CARE HOMES FOR OLDER PEOPLE
Heath Lodge Danesbury Park Road Welwyn Hertfordshire AL6 9SN Lead Inspector
Marian Byrne Unannounced Inspection 1st May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heath Lodge Address Danesbury Park Road Welwyn Hertfordshire AL6 9SN 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) 01438 716180 01438 715181 heathlodge@goldcarehomes.com www.goldcarehomes.com GCH (Heath Lodge) Limited Manager post vacant Care Home 50 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (50) Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home may accommodate one named service user who is currently under the age of 65. The above condition applies only to this named service user and ceases to be in force when the service user leaves the home for any reason. 7th February 2007 Date of last inspection Brief Description of the Service: Heath Lodge provides residential care for up to 50 older people. This includes a separate dementia unit accommodating up to 13 service users. The residential accommodation is arranged on three floors. The dementia unit is on split-levels and is therefore not suitable for wheelchair users. The majority of rooms have en-suite facilities The third floor has been converted to provide additional accommodation, which has not yet been registered for use as part of the home. Heath Lodge is set in extensive grounds, which while accessible by car, are not close to public transport or local amenities such as shops. Detailed information about the services offered including the latest report by the Commission for Social Care Inspection can be obtained from the home on request. Fees are based on an assessment of individual needs and start at £500. Additional charges are made for newspapers, hairdressing and chiropody. (This information was correct on 20.4.06). Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection over one day. Both inspectors observed the care of service users. One inspector spent two hours observing care of the most vulnerable service users in the Churchill unit. The Manager was not present at the time of the inspection. The Deputy Manager was in charge and was found to be very helpful and welcoming. This was a key inspection. What the service does well: What has improved since the last inspection? What they could do better:
Care plans need more detail. One care plan inspected stated that a service user had ‘Vascular Dementia she needs full care assistance in washing and dressing, assistance while walking and in standing, needs feeding during mealtimes’. The care plan did not detail how this care should be delivered. Care plans contained charts on various care matters including how much nutrition the service user was taken in. This started out well detailing exact amounts of food and liquid, later it detail was scant and gave no amounts of food or liquid rendering the exercise futile. One chart stated that the service user last had her bowels open on the 18th April 07, on the day of the inspection 1st May 07 there was no further entry.
Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 6 None of the care plans inspected gave enough detail on how to care for very vulnerable service users. This was evident in care delivery. Training undertaken by staff must be translated to good care delivery. Dignity of service users must be recognised and maintained. Staff were observed to assist a service user to move by using a hoist, while this was done in a manner that was safe, the dignity of the service user was not maintained and she was not re-assured when she showed distress. A medicines cabinet was stored in the room of a service user; also there was no pillow on her bed. This service user has leg ulcers and her care plan states that staff must encourage her to keep legs up. She sleeps in dining room on chairs at night. There was building work being carried out in the home at the time of the inspection, the person in charge on the day of the inspection was asked how the service users were being kept safe, the inspectors were not given a risk assessment on this. The service users were prevented from going into the area through the use of a wooden panel that was not attached to the wall and could be pushed over by the service users. One of the builders did not display the temperament needed to work with vulnerable people. The inspector asked him if he had worked in a care home before he said no and never again. One service user was being assisted to eat over one hour after her lunch of beef stew had been served. This food was cold and staff were encouraging her to eat this. Her care plan stated that she should have a soft diet. The main course of lunch was served covered in cling film to people who have dementia two of them tried to eat their food unaware that it was covered, staff were unaware of this. Several service user throughout the home said that the food is served cold. One service user whose care plan stated that she was nutritionally at high risk and whose diabetics is managed through her diet had a gap from tea and biscuits at 19.30 on the 30th April 07, (there was not record of this) until breakfast on the day of the inspection at 11.30 hours. Snacks of biscuits and fruit were available to service users. Care plans inspected listed what the home regarded as nutritious snacks nothing from the list was in the Churchill Unit on the day of the inspection. There are no facilities in this unit to make hot drinks or to make snacks such as toast or sandwiches. In the main dining room a service user had returned from a hospital appointment, had missed lunch and was requesting a cup of tea. It was about time for the tea trolley to be taken around, she had to wait until it was her turn for tea, when it would have been easy and made her less distressed if staff were able to attend to her needs at the time she requested it. Another member of staff made her a ham sandwich. A service user sat