Inspection on 20/04/09 for Honeymead Care Home

This inspection was carried out on 20th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Honeymead Care Home 27/02/08

Honeymead Care Home 12/06/07

Honeymead Care Home 23/05/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Honeymead Care Home 183 West Street Bedminster Bristol BS3 3PX     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: Odette Coveney     Date: 2 1 0 4 2 0 0 9 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 44 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 44 Information about the care home Name of care home: Address: Honeymead Care Home 183 West Street Bedminster Bristol BS3 3PX 01179535829 01179231480 honeymead@mimosahealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mimosa Healthcare (No4) Limited care home 68 Number of places (if applicable): Under 65 Over 65 68 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accomodated is 68 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Honeymead Care Home is one of four nursing homes in the Bristol area owned by Mimosa Healthcare Ltd. The three other homes in the Bristol area are in Bishopsworth, Southmead and Shirehampton. Honeymead Care Home is a purpose built care home with accommodation provided over two floors. The home is run as two units. The first floor Ashton Suite, accommodates 37 persons. The ground floor Clifton Suite, has 31 beds. The home has a number of shared rooms that are only used by one person and therefore the number of people that can be accommodated is reduced to 64 in total. Placement is generally for people aged 65 years and over, however providing the home is able to meet the Care Homes for Older People Page 4 of 44 Brief description of the care home needs of younger people they can live here. Both floors have communal rooms and bathing facilities. The home is located within walking distance from the main Bedminster area where there are local shops, public houses and a post office. There is a regular bus service into the centre of Bristol that passes in front of the home. The front of the property is used for car parking, so visitors can park near to the front entrance and main reception. The gardens to the rear of the home are level, have a pleasant patio area and established shrubbery. The area is secure and fairly secluded. The cost of placement is between 370 pounds for residential care and 500 - 641 pounds for nursing support the price is dependent upon individuals assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Care Homes for Older People Page 5 of 44 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: This key inspection was undertaken in line with the Care Standards Act 2000 and following the Commissions Inspecting for Better Lives guidance. The purpose of the visit was to review the progress to the requirements and recommendations from the last key visit undertaken in February 2008. This visit took place over two full days and was conducted by two inspectors. All of the required key standards were reviewed. The visit commenced at 09:15 and the total site visit lasted a total of 14.5 hours. In February 2009 we undertook an annual review of this service, this involved a review of the The annual quality assurance assessment (AQAA) that was sent to us by the Care Homes for Older People Page 6 of 44 service. The AQAA is a self-assessment tool for providers that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We reviewed information we have about how the service has managed any complaints. We also looked at what the service told us about things that have happened in the home, these are called notifications and are a legal requirement. This annual service review lead us to have some concerns about how the home was being managed and how this was potentially affecting outcomes for people living at Honeymead Care Home. It was as a result of this review we decided to bring the key inspection of this service forward. During this visit time was spent with those who live at the home, the area support manager, staff employed at the home and relatives of individuals who were living at Honeymead at the time of our visit. During our time at the home we reviewed a number of records including care and associated records for people who live at the home, staffing records including training records, recruitment and selection records. We also reviewed records in respect of health and safety at the home such as risk assessments and fire records. What the care home does well: What has improved since the last inspection? What they could do better: During our last key visit to the service, which was on 27th & 28th of February 2008 three requirements and four recommendations were made. A review of records, discussion with staff and the area support manager lead us to report that one requirement has been met. and three of the recommendations had been met, leaving two requirements and one recommendation which remain outstanding and details of these can be found within this section of the report and also within the main body of the report. The registered person must ensure that the needs of people are fully assessed, by a suitably trained person, before placement is offered. This is so that people can be assured that their needs will be met and that the home has the appropriate facilities and staff skills to care for them. Care Homes for Older People Page 8 of 44 It is required that care plans must fully reflect the complex and diverse needs of people and must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. The registered person must arrange for the falls prevention nurse to be contacted for advice in respect of the individual identified during this visit. Body maps which record any bruising, wounds or injuries on people should be better maintained at the home in order that these areas can be monitored and appropriate action taken to respond as required to enable effective treatment. Incidents of behaviour which may be challenging and difficult to manage for staff should be recorded within the homes incident records. This is in order that situations may be monitored and