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Inspection on 08/12/08 for Farrant House Nursing Home

Also see our care home review for Farrant House Nursing Home for more information

This inspection was carried out on 8th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

As stated in previous inspection reports before a person is admitted to the home they have an assessment of their needs to make sure the home can meet all of their needs. Residents and visitors spoken to during the visit were complimentary about the staff. Some comments included "the staff are very caring, especially the lady in charge" and the "staff are kind and helpful, if you ask them to do something they do it for you". The relatives spoken to said that are are always made to feel very welcome when they visit. Residents said that the food was "very good" and there was always a choice. The residents living at the home benefit from visits from a variety of different religious denominations and evidence was seen that individual religious and cultural needs were being met. The home was clean, tidy and pleasantly decorated and furnished. Residents spoken to said that the home "is always lovely and clean". There are a variety of communal areas for residents and there is a safe enclosed garden area. Staff are encouraged and supported to undertake training to ensure they have the necessary skills to meet the needs of the residents living at the home.

What has improved since the last inspection?

Since the last inspection visit a new activity coordinator has been employed. From speaking to the activity coordinator it was obvious that she had a good understanding of resident`s changing needs.Records were kept of the activities and any changes in residents moods were documented and reported to the person in charge. A variety of activities are available from one to one activities to outside entertainers. One resident said that "there is plenty of activities" and another comment was "there is something going on all the time". Maintenance and decoration of the home is undertaken on a continuous basis and several areas had been re-decorated since the last visit. A gardener has been employed and improvements were seen to the rear enclosed garden area.

What the care home could do better:

