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Inspection on 13/12/05 for Diamond House Care Home

Also see our care home review for Diamond House Care Home for more information

This inspection was carried out on 13th December 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff indicate that they feel well supported by the manager. The home has a staff group who appear enthusiastic and committed to trying to provide good care to service users that helps to create a homely atmosphere. There is a relatively low turnover of staff and stable staff team.

What has improved since the last inspection?

Care plans demonstrated an improvement on those reviewed at the last inspection, providing care staff with clearer information as to the care requirements of service users. Some improvements to the environment have been made, in particular the replacing of a number of carpets in service users bedrooms. Specialist dementia training has been made available to all care staff at the home, those staff spoken to during the inspection appeared to have benefited from, and valued this training.

What the care home could do better:

The majority of the care and practice inspected falls below the standard required by the National Minimum Standards of care for older people. Twentynine Standards were inspected, and seventeen of these were not met. Consequently there are a high number of requirements contained within thisreport. Two requirements made at the last inspection have been repeated due to non-compliance. The environment on the first floor of the home requires significant improvement including redecoration and repair. At present the first floor environment provides service users with little in the way of stimulation or interest. Despite noted improvements in care planning, further improvements are required in order to involve service users and their relatives in this process. Care plans need to be reviewed in order to reflect the quickly changing needs of service users. A number of odorous areas in the home indicate evidence of difficulty in managing service users continence needs and professional advice about the promotion of continence should be sought. Service users choice and control over their lives is limited. Examples of this include lack of evidence of service user involvement in care planning, lack of privacy for telephone use, staff difficulty in accessing bedrooms when call bells have sounded, waiting for access to the hoist and the routine practice of locking service users bedroom doors on the first floor (therefore service users who do not hold their own keys cannot independently access their own bedrooms). These and other matters identified within the report including health and safety, infection control, confidentiality and arrangements for protecting service users from abuse are matters associated with supervision and management within the home.

