care they needed. Comments included: • Yes, I receive good medical attention and the local health centres and doctors are on call if ever they are needed • All the staff are very nice and • Deer Park provides a good standard of care On the day of inspection, the residents that were part of case tracking said they were ‘very satisfied’ had ‘no complaints’ and thought the staff were ‘fabulous’ and ‘wonderful’ Records and discussion with residents showed that each resident is allocated a main carer/named nurse who is available to sort any problems out. Relative’s comments included: • • • • • • • • In my opinion the care assistants are excellent. My mother’s main carer is brilliant. I can approach her about any worries I have. I feel it is important to always speak with her as she deals with my mothers needs on a daily basis The caring nature of all the staff: Office, carers, nurses, kitchen staff and cleaners is exceptional in this home. My mother has been very happy here. If I have any concerns of any kind I find that the staff are very approachable and always willing to try and provide the best possible care. The junior care assistants are the key to satisfactory care. I have been very happy with the care given and always feel welcome. There is a very positive atmosphere and I have confidence in the home. I find the staff very courteous and everyone is so nice to my aunt. My mother has been a resident at Deer Park for almost a year and we are more than satisfied with the care given to her. She has always been treated with kindness and a lot of respect. The staff are always welcoming and polite when we visit. It is very reassuring first class care in very pleasant surroundings The family are all very pleased with the care he gets at Deer park. Dad seems very happy and content. The Nursing and admin staff are always available. My aunt arrived in poor health and 4 years on she is so improved always clean and very happy. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 16 • • • My mothers sociability and general health have improved since arriving at Deer Park Although the home have contacted me when my mother is ill or had a call, they do not update me when she has seen a Dr etc. and Generally I am satisfied The homes diary and residents notes confirmed that they are able to access a variety of services including the dentist, GP, district nurse specialists, optician, chiropodist and other specialist professionals. Positive responses on the questionnaires were received from GP’s, chiropodists, CPN (Community Psychiatric nurse), care assessor, speech and language therapist, community nurses, clinical nurse specialists, dentists, and optometrist Comments include: • The matron and staff are always willing to work with myself for the benefit of the patient. They are a pleasure to work with. • The care has greatly improved over the past few years with NVQ being undertaken by a number of carers. The trained members of staff are usually very helpful and communicate with us regularly keeping us updated with the clients needs. • All the staff I have met at Deer Park appear cheerful and friendly. They have a can do attitude and are always willing to seek the views and opinions of others in an endeavour to enhance client care. None of the clients I visit have said anything negative about Deer Park. Senior staff are always eager for educational updates for their team. • I sometimes visit Deer Park to carry out domiciliary visits for some of the residents. I have always been impressed with the home. It is clean and friendly. The staff are always helpful and seem well organised. There is a great atmosphere at the home and the residents I see appear well cared for. Staff seen on the day of inspection were heard to be polite towards residents. Staff were seen and heard to knock at resident’s doors before entering. All residents’ case tracked had a care plan and supporting information. These records did not always reflect the standard of personal and nursing care that was given. Many changes in care relied heavily on staff reading the many pages of daily entries or being informed by colleagues. Staff were asked if you could change the way the home works, what would it be? Comments included: • More consistent information given at handover between certain trained staff. If staff have been off for a few days there is no one to hand over all details DS0000026711.V325141.R01.S.doc Version 5.2 Page 17 Deer Park Nursing Home • • • • Need to keep communication up to scratch More communication Communication is sometimes poor between nurses and carers and kitchen staff. I find that the kitchen do not know about dietary requirements or who requires trays. Carers are often given inadequate information about the shift. The records contained evidence that assessments had been performed following admission for moving and handling, clinical risks, falls risk and pressure area assessment. Some of these had been reviewed but others had not. Inspection showed that changes in residents condition is not always recorded in a way that shows trends or changes in condition. An example of this was seen where weights for residents are recorded in several places but nowhere that would indicate whether the weight has risen or fallen. One plan identified a substantial weight loss in a short time, which had not been identified by staff and no plan of care made. This places residents at risk. Discussion