It is recommended that the new `Assessment of Needs` form that is completed before a resident moves into the home includes a section for specific religious and cultural needs. Each resident has a plan of care. However shortfalls were seen and improvements are needed to ensure that it contains details of each identified need and how that need is to be met by the staff who are caring for them. Resident`s dignity must be maintained at all times and consent should be obtained before any photographs are taken.Procedures must be put in place relating to resident`s choice and the need to ensure that the residents capacity to make decisions is assessed and recorded as required under The Mental Capacity Act. Improvements are needed to the medication systems to ensure that it gives details of how all of the prescribed medication should be given to the resident as the GP intended.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Farrant House Nursing Home 44 Farrant Road Longsight Manchester M12 4PF     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: Geraldine Blow     Date: 0 8 1 2 2 0 0 8 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 30 Information about the care home Name of care home: Address: Farrant House Nursing Home 44 Farrant Road Longsight Manchester M12 4PF 01612573323 01612259920 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Healthcare Services Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: A maximum of 44 service users will be accommodated. The home can accommodate up to 24 service users requiring nursing care on the ground floor and up to 20 service users requiring personal care only on the first floor. All service users will be aged over 60 years of age except where a variation has been granted in respect of age for a named individual. One named service user requires personal care only, out of category by reason of age. If this service user no longer resides at the home or their primary reason for requiring care changes, the service user category will revert to OP (old age). Date of last inspection Brief description of the care home Farrant House Nursing Home provides accommodation with nursing care for up to 44 older people. The home is situated in the Longsight area of Manchester close to a main public transport route, a local market, shops and a supermarket, public houses and other social facilities and amenities. The home is a purpose built, two-storey home set in its own small and accessible grounds. The home offers accommodation in 40 single Care Homes for Older People Page 4 of 30 Over 65 40 0 0 4 Brief description of the care home and 2 double bedrooms. 18 bedrooms, including both double bedrooms, have en-suite facilities. Access to the home is at ground level. A passenger lift is provided. The front door is digitally locked for security reasons and exit could be achieved by pressing a switch at the side of the door. CCTV covers the homes entrances and grounds. The home provides smoking and non-smoking areas for the residents. The homes hairdressing salon and the administrators office are situated in the reception area. The most up to date inspection report is made available in the main reception for people to access. The fees at the time of this visit were from 383.88 to 599.80 pounds. Additiional charges are also be made for hairdressing, Chiropody and other personal requirements. Care Homes for Older People Page 5 of 30 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: This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 28 April 2007. This visit was unannounced, which means that the manager and staff were not told that we would be visiting. The visit forms part of the overall inspection process and took place on Monday 8 December 2008 and was undertaken by one inspector and one Regulation Manager. The opportunity was taken to look at all the core standards of the National Minimum Standards (NMS). This report is an overview of what the inspectors found during the visit. As part of the visit we (the commission) spent time examining relevant documents and Care Homes for Older People Page 6 of 30 files. We also spent time talking with the manager, several people living at the home, some visitors, members of staff and a tour of the building was undertaken. Feedback was given to the manager during the course of this visit. What the care home does well: What has improved since the last inspection? What they could do better: It is recommended that the new Assessment of Needs form that is completed before a resident moves into the home includes a section for specific religious and cultural needs. Each resident has a plan of care. However shortfalls were seen and improvements are needed to ensure that it contains details of each identified need and how that need is to be met by the staff who are caring for them. Residents dignity must be maintained at all times and consent should be obtained before any photographs are taken. Care Homes for Older People Page 8 of 30 Procedures must be put in place relating to residents choice and the need to ensure that the residents capacity to make decisions is assessed and recorded as required under The Mental Capacity Act. Improvements are needed to the medication systems to ensure that it gives details of how all of the prescribed medication should be given to the resident as the GP intended. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into the home so they know their needs can be met. Evidence: As detailed in previous reports before anybody is admitted to the home they have an assessment of their needs to make sure that the home can meet all of their needs. Since the last inspection visit a new pre admission document has been implemented. It was noted that the document did not have a section to assess any specific religious or cultural needs. A recommendation has been made. It was encouraging that the manager confirmed before she undertakes her own assessment of needs she obtains an assessment from the persons care manager or the the funded nursing assessment. Care Homes for Older People Page 11 of 30 Evidence: The manager stated that where possible potential residents and/or their relatives are encouraged to visit the home before a decision is made about admission. The homes Statement of Purpose, Service User Guide and the last inspection report are available in the main reception for people to access. Care Homes for Older People Page 12 of 30 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. Improvements are needed to the care planning and medication procedures to ensure residents personal and health care needs are fully met. Evidence: A sample of residents care files were looked at. They were seen to contain a lot of duplicate, contradictory information and some outdated assessments that made the file difficult to follow and get an accurate picture of the up to date care required. For example, in one file there were three risk assessments relating to falling out of the wheelchair dated 2006, 2007 and 2008. It is recommended that all outdated and contradictory information is removed to ensure the care files contain accurate information and are less confusing to staff using them. A number of identified problems had not generated a care plan. For example it was documented in one file that the resident was blind and there was no plan of care to support this particular need. Also, in another file it was documented the resident had a skin tear and needed a referral to the Tissue Viability Nurse (TVN). There was no Care Homes for Older People Page 13 of 30 Evidence: evidence of the referral being made and no care plan had been generated. The manager explained why the referral had not been made. However none of the information had been documented, there was no care plan and no further reference