responded to appropriately ensuring that individuals needs are identified and met. The registered person shall ensure that the home is conducted in a manner which respects the privacy and dignity of service users. People living at Honeymead should be supported fully to ensure they do not look unkempt. Private dietary information about people should not be on public display, people should be supported to maintain their dignity and be treated with respect. The registered person must make arrangements in order that unnecessary risks to the health and safety of people who live at the home are so far as possible eliminated. Detailed risk assessments must be completed in respect of dealing with, and responding to behaviour which can challenge. This is to ensure that appropriate action is taken to support people in a safe manner. It is recommended that meetings are held with those who live at Honeymead and also with relatives of individuals who live at the home to provide a forum in which information can be shared. The registered person must ensure that any complaint made under the complaints procedure is fully investigated. This is to ensure that people can be confident that issues raised are responded to and fully investigated as required. The registered person must ensure effective management of staff. This is in order that staff have clear direction and guidance and the time to do their job properly and peoples care needs can be met in a timely manner. The registered person shall, having regard to the size of the home, statement of purpose and the number and needs of service users ensure that staff employed at the home receive the training appropriate to the work they are to perform. Staff must undertake training in core areas such as manual handling, first aid, health and safety and basic food hygiene. Refresher training as required in these areas must also be arranged. Staff must have the skills. knowledge and understanding to support those people living at the home with special needs, therefore training must be provided in supporting those with behaviour which can challenge and also training must be Care Homes for Older People Page 9 of 44 provided in dementia awareness. Individual training files should be in place for all staff, this could be where certificates and evidence of induction training could be maintained. It is required that a manager be appointed by the organisation in order that the service has clear leadership and direction from a person who is fit to do so. It is recommended that the home amend the service users fire evacuation list and ensure that this is kept under review and updated when required in order that this list contains accurate information for the safe evacuation of people living at the home in the event of a fire emergency. During our last visit to the service we made a requirement that all care staff working in the home must be formally supervised. That at least one session for each staff member of care staff should be recorded within this timescale. At our last visit we also recommended that staff must receive formal supervision at least six times per year. We do not find this requirement or recommendation to have been met and therefore will remain and will be reviewed by us when we next visit the service. The registered person must ensure the records required as specified are kept up to date. This is to ensure that records required by regulation for the protection of people living in the home and for the effective running of the business are maintained and accurate. It is recommended that the registered person check the details of their liability insurance to ensure their is adequate cover in respect of staff manual handling requirements. It is recommended that the registered person should review the current induction process for manual handling training in order to ensure that all staff are competent in manual handling and do not potentially put themselves and those who use the service at risk. The registered person shall make arrangements by training staff, or other measures, to prevent service users from being harmed. The registered person must ensure that staff undertake core training in adult protection procedures in order to ensure that staff are given the information and knowledge required and to ensure that they are aware of their role and responsibility in this area. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 44 Care Homes for Older People Page 11 of 44 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 12 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is comprehensive information describing the service and its facilties available to prospective service users and current individuals living at Honeymead. Individuals needs are assessed prior to admission, however pre admission assesments are not robust and recording in this area could be improved upon. Evidence: Honeymead Care Home is registered with the Care Quality Commission to provide a service for 68 people. At this key visit we reviewed the statement of purpose and the welcome pack (service users guide). These documents have been produced by the organisation to provide information about the services and facilities that are able to be provided. The statement of purpose provides information about the main aims and objectives of the home, the pre admission assessment process, main social events of the year which are Care Homes for Older People Page 13 of 44 Evidence: celebrated at the home, procedures in the event of a fire or first aid emergency and details of how to raise concerns were also recored. The document contained all of the required information, however, we did note that within the organisational structure for the home an individual was named as the manager of the home. This person no longer works at the home and this information within the statement of purpose should be updated to provide accurate information in respect of the management situation at the home. We looked at the pre-admission assessment for one person who had recently been admitted to the home. Despite the documentation covering a comprehensive range of needs, we