with the trained staff showed that they have a good knowledge of what needs residents have but often this is not shown in care plans. Daily recordings showed changes in the plan of care. These changes did not result in a new plan of care being written but relied on staff passing the information on verbally between each shift. When this works observation shows it works well, but evidence was seen during the inspection of where information is missed. Feedback from staff questionnaires showed that staff felt communication is poor between trained staff and care staff. As a result, the lack of initial assessment, detailed care plans and poor communication can and have resulted in important information not being passed between staff which can result in poor, inadequate or unsafe care being given or missed. Accident books confirmed where detailed assessments, care planning and communication could minimise risks. The registered nurses manage medication at the home. A general medicines and self-medicating policy was available and had been reviewed in September 2006. A policy was available for the use of homely remedies but this was out of date and did not include the remedies that were seen at the home. There was no reference to a pharmacist. Medication administration records (MAR sheets-where staff sign to say they have given medicines) contained gaps where no explanation was given for the Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 18 missed medication. Creams that had been prescribed were not signed to show they had been given. Care Plans did not explain that they had been given. This could result in medication being repeated or missed because of this poor record keeping. Where residents and staff could decide how many tablets could be given (e.g. painkillers) it was not clear on the MAR sheet how many were given. This does not show how many tablets were needed to control the situation and could affect future care. Where MAR sheets had been completed by hand there were not two signatures to minimise error. The storage of medicines was generally acceptable with the exception of incorrectly stored eye drops, which could affect the potency of the medicine and could affect resident’s conditions worsening. Metal drug cabinets and safe storage facilities for controlled drugs were seen. Comments from the residents’ questionnaires regarding medication included: ‘I have to ask several times for the pills I need’ From relatives comments included: ‘The accuracy of dispensing medication is sometimes inconsistent and response to standard medications such as paracetamol can be very slow.’ Staff comments on the questionnaires revealed the practices of some of the registered nurses in the home were unsafe, meant that care staff were left to give medicines and were not prompt at giving out medications. These shortfalls in medication place residents at risk and mean they may be waiting in discomfort for pain relief. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents enjoy a variety of activities and links with friends and families. They have choice over their lives and enjoy the meals. EVIDENCE: Records showed that social assessments performed on residents were good. This enables staff to understand who the resident is, their interests and hobbies so activities can suit their needs. Resident questionnaires asked: Are there enough activities arranged that you can take part in? The majority of replies were always or usually Comments included: • It is difficult due to my condition but I am taken in for musical or festive activities which is good for motivation • I do not generally take part, as I prefer to stay in my room. On odd occasions I do take part Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 20 • • • • • • • I don’t want to participate The home are very good at ‘putting on a bit of a do’ and everyone is made to feel welcome. The church folk who visit have a very warm approach to everyone. The TV is not accessible to all. Lighting is poor for those who want to read especially in the evenings There used to be chair exercises once a week Great hairdresser Lovely trips but puts a strain on the staffing levels. The owner is reluctant to recruit volunteers I’m unable now but used to join in Observation of social activity and how residents are involved in the life of the home was undertaken in the homes main communal room. The atmosphere was relaxed and engaging. Interaction between residents and with staff was cheerful and respectful. Some residents were receiving visitors, others were watching a movie and some were chatting among themselves. A group of approximately 6 residents went out on a mini bus trip. Residents spoken with confirmed they are able to choose how and where they spend their time. The visitor’s book showed that relatives and friends have access to the home at all times. Posters, and discussion with staff and residents confirmed that outside entertainers come to the home. Residents also said they liked the hairdresser coming to the home. Relative questionnaires stated that: • • The staff are always welcoming and polite when we visit. It is very reassuring to see first class care in very pleasant surroundings My mothers sociability and general health have improved since arriving at Deer Park All feedback received regarding food was complimentary. Roast Pork was served on the day of inspection, which looked appetising and residents said