beside her and said what a nice ham sandwich it was and helped herself to a section of it. Staff instead of getting another sandwich told her it wasn’t for her she did not appear to understand or chose to ignore, this reduced the two service users to argue about the sandwich and the service user whom the sandwich had been made for to give up and not to eat. One relative who visits regularly stated ‘they are really short staffed especially at the weekend, Nicky runs the place but is only here four days, when she is not here it is awful’. Two service users stated that they are not allowed in the garden unless they go with someone. They both stated that they only go out Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 7 with their visitors, when asked if staff has time to take them they said that they didn’t wish to answer. One service user is partially sighted and that she likes to read, her daughter expressed a wish that she is given an aid to assist her to read. 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. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans contained evidence that an assessment had been completed. EVIDENCE: Care plans contained assessments of service user’s needs on admission. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 7,8,9,10. This judgement has been made using available evidence including a visit to this service. Care plans did not contain sufficient details on service user’s needs. Health needs were not fully met. The dignity of service user’s was compromised. The administration of medication was in order. EVIDENCE: The inspector looked at the care plans that had been updated by the home. These did not contain enough information on how to care for the service user. The service users needs were highlighted but no guidance was given on how to care for the service user. For instance the care plan had that the service user had Vascular Dementia and that she needs full care assistance in washing and dressing, assistance while walking and in standing, needs feeding during mealtimes. There was no guidance on how to carry out these tasks in a manner that suited the service user and promoted her privacy and dignity. Her dietary requirements were for soft food, she was being assisted to eat cold beef stew at 13.30 hours that had been served at 12.33 hours. Care plans had
Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 11 food intake charts on them for each service users. These started out giving good detail on the amount of food or liquid taken, but the latter records did not indicate the amounts of food taken reducing these charts to a paper exercise. For example the detail on one service user’s chart was omelette, mashed potato, desert, lemonade. Another stated soup, bread and tea. Another care plan stated that the service user needs assistance with his personal care – one carer if he is in a good mood and two carers if he is becoming aggressive. There was not detail on how to recognise the moods and how to assist him to ensure the aggression is not escalated. One service user likes to spend the night in the sitting/dining room with the staff, her care plan stated that she has leg ulcers and staff should encourage her to keep her feet elevated by using a foot stool. Her care plan did not identify why she liked to sleep in the sitting/dining room or what had been done to encourage her to sleep in her room. On the day of the inspection a medication trolley was stored in her bedroom and there was no pillow on her bed. One service users was having her nails clipped in the communal sitting room. One service user was hoisted from her wheel chair into a more comfortable chair. She was wearing a dress and during this task her under garments were clearly visible. The administration and recording of medication was in order. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 12,13,14,15. This judgement has been made using available evidence including a visit to this service. Visitors are welcome in the home at all reasonable times. Service users do not receive a wholesome balanced diet at times convenient to them. Lifestyle in the home does not meet service users expectations and satisfy their social, cultural, religious and recreational interests and needs. EVIDENCE: There was no evidence in the day-to-day life of the home of where service users get their comfort, identity, attachment, occupation and inclusion from. One service user was being assisted to eat over one hour after here lunch of beef stew had been served. This food was cold and staff were encouraging her to eat this. Her care plan stated that she should have a soft diet. The main course was served covered in cling film to people who have dementia two of them tried to eat their food unaware that it was covered; staff were unaware of this. Several service user throughout the home said that the food is served cold. One service user whose care plan stated that she was nutritionally at high risk and whose diabetics is managed through her diet had a gap from tea and biscuits at 19.30 on the 30th April 07, (there was not record of this) until breakfast on the day of the inspection at 11.30 hours. Snacks of biscuits and fruit was available to service users. Care plans inspected listed what the home
Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 13 regarded as nutritious snacks nothing from the list was in the Churchill Unit on the day of the inspection. There are no facilities in this unit to make hot drinks or to make snacks such as toast or sandwiches. In the main dining room a service user had returned from a hospital appointment, had missed lunch and was requesting a cup of tea. It was about time for the tea trolley to be taken around, she had to wait until it was her turn for tea, when it would have been easy and made her less distressed if staff were able to attend to her needs at the time she requested it. Another member of staff made her a ham sandwich. A service user sat beside her and said what a nice ham sandwich it was and helped herself to a section of it. Staff instead of getting another sandwich told her it wasn’t for her, which she either did not appear to understand or chose to ignore, this reduced the two service users to argue about the sandwich and the service user whom the sandwich had been made for to give up and not to eat. The care plans do not contain enough detail on how to meet the social needs of service users. They gave no idea as to where the service users who have dementia get their comfort, identity, attachment, occupation and inclusion from. The service user who liked to spend the night in the sitting room had not had the reasons explored, nor had the home addressed the issue of how to accommodate her wish without there being a detrimental effect on her health. For example one care plan stated that a service user is partially sighted and that she likes to read, no assessment had been done on how to assist her to achieve this. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 16,18. This judgement has been made using available evidence including a visit to this service. Complaints are addresses. Service users are not protected from abuse. EVIDENCE: The home has a complaints policy that is followed. Service users are not protected from emotional abuse. This was clear throughout the inspection. The observations outlines in this report indicate that the staff do not know enough about the service users to protect them from abuse. Working practices where the dignity of the service users in not protected could be seen as abusive. These include not ensuring a service user who is diabetic has access to food at appropriate times and feeding another service user cold food that should be served hot and was served hot to other service users i.e. beef stew. Serving food covered in cling film to service users who have dementia. Not identifying and meeting needs as set out in this report. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 19,26. This judgement may have been adequate if there was a risk assessment available on the building work being carried out. This judgement has been made using available evidence including a visit to this service. On the day of the inspection it was not possible to say if the home was safe as a risk assessment of building work was not given to the inspectors. The home was clean and fresh except for an area at the entrance of the home where there was an odour that could be associated with incontinence. EVIDENCE: On the day of the inspection there were three men working in the Churchill Unit. It was very noisy and unpleasant. When staff were asked about the noise they said that it hadn’t been noisy until today. There did not appear to be any risk assessment on how to ensure the service users were to be kept safe or any assessment on how much noise the work would produce and how this would affect the service user. Some service users have been moved to a different part of the home that has been renovated. When asked if the service
Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 16 users from Churchill Unit were given the option on moving while the building work was in progress the inspectors were told that it wasn’t noisy until today. In general the home was clean and odour free except for the area near the entrance to the home. The lack of a lift or ramp in the Churchill Unit means that service users, who need the use of walking aids, have to leave the unit and gain access to the rest of the home via the garden and the front entrance. This means that they do not have easy access to the activities and other service users in the rest of the home. As stated in the report service users do not have free access to the grounds of the home. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 27,28,30. This judgement has been made using available evidence including a visit to this service. Staff were found to be kind and caring but lack the training and direction to deliver good care to vulnerable service users and service users who have dementia. EVIDENCE: The staff are not trained sufficiently to meet the needs of the service users. Staff make efforts to work well with service users, but are unable to work beyond that of carrying out tasks. From observations staff go through motions of caring for service users who have dementia but don’t really have an understanding of what they are doing or why they are doing this. An example of this was a member of staff going through a cookery book with a service user, when another service users came into the lounge she took the book away and moved on to the new service user. She made no effort to conclude the interaction. Another example was a member of staff gave a service user a piece of paper and pen and instructions to write a shopping list, this was going well and when the service user stood up the carer danced in front of her and tried to get her to join in when her body language was showing that she clearly did not want to. Service user was woken to have a cup of tea when the tea arrived, rather than wait until the service user woke and then offer a cup of tea. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. 31,32,33,38. This judgement has been made using available evidence including a visit to this service. The Deputy Manager was found to be kind, hard working and caring but lacked the direction and training to deliver good quality care to vulnerable service users and service users who have dementia. The home is not well managed and lacks direction and leadership. It is not run in the best interests of the service users, the health and safety of service users is compromised. EVIDENCE: This home is not managed in the best interests of the service users. Care is task led and staff lack direction. Staff asked the inspectors questions that they should be getting direction on from management in the home. The inspector drew attention of staff to the noise created by the building workers in the Churchill Unit, to be told that today was the first day that it was noisy. No risk
Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 19 assessment was produced when staff were asked how the service users were kept safe. Building work is by its nature noisy and provision should have been made to assess and identify those service users who would have been affected by this. The staff’s care is task led and once they move away from task they flounder and do not know how to care for service users. The care staff were found to be kind and caring. This must be channelled into good care. The outcomes for the service users in the home is that the training is ineffectual and does not improve the quality of life in the home. Many examples of this have been given previously in this report. Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X x x 1 Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? 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 OP15 Regulation 16(1)(i) Requirement The Registered Person must ensure that Food served in a manner that does not confuse service users who have dementia i.e. not covered with cling film Timescale for action 01/05/07 2. OP7 14(2) 15(2) The Registered Person must 18/06/07 ensure that each resident has an individual plan of care based on an assessment of needs, which is regularly reviewed and updated in response to changes. The plan of care should be agreed and signed by the resident and/or their representative. The updated care plans do not contain sufficient information for staff to deliver good quality care. This standard was not met and will be subjected to a Statutory Requirement Notice. 3. OP8 15(2)16 (2)(i) The Registered Person must ensure that the nutritional needs of residents are kept under review and records of weight
DS0000063065.V335922.R01.S.doc 18/06/07 Heath Lodge Version 5.2 Page 22 gain or loss are maintained and appropriate action taken. Some records are now being kept of nutrition input of some service user. The records are not sufficient to know if service users are receiving sufficient nutrition. This standard was not met and will be subjected to a Statutory Requirement Notice. 4. OP15 16(2) (i) The Registered Person must ensure residents have access to drinks and snacks as appropriate to maintain their fluid balance and nutritional needs. This includes ensuring those service users who have diabetics are not left without nutrition. That snacks identified on care plans are available to service users. This standard was not met and will be subjected to a Statutory Requirement Notice. 5. OP8 13(1)(b) The Registered Person must 18/06/07 ensure that heath needs raised in care plans are met. Service user with a visual impairment must be assisted to visual aids that will assist to part take in her hobby i.e. reading. The service user who does likes to spend the night in the dining room must be assisted to do this without her health being compromised. 18/06/07 The Registered Person must ensure that the dignity of service user must be promoted through ensuring food served is of an appropriate temperature and that service users are not assisted to eat cold food that had been left uncovered and should
DS0000063065.V335922.R01.S.doc Version 5.2 Page 23 18/06/07 6. OP10 OP15 16(2)(i) 12(4)(2) Heath Lodge 7. OP10 13(2)17(1 )(a) 8. OP27 18(1) be served hot. The Registered Person must ensure that moving and handling is carried out in a manner that promotes the service users dignity. The Registered Person must increase the number of care staff on each shift to ensure service users receive all the care and support they need in a timely manner and to enable staff to support their emotional and social needs. The registered provider has agreed to update the original improvement plan provided to the Commission following a review of standards by an independent consultant. A copy should be made available to residents and their representatives. This requirement was made at a previous inspection. 01/05/07 18/06/07 9. OP33 24A(1)(2) (3) 18/06/07 10. OP10 12(1)(a) 11. OP19 23(2)(a) 12. OP38 13(4)(a) 13. OP26 23(2)(d) The Registered Manager must ensure that staff deliver care in a manner that ensures the emotional well being is safe guarded. The Registered Provider must ensure that service users in the Churchill Unit have access to the rest of the home without having to leave the building. The Registered Provider must ensure that all building and construction work is risk assessed. The Registered Provider must ensure that any odours that could be associated with incontinence is removed.
DS0000063065.V335922.R01.S.doc 01/05/07 30/06/07 20/05/07 20/05/07 Heath Lodge Version 5.2 Page 24 14. OP30 18(1)(c) (i) 15. OP32 9(2)(b)(i) 16 OP30 18(1)(c) (i) 18(1)(c) (i) 17 OP32 18. OP19 23(2)(o) The Registered Provider must ensure that all care staff are trained in a manner that facilitates them to delivery person centred care to vulnerable service users and those service users who have dementia. The Registered Provider must ensue that the home is run in a manner that is flexible, and that autonomy and choice lead the delivery of care, rather than task led as it is at the moment. The Registered Provider must ensure that the outcomes of training are monitored through the outcomes of care given. The Registered Provider must ensure that the home is managed in a way that delivers person centred care to the service users and that the service users are protected from abuse and other identified risks The Registered Provider must ensure all service users have safe access to the grounds of the home. 18/06/07 21/05/07 21/05/07 21/05/07 18/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Heath Lodge DS0000063065.V335922.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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