found it to be poorly completed, with many of the areas left uncompleted. We also saw that there had been no recognition that this persons needs were outside of the conditions of registration for placement at the home. We have recently been involved in a safeguarding meeting where concerns had been raised regarding the care of this person and one other. For this other person, the pre-admission assessment process had identified the need for specific equipment to be available to aid the persons independence, however this was then not available. Whilst we do recognise that there had been a change in admission dates beyond the control of the home, the staff should have checked that the service that they could offer matched what was needed. The home is only registered to look after people whose primary needs upon admission are within the older persons category. They are not registered to offer placement to people whose primary care needs are in respect of a dementia illness. We found that the condition is not always fully considered. For one other person we felt that their placement should be reviewed by the local authority, as their needs had significantly changed and their dementia care needs were now paramount. Contracts or terms and conditions of the placement were not reviewed at this site visit and therefore will be reviewed at our next visit to the home. During our visit staff were observed interacting with individuals, using appropriate language and tone of voice and were caring in their approach. Intermediate care is not provided at this home. Care Homes for Older People Page 14 of 44 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. Individuals personal and health care needs are being met at the home. Supporting people with their emotional wellbeing and ensuring that all are treated with dignity and respect could be better. Care plans were in place, however, significant information had not been recorded in respect of people with complex needs. This potentially puts people at risk. People are not treated with dignity and respect at all times, improvements in this area for people living at Honeymead is required. Individuals are protected by the homes medication administration and practice, one minor improvement in recording of returned medication is needed. Evidence: It was evident at this visit that most staff are sensitive to the physical and health needs of those living at the home and through observation and discussion demonstrated an understanding of the wishes of individuals living at the home. Care Homes for Older People Page 15 of 44 Evidence: Furthermore staff were observed going about their duties in a friendly and calm manner and responding to the people living in the home in a friendly, familiar style. Each person living in this home has a care plan prepared, this has been based upon an assessment of their care needs. We looked at four peoples care plans in detail and a number of others to check out specific information. Within each persons care records the following areas were covered: maintaining a safe environment, support with eating and drinking, communication, mobilising, working and playing and sleeping. Where possible the resident had signed their plan of care. Within care files we also saw that information about an individuals past history had been obtained. In respect of the care plans in general, all the plans were not good enough. In some cases there was good information recorded about how peoples specific care needs were being met. We saw a very detailed plan written about how to maintain a persons safety and it was clear what actions the care staff had to take. We also saw an informative plan about how the persons eating and drinking needs were met. However, other plans were poorly prepared. Examples of this include a plan prepared to tell staff how to deal with a persons resistive behaviour- the plan just listed what the person does and not what actions the staff may need to take in order to continue to meet their care needs. Another plan detailed specific information about how the persons needs should be met and yet this was not being followed. We spoke to one person who was very agitated about not being helped to get ready for an appointment - he always gets like that was the response from the care staff. This person had no plan of care to instruct staff on how to deal with this persons anxiety. The care plans are reviewed on a monthly basis, and in some cases as part of this review, changes in a persons needs had been recorded. These changes are not always updated into the care plan to reflect how the needs were to be met. An example of this is where a persons wishes about where they spend their day time, was not reflected in their current plan. Daily progress notes are kept for each person and were looked at in respect of the people whose care plans were looked at. Some of the recordings were inappropriate and there was not enough details recorded to evidence the actual care given. Within another persons records we saw three recorded incidents whereby they had been left to sit at reception until they had become more approachable, on all occasions this person was left in this area until after midnight, records do not state how long this person had been left in this area and no explanation was given of the outcomes for this individual who had been left unattended whilst distressed. We reviewed this persons care records and saw that within the past four weeks the home had recorded eleven incidents stating that this person was either very agitated or very aggressive. On another occasion the home had reported that this person had said that they were suicidal, we saw within this same time period that there had been seven incidents where this person had refused their medication. When we reviewed the care plan and Care Homes for Older People Page 16 of 44 Evidence: associated records for this person we were not satisfied that the care plan provided sufficient detail on how this person is supported. Within the personal hygiene section of the report we saw recorded when ..... is aggressive, just leave them alone