Inspection on 09/03/07 for Hales Lodge

This inspection was carried out on 9th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hales Lodge 03/03/09

Hales Lodge 25/01/06

Hales Lodge 08/08/05

Hales Lodge 28/02/05

Hales Lodge 14/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Hales Lodge Somerton Road Winterton On Sea Great Yarmouth Norfolk NR29 4AW Lead Inspector Mrs Judith Last Key Unannounced 9th March 2007 03:00 Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 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 Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hales Lodge Address Somerton Road Winterton On Sea Great Yarmouth Norfolk NR29 4AW 01493 393271 P/F01493 393271 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) www.mencap.org.uk Royal Mencap Society Mrs Beverley Jane Pitt Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users have a learning disability; all or some may also have a physical disability Total number of service users not to exceed 8 Date of last inspection 25th January 2006 Brief Description of the Service: Hales Lodge is a purpose built care home providing care and accommodation for up to eight adults with learning and physical disabilities. The home is divided into two single storey bungalows interconnected by a corridor. Residents share all facilities. Specialist equipment is in place to ensure that residents are able to receive the most appropriate care. All residents have single accommodation and there is a good range of communal space. Fees for the service range from £700 to £1000 per month. There are additional charges for hairdressing, chiropody, holidays and personal spending. Transport is charged at 34.8 pence per mile. Residents also pay rent. At the time of the visit, there were 7 people living at the home. The manager says that information, including inspection reports, is made available for discussion during residents’ meetings and keyworker meetings. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. Our visit was unannounced and lasted almost 6 hours. We got information from talking to the manager, some staff on duty, and two residents, as well as looking to see what was going on. We also looked at the records the home keeps. Relatives sent three written comment cards to us, and one was sent by a visiting health professional. Other information came from the questionnaire the manager filled in before the inspection. Based on this information the service has been assessed as good. What the service does well: What has improved since the last inspection? Some information for residents has been put into pictures, and uses photographs and simple language. This includes information about what people like or dislike and about important events in their history. At the last inspection, staff needed to use proper coding on the charts they use to record medication. This has been done. Some parts of the home have been redecorated. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If existing procedures are followed and assessment forms completed, prospective service users would have their needs properly assessed and could be sure they would be met. EVIDENCE: There is good assessment of existing service users. Were this to be followed, prospective service users could be sure their needs would be met. The manager is aware, based on discussion of a possible admission, that she needs to obtain as much information as possible to determine whether the person’s needs can be met in the home, and whether the “mix” with existing service users will work. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be sure that their changing needs and goals will be reflected in their care plans (although there is room for improving organisation of this information). Residents are supported with decision-making subject to an assessment of risk. EVIDENCE: The manager has started to revise care plan files and make these more organised. Even so, there were still some difficulties finding up to date information. This was also identified as an issue in the provider’s service review. Keyworker meetings are recorded and show when it has been identified that the support plan needs to be updated. However, not all of the support plans seen were dated to show that updates were consistent with the review sheets. Recommendations have been made. Service users have some information in their rooms about their likes and dislikes, supported by pictures to make it more accessible. The manager says one person has their own computer and they will be looking at ways to make Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 10 information about the person’s care easier to understand and will put this on the person’s own computer. This would be good practice. Residents were heard being consulted about choices and activities. The manager says that objects of reference are used to help encourage choices and there are two communication coordinators in the home who have worked hard with the staff team to help in this area. (However, one of these two staff is leaving the home.) The manager agrees there is scope for increasing the use of pictures in developing care plans and encouraging choice. Staff are positive about residents and committed to offering new opportunities and choices. They say that one person who previously would not engage in many activities is now enjoying going shopping with staff and helping purchase weekly groceries (and the person did so during the visit). There are risk assessments in place on files, and moving and handling assessments as residents have some degree of mobility impairment – four being reliant upon wheelchairs. These show that they are updated when needs change. Information that residents need, such as how to make a complaint, or what the service will offer them, has been put into simple language and makes use of photographs to make it more accessible. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff show great commitment to providing opportunities to residents in and out of the home, to enhance their lifestyle. They enable residents to maintain contact with their family and friends, and offer a healthy diet. EVIDENCE: Residents are supported to develop meaningful occupation and activities and discussion shows the duty roster can be organised flexibly to allow for this. Opportunities for employment are limited by complex or profound needs. Records show people can go on holiday, have days out, theatre trips, meals out, and shopping. There are pictures of residents enjoying parties and 10-pin bowling. One person goes to college. During the fieldwork visit one person went shopping with staff, another practiced with an electric wheelchair round cones in the car park (with the aim of being able to use this in the community and at day care), and one person was doing a jigsaw puzzle. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 12 Records show staff support residents in making arrangements for them to visit their family homes and to send letters and cards for family celebrations. Sometimes relatives attend the residents meetings, as seen on minutes. Both relatives completing comment cards say that the home always helps their family members stay in touch. One kitchen has been adapted to make it more accessible for those in wheelchairs. This was the focus for some activity with three people enjoying a drink together and with good “banter” between the staff member and residents, who were laughing and clearly enjoying themselves. One person has a lock fitted and a key for their room, although they are not able because of physical impairment to use the key themselves. The person also has a safe to keep things private but says they need staff to help to open it for them. Staff were heard knocking on bedroom doors before entering and one person was prompted regarding the toilet door, showing the privacy of residents is respected. The freedom of some residents to move around their home is limited by physical disability, although one person is able to use an electric wheelchair (currently only used at the home) and so can move independently from place to place. Those who are not independently mobile were offered choices about where they wanted to be. Residents spoken to say that they like the food. The menus show a range of food on offer and records show that ideas for what to eat are discussed at residents’ meetings. There are dining areas at both ends of the home. Regrettably the kitchen area in one of these has not been adapted and when the home is full will be cramped should residents wish to watch or join in meal preparation for example. The vacancy for one person is likely to be filled in the near future and would result in additional pressure for space in this area. A recommendation has been made. The provider’s monthly report for January confirms that work is underway to increase the use of photographs in compiling “meal books” to increase opportunities for people to make realistic choices. See recommendation made under standard 7. The risks of aspiration are documented and contain up to date information for one person who has swallowing difficulties and a PEG feed. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are met, although supporting documentation could be made more easily accessible. Residents are safeguarded by the practices and processes for managing medication. EVIDENCE: The personal support needs of residents are set out in their plans. This includes guidance for positioning people at night and preferred times of retiring. One person spoken to confirms that they do not like to go to bed early and that staff will help at their preferred time. The supporting information says that the person has said they do not like to be treated like a baby and therefore prefer to go to bed later. The manager acknowledges that there are difficulties to some extent with flexible routines for getting up, as these are frequently determined by the arrival times for transport to day care during the week. However, the routine is said to be more flexible at weekends and on other days according to individual programmes. Residents have access to equipment such as hoists, adapted bathing and toilet facilities. Staff have training to use this based on records. There is evidence in files of other professionals being consulted (such as occupational therapists Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 14 and community nurses). Records show there are designated keyworkers for each person. Most of the residents do not have routine eye tests. The manager says that the optician is not able to assess those with more complex disabilities. This means that developing problems such as cataracts or glaucoma may not be picked up promptly. A recommendation has been made. One person has eye tests every two years and the last recorded on the health care sheet was in January 2005. Information about appointments is contained in the diary and incorporated in daily notes. Some information was traced in this way. There are dedicated sheets within care plan files that could be used for this purpose, but use of these is sporadic. This means information (as with care plans) is not easily retrieved. The health care information sheet would provide a much more accessible means of identifying appointments, outcomes and any follow up needed. A recommendation has been made. One person has information indicating they have sensitive skin that needs to be dried carefully and that they are prone to rashes. This information is contained in one part of the plan but has not been translated consistently into working parts of the care plan. A recommendation has been made. The care notes for the person show that on one occasion the person had a long red area on the inside of the right leg and the top of the person’s bottom was very red. There were no subsequent references showing that staff had followed up the issue to show whether the condition persisted or had improved/resolved itself. A recommendation has been made. One visiting health professional comments that there have been improvements in staff awareness of residents needs recently; and that staff show a clear understanding of service users needs. Given discussion with staff and the manager, and a “trawl” through information, it would seem that records are not made best use of to wholly do justice to the practice in the home. Relatives express a high degree of satisfaction with overall standards of care. Medication was held securely in a locked cupboard in the office. There is a monitored dosage system in place and staff confirm that they have had training. Medicine was administered with reference to the medication administration record (MAR) charts and labels on the monitored dosage packs. There were no omissions from the records and staff provide a double check for each other when the medication round is finished. This would help pick up any errors. Medication not in the monitored dosage system is recorded with balances carried forward and with interim checks. This is good practice. However, on two occasions the balances had been recorded wrongly when checked. It is noted that no medication had gone missing or been over Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 15 administered when audited but casts doubt on the rigour of completion of these records, therefore a recommendation has been made. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their representatives feel confident their concerns would be listened to and they are protected from harm. EVIDENCE: Two residents spoken to know who they would speak to if they had concerns about their care. There were only three comment cards received from relatives. Two relatives know how to make a complaint if they need to and one has forgotten. The cognitive and communication difficulties of some service users mean that keyworkers, relatives or other advocates would need to speak up on their behalf. The organisation has a whistleblowing procedure and the manager says this is covered in induction. Some staff have received training in basic awareness of the abuse of vulnerable adults. The manager says that the remaining staff will complete the training by 26th March. Service users’ financial records are stored in the office. Receipts were checked against entries and show that money is accounted for, and balances were correct. The manager was able to track one inconsistency and provide evidence that this had been put right. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely and comfortable environment that is clean and hygienic EVIDENCE: No detailed inspection of the premises was made as the service has a good history of compliance in this area. Nothing was seen on the brief tour to indicate that there had been a regression from standards. Some alterations are needed to the second kitchen to increase its accessibility to residents, particularly if the vacancy is to be filled. There are four people who need wheelchairs to move around the home and this should be taken into account in provision of additional opportunities and increased access. (See recommendation made under standard 17.) Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 18 There were no unpleasant odours and areas seen were clean. However, patio doors from the lounge area needed cleaning, as it was difficult to see out with the sun shining on them. A recommendation has been made. The home has recently received inspection from environmental health, and no concerns have been raised with the Commission arising from this. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32.33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to evidence satisfactory completion of training, including induction and foundation and NVQ, required as part of statutory records. EVIDENCE: The manager has secured some funding for service users who do not currently receive conventional day care. The duty roster shows that this enables people to have opportunities to be supported in activities during the course of the day. Records show that residents are able to go out some evenings and at weekends, with staff support as needed. Staff observed at work had a good understanding of their roles and a good rapport with residents. Records show that staff meetings take place regularly. The pre inspection questionnaire shows that four staff have completed NVQ 3 qualifications and that one is pursuing this. Also that one person has completed NVQ 2 and two more are working towards it. The training files for staff do not all contain adequate evidence of training and qualification. For example, there is no evidence in one case of the achievement of satisfactory competence in induction/foundation and one person said to have achieved NVQ Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 20 did not have a certificate on file. One photograph was missing although this had clearly been in place as the staple common to other files where it had been fixed was in situ. This was rectified during the visit by using another photograph from the noticeboard. A requirement has been made. Staffing records show that appropriate checks are made on applicants who are to be recruited including a third reference where necessary. Care is needed that where a third reference is needed in order to obtain satisfactory information about an applicant, this is obtained before appointment. The manager says there had been some confusion with the human resources department over this issue in one case. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home. Their welfare and safety is promoted and their views (or those of their representatives) are taken into account in monitoring and developing the service. EVIDENCE: Mrs Pitt has considerable experience in her role and has achieved the necessary qualifications based on discussion and the provider’s monthly monitoring reports. She participates in periodic training to ensure her knowledge is kept up to date. However, she is shortly to commence a 6month secondment away from the home. She says that she will be overseeing the home for one or two days a week until interim arrangements are in place. There has been some confusion, based on meeting notes and discussion, as to these proposed arrangements. The providers have undertaken to notify the Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 22 Commission as set out in regulations, when alternative arrangements have been made. The organisation has good systems in place for monitoring service quality. These include monthly visits on behalf of the registered provider, annual stakeholder surveys and service reviews carried out by persons not working at the home. These are used to develop an action plan, which the manager maintains on the computer. This was seen. There is scope for reflecting outstanding actions in the provider’s monthly monitoring visits. Residents have meetings to discuss issues, and these can be attended by relatives as their representatives. Given communication difficulties the use of outside and independent advocates could be of help. A recommendation has been made. There are systems in place for monitoring service safety. These include checklists completed by staff (a sample was seen), and instructions for particular checks to be carried out are marked on the duty roster. The boiler was serviced in September 2006 based on the certificate seen, with electrical wiring tested in January 2003. Certificates show that hoists are tested and serviced at 6 monthly intervals and that staff check the condition of these between times to make sure there are no obvious safety issues arising. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 YA32 YA35 Regulation 19 Sch 2 Requirement The registered persons must maintain the records for staff employed that are required by regulations as amended. Timescale for action 13/04/07 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 YA6 Good Practice Recommendations The registered persons should ensure files are organised properly (and as suggested in the provider’s service review) so that the most up to date and current information about support needs is easily accessible. The registered persons should ensure that all documentation, when completed, revised or updated, is dated and signed by the person responsible so that evidence of review is clearer and it is obvious which is the most recent information. The registered persons should continue to explore alternative methods of communication and encouraging accessibility of information. This is important to sustain given one of the two trained communication coordinators has left the home. The registered persons should consider refurbishment of DS0000027468.V332909.R01.S.doc Version 5.2 Page 25 2. YA6 3. YA7 4. YA17 Hales Lodge 5. YA19 6. YA19 7. 8. 9. YA19 YA19 YA20 10. 11. YA24 YA42 the second kitchen to increase its usefulness and accessibility for those needing wheelchairs. The registered persons should make arrangements for periodic screening so that any developing problems with eye health (e.g. glaucoma or cataracts) are diagnosed promptly and can be treated. The registered persons should ensure that dates and outcomes of appointments with health care professionals are recorded on the sheet dedicated for this purpose rather than in daily notes. This would facilitate monitoring and follow up, and to make retrieval of information easier. The registered persons should ensure that information identified at assessment or review is consistently included in care plan documentation. The registered persons should ensure that daily records adequately follow up issues where a problem is noted as having developed. The registered persons should ensure that periodic checks are made that staff are making accurate entries for the balances of medication where these are not in monitored dosage packs. The registered persons should increase the frequency with which windows are cleaned so that residents are able to see out into the garden more easily. The registered persons should consider contracting independent advocacy input for services where residents have complex needs and impaired communication. Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hales Lodge DS0000027468.V332909.R01.S.doc Version 5.2 Page 27 - 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. 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