Inspection on 15/12/08 for Holmwood Nursing Home

This inspection was carried out on 15th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmwood Nursing Home 10/01/07

Holmwood Nursing Home 20/10/05

Holmwood Nursing Home 26/05/05

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Hall     Date: 1 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB 01737217000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Robert William Kibble Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 48 dementia old age, not falling within any other category Additional conditions: 48 0 The maximum number of service users to be accommodated is 48 The registered person may provide the following category of service: Care home with Nursing(N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Holmwood is registered with the Commission for Social Care Inspection as a care home with nursing for forty-eight service users. The home is located in Tadworth in Surrey and close to public amenities and other facilities. Accommodation is provided on two floors and comprises of an office, lounge, dining area, kitchen, bathrooms, toilets, showers, laundry and bedrooms with en-suite facilities. The home has an attractive garden which is private and accessible to service users. Care Homes for Older People Page 4 of 34 Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor, quality outcomes. The Inspector agreed and explained the inspection process with the Deputy Manager at the start of the inspection. The focus of the inspection was to assess Holmwood in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Care Homes for Older People Page 6 of 34 The Inspector used a varied method of gathering evidence to complete this inspection, pre-inspection information such as the previous report and discussion and correspondence with the registered provider was used in the planning process to support the inspector to explore any issues of concern and verify practice and service provision. The home had completed an AQAA an annual quality assurance assessment questionnaire, which was received prior the site visit to the home. This provided the Inspector with information relating to what the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. Survey questionnaires were sent to the home prior to the inspection. Documentation and records were read. Time was spent reading written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, staff rota, training records and recruitment records. The Inspector identified four people who use the service for case tracking, speaking with one of them whilst assessing the available information held in the home pertaining to the care provision for them. In addition the Inspector met with the other people who use the service and their family, which gave her a good opportunity to observe the quality of care being provided by the home and understand the impact the care provision has on their quality of life. What the care home does well: What has improved since the last inspection? What they could do better: The management of the home is poor, and the registered provider should have notified the Commission for Social Care Inspection when the registered manager retired. He should also have confirmed arrangements for the management of the home in the absence of a registered Manager. The appointed person currently managing the service is not a registered nurse. The clinical lead role is being undertaken by the deputy manager who is a registered nurse level 1. She does not currently hold a formal qualification in caring for people with dementia, which is a category of registration for this service. She has not received training in risk management or assessment of risk. She has not carried out her obligations under her professional Code of Conduct to ensure that she has the training, knowledge, skills and qualifications to carry out her role. All perspective service users should have a pre-assessment undertaken before they are offered a place at the home to ensure that their needs can be met by the experience and skills of the staff working there. This is not currently happening placing people who use the service at risk of harm Care Homes for Older People Page 8 of 34 A care plan written with the service users and or family involvement should be available for staff to follow to ensure all the service users care needs wishes and preferences are followed. There should be a number of assessment tools used and the care plans should reflect the assessments undertaken and reflect any changes to care needs over time. This is not currently happening placing people who use the service at risk of harm Persons trained to do so should undertake a risk assessments this is not currently the case. All service users should have a moving and handling risk assessment and there should be a risk assessment available for any identified risk, it should detail the risk, give the management strategy, and indicate when reviews should take place. This is not currently happening placing people who use the service at risk of harm The home should follow the Nursing and Midwifery Council ( NMC), guidelines for the administration of medication and this practice should be monitored on regular basis to ensure service users are correctly receiving their prescribed medication. Medication is not being administered in date sequence, which makes it difficult to see that medication is being given correctly All service users should be given medication prescribed only for them, which is labelled correctly, during the tour of the build a number of creams/ointments were found with different names to the owners of the room or with the name label removed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user and families can not be fully confident that if admitted to the home that the pre assessment will be enough to inform staff of all the persons needs wishes and preferences on admission. Evidence: The deputy manager confirmed that she undertakes to visit service users before they are admitted to the home and does an assessment. The deputy manager stated that she does gather all the information however she does not always fully record or document it. She did confirm assessment information is used to see if they can meet the prospective service users needs before they make the decision to accept the application for admission and offer a place. However the assessments seen in the files sampled were not fully completed and did not evidence fully the needs the prospective service users may have. For some of the service users at the home copies of the joint assessments carried out by social services care management and the health authority Care Homes for Older People Page 11 of 34 Evidence: were seen. However service users who are self funding would rely only on the assessment undertaken by the deputy manager. The home provides staff training to ensure they have the necessary skills and ability to care for individuals who are admitted. The home does not provide intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not protected in all cases by a robust comprehensive