Inspection on 12/01/09 for Docking House

This inspection was carried out on 12th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Docking House 19/12/07

Docking House 27/04/07

Docking House 21/12/06

Docking House 25/05/06

Docking House 25/01/06

Docking House 30/10/05

Docking House 18/05/05

Docking House 17/02/05

Docking House 06/01/05

Docking House 01/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Docking House Station Road Docking Kings Lynn Norfolk PE31 8LS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Craig     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Docking House Station Road Docking Kings Lynn Norfolk PE31 8LS 01485518243 01485518436 care@dockinghouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ARMS Associates Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Docking House is a residential home for 28 older people who have personal care or dementia care needs. The home is situated in the in the village of Docking, between the towns of Hunstanton and Fakenham. There is a post office and shop close by. The home is supported by two G.P. practices. The accommodation is all on the ground level. The home has shared and single bedrooms with hand wash basins and a number of lounge and dining areas. Information about the home, including the last inspection report, is available from the home. At 12th January 2009 the weekly fees ranged from 417 pounds for people who were funded by social services to 470 pounds for people who funded their own care. There was an extra charge of 5 pounds per week for toiletries and activities. Other extras included hairdressing, newspapers and staff escorts and transport to hospital appointments. 0 0 Over 65 18 10 Care Homes for Older People Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 19th December 2007. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 12th January 2009 by two regulatory inspectors. During the visit we met with some of the residents and wherever possible asked about their views of Docking House. We spent time observing daily routines in the home and Care Homes for Older People Page 5 of 29 how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager and four members of staff. We looked around the home and viewed a number of documents and records. What the care home does well: What has improved since the last inspection? What they could do better: The service users guide should be updated and everyone should be given a statement of terms and conditions at the point of moving into the home. This is to ensure that people are given accurate information to help them to make a decision about whether Care Homes for Older People Page 7 of 29 the home is right for them and that they are clear about the service to be provided. Some of the care plans did not give staff enough instructions to help them to meet residents individual health care needs. Plans to monitor and improve residents health should be followed. Care plans were not always specific enough to help staff to meet residents individual social care needs. There were regular social sessions led by outside entertainers but staff did not generally have enough time to follow the daily activity programme or spend time with residents who preferred individual activities. In order to make sure that the manager and staff are clear about what to do if they suspect or witness abuse of a resident, there should be clear safeguarding procedures and all staff should attend training. There were a number of residents, who, because of their mobility needs, could not use the baths or shower. There must be adequate assisted facilities, so that all residents who wish to have a bath or shower will be able to do so. This had been required at the last inspection but has not been met. We may consider taking enforcement action. In order to protect the health and safety of residents, staff must follow procedures that reduce the risk of the spread of infection through the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff received sufficient information about prospective residents to understand and plan for their needs but the shortage of accessible information for residents could result in them not being clear about the service to be provided. Evidence: There was a combined statement of purpose and service users guide, which was given to people thinking of moving into the home. The document had not been reviewed recently and some of the information was out of date. For example, since the last inspection the majority of people who were admitted to the home needed dementia care. The statement of purpose and service users guide had not been updated to show what changes had been made to the service to ensure that the specialist needs of people with dementia would be met. People who funded their own care had a statement of terms and conditions of Care Homes for Older People Page 10 of 29 Evidence: residency but those who were funded by social services did not. This could lead to misunderstandings about what services were to be provided. Residents were charged an extra 5 pounds a week for toiletries and a contribution to activities. Although there was a notice on display in the foyer of the home, this information was not in the service users guide and was not readily accessible to everyone. The manager said that people could opt out of this charge and provide their own toiletries. However, it was not completely clear about their position with regard to activities if they opted out. People who wished to move into the home were assessed by the manager to make sure that their needs were understood and could be met at Docking House. The manager said she discusses assessment information with the care team before confirming admission. She also makes sure that any special equipment is in place and staff have any further training they may need. We saw one example of a recent preadmission assessment. It showed that all the relevant areas were looked at but the information was very brief. There was no care management assessment on the file, which the manager said was unusual. Standard 6 was not applicable. Intermediate care was not provided at Docking House. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the care plans provided staff with the information they needed to meet residents health care needs and some practices compromised residents privacy. Evidence: We looked at three sets of care files as part of the case tracking process and some others in less detail. As required after the previous inspection, new residents had care plans within the first few days of their admission. Although some of the files were slightly unwieldy and repetitive, there had been general improvements in the content of the care plans. The examples we looked at were person centred. This meant that they contained detailed information about the residents preferences and how they wished to be supported to meet their individual personal care needs. There were some good plans aimed at helping people to maintain their independence. Care plans were reviewed and updated when the residents needs changed. This meant Care Homes for Older People Page 12 of 29 Evidence: that staff had accurate and up to date directions to follow. Staff said they also had verbal handovers at the beginning of each shift so that they were kept in touch with all changes. This handover time was not built into the shift which meant that staff gave up their own time for this. None of the care plans we saw showed that the resident or their relative had been involved in drawing up or reviewing the plans. The manager said relatives were invited to reviews and had opportunities to be involved in care planning if they wished. Each resident had a set of assessments which helped to identify factors that caused risks to their health and safety. For example, factors that increased the risk of falls and developing pressure sores. In most cases there were detailed plans to minimise the risks. However, one person was assessed as having poor nutrition but their care plan did not address their individual needs. Furthermore, staff were not following the plan to monitor the persons weight every month. There was evidence that residents ongoing health care needs were monitored and records showed that they were referred to outside professionals where necessary. However, plans were not always in place to incorporate advice from the health care professional or to instruct staff as to what care they should be providing to meet the health care need. For example, wound care plans. There were no specific plans to assist people to meet their individual needs relating to memory loss or other needs associated with dementia. Throughout the course of the visit staff were seen to speak to residents politely and respectfully. Personal care was carried out in private and any residents who had a preference for female staff were accommodated wherever possible. However, there were some practices that compromised residents privacy and dignity. For example, one resident, who spent long periods of time in bed, did not have any privacy blinds at his window and he could be clearly seen from the car park. There were no curtains at the windows of the newly created lounge or conservatory which was on the front of the home and visible from the main road in the village. All staff with responsibility for administering medicine had received training. On the day of the site visit we observed a senior member of staff doing the medicine round safely and in accordance with good practice guidelines. Records of medication received and administered were complete and accurate. A few entries on the medication administration record (MAR) charts were handwritten but had not been signed or witnessed. This increases the risk of transcribing errors. We did a random check on stocks of medicine not in the monitored dose system. They were Care Homes for Older People Page 13 of 29 Evidence: accurate, which indicated that people were receiving their medication as it was prescribed. Occasionally medicines were prescribed to be given when required. There were no directions for staff to help them to recognise when these medicines should be given. This is particularly important because some of the residents would not be able to recognise if they needed the medication and the lack of clear criteria could result in the resident being under or over medicated. Medication was stored safely and at the correct temperatures. There were no controlled drugs at the time of the visit but appropriate storage was available. The manager carried out regular medication audits which covered administration, records and storage. She said this had helped to reduce errors and improve safety. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all routines in the home centred around the needs of the residents and the lack of individualised activities meant that residents social and recreational needs were not always met. Evidence: Most of the care records we saw included information relating to the residents past social history but this information had not been used to assist in care planning. There was nothing on the files about the residents current interests or whether they were still able to pursue them. One person had a risk assessment that acknowledged he could be at risk of social isolation but directions for staff were not person centred and did not meet his individual needs. A member of staff said more improvement was needed with regard to activities. Two staff said there were outside entertainers coming in regularly but staff did not have enough time on a daily basis to carry out the programme of planned activities. Another member of staff emphasised the importance of talking with the residents and also said they occasionally did some one to one activities. A resident said, we waste a lot of time here it is boring, there is nothing to do. Care Homes for Older People Page 15 of 29 Evidence: There was open visiting, which helped people to maintain contact with their family and friends. The manager said that relatives were invited to any of the events in the home such as a BBQ in the summer and the recent Christmas party. Information about the residents preferred routines was included on their care file. Staff said some routines in the home were flexible, for example, residents could get up and go to bed when they wanted to. However, some personal care routines were led by staff. Which meant, for example, that residents were encouraged to go to the toilet at times that suited staff. Staff said there had been improvements in the variety and choice of menus but that more was needed. The menus were chosen by the owner with no input from residents or staff. However, the cook said that residents liked most of the meals and the records showed that they had a varied diet with a choice at each meal. Care staff went round with the lunchtime menu asking people what they preferred. One member of staff said, residents can ask for whatever they want and some do. At lunchtime staff were observed offering a resident alternatives to the meal she had ordered but decided she did not want. Most people took their lunch in the dining room. Tables were set and people were chatting to each other. It was generally a calm and social occasion, although there was a long gap between courses, when some residents became restless. Residents described the meal as lovely and delicious. Staff were observed helping some people to eat their lunch. They provided assistance in a sensitive manner, making conversation and making sure to provide help at the right pace. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure ensured that complaints would be investigated and acted upon. The lack of staff training and clear guidance in safeguarding could result in abuse being mismanaged. Evidence: There was a clear complaints procedure on display in the hall and each resident was given a copy in their service users guide. The procedure indicated that the service welcomed the views of residents and their families and responded positively to any complaints. There had been no complaints in the past year, either to the Commission or directly to the service. The manager advised that the reduction in complaints could be because of improved communication with families and other stakeholders. Not all staff had received training in safeguarding but those spoken with said they would report any suspected abuse to the manager. There was a safeguarding policy specific to the home but some of the information was misleading. For example, it was not clear about who should investigate suspected or actual abuse. Staff did not have a copy of the local social services procedure to refer to. The lack of clear guidance meant that the manager was not completely sure about her role in investigating allegations of abuse but she knew who to contact for advice. The manager and a senior carer had attended several courses about the Mental Care Homes for Older People Page 17 of 29 Evidence: Capacity Act, which had given them a greater understanding about how to protect the rights of residents who have dementia. The manager had arranged for a resident to see an advocate who was assisting them with their finances. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improving, not all areas of the home were hygienic, comfortable and well maintained. The lack of suitable facilities meant that some residents were not able to have a bath. Evidence: There had been a number of major improvements to the environment since the last inspection. For example, the home had been extended to provide more communal space, several rooms had been refurbished and there were new radiators in the bedrooms. A resident said the home was, comfortable. However, whilst looking round the building we noted that there were still some areas in need of improvement and this could impact on the comfort and safety of the residents. There was no maintenance and renewal plan available, which meant that we could not be sure that these areas had been identified and when they would be addressed. There had been no improvements to the garden, which meant that residents, most of whom were not able to go out alone, did not have a suitable outside space to walk or to sit during good weather. The requirement made at the last inspection to provide more assisted bathing facilities had not been met. A new bath had been installed but was not suitable for people who Care Homes for Older People Page 19 of 29 Evidence: were not independent. None of the bathrooms were suitable for people who needed a hoist and several of these residents could not use the shower seat. This meant that a number of residents were not able to have a bath or shower. This information was not available in the statement of purpose and service users guide which meant that people would not be made aware of it before deciding whether to come into the home. There had been improvements in the overall cleanliness of the home. Most areas of the home were free from unpleasant odours. Since the last inspection the manager had employed specific cleaning staff but they may not have sufficient time allocated because some areas of the home were still in need of a deep clean. For example, a bathroom window was covered in cobwebs and a grab rail in one of the bathrooms was heavily stained. The manager stated that most staff had received some level of training in infection control. However, throughout the course of the visit we saw some practices that could increase the risk of the spread of infection and put residents health at risk. For example, staff were making drinks and washing medicine pots in the dirty laundry area. There were indications that combs and razors could be being shared. In addition to increasing the risk of cross infection, this practice does not promote residents dignity. There were a number of toilets without hand towels which prevented effective hand washing. The laundry had been re-sited since the last inspection. It was adequately equipped for the size of the home and there were enough hours allocated to laundry staff to make sure that residents always had enough clean clothing. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the recruitment practices but there were not all always sufficient staff, with appropriate training, to meet their needs. Evidence: The manager and care staff said the staffing levels in the home had improved since the last inspection. There were more care staff on duty in the morning to assist residents with their personal care. Staff had also been employed specifically for domestic and cooking duties, which meant that care staff were not taken away from delivering care. However, there were some indications that there were not enough staff to assist at lunchtime. For example, there were a number of residents who needed one to one care to help them with meals, which did not leave enough staff to serve others. On the day of the visit residents had to wait almost an hour between courses. This meant that some people, who had poor concentration, became restless and left the table. A member of staff confirmed that more staff were needed at this busy time. Other staff mentioned the lack of staff time to ensure that the activity programme was followed. Residents who were asked said they liked the staff. One person said, they are lovely. We looked at the files of