was very good. Residents that were being assisted with their meals were helped in a sensitive unhurried manner. Resident questionnaires asked: Do you like the meals? The majority said always or usually Comments included: • The meals are well prepared, wholesome and generous. Never cut down if plates are left unfinished and staff always available to feed those like my relative. • The presentation could be a little better • I find the sizes of the meals are too big Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 21 • • • • • They have an excellent cook here Usually but attention should be given to alternatives to pre packed items such as soups and mousses. Chips for tea each week is not appropriate especially for those with no teeth. Great lunches and special teas at festive times. Catering staff are excellent Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Policies, training and awareness of the prevention and reporting of vulnerable adults issues are dealt with appropriately at the home. However, the attitude and efficiency of dealing with concerns and complaints is sometimes poor at the home. EVIDENCE: A complaints procedure is available at the home, in the Service User Guide and Statement of Purpose. The Complaints procedure contains details of how to contact the Commission for Social Care Inspection. A complaints procedure was located at the inspection and showed the last complaint received was in 2003. Staff said they had not received any complaints since then. However the Commission for Social Care Inspection sent a complaint for the home to investigate in September 2006. No records of this were seen in the complaint file. There were no records of minor concerns made at the home, but feedback from questionnaires showed that response to these concerns was sometimes slow and left for relatives or residents to chase issues. Comments on resident, staff and relative questionnaires were mixed regarding how the home deal with complaints. The negative comments do question the Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 23 response and attitude of staff, the Matron and provider to concerns and complaints. These comments included: • When a carer needs support from a manager, matron or nurses it is not always given, any problems are not dealt with and just left to be forgotten, they won’t listen when a carer says the Service User looks unwell, they brush it off. The matron and nurses need to listen to the carers more often and not brush any problem away. (Either client or staff problems) When I have complained to Matron she is defensive about her staff. After this, the senior staff were off hand with me and were off hand when I have asked about the welfare of my relative Have not had a reply from Mr Orchard regarding the complaint. (This issue was looked at following the inspection and letters from the Commission for Social Care Inspection and Deer Park were resent) You have to do the chasing up for answers Sometimes it feels like you are facing a firing squad Sometimes it is not worth the bother • • • • • • Feedback was not always negative. Resident questionnaires showed that the majority of residents knew who to tell if they were unhappy. Some said they would speak with staff at the home and others relied on their families or GP. Comments included: • • • • • • I tell nursing staff or matron Very helpful with minor problems Appointment with matron is there is we need it If I have any concerns of any kind I find that the staff are very approachable and always willing to try and provide the best possible care. Matron has dealt with problems that have been reported to her. We get support if you have problems in or out of the home. Matron is easy to talk to and will offer support. She will also not tell anyone about your personal problems without your permission Discussion with the Matron confirmed that the home have improved the way allegations to adult abuse are dealt with and reported. This has occurred following a recent experience. Inspection of these records showed that the Matron acted appropriately and efficiently. The Matron explained that she has changed the way the home deals with allegations, taken steps to address poor practice and has worked hard to ensure staff receive training in how to recognise, report and prevent adult abuse. The Matron was able to provide local Devon County Council Alerter Guide policies, which were used as part of the investigation. The Matron also explained that she is aware of how to refer cases to the POVA (Protection of vulnerable Adults register) Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Areas of improvement are required within the environment to ensure the home is a safe, hygienic pleasant place to live and work. EVIDENCE: Park Nursing Home is a purpose built care home situated on the edge of Holsworthy, a market town in North Devon. It is a purpose built care home arranged over two floors. There is a spacious lobby / entrance hallway which is furnished to provide a pleasant and comfortable seating area for visitors and Residents. Some areas of the home had been redecorated. The dining room chairs had been recovered. The toilet frames that were rusty at the last inspection had been recovered. Flooring by a kitchen door and in the lift had been repaired and a new bath and taps had been installed. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 25 Toilets were located within residents’ rooms and within close proximity to communal spaces. These were clearly marked. The majority of rooms have ensuite shower facilities. The Staff stated that these are rarely used as residents continue to enjoy their baths. Service Users have access to all areas of the home by the use of ramps, lifts and grab rails. Hoists and lifting equipment were in use on the day of inspection. Inspection confirmed that two hoists were available for each floor and a standing device used for the whole home. Observation confirmed that these hoists were dirty and discussion with staff and questionnaires confirmed that they regularly breakdown. The number of hoists seen was insufficient for the size of the home and number of residents. A tour of the home confirmed residents enjoy a homely environment and a choice of communal or private space. Grounds were seen to be attractive and well maintained and residents stated that they enjoy sitting outside during fine weather. The home employ a maintenance man three days a week and use outside contractors for specialist services which include hoist, bath, lift, electrics, emergency lighting and the call bell system. Maintenance records were seen for these, which showed that servicing had been done in 2006. Despite this, some equipment was poorly maintained or not working. Maintenance records showed that faults are reported to the maintenance man for repair. An example was that hot water was either brown or insufficient. A fault was identified and repaired. Other areas of the home were seen to be poorly maintained. Some carpets were worn. Some bedroom furniture provided by the home were damaged or appeared ‘tired’. An unsafe plug socket in the lounge and light fitting in entrance hall were unsafe. A recent EHO (Environmental Health Office) inspection recommended kitchen worktops that needed to be repaired. Areas, which had been identified at the previous inspection, were seen for the second time. These areas included a mouldy boiler cupboard and inadequate sluices (not disinfecting). In addition to this, the hand washing sinks in sluices are badly stained – a dedicated hand washing sink for staff use to minimise risk of infection should be available. These areas must be addressed as a matter of urgency to reduce infection at the home and prevent enforcement action being made by the Commission for Social Care Inspection. At the previous inspection the effectiveness of the washing machines were questioned. The Matron was ask to obtain evidence that the machines could meet temperatures for a specified length of time to reduce infection. This information was obtained but not in detail to show the machines were suitable for washing soiled laundry. On the day of inspection the machine was leaking Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 26 and staff said that it had been leaking for a few months. A pink towel was being used to mop up water from the leaking washing machine. Used linen was on the laundry floor and not in appropriate laundry bags. The business manager gave assurances that the machine would be replaced as a matter of priority. Measures to reduce the spread of infection at the home were poor in places. Inspectors saw an inappropriate use of gloves and aprons, no evidence that washing machine reaches correct temperatures, sluicing soiled linen by hand. A bucket containing linen being soaked was in the basin in the laundry – a separate hand washing sink was not available for staff to use to wash their hands. Kitchen hygiene continued to be poor in places poor, staff were seen to still have free access to kitchen, despite a kettle being provided in the staffroom. Some fridges contained unlabelled and uncovered foods. Discussion with kitchen staff confirmed that the food standard agency work book-safer food, better business was used at the home, A tour of the building confirmed that residents were able to bring in items of furniture, pictures and ornaments to personalise their rooms. Resident were asked on the questionnaire: Is the home fresh and clean? The majority of Service Users said always Comments included: • No cleaning staff at weekends to deal with spillages and soiling of a personal nature • Housekeepers are excellent, unobtrusive/dedicated and have only seen one go in 5 years • Cleaning is ongoing all day, there is always fresh flowers and plants for us to enjoy • Very • Daily cleaning seen in the room and the standard is good, the corridors, lounge and dining room are carpet shampooed on a regular basis, again good. • Some of the carpets in rooms and corridors are tired looking as do the dining and lounge chairs. • Costs of refurbishment, cleaning, and looking after the environment is high but is conducive to patients well being, visitors and reduces infection. • Clean during the week but not at weekend Staff questionnaires contained remarks such as there is not enough equipment, hoists keep breaking and there is no cleaning staff at the weekend. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 27 Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The numbers of staff are generally adequate but their inconsistent induction, lack of supervision and training places Service Users at risk. EVIDENCE: Residents spoken with and comments on the questionnaires - All comments are that staff are marvellous and work extremely hard. Comments heard on the day of inspection included: ‘the staff are fabulous’ and ‘the staff are wonderful’ and ‘the staff are like family’. Questionnaires contained comments such as: ‘All the staff are very nice’, ‘In my opinion the care assistants are excellent’, ‘The caring nature of all the staff: Office, carers, nurses, kitchen staff and cleaners is exceptional in this home’, ‘The junior care assistants are the key to satisfactory care’ and ‘I find the staff very courteous and everyone is so nice’. Off duty records showed that staffing numbers are constant at the home. The Matron stated that short-term sickness is sometimes difficult to cover. Resident questionnaires showed that sometimes they have to wait for call bells to be answered and for carers to attend. Comments included: ‘Staff attend as soon as possible’, ‘Like any organisation there are times when staff are needed, are busy and short. I.e. meal times and after tea when patients are being put to bed or made comfortable in their rooms’, ‘Usually, but in the Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 29 early evenings waiting times can be lengthy’ and ‘I have to ask for things once or twice’ Residents seen on the day of inspection had call bells within reach and did not have to wait long for bells to be answered. Records showed that the recruitment procedure has improved since the last inspection. Staff files all contained an application form, evidence of identification CRB (criminal Records Bureau-Police check) and POVA (Protection of Vulnerable Adults) checks and two written references. References were not always from suitable sources and photocopies of original documents were not always signed to show original had been seen. Observation on the day of inspection showed that staff were pleasant towards and seen to interact with Service Users appropriately. Training records were poor, with no way of seeing who had not received training. Some staff had received some training but there was no evidence to show staff had received all training. Discussion with the matron confirmed that over 50 of care staff had NVQ 2 training or equivalent. The Matron confirmed that care staff have a formal induction but there was no evidence seen to support this. The Matron explained that at present staff keep the induction book. The Matron also stated that funding is obtained for NVQ training wherever possible and staff are able to do training for NVQ in work time. However, mandatory training is not always provided in work time. Discussion on the day of inspection confirmed that ancillary staff receive no formal induction but have a few days of shadowing existing staff. Feedback from health care Professionals contained comments. These included: • There could be a better skill mix amongst the care assistants. They are nearly all very young and inexperienced. They could benefit from a more mature/experienced care assistant to work alongside and be guided and mentored Staff used to attend total communication courses and eating and swallowing difficulties. Both these courses are available and would benefit staff and Service User. • The skill mix seen on the day of inspection appeared adequate. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Management of the environment is poor in places, which puts residents, staff and visitors at risk. Communication within the home could be improved which would increase staff morale and improve information shared. This would result in improving the care that resident’s receive. EVIDENCE: Mixed feedback in the questionnaires was received about the management of the home. Comments included: An appointment with matron is there if we need it’, ‘I tell matron if I have any problems’, ‘support has come from matron’ and ‘sometimes it is not worth the bother’. Feedback was good on day of Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 31 inspection. Residents said Matron was ‘a nice lady’ and ‘super’. Staff said she was approachable. There appeared to be clear lines of Management within the home. Staff said they always go to the Matron with problems as although there is a business Manager and Provider, requests for equipment is sometimes ignored. Contact details for the matron and manager are available in the home. Insurance certificates were displayed within the home and showed that Deer Park have adequate insurance cover. Staff questionnaires stated that staff meetings had not been held. Discussion with the matron confirmed that last year there were not as many meetings held. She had held an informal meeting for care staff recently where staff were given an opportunity to raise concerns, which were similar to those, raised in the staff questionnaires. Informal notes were seen of this meeting. Training records were inadequate in respect of mandatory training. Records did not show who had and who had not received training in first aid, moving and handling and fire safety. Supervision of staff had still not been performed but a meeting held on day of inspection was being held to introduce new system. This was positive as staff feedback from the questionnaires confirmed that staff wanted some form of supervision. Quality assurance surveys were seen at inspection, which had been obtained since the last inspection. These had not been summarised at the time of inspection. Comments from inspection questionnaires were read to the matron at inspection. These comments had been made anonymous. The ‘personal money’ kept by the home was inspected for the