assessment of risk, effective planning of the care needs, and good communication by staff. Service users are not protected from the risk of harm as Registered Nurses are not obtaining, recording or administrating medication in accordance with their professional obligations. Evidence: Services Users needs may be not meet in full and at all times and this places vulnerable people at risk. Although there is a plan of care for most service users in place, records seen evidence that this is not based on either a comprehensive assessment or one that is reviewed and updated regularly. One person had been resident in the service for seven weeks without a care plan. Care plans the deputy manager confirmed are often not available for up to four weeks after admission. Relatives and allied visiting professionals input is not sought or updated when changes to care needs are identified with no six monthly review meeting being held, the information from which could then used to identify up to date care needs, personal Care Homes for Older People Page 13 of 34 Evidence: preferences and changes in care required. Care Plans did not contain the assessments expected in a nursing home for people with dementia, such assessments are necessary for all the service users to identify if they are at risk and allow for a risk strategy to be developed to minimise that risk whilst respecting the service users wishes. The deputy manager was not able to provided evidence that any of the service users had had a moving and handling risk assessment. Although many of the residence at the home were observed to have mobility difficulties there were no risk assessments in place for mobility. A large number of service users are cared for in bed or have little mobility however very few risk assessments were seen regarding skin integrity and the risk of developing skin damage. Many of the service users at the home have a diagnosis of dementia or other cognitive impairment but little was seen regarding cognitive impairment assessment and associated risks. The person appointed by the provider to manage the service is not registered with the Commission for Social Care Inspection or a Registered Nurse. However, the Deputy Manager is in post and is responsible for service users clinical care. There is currently no system in place to monitor and audit the care plans or the receipt, storage or administration of medication. Medication systems in place are not robust especially when receiving into the service medication not packaged as a monitored Doses System (MDS). Medication was seen to have been administered out of sequence of the month of receipt with medication dated August being given out in December, the same medication dated November was still in stock. Registered nurses have a responsibility under their Code of professional Conduct and their registration with the Nurses and Midwifery Council ( NMC) to ensure that no omissions in their practice and deliverance of care needs places a person in their care at risk. The previous report did not highlight an issue with this outcome area and therefore the situation has clearly changed in recent times. The manager must take the urgent steps needed to address these issues and restore the system, records and care practice in the service. Observed communications between service users whose ability to communicate was decreased and some staff was seen to be poorer than when the service user was more skilled with making their needs or preferences known. All staff should be skilled at communicating with people and especially with the category of service users currently residing in the home. Care Homes for Older People Page 14 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have the opportunity to take part in activities on a daily bases and some activities are provided on an individual bases. Service users would benefit from being offered a choice of meals at meal times and a record being kept of food intake and a nutritional assessment being undertaken. The use of reclining ( fallout) chairs is not good practice and places the service users in them at risk of harm or restriction of their liberty. Evidence: Service users are given the opportunity to take part in a variety of activities within the home were they are able to. A large number of service users at the home would find it difficult to take part in group activities as well as those being cared for in bed. The occupational therapist explained that she does do things like hand massage for service users nursed in bed and one service user for example enjoyed playing cards on a one to one basis. There were no records kept in the home of what activities are being provided to whom, so it was not possible to assess whether all service users are given the opportunity of some activity though the week. The deputy manager has asked the occupational therapist to record the activities in the service users daily notes from now on. Care Homes for Older People Page 15 of 34 Evidence: Regular outings are not facilitated by the home and if service users do go out it is normally their family who takes them staff commented. Visitors spoken to confirmed that the homes staff always made them feel welcome, and there had been no restrictions on visiting. One visitor says she enjoys the time she spends with her mum and appreciates the support the staff have given her now her mum has dementia. The daily menu was seen displayed on the notice board out side the dinning area however it did not offer an a real alternative that service users could chose from. Staff said that omelettes /salad etc could be offered if the service users did not like the meal of the day. It is important that choices are made available, as well as it being good practice, the importance of meals can not be negated as they are often the highlight of peoples lives. The kitchen produces the home cooked meals from fresh ingredients the deputy manager confirmed. Care Homes for Older People Page 16 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and or there families are aware of their rights with regard to making a complaint and to whom to complain. Service users are also protected from the risk of abuse by the homes Adult Protection policy and procedures. Evidence: The home has a complaints procedure which details the times scales for action. No complaints had been received since the last inspection the deputy manager confirmed. There was a large number of compliments received by the home on file. A visitor spoken with confirmed that they know how to complain and although they had never had to do so felt that if they did it would be taken seriously. The CSCI has not received any complaints since the Annual service review. The home has a policy on protection of vulnerable adults which has been reviewed within the last 12 months. The home also had a copy of the local authority (Surrey County Council) procedures on safeguarding adults. However the copy seen was out of date the deputy manager confirmed an up to date copy is being organised. Further evidence confirmed that the home had a whistle blowing policy. Evidence was