two recently appointed staff. The files were complete and Care Homes for Older People Page 21 of 29 Evidence: contained all the relevant documents and information. All the required preemployment checks were carried out to make sure that staff were suitable to work with residents. The induction training for new staff was brief. It did not cover all the topics that the Skills for Care training organisation recommend in order for new staff to understand their role. The manager had a new training package which covered the recommended areas. She said she aimed to put this into place over the next few weeks. There were no central records to show what training the staff team had undertaken. The manager stated that most staff had completed refresher training in the mandatory health and safety topics and in dementia care but this could not be evidenced. The manager said that she would be drawing up the training plan for 2009 in the next few weeks and would address any shortfalls then. The manager told us that 60 of care staff had an NVQ level 2 in care and a further two staff were enrolled on the course. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager was working to improve the organisation and management of the home for the benefit of the people living and working there. Evidence: Since the last inspection the manager has registered with the Commission. We saw evidence that she has continued to improve the management and administration systems in the home. For example, she is developing the role of senior staff to assist her with management duties, which will enable her to continue to work in a hands on capacity to supervise staff and keep in touch with residents care needs. Staff said the manager met with them regularly to discuss their work. They were positive about her leadership skills. One person said, A good manager, she listens and provides advice. Another said that the changes the manager had brought in were for the better. Care Homes for Older People Page 23 of 29 Evidence: There were systems for monitoring the quality of the service, which included seeking views of residents and relatives. The manager said the responses to the latest surveys were mainly positive but they were not available at the time of the visit. There were also some audits of procedures and practices. For example, the manager monitored all accidents in the home so that she could identify any patterns and put preventative measures into place. Although the home did not have an annual development plan, the manager was aware that there were still a number of shortfalls in the standard of the service offered. She said she planned to make improvements in activities and care planning a priority. The manager did not hold any money or valuables on behalf of people using the service. She confirmed that secure facilities were available if needed. There were some recommendations made following the fire risk assessment last year. The manager confirmed that they had been met. Records showed that fire safety systems and equipment were tested and serviced on a regular basis. There was one outstanding requirement from the health and safety officers visit in 2007, which was to tarmac the car park. The manager did not know if or when this was due to start. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 21 23(2j) People who use the service must be provided with an adequate number of bathrooms with suitable equipment. So that their needs can be met. 01/03/2008 Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 Staff should have training and clear guidance in recognising and handling suspected or actual abuse. To protect residents. 31/03/2009 2 21 23 People who use the service 19/01/2009 must be provided with an adequate number of bathrooms with suitable equipment. This requirement had a timescale of 01/03/08 which has not been met. Enforcement action is now being considered. To ensure that all residents with mobility needs have access to assisted bathing facilities. 3 26 13 Procedures and practices to control the spread infection must be followed by staff. To protect the health and safety of people living and working in the home. 27/02/2009 Care Homes for Older People Page 26 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service users guide should be reviewed and updated to ensure that people thinking of using the service have access to accurate information about the service. Everyone should be given a statement of terms and conditions at the point of moving into the home so that they are clear about the service they can expect. Care plans and risk management strategies should contain enough directions for staff to meet the residents health care needs. In order to reduce the risk of transcribing errors, handwritten entries on MAR charts should be signed and witnessed. In order to reduce the risk of residents being under or over medicated, staff should draw up clear criteria for medicines that are to be given when required. 2 2 3 8 4 9 5 10 In order to protect residents privacy there should be curtains or blinds at the lounge windows. Thought should also be given to protecting the privacy of residents who are in bed during the day in rooms which can be seen from outside the home. Residents should have an individual plan to direct staff to help them to meet their social and recreational needs. The manager should carry out an audit of the home and draw up an action plan, with timescales, showing when the remainder of the improvements to the environment will be completed. The manager should review the staffing levels and the way that staff are deployed in the home during periods when residents require increased staff attention, which includes mealtimes. Any shortfalls should be addressed. The manager should draw up a central training record to show what training has been completed by the staff team. Any shortfalls in training in the safe working practice topics and dementia care should be addressed. There should be a clear plan, with realistic timescales, to show what service developments are planned in the next year. Wherever possible the views and suggestions of residents or their representatives should influence the plan. Page 27 of 29 6 7 12 19 8 27 9 30 10 33 Care Homes for Older People 11 38 The requirement to tarmac the car park, as required by the health and safety officer, should be actioned. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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