to the problem was made in the file. Some areas of the care plan were found to be vague and did not clearly set out the personal choice and preferences of residents or the individual actions which needed to be taken by staff to ensure that residents individual health and personal care needs are fully met. For example some entries included support limbs with pillows but it did not state which limbs or where the pillows were to be placed. To ensure that residents care needs are appropriately met the plans of care must accurately reflect the identified care need and how that need can be met. It is also recommended that the individual plans of care contain more information regarding the residents personal preferences and wishes regarding their day to day care. It was noted that the plans of care had been signed as being reviewed on a monthly basis yet the information in the plans had not been updated to reflect the residents changing care needs. For example in one file the plan of care dated March 2007 stated that the resident was catheterised and the mangaer stated that the resident was doubly incontinent and did not have a catheter. To ensure residents needs are appropriately met the plans of care must be updated when there is a change of care needs. The care plan for one resident, who was a diabetic, detailed that the blood sugar levels should be recorded before breakfast and before tea. However the recording chart did not evidence the exact time of the recording or that it was taken before meals. The recording was documented as AM and PM. To ensure residents are not placed at any unnecessary risk it is recommended that an accurate time of the blood sugar test is recorded, as per instructions in the care plan. In one file there was photographs of a sore. The photographs were very exposing and did not respect the residents privacy or dignity. In addition consent had not been obtained from the resident or their advocatr advocate to take the photograph. Photographs taken of wounds or sores should not expose the resident. Only the specific area must be photographed. Residents privacy and dignity must be maintained at all times. In the same file there was a risk assessment for the use of a lap belt which stated it should be worn while the resident is in the wheelchair. However, it was noted that the resident did not have the lap belt in place on the day. During further discussion it was Care Homes for Older People Page 14 of 30 Evidence: evident that issues relating to choice and the need to ensure care plans contain a mental capacity assessment were also identified as areas to be addressed to ensure that peoples capacity to make decisions is assessed and recorded as required under the Mental Capacity Act. There was a daily information record. However it was of some concern that we were told one particular resident had been coughing on fluids over the weekend and none of this information had been recorded in the daily record and there was no record of any oral fluids being given. In addition there was confusion between the staff as to whether the resident needed thickened fluids or normal fluids and the plan of care did not include this information. This has the potential to put the resident as risk. In order to ensure that all assessed needs of residents are being met there must be an accurate daily record of the care provided which includes a record of oral fluids taken. The records regarding medication were examined. There were no gaps in the recording of medication and medication had been signed into the home. There was a daily temperature check of the drug fridge and of the treatment room temperature to ensure that medication is being stored at the correct temperature. From a visual check of the blister packs and a tablet count of some boxed tablets it appeared all medication had been given as prescribed. However it was noted that some medication had been prescribed as apply to affected area. There were no directions as to where the affected area was and there was no details in the plans of care. To ensure that residents are not placed at risk there must be sufficient information to enable nurses to administer medication as intended by the General Practitioner (GP) and therefore the doctors instructions must be recorded. It was also of some concern that one resident had been prescribed medication for heartburn yet the plan of care did not include this particular problem area. This was discussed with the manager and the deputy manager. Care Homes for Older People Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with activities and a variety of home cooked food. Evidence: Since the last inspection a new activity coordinator had been employed. The coordinator was able to describe a variety of activities that are available and there is an activity board in the main reception displaying the activities. Residents and visitors spoken to were happy with the activities available. On the day of this visit one resident had spent the day at a local community center, which she was attending twice a week. It was encouraging that the home facilitated and met the different cultural and religious needs of the residents living at the home. For example there are visits from a variety of different religious denominations and specific prayer aids had been provided. In addition different cultural dietary requirements were being met. As detailed in previous reports the home had open visiting and the residents spoken to confirmed that this was still the case. Visitors stated that they were made to feel welcome whenever they visited and this was confirmed by observations made during the visit. Care Homes for Older People Page 16 of 30 Evidence: Residents spoken to confirmed that they get choices around their day to day lives. For example, one resident said that she can go to bed and get up when she wants to and can eat her meals where she wants to. A variety of wholesome and nutritious meals are provided. Residents spoken to said that the meals are very nice and there is always a choice. Residents also confirmed that they can have drinks and snacks on request. The dining areas are clean, bright and inviting. It was observed that residents on the first floor were sat at the dining tables waiting for lunch while the residents on the ground floor were served first. Staff spoken to confirmed that this was usual practice. It is recommended that the system for serving meals should be reviewed to reduce the waiting time for residents on the first floor. The Nutmeg system continues to be used. This consists of the nutritional value of the meals being calculated, to ensure that it is satisfactory to meet residents nutritional needs. A bar chart is produced, which is on display in the main reception next to a copy of the menu. Care Homes for Older People Page 17 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place, which help to ensure that residents are protected from harm or injury. Evidence: The complaint procedure is included in the statement of Purpose and Service User Guide, both of which are available in the main reception. There was a record of complaints made. Details of investigations, staff statements and an outcome of complaints are stored separately from the record. It is recommended that the record of the complaint cross references to where the rest of the information is kept to complete the audit trail. Residents spoken to said that they would know who to talk to if they wanted to make a complaint. One resident said I have never made a complaint why would I want to. At previous inspection visits the corporate polices and procedures were seen in relation to Safeguarding Adults and the manager confirmed that they remained unchanged. A Whistle Blowing policy was included in the staff handbook. Care Homes