seen that staff attend Safeguarding training (adult protection) and further courses have been booked. Care Homes for Older People Page 17 of 34 Care Homes for Older People Page 18 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can feel confident that the home will be clean and free from odour, being decorated and furnished to high standard giving a pleasant and homely place to live in. However service users who share a bedroom have a restriction placed on them of where to store some of their personal possessions due to the lack of space as no individual chests of draws and to where to sit as only one chair available. Evidence: The home is furnished and decorated to a high standard and evidence was seen that There is an ongoing maintenance plan with redecoration taking place to ensure the home remains at a good standard. The home provides both single and shared bedroom accommodation. It was noted that there was not all the required furniture with in the shared rooms with just a single chest of draws and one arm chair which could restrict the service users who room it is from relaxing there during the day. It could also mean that service users may not have sufficient space for their belongings. A large number of the rooms have en-suit facilities and where this is not the case toilets were sited near by. The home was clean, with no offensive odours being detected. However during the tour a cleaners cupboard was found unlocked and a trolley was left unattended which presents a risk of harm to service users who are cognitively Care Homes for Older People Page 19 of 34 Evidence: impaired and unable to recognise danger. The communal areas are spacious and gave service users there the opportunity to walk about freely, it also is suitable for people in wheel chairs or who use walking aids to move around. The lounge area is very light and gives a very good view of the garden. The dinning area is to one end of the lounge and provides comfortable seating in a pleasant setting. Care Homes for Older People Page 20 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Registered Nurses do not in all cases work within their professional Code of Conduct so placing people who use the service at risk of harm. Service users care, social and emotional needs are promoted by care staff in sufficient numbers with the skills to meet their assessed needs and meet the services own statement of purpose. Service users are protected by the recruitment procedures within the home. Evidence: The duty roter was discussed with the deputy Manager who stated that the ratio of staff is determined by the assessed dependency of the service users. Relatives and observation by the inspector confirm that staff rostered as on duty were in sufficient numbers. Staff do receive training in order to give them the skills they needs to meet the assessed needs of service users. However further training on communication with those service users who have limited speech or understanding would be an advantage. The home employs cleaners, kitchen assistants, cook and a maintenance person who are on shift to support care staff and nurses. From documentary evidence seen the standard of staff training was adequate with the majority of staff completing basic courses. However the home has not yet met the requirement in the NMS National Minimum Standards, which looks to an excess of 50 percent with regards to the number of care staff achieving an NVQ National Vocational Care Homes for Older People Page 21 of 34 Evidence: Qualification Level 2 or above in care qualification. The deputy manager confirmed that 4 staff are currently undertaking the award with a further 6 hopefully starting in the near future. Training was seen booked that would ensure that all staff have completed both adult protection and refresher moving and handling training. Dementia training was identified as a need within the home to enable staff to support residents further as their needs change, a number of care staff have undertaken this training. It was also identified that as the deputy manager is responsible for the care within the home a qualification in dementia care management would be an advantage. Induction training is undertaken but it was not evidenced that this then lead to a foundation course within six months of employment as required by the NMS. The manager confirmed that the induction does meet with Skills Council Workforce training objectives. The home showed that it undertakes a recruitment practice including submission of an application form detailing all previous work history, seeks two written references, and confirms work status. The staff also have a CRB (Criminal Record Bureau) check proof of the staff member identity is being retained on file. The home does not currently take copies of qualification certificates gained prior to staff working in this home. Staff are issued with a contracts detailing there terms and conditions of employment. The home does not currently record or keep interview notes. Care Homes for Older People Page 22 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do not fully benefit from a well run home with shortfalls noted with regards to documentation and the poor monitoring systems leaving service users at risk from harm. The person appointed as manager recognises service users and family views and opinions are important. Evidence: The home currently has no manager registered with the Commission for Social Care Inspection. The person appointed by the provider to manager the service for the registered provider has recently completed an NVQ level 4 in care, but has no nursing qualifications. The person employed as the clinical lead for care is a Registered Nurse level 1. She has experience is the care of older people. She does not currently hold a formal Care Homes for Older People Page 23 of 34 Evidence: qualification in caring for people with dementia, which is a category of registration for this service. She has not received training in risk management or assessment of risk. She has not carried out her obligations under her professional Code of Conduct to ensure that she has the training, knowledge, skills and qualifications to carry out her role. Moving and Handling assessments are not in place or assessment of tissue viability and risk when people have poor mobility. She has not monitored or audited either the care needs of service users or the supply, administration and disposal of medication From observations of the staff interactions with the service users, it was clear that there was an atmosphere of openness and respect, this was also confirmed by the families spoken with during the process. The tour of the building highlighted the need to secure storage of chemicals around the home, action was taken by staff straight away to ensure safety on this occasion. The deputy manager confirmed a COSHH file was available should an accident with chemicals occur. The home has an accident book and staff record incidents appropriately. The training records show that most staff have undertaken the health and safety and associated courses, further courses