Inspection on 23/08/05 for Heatherbrook Nursing Home

This inspection was carried out on 23rd August 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heatherbrook Nursing Home 22/08/07

Heatherbrook Nursing Home 21/10/06

Heatherbrook Nursing Home 25/02/06

Heatherbrook Nursing Home 23/03/05

Heatherbrook Nursing Home 06/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Heatherbrook Nursing Home 80 Como Street Romford Essex RM7 7DT Lead Inspector Rhona Crosse Unannounced Inspection 23 August 2005 10:30 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 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. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Heatherbrook Nursing Home Address 80 Como Street, Romford, Essex RM7 7DT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01708 737961 01708 737962 Care UK Community Partnerships Ltd Miss Emma Louise Bryer CRH Care Home 45 Category(ies) of DE(E) Dementia - over 65 (45) registration, with number of places Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum Staffing Notice 2. Manager to receive training on Adult Protection Procedures 3. Homes Adult Protection Procedure to be amended in line with No Secrets document. 4. To include one named person under 65 years of age. Date of last inspection 23 March 2005 Brief Description of the Service: Heatherbrook is a purpose built home in a residential area of Romford. It is in walking distance of local shops and transport links. The home provides 24 hour nursing care for 45 older people with dementia. Service users are accommodated on two floors. A passenger lift is provided. All rooms are single ocupancy and have en-suites. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection so the home did not know the inspector was coming. The inspector arrived at the home at approximately 10.30 am. The manager was at the home and the home was appropriately staffed. A training session with the Adult Protection Co-ordinator from Havering Social Services was taking place on the morning of the inspection for the staff. The inspector looked at daily records, care plans, risk assessments, accident reports, food and fluid charts and pre admission records as well as staff training and formal supervision records. An inspection of a random selection of bedrooms and bathrooms was undertaken and an inspection of the communal areas of the home. The homes main kitchen and the laundry were inspected. The grounds and the storage of clinical waste awaiting collection was also inspected. The home is in the process of redecorating the hallways on both floors in line with guidance about décor for people with dementia. Last Saturday (20 August) a garden fete had taken place at the home and was supported by relatives assisting with some of the stalls. What the service does well: From a random selection of service user’s files it was observed that GP and other health professionals are contacted for advice and visits were well documented, showing that service user’s health care is being monitored appropriately. The majority of care plans were updated on a monthly basis along with risk assessments. Food and fluid charts were appropriately completed. Meals and meal choices were well managed with the home providing special diets for medical reasons. Staff were observed to be seated when assisting service user with their meal. The kitchen was clean and well managed as was the laundry taking into account good infection control procedures. Meetings with relatives take place, minutes are kept and are available to anyone wishing to see these. Quality questionnaires are sent to relatives and Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 6 visiting health professionals to gauge the view of the service provided by the home. What has improved since the last inspection? Progress has been made by the current manager to make the home more open and accountable to service users and their relatives. Complaints are well documented and action is taken to investigate any complaints brought to the manager. 5 complaints have been made since the last inspection. Three have been substantiate, one complaint is still under investigation by the home. The 5th complaint was made anonymously to the Commission. This complaint was investigated as part of the unannounced inspection. However the inspector was unable to substantiate any of this complaint as the information given by the anonymous caller was not sufficient in detail to: 1/ identify the service user as no name or room number was given (the information could have related in part to 3 different service users in the area described). 2/ other information given could not give any leads as to who the service user was. Dates given and the description of an accident and where the accident was said to have happened did not correspond with information held by the home. Nothing could be verified from daily records or accident records from the dates given by the anonymous complainant, or from the inspection of the said records for the whole month of July 2005. The home set up a system of monitoring service user’s after fall and has been using this system since before the last inspection. This was seen operating well when an inspection of accidents was made at this visit. A ‘falls’ care plan is drawn up and the service user is monitored for one week after a fall. Any bruising that was not visible at the time of the accident is now documented if and when they appear and a body map is drawn up. The manager has been carrying out spot checks at night to ensure the care is appropriate. Action was taken by the home due to poor practice found on one of the spot check visits. The hallways and corridors are in the process of being decorated in line with guidance about décor for people with dementia. Names and a picture that has a meaning for each service user will shortly be displayed on the bedroom doors to enable service user to move around the home, finding their own rooms more readily. There have been improvements in the access to the garden for service users. The garden has been divided into two areas with a connecting gate. This division allows staff to monitor where service users are in the garden more effectively. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 7 Policies and procedures have been developed specifically for Heatherbook ( in line with the companies overall policies and procedures). Formal written supervision has commenced with care staff and domestic staff. 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. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 standard 6 does not apply to the home as they do not offer this service. The home meets this standard. Records were easily accessible and well maintained. EVIDENCE: From a random selection of service user’s records it was observed that if the service user is placed by a local authority that the home receives an assessment of needs prior to admission. The home also have a pre admission assessment process. This is always carried out prior to admission to ensure that the home can meet the needs of the service user and this was well documented. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 11. Standards 9 and 10 will be inspected at further inspections. The home manages the health care needs of service users well in relation to referrals to health professionals. This was observed to be well documented such as referrals to the tissue viability nurse, the speech and language therapist , falls clinic, psychiatrist, and dietician. Closer monitoring of all the areas of the care plans needs to take place to ensure any changes are documented. Several service user’s files required updating. EVIDENCE: From a random selection of service users records it was observed that not all areas of care plans were being updated as required. For one particularly frail service user who has complex needs the care plans had not been updated since June 2005. This is seen as poor practice. This service user who’s pressure sore had been referred to the tissue viability nurse did not have the care plan changed to reflect this, in discussion with the nurse in charge of the unit it was established the there had been a further change in how the wound was being managed but this had also not been identified. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 11 For a service user who has challenging behaviour there was no care plan to provide in detail the action the staff should take when the challenging behaviour takes place. The care plan should detail the best way of dealing with the individual at this specific time to ensure that the service user and the staff are not put at risk. For another service user who had required a dressing to a sacral wound, no care plan could be found or wound assessment sheet. The only mention of this wound was for 3 days in the daily records. One entry identified the need for a dressing to be applied, the next day the entry identified the type of dressing being used and the third day the entry in the daily record stated that the dressing was intake and therefore not renewed. In discussion with the nurse in charge of the unit it was established that this wound had now healed. Records that had been archived were inspected but no wound management sheet or care plan could be produced for this wound. The home must be able to evidence the care they provide from the records at all times. This must be addressed. Information held in relation to the needs and wishes of service users at the time of death were documented. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15. Standards 13 and 14 will be inspected at further inspections. There needs to be an improvement in the activities provided within the home. The manager may have to negotiate an increase in her budget to achieve this. The management of the kitchen, the menus and food prepared was good. EVIDENCE: The home held a garden fete on 20 August, relatives helped with the stalls and the day was said to have been a success. New garden furniture has been provided since the last inspection and gazebos have been erected to provide shade when sitting in the garden. The grounds have been divided into two areas so that staff can monitor service users in each area more easily. Although the home has an activities co-ordinator no record is kept of the activities service users undertake on a daily basis. There was a lack of stimulation in Bluebell unit on the day of the unannounced inspection. However music was playing in Hylands unit and staff interacted well with service users during the inspection. Although entertainers are brought into the home, as service users are either too frail to participate in activities outside the home or do not wish to go out. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 13 These entertainers do not visit very frequently. The home should look at ways of providing more entertainment. Due to the home caring for people with dementia the home should provide appropriate training for staff in providing activities for people with dementia and also look at providing or hiring specific entertainment and activity packs to allow meaningful activities to be provided. The home has a 4 week rotating menu. Food seen by the inspector looked appetising and there was a choice of main meal offered. In discussion with the new cook it was established that the home can and does cater for people with specific dietary needs such as a Celiac diet, diabetic diets and pureed diets. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints are now being addressed and action is being taken by the manager to ensure the ongoing welfare of service users. EVIDENCE: Whilst there had been a history that complaints were not listened to and action in some cases had not been taken to address complaints in the past. It has been the task for the new manager to ensure that the home is run in the best interest of service users. At the last inspection in March 2005 the complaints process was not inspected. At this inspection it was established that five complaints had been received since the last inspection. Three had been substantiate and one was in the process of being investigated. A further anonymous complaint was made to the CSCI which was looked into as part of this unannounced inspection. The information provided to the inspector did not identify the service user or room number. Other information given by the complainant, dates and areas within the home were taken into consideration. However this did not evidence who the service user was (of the three service user’s it could have been, the overall information given did not fit entirely with any one of these people). The information given could not be substantiated from daily records or the recorded accidents held within the home for the dates given by the anonymous complainant. Records for the whole month identified no accident in the area or to service users (1 male and 1 female) as stated by the complainant. Therefore this complaint could not be appropriately investigated. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 15 The manager has carried out spot checks in the early hours of the morning to establish the level of care being provided. Action has been taken by the company as a result of the manager’s findings. On the day of the unannounced inspection training in the detection and reporting of suspected abuse was being given by an Adult Protection Coordinator from Havering Social Services to staff at the home. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The majority of the rooms inspected throughout the home were clean and tidy. Odour control must be improved as there was a smell of urine in 4 bedrooms in the afternoon long after the daily cleaning of rooms had taken place. Greater care needs to be taken when bed making. Two rooms had stained pillowcases and two had pillows that were lumpy and misshapen require replacing. EVIDENCE: A random selection of bedrooms were inspected along with bathrooms and communal area throughout the home. Bedrooms were suitably furnished and many had lots of personal possessions on display. Other rooms had very few items. Rooms were personalised in accordance with service user’s needs. Several bedrooms had an odour control problem. Bedroom 1, 15, 29 and 39 require the carpets cleaning daily to remove the odour of urine. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 17 Other bedrooms had had the carpets cleaned on the day of the unannounced inspection and were clean and tidy, with beds well made. Room 4 had two pillows that were lumpy and misshapen these must be replaced. One pillowcase was stained and required a clean pillow case. Room 29 had a stained pillowcase (the beds was made up ready for re-use). Staff must ensure that all linen is clean and that any stained linen is removed from the bed and replaced daily. Specialist equipment for pressure care is provided such as beds, specialist cushions and mattresses. Lifting equipment and aids and adaptations in bathrooms are provided. Bathrooms and W.C.’s are arranged around the building so that service users have easy access to these. Bathrooms were clean and free from odours. The home has a call alarm system. The call alarm was activated by the inspector. 2 staff responded within a reasonable time to the alarm. Extractor fans in several en-suites were not working. This was raised with the manager who said that the company had been advised and several needed either repair or replacement, although she did not know when this work would take place. Clinical waste was appropriately stored awaiting collection. Infection control was good in the laundry and this area was clean and well managed. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30, standard 29 will be inspected at further inspections. The home was appropriately staffed at the time of the unannounced inspection. Training is being provided for staff however training in dealing with infection control and basic first aid should be provided with updates for staff who have already attended this training. EVIDENCE: The home was appropriately staffed at the time of the unannounced inspection. There was a mix of age range within the staff group and also a mix of skills. The home employs both male and female care staff. There is a staff training programme. Training in the protection of vulnerable adults was training place on the day of the unannounced inspection. Other training that has taken place this year is: manual handling 11/1/05, 8/1/05, 3/5/05, 4/5/05, food and hygiene 15/3/05, fire training 8/3/05, challenging behaviour 1/7/05. Care of the dying and medication training have also been provided. Training identified and booked for later this year is: active listening 15/9/05, protection of vulnerable adults 1/9/05. Oral hygiene and Parkinson’s disease have yet to have dates set for these training sessions. The manager stated that 35 of the staff group have been trained to NVQ level 2 standard and currently 1 staff member holds the NVQ level 3 Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 19 qualification. Both the manager and the deputy manager are undertaking the Registered managers award training. New staff have not yet attended a fire drill although they have gone through the fire procedure as part of their induction programme. All new staff must attend a fire drill as soon as possible. The home must also undertake training in infection control and basic first aid. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 and 38, standards 33 and 35 will be inspected at further inspections. Health and safety was well managed with information readily available for inspection. Meetings with relatives and staff are well managed giving people an opportunity to bring new ideas to the home and raise any concerns they may have. Formal written supervision sessions with the nursing staff must take place. Other staff’s formal written supervision sessions are well managed. EVIDENCE: The manager holds meeting with relatives and minutes are kept, the last meeting was held on the 15/6/05. The next relatives meeting is planned for the 15/9/05. The minutes are available to all relatives from the administrators office where they can pick up a copy. This is seen as good practice as this Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 21 enables relatives to have a say in the operation of the home and raise any concerns or bring new ideas to the home. Staff meetings also take place and minutes are kept of these. Staff are able to add items to the agenda. Staff are receiving formal written supervision. From the records held 25 staff have received one formal session and 10 staff have received 2 supervision sessions to date for the year 2005. However none of the nursing staff have received any formal written supervision. This was discussed with the manager. As the nursing staff are to carryout formal supervision sessions with other staff it is important that these staff receive supervision themselves. Formal written supervision with all nursing staff must be completed by 30/9/05. The home are aware that all staff must have the minimum of 6 formal written supervision sessions within one ‘rolling’ year. The homes policies and procedures are updated. There are new policies specifically written for Heatherbrook in line with the company policies and procedures. These are available for staff to refer to at any time. Records are kept up to date are securely held and easily accessible. Certificates for equipment maintenance were well managed and easily accessible. The gas safety certificate was dated 16/11/05, the 5 year electrical safety certificate is due to be carried out in 2006. The annual electrical portable appliance test was dated 3/12/04.The fire extinguishers received their annual check in December 2004, the fire alarm system was service on 29/7/05. Fire call points are being tested weekly and a record is kept of these. The last visit by the fire officer was dated 16/2/05. The last fire drill took place on the 26/7/05. There is no written record on the drill date of who attended this drill. The home should ensure that all staff sign to state they have attended a drill and this should be monitored to ensure all staff have undertaken a fire drill including night staff. All new staff should attend a fire drill as soon as possible. The lift inspection certificate issued by the insurance company was dated 27/9/05 (these inspections and certificates are now carried out 5 yearly). The lift was last service on 16/5/05. The Legionella test of the water system was carried out on 1/4/05. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x 2 3 3 Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 23 NO 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. 2. Standard OP7 OP7 Regulation 15(1) & (2) 17(1)(a) schedule 3(k) and 15(1) & (2) 16(2)(n) 16(2)(c)& (e) 23(2) (c) 16(2)(k) Requirement All parts of the care plans must be updated as changes occur. There must be a record of all nursing pratices carried out (wound assessment chart for any wound that requires a dressing and a plan of care). Improve the activities within the home both daily and entertainers being brought into the home. Ensure that bedding is suitable for use (stained pillow cases and mishapen pillows. should not be used). Replace/repair all the fans in the en-suites that are not working. Improve odour control in bedrooms 1, 15, 29 and 39, daily cleaning may be required if the odour can not be removed then the carpets will need to be replaced. Timescale for action 30/9/05 30/9/05 3. 4. OP12 OP24 30/11/05 23/8/05 5. 6. OP25 OP26 30/11/05 Daily cleaning or replace the carpets if odour cannot be removed by 30/12/05 9/9/05 30/1/06 30/1/06 Page 24 7. 8. 9. OP30 OP30 OP30 18(1)(c)(i ) 13(2)(c) 13(3) & 18(1)(c) All new staff must attend a fire drill. All staff must attend a basic first aid course. Staff should receive training in infection control. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 10. 11. OP30 OP36 18(1)(c)(i ) 18(2) The activities co-ordinator should 28/2/06 be trained to provide activities to people with dementia. All nursing staff must have 30/9/05 formal written supervision. 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 OP12 Good Practice Recommendations Purchase/hire activitiy packs designed for people with dementia. Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heatherbrook Nursing Home G55 S0000015594 Heatherbrook V245582 19805 Stage4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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