residents who were being case tracked. Some residents had finances managed by a solicitor, others family members. The Business Manager stated that the home are not appointee for any resident at the home and only hold small amounts of cash for safe keeping which can be spent on hairdressing, chiropody, newspapers and toiletries. The monies inspected all had records, receipts and correct balances. The Recommendation made at the last inspection to obtain two signatures for each transaction had not been implemented. This would protect staff and residents. The Management of the home was poor in places. There are first aid boxes and Health and Safety Executive posters and information. Accident and incident records are well maintained. Some events could be prevented by ensuring pre admission assessments are performed. Also, removing COSHH (Control of Substances hazardous to health) products, which were left out in laundry room Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 32 would reduce risk. This poor practice had been identified at the previous inspection. The safe storage of O2 was discussed. Door wedges were seen throughout the building and a fire escape at the rear of the property was obstructed. Fire escapes were all seen to be clear on the day of inspection. However, corridors were obstructed with wires and were used for storage of equipment, which could obstruct exits in an emergency. At the rear of the property a stair gate guarded a fire escape. The height of this gate was questioned and a suggestion to put in a full height gate was discussed at the previous inspection but had not been replaced. Maintenance records were seen for hoists, baths, emergency lighting and lifts. The Matron stated it was the night staff responsibility to do this but no records were kept. Observation showed many cases of residents being wheeled around in wheelchairs with no footplates. This is poor practice, uncomfortable for residents, places residents at risk and does not demonstrate that staff are taking time to ensure their work is safe at all times. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 3 3 3 x 3 2 1 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 2 3 x 2 1 1 1 Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Assessment of service users 14. - (1) The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; 58 (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. (2) The registered person shall ensure that the assessment of the service users needs is (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change of circumstances. Timescale for action 01/06/07 This relates to inadequate assessments being performed prior to admission. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 35 Residents must have sufficient information to ensure all needs of the resident have been assessed. 2. OP7 15(1) Service users plan 15. - (1) Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. 01/06/07 This relates to: • The care Plan not setting out in detail the action that is needed to ensure all aspects of the health, personal and social care needs of the resident are met. • The care plan not reflecting the changing needs of the resident 3 OP9 13 13. - (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 01/06/07 This relates to: • Registered nurses leaving care staff to administer medications • The out of date homely remedy policy and storage of products not on the homely remedy list agreed by GP’s. • The incorrect storage of eye drops • The incorrect recording of medicines that have been missed • The lack of recording that prescribed creams have been administered Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 36 • • The poor time keeping of the administration of medicines and The poor response time to administration of painkillers and other as needed medication 01/06/07 4 OP16 22(3) Complaints 22. - (3) The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. (8) The registered person shall supply to the Commission at its request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. This relates to: • The complaints register not containing details of the complaint forwarded from the CSCI. • Comments that residents, staff and relatives do not find the reaction by managers to complaints is open and responsive 5 OP19 239b) Fitness of premises 23. (2) The registered person shall having regard to the number and needs of the service users ensure that (a) the physical design and layout of the premises to be used as the care home meet the needs of the service users; (b) the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally 01/06/07 This relates to the unsafe plug socket in the lounge and light fitting in the entrance hall. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 37 6 OP19 16(2j) Carried forward: Facilities and services 16. (2) The registered person shall having regard to the size of the care home and the number and needs of service users (j) after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; 01/06/07 This relates to: • The unlabelled and undated food seen in the kitchen fridge • The staff still using the kitchen as a corridor 7 OP22 23 (2c) (2n) and 23(2l) Fitness of premises 23. (2) The registered person shall having regard to the number and needs of the service users ensure that - (c) equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order; and (l) suitable provision is made for storage for the purposes of the care home; and (n) suitable adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled; 01/06/07 This relates to: • The hoists not being in good working order • The hoists being dirty • Wheelchairs being dirty • The insufficient numbers of hoists and standing equipment and • Poor storage of equipment 8 OP26 13(3) Further requirements as to health and welfare DS0000026711.V325141.R01.S.doc 01/06/07 Page 38 Deer Park Nursing Home Version 5.2 13. (3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This relates to: • The absence of a weekend cleaner • The lack of a washing machine with the specified temperatures to clean linen and control the spread of infection • The leaking washing machine used for washing soiled linen • The hand sluicing of foul laundry • The lack of separate hand washing facilities in the sluice • The existing mould in the boiler cupboard within the staff room 9 OP26 23(2) Carried forward existing timescale not changed: 14/03/07 Fitness of premises 23.(2) The registered person shall having regard to the number and needs of the service users ensure that (k) any necessary sluicing facilities are provided; This relates to: • The absence of a disinfecting sluice in the home 10 OP38 19 (1) 13(1,5,6) 23(4) 19. - (1) The registered person shall not employ a person to work at the care home unless - (5) For the purposes of paragraphs (1) and (4), a person is not fit to work at a care home unless (b) he has qualifications suitable to the work that he is to perform, and the DS0000026711.V325141.R01.S.doc 01/06/07 Deer Park Nursing Home Version 5.2 Page 39 skills and experience necessary for such work; 13. - (1) The registered person shall make arrangements for service users and shall make suitable arrangements for the training of staff in first aid. (5) The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. (6) The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 23. - (4) The registered person shall after consultation with the fire authority (d) make arrangements for persons working at the care home to receive suitable training in fire prevention; and This relates to the lack of evidence of what staff have and have not received training in: • First Aid • Fire Prevention • Moving and Handling And • Protection of Vulnerable adults 11 OP38 13 Further requirements as to health and welfare 13. (3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (4) The registered person shall ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free DS0000026711.V325141.R01.S.doc 01/06/07 Deer Park Nursing Home Version 5.2 Page 40 from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, This relates to: • The COSHH products in the laundry room • Storage doors wedged open • The use of door wedges on fire doors • The obstructed fire exit • The inappropriate storage of equipment obstructing walkways and corridors • The lack of evidence that fire doors have been checked • Residents being wheeled in wheelchairs without footplates. 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 Carried forward: The Manager should ensure the pre assessment tool contains all information listed in standard 3. The Manager should use the assessment as a basis for planning care 2 OP7 OP8 The Manager should ensure that any assessments are reviewed to show changes in conditions and trends. E.g. weights should be recorded in a way that losses can be monitored and reviewed. The Manager should ensure that care plans are drawn up DS0000026711.V325141.R01.S.doc Version 5.2 Page 41 3 OP7 Deer Park Nursing Home 4 OP9 and reviewed with involvement of residents and/or their families/representative. The Manager should ensure: • Photos are kept in the MAR folder for all residents, including the cat (to stop misunderstanding for agency staff) The Manager should keep a record of all complaints and concerns to show any trends and what action has been taken. The Manager should continue with the planned replacement of carpets in the home. The Manager should continue to meet the recommendations made by the EHO (Environmental health) The Manager should continue with the planned programme of replacing divan beds for nursing beds that are adjustable. The Provider should obtain written assurances that a generator can be obtained in the event of a power cut The Manager should: • Sign to say she has seen the original documents used for ID • Ensure references used are suitable (Previous employer) The Manager should ensure she obtains copies of the induction performed by staff as evidence that staff have received an induction The Manager should ensure the home is conducted in a way that staff, residents and visitors are comfortable in raising concerns, complaints or new ideas. The Manager should also encourage trained nurses and carers to listen and communicate well with each other. Carried forward The Manager should ensure Service Users personal money is handled in a way that protects the resident and staff. It is recommended that: Two signatures are obtained on each transaction 5 6 7 8 9 10 OP16 OP19 OP19 OP24 OP25 OP29 11 12 OP30 OP32 13 OP35 14 15 OP38 OP38 The Manager should consider a system to see what staff are missing what mandatory training Carried forward The Provider and Manager should put an alternative gate on the top floor rear fire exit. Deer Park Nursing Home DS0000026711.V325141.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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