for Older People Page 18 of 30 Evidence: Safeguarding Adults is covered during the induction process and the manager was in the process of arranging training updates for staff. Since the last visit there had been three allegations of abuse. Two had not been upheld and one was still under investigation. Care Homes for Older People Page 19 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and comfortable environment is provided. Evidence: As part of this visit a tour of the building was undertaken which included all the communal areas and several bedrooms. The home was clean, tidy, well decorated and furnished to a good standard. One resident spoken to said its always lovely and clean. There are several communal areas and a dining room on each floor. The garden is a safe secure area that residents can enjoy. Bedrooms were seen to have been personalised with residents own belongings. Bedroom doors were fitted with privacy locks that could be locked and unlocked by the residents once inside their bedroom if they so wished. Maintenance, redecoration and refurbishment of the home is undertaken on an ongoing basis and several improvements had been made since the last inspection visit. These included the re-decoration of the first floor lounge and corridors, several bedrooms and en-suite toilets. Care Homes for Older People Page 20 of 30 Evidence: There were corporate policies and procedures seen in relation to Infection Control, an Infection Control manual and the NHS Infection Control Guidelines. The manager confirmed that in-house infection control training was provided in March 2008. Care Homes for Older People Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate numbers of staff are provided for the number of residents living at the home. Evidence: From direct observation and from reviewing the staff rota it appeared that there were sufficient staff to meet the needs of the number of residents living at the home. The manager confirmed that 16 care staff are employed. Five carers had successfully completed NVQ Level 2 training and were currently undertaking NVQ Level 2 training and two were undertaking Level 3. A random selection of staff files were looked at. All files looked at contained the required documentation and safety checks. Evidence was seen that staff had completed the homes induction programme and Southern Cross had developed a Continual professional development to safer manual handling in line with recent legislation. All staff are given a staff handbook. There is a staff training matrix and each member of staff has an individual training record. Care Homes for Older People Page 22 of 30 Evidence: Evidence was seen of ongoing training and development of staff. Care Homes for Older People Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the residents. Appropriate health and safety practices are carried out to ensure the environment is safe for people. Evidence: The manager adopts an open approach and there are management procedures in place to protect people. As already detailed in this report improvements are needed to the implementation of the care planning process. Poor documentation was found which in turn leads to poor communication between staff. For example, the care required for one resident differed depending on which member of staff we spoke to. The shortfalls found have the potential to put residents at risk. It is recommended that the care planning process, the documentation and the communication systems in the home are reviewed and improvements made to ensure residents are not placed at any unnecessary risk. There are corporate policies and procedures in place and available on each floor. Any Care Homes for Older People Page 24 of 30 Evidence: updates come via the intranet from head office and can be printed off. There is a opinion questionnaire available in the main reception area in an attempt to gain peoples views of the service provided. The completed questionnaires go to the head office for analysis and are then sent to the home manager for her attention . In addition to this formal tool the manager confirmed that feedback regarding the service delivery is obtained via the managers and staff discussions with relatives, visitors and visiting professionals on a one to one basis. The manager undertakes monthly audits in an attempt to ensure standards are maintained. For example staff training, medication administration and fire records. In addition to this the operations manager undertakes bi-monthly validation audits and feeds back to the home manager with her results. Evidence was seen that the systems in place safeguarded the residents financial interests. The previous inspection report demonstrated that the homes maintenance certificates and records were up to date. The manager stated that this remained unchanged. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must clealry idnetify the action to be followed by staff delivering care to the resident. To ensure that residents are not placed at unnecessary risk. 12/12/2008 2 7 14 Procedures must be put in place relating to resident choice to ensure that peoples capacity to make decisions is assessed and recorded as required under The Mental Capacity Act. To ensure that residnets who have capacity can make their own decisions. 05/01/2009 3 7 17 There must be an accurate daily record of the care provided which includes a record of oral fluids taken. 11/12/2008 Care Homes for Older People Page 27 of 30 In order to ensure that all assessed needs of residents are being met. 4 7 15 1. The plans of care must 05/01/2009 accurately reflect the identified care need and how that need can be met. 2. To ensure residents needs are appropriately met the plans of care must be updated when there is a specific change of care needs. To ensure that all residents care needs are appropriately met. 5 9 13 There must be sufficient 05/01/2009 information to enable nurses to administer medication as intended by the General Practitioner (GP) and therefore the doctors instructions must be recorded. To ensure that residents are not placed at risk and receive their medication as intended by their GP. 6 10 12 Photographs taken of wounds or sores must not expose the resident. Only the specific area must be photographed. Residents privacy and dignity must be maintained at all times. 12/12/2008 Care Homes for Older People Page 28 of 30 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 3 To ensure all residents needs can be met it is recommended that the pre- admission assessment document include an assessment of any specific religious and cultural needs 1. It is recommended that the individual plans of care contain more information regarding the residents personal preferences and wishes regarding their day to day care. 2. It is recommended that all outdated information is removed to make the care files less confusing to staff using them. 3. To ensure residents are not placed at any unnecessary risk it is recommended that an accurate time ofblood sugar tests are recroded, as per instructions in the care plan. 2 7 3 8 When photographs are taken of residnets, with particular reference to wounds or sores their consent should be obtained prior the photograph being taken. It is recommended that the system for serving meals should be reviewed to reduce the waiting time for residents on the first floor. It is recommended that the record of the complaint cross references to where the rest of the information relating to that complaint is kept to complete the audit trail. It is recommended that the care planning process, the documentation and the communication systems in the home are reviewed and improvements made to ensure residents are not placed at any unnecessary risk. 4 12 5 16 6 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!