CARE HOMES FOR OLDER PEOPLE Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ Lead Inspector Mr Jerry Crehan Announced Inspection 13th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 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. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Diamond House Care Home Address Bennett Street Downham Market Norfolk PE38 9EJ 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) 01366 385100 01366 385600 Ashbourne (Eton) Limited Mrs. Judith Elizabeth Eglen Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th July 2005 Brief Description of the Service: Diamond House is a care home providing residential care for up to 42 older people including service users with dementia. It is situated on the edge of the town of Downham Market and is within easy reach of local facilities including shops, pubs and other community facilities. Diamond House is purpose built with accommodation provided on two floors, service users with dementia occupy the first floor. Stairs and passenger shaft lift service floors. There are 38 single rooms and 2 shared rooms. There are patio and garden areas that are visible from a number of service users bedrooms. Diamond House is one of several homes in Norfolk owned by the proprietors. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 9.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with many of the forty-eight service users in addition to visiting relatives, staff and the registered manager. Ten comment cards were received from service users prior to the inspection. These largely expressed satisfaction as to the care provided at the home. A single comment card from a relative was received. Any areas of dissatisfaction were explored within the inspection. What the service does well: What has improved since the last inspection? What they could do better: The majority of the care and practice inspected falls below the standard required by the National Minimum Standards of care for older people. Twentynine Standards were inspected, and seventeen of these were not met. Consequently there are a high number of requirements contained within this Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 6 report. Two requirements made at the last inspection have been repeated due to non-compliance. The environment on the first floor of the home requires significant improvement including redecoration and repair. At present the first floor environment provides service users with little in the way of stimulation or interest. Despite noted improvements in care planning, further improvements are required in order to involve service users and their relatives in this process. Care plans need to be reviewed in order to reflect the quickly changing needs of service users. A number of odorous areas in the home indicate evidence of difficulty in managing service users continence needs and professional advice about the promotion of continence should be sought. Service users choice and control over their lives is limited. Examples of this include lack of evidence of service user involvement in care planning, lack of privacy for telephone use, staff difficulty in accessing bedrooms when call bells have sounded, waiting for access to the hoist and the routine practice of locking service users bedroom doors on the first floor (therefore service users who do not hold their own keys cannot independently access their own bedrooms). These and other matters identified within the report including health and safety, infection control, confidentiality and arrangements for protecting service users from abuse are matters associated with supervision and management within the home. 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. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 7 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 Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 & 6 Prospective service users or their relatives are provided with the opportunity to visit the home prior to admission. Service users are provided with terms and conditions of residence. EVIDENCE: Either service users or their relatives sign terms and conditions (or contracts) for their accommodation at the home. These appeared to reflect services provided. The relevant documentation was seen and adequately meets the standard required. The manager explained that there are some service users who have a contract with the placing authority though, as yet, do not have a contract with the home. She explained that work is currently in progress to ensure that every service user has a contract for their care with the home. There are two ‘residential’ service users accommodated on the first floor where the home provides care to service users with higher levels of need arising from dementia. However, the manager indicated that this was a matter of choice for the service users in question. Most service users spoken to indicated that either they or someone on their behalf had had the opportunity to visit the home to assess its suitability. Some Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 9 service users spoken to who had not had this opportunity, explained that their circumstances had prevented the possibility of a visit to the home. A visitor spoken to stated that they had visited the home on behalf of their relative. The home does not provide intermediate care. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 There are general concerns about the comprehensiveness and accuracy of some information in care plans, and whether care plans include the necessary information to promote and maintain service users health. However, improvement from previous inspection is noted. EVIDENCE: Sample care plans and accompanying risk assessments were reviewed. These demonstrated an improvement on those reviewed at the last inspection of the home. They now contain detail as to the action that needs to be taken by care staff to meet the individual needs of service users. Further clarity for staff is required for some care plans, as well as further input or contribution toward their care plan from service users, where possible. Care plans for service users with identified challenging behaviour explain behaviours satisfactorily, though need to go on to advise staff as to the action they should take when challenging behaviours are exhibited. Care plans for service users requiring a greater degree of physical and personal care were largely satisfactory with accompanying ‘turn charts’ and monitoring of food and fluid intake. However, a care plan for a service user Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 11 who is unwell and confined to their bed had not been reviewed satisfactorily to reflect that their needs were changing quite quickly. The emphasis of this service users care plan should focus more precisely on physical, personal and health care needs to ensure their comfort. Evidence of difficulty in managing service users continence needs was found in the form of at least three service users bedrooms that are odorous, and in evidence of inappropriate urination in the corridor area on the first floor, which also presented a health and safety issue. There are currently no service users accommodated at the home who take responsibility for administering their own medication. Medication records and storage were reviewed. It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. This practice was in evidence for a variety of containered and liquid medication. It is evidently clear that individual medication can become mixed, and therefore presents the risk of its being wrongly administered. Medication