have been arranged. The AQAA, (Annual Quality Assurance Assessment ) completed and sent by the appointed manager confirmed that the maintenance certificates pertaining to servicing and the standard of services and appliances are in date. The person appointed as manager sends out quality assurance questionnaires, theses were seen along with the feedback. The deputy manager confirms the information is used to improve the service and the appointed manager speaks to families on an individual basis about any action the home has taken to improve the service. Care Homes for Older People Page 24 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 14. Assessment of service users 1, The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so, a, needs of the service user have been assessed by a suitably qualified or suitably trained person, b, the registered person has obtained a copy of the assessment, c, there has been appropriate consultation regarding the assessment with the service user or a representative of the service user, All prospective service users should be assessed and that assessment fully documented evidencing that service users are only being 09/02/2009 Care Homes for Older People Page 26 of 34 offered a place at the home if their needs can be met by the home. If the service user has been referred by the local authority or heath authority then a copy of their assessment should be available in the home before admission again to help with the decision process. Other than in an emergency when with in three days a review will be held and documentation made avaiable. Service users and their families where appropriate should be part of the assessment process also. 2 7 15 15 Service users plan 09/03/2009 1, Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan, the service users plan, as to how the service users needs in respect of his health and welfare are to be met. All service users when admitted should a have a care plan that informs staff at the home of the care provision required by the individual. The care plan in the first instance should be based on the assessments undertaken prior to admission and in Care Homes for Older People Page 27 of 34 consultation with the service users and family if appropriate. The care plan will then remain under review and at the end of the trial period should be reviewed with all interested parties, which includes the service user, their family, the placing authority if appropriate, the key worker and the homes manager/lead nurse. 3 8 12 Health and welfare of 09/03/2009 service users The registered person shall ensure that the care home is conducted so as a, to promote and make proper provision for the health and welfare of service users. The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. That service users are consulted along with their families or representatives if appropriate, on a health action plan, this may be part Care Homes for Older People Page 28 of 34 of the service users care plan or a separate document. It should be underpinned by health assessments undertaken to identify the service users health needs and any risks they may pose. it should not only prevent or reduce risks but look to promote good health. 4 8 13 13.5, The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. To ensure the service users and staff safety, all service users must have a moving and handling risk assessment undertaken, where risks are identified then the action required by staff should be clear, the risk management strategy. The risk assessment must contain the review date, which should be determined by the level of the risk identified. Good practice would be to review all risks at least six monthly. 5 8 13 13.4 The registered person shall ensure that c, unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, To ensure that service users remain as safe as possible 20/02/2009 20/02/2009 Care Homes for Older People Page 29 of 34 risk assessments should be undertaken for individual service users, where a risk is identified then the action required by staff to minimise that risk should be documented, the risk management strategy. The risk assessment should contain the review date, which should be determined by the level of the risk identified. Good practice would be to review all risks at least six monthly. 6 8 14 14.2 The registered person shall ensure that the assessment of the service users needs is a, kept under review, and b, revised at any time when it is necessary to do so having regard to any change of circumstances. All service users needs once assessed must be kept under review and changed to reflect changes in circumstances. 7 9 13 13.2 The registered person 20/02/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Nurses must follow the NMC guidelines for the ordering, storage, administration and disposable of medication. Making sure that there are 09/03/2009 Care Homes for Older People Page 30 of 34 systems in place to audit and monitor medication regularly to ensure service users get the medication they have been prescribed. 8 14 13 13.7 The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. That the use of fall out cahirs breviewed and evidence be documented as to the use of these chairs regarding individual service users to ensure they are not being used as a form restraint 9 24 16 16 Facilities and services (c) provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users and screens where necessary. Service users should have adequate draw space and a comfortable chair for their own use in their bedrooms. 10 30 18 18,c, ensure that the persons employed by the registered person to work at the care home receive i, 09/08/2009 09/06/2009 20/02/2009 Care Homes for Older People Page 31 of 34 training appropriate to the work they are to perform Ensure that registered nurses have sufficient training and qualifications to enable them to work within their proffesional code of cunduct 11 31 8 8 Appointment of manager 09/03/2009 1 The registered provider shall appoint an individual to manage the care home where a, there is no registered manager in respect of the care home, it is the registered providers responsibility to appoint a manger for the home who will be put forward to be registered with in a reasonable timescale and ensure that any changes to the management of the home are reported in writting immediately. 12 31 10 10 Registered person: general requirements 1 The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficient care, competence and skill. It is the responsibility of the registered person to ensure 09/07/2009 Care Homes for Older People Page 32 of 34 that the person they have appointed as the manager has the necessary experience, training and qualifications to understand and care for the category of service users the home care for, in this case older persons with dementia and in need of nursing. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 It is import that all chemicals in the home are kept secure, and if in use are supervised at all times. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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