records were reviewed and found to be satisfactory. The home has in place appropriate storage and a book used to record controlled drugs, which provides an additional level of security. The book meets the requirements of the Misuse of Drugs Regulations 2001. Observation during the inspection and comments from service users showed that staff had an understanding of how to promote service users privacy and dignity. However, it was noted that a service user confined to their bedroom due to ill health had their bedroom door left open, despite the fact that their room is directly opposite the main lounge area on the first floor, and that this was unlikely to be the service user’s choice. A service user who requires a hoist for transfers indicated that they sometimes have to wait until the hoist is available and that they would prefer quicker access. Communication observed between staff and service users was appropriate to the individual needs of service users. The staff workstation on the first floor is in an open area on the corner of the corridor. It is the site for a telephone extension that is in regular use. At the last inspection of the home it was noted that it is difficult for staff to communicate with callers to this extension in a private or confidential way, which is sometimes required and this is still the case. Telephones provided at the home do not provide sufficient privacy for service users wishing to make or receive telephone calls, as they are situated in the hallway. Alternatives to these arrangements must be explored that provide sufficient privacy. The home has evidently provided palliative care to service users at the home, and have an appropriate policy to support staff in the care of service users who are dying. Though as indicated above, care plans must be regularly reviewed and clearly set out with a focus on physical, personal and health care needs, and ensuring that the individual retains maximum control. Care plans sampled included appropriate reference to the wishes of service users in the event of their death. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 12 Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 & 15 Service users are able to maintain contact with relatives and others as they wish, though other aspects of control of their lives are limited. The availability of food is not always convenient or appropriate to the needs of service users. EVIDENCE: Service users and visiting relatives indicated that they were made welcome at the home at any time of their choosing. Visitors are usually seen in the privacy of service users own rooms. A number of visitors were present at the time of the inspection. However, it is noted that there are other aspects of life at the home where service users choice and control over their lives is limited. Examples of this include the lack of evidence of service user involvement in care planning, lack of privacy for telephone use and the routine practice of locking bedroom doors on the first floor whilst service users are elsewhere. As a result of this practice it was observed that a service user (who ‘wanders’ the corridor of the first floor checking each door handle) was excluded from their own bedroom. Service users gave a good response as to the quality of the food available at the home. The meals seen at the time of the inspection looked reasonable. However, food was evidently not available outside of mealtimes. There was no evidence of fresh fruit or finger foods for service users on either floor of the home. The availability of these foods for service users with dementia is Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 14 reflective of current good practice and supportive of their health and wellbeing, particularly for those service users whose mental health needs are such that it is difficult to maintain an adequate diet at designated mealtimes alone. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The home’s complaints system is satisfactory, as are its arrangements for protecting service users legal rights. Arrangements for protecting service users from abuse have not been satisfactory. EVIDENCE: Service users and relatives spoken to indicate that they would speak with the manager or with their carers if they had a complaint or concern, and felt it would be acted upon. Information about complaints is readily available within the home, including a confidential telephone helpline operated by the proprietor. From information provided by the manager the home had received and investigated one complaint that was fully substantiated. A further complaint made (concerning adult protection) and investigated under adult protection procedures, was partially substantiated. The investigation revealed shortcomings in the home’s training programme and management approach to adult protection and ‘Whistleblowing’. Staff spoken to at the inspection are aware of the home’s ‘Whistleblowing’ policy and its function in the protection of vulnerable adults. The manager indicated that the majority of service users have access to relatives or friends, many of whom assist service user in managing their affairs. There are no independent advocates currently supporting service users, though there has in the past, where necessary. Service users are able to take part in the political process, voting by postal ballot. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 26 The home’s environment does not meet the needs of all of its service users. EVIDENCE: At the time of this announced inspection it was evident again that one of the fire exits from the first floor was partially blocked by the home’s hoist, which had been positioned there to re-charge. This issue had been made the subject of a requirement at the home’s last inspection. The home provides adequate communal space including access to outdoor space that is accessible to those in wheelchairs or with other mobility needs. The home’s grounds and garden are well maintained. The decoration and furnishings throughout the ground floor are satisfactory, though those on the first floor are requiring significant attention. There are numerous cracks in walls on corridors and a soiled chair in a service users bedroom was seen and removed on request. A number of new carpets were noted throughout the home and the manager indicated that redecoration for this part of the home is a priority. The environment on the first floor provides service users with little in the way of stimulation or interest. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 17 There are suitable and sufficient lavatory and bathing facilities. There is one portable electric hoist and a stand aid at the home for service users on both floors. As indicated earlier in this report a service user who requires a hoist for transfers indicated that they sometimes have to wait until the hoist is available and that they would prefer quicker access. Therefore the issue of the adequacy of hoists or the way they are used at the home must be satisfactorily addressed on this occasion. It was noted that there is significant use of the available communal space on the ground floor by service users from both floors at the home. Whilst the freedom for service users to associate freely is supported, the pressure on the limited space available is significant. Discussion took place with the manager as to how this may be addressed, including improving the way in which communal areas on the first floor are used. Service users own rooms appear to suit the individual needs and preferences of their occupants, though access to bedrooms on the first floor is a matter that must be addressed as indicated in Standard 14 of this report. Access to bedrooms is further exacerbated by problems for care staff in locating keys to rooms. A service user was observed to ring their call bell from their bedroom and care staff were not able to easily locate the key to the bedroom door. The matter of care staff requesting keys from each other has other notable difficulties, such as hampering communication between staff and service users as discussions are regularly interrupted by requests for keys, and contributing to doors that should remain locked, being left open. Many service users bedrooms (particularly those on the ground floor) were clearly personalised with their own furniture and possessions, creating a homely feel in many rooms. All of the bedrooms except two are designed for single occupancy. The home appeared largely clean and hygienic, with cleaning in progress at the time of the inspection. Though at least three service users bedrooms were odorous at the time of the inspection, and there was evidence of inappropriate urination that had not been attended to in an area of the corridor on the first floor. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Service users are not fully supported or protected by the home’s recruitment practices. Staff training programme addresses service user needs, though the absence of current first aid training may compromise service user safety. EVIDENCE: Comments from service users and relatives were favourable about the care provided by staff at the home. From information provided by the manager it is apparent that 30 of care staff have achieved NVQ 2 training (or above). The manager acknowledged that first aid training for staff was out of date, and that she would be arranging further training in order to ensure that there is a qualified first aider on duty at the home at all times. Sample files reviewed included evidence of the recruitment of recently appointed care staff without a satisfactory POVA check or CRB disclosure. All new staff should be appointed subject to a satisfactory CRB disclosure, and should not work unsupervised with service users until this is obtained. It is evident from staff spoken to and from training records seen that staff have access to induction training and a full range of mandatory training, including recently undertaken specialist training in relation to dementia care. Staff also appeared to show interest and enthusiasm in their role. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 38 An experienced manager manages the home. Service users would benefit from more effective management of staff. The health, safety and welfare of service users are not consistently supported at the home. EVIDENCE: The manager has experience within the care sector and has been in post for over four years at Diamond House. The manager was a trained nurse and had completed the City & Guilds Advanced Management for Care course. The manager stated that she would be undertaking NVQ 4 training in 2006. Service users and staff spoken with indicated that they felt they could approach the manager or deputy manager with a problem or difficulty if necessary. However, it is the case that the home has suffered significant recent difficulties within the staff group, partially as a consequence of management shortcomings in the approach at the home toward adult protection and Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 20 ‘Whistleblowing’, and partially as a response to a less than robust management approach in the management of the staff group. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. Feedback from care staff suggested that formal staff supervision has not been routinely taking place. The manager acknowledged that supervision has not been taking place at an appropriate frequency; consequently some staff have not received supervision recently. There are health, safety and welfare issues at the home and referred to in this report, including the absence of a first aider at the home with a current qualification, health and safety concerns following difficulties for the home in effectively managing service users continence and in leaving sluice room doors unlocked, infection control concerns in not removing soiled articles from service users bedrooms. Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 21 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 X 2 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 2 3 3 2 3 2 X 2 STAFFING Standard No Score 27 X 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 X 3 3 2 X 1 Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 22 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 OP7 Regulation 15(1) Requirement The registered person must ensure that written care plans are prepared with the involvement of service users or their representatives. The registered person must ensure that individual care plans set out action required by care staff to manage behaviour and meet needs. The registered person must seek professional advice about the promotion of continence. The registered person must ensure the privacy and dignity of service users through provision of telephone facilities that can be used in private, through ensuring that bedroom doors are closed where necessary and through the provision of sufficient hoists to meet the needs of service users. The registered person must ensure that the changing needs of service users with deteriorating conditions are reviewed regularly and met swiftly. DS0000065214.V260878.R01.S.doc Timescale for action 13/12/05 2 OP7 15(1) 13/12/05 3 4 OP8 OP10 13(1)(b) 16(2) 12(4) 23(2) 31/01/06 31/01/06 5 OP11 15(2)(b) 13/12/05 Diamond House Care Home Version 5.0 Page 23 6 OP14 12 (2&3) 7 OP15 16(2)(i) 8 OP18 13(6) 9 OP19 23(4)(b) 10 OP22 23(2)(n) 11 OP26 16(2)(k) 12 OP28 12(1)(a) 18(1) 19(1)(b)( 1) 13 OP29 14 OP36 18(2) The registered person must ensure that the home is conducted so as to promote service users personal autonomy and choice. The registered person must ensure that service users with dementia have access to suitable, wholesome and nutritious foods at such time as they are required. The registered person must ensure that robust procedures for responding to suspicion or evidence of abuse are followed. The registered person must ensure that fire exits are kept clear at all times. THIS REQUIREMENT IS REPEATED The registered person must ensure that sufficient hoists are available to meet the needs of service users. THIS REQUIREMENT IS REPEATED The registered person must ensure that the home is kept clean, hygienic and free from offensive odours. The registered person must ensure safe working practices including the provision of staff that are qualified first aiders. The registered person must ensure that new staff are confirmed in post only following satisfactory checks set out in Schedule 2 of the Care Homes Regulations 2001. The registered person must ensure that staff at the home are appropriately supervised. 13/12/05 13/12/05 13/12/05 13/12/05 13/12/05 13/12/05 28/02/06 13/12/05 13/12/05 Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 24 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 OP9 Good Practice Recommendations It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. It is recommended that the registered person ensure continued progress toward meeting the 50 requirement by 2005. 2 OP28 Diamond House Care Home DS0000065214.V260878.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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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