and give them a wash when they have calmed down. There was no guidance or direction for staff to follow and no strategies for staff in order that they respond appropriately to meet this persons needs. For this person we also saw that the home were not completing their own internal incident forms as required. We saw that appropriate action had been taken by the home to respond to this persons mental health needs and saw that this individual has been seen on a number of occasions by the consultant psychiatrist in respect of their mental health, most recently being in April 09. In respect of this person refusing their medication we saw that the home have contacted this persons GP and had sought advice in this area. The GP decided that it would be in this persons best interests if their medication was put covertly in the persons food. We saw that the home had discussed this issue and had obtained consent from the persons next of kin to administer medication covertly, we saw on medication records the method by which the medication is given. We also saw that the home had developed a refusal of medication care plan, to be used in conjunction with the main care plan, however, this was not sufficiently detailed and made no reference to the fact that medication was being given covertly. These shortfalls have the potential to mean that peoples individual needs may not be met. It is required that care plans must fully reflect the complex and diverse needs of people and must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. For two people living at the home we found their behaviour can challenge staff at times and their behaviour support in respect of their metal health is complex. We noted that for both people their had been a number of occasions where incidents of inappropriate, unsafe behaviour had been exhibited, when an injury in these incidences had been sustained an accident form had been completed, however, risks to the individuals themselves, others living at the home and staff had not been recorded. It is required that detailed risk assessments must be completed in respect of dealing with, and responding to behaviour which can challenge. This is to ensure that appropriate action is taken to support people in a safe manner. We reviewed the records for one individual who had recently moved into the home. Within their records we saw that this person has a high level of support need and that since their admission they had, had, six falls, one resulting in a GP being required to visit and another resulting in them requiring hospital treatment. Within this persons records we saw that a falls risk assessment had been completed, this recorded that this individual was at a very high risk of falling, we also saw that an initial manual Care Homes for Older People Page 17 of 44 Evidence: handling risk assessment had been completed, this also recorded that this individual was at a very high risk of falling. We saw that a falls record chart had been maintained, four of the falls had been documented within accident records, however, we found that for one fall an accident form had not been completed. Recording in this area must be consistant. We noted that some people in the home have been visited by the falls prevention nurse, this had not been arranged for this person. It is required that a referral is made by the home to request this specialist service in order that advice is sought and any required actions taken to support this person and, where possible prevent further reoccurrance and injury. During our last key visit to Honeymead we reported that it would be good practice for those people who have lived at the home for sometime to have a complete re assessment of their needs on at least a yearly basis and that as a result of this new care planning documentation is prepared. We looked at the plans for two people who have lived at the home on a long term basis and found that a full review had been undertaken as recommended on an annual basis, care plans had been updated as required. Included with the care plans are a number of screening tools or risk assessments in respect of falls, nutrition, manual handling and the likelihood of pressure sore formation. Although each person has a falls assessment, any falls that they may have are not always recorded on their falls log (one person only had one fall recorded, yet five accident forms were completed). Moving and Handling risk assessments are completed and a safe system of work is devised to inform staff what actions they have to take with regard to particular transfer movements. One persons work plan was missing a section and therefore was not complete and each was stored in amongst other documentation and therefore not very visible. Another persons safe system of work contained an action plan that was in complete contrast to their safety management plan. Where the likelihood of pressure sore formation had been identified it was evident that the appropriate equipment is being provided. There is one person at the home who requires pressure area care and the home is supporting this individual with this aspect of their care. We reviewed the records for the management of these pressure areas and found that wound care plans do not always show that the progress of the wound is being monitored. For this person the date that the wound was first noticed was wrongly recorded and there was no photography, measurements or wound mapping in place. The care plan did state the products to be used and the frequency for re-dressing, however there was only a record made on one occasion when the dressing had been redone. This is not good enough. We did however see other plans where wound progress monitoring had been in place previously for others. We were told by a qualified member of staff that more Care Homes for Older People Page 18 of 44 Evidence: recent photographs of the wound area were not in place as a request for consent had not been responded to. We do not accept that because consent had not been obtained for photographs of the wound to be taken, other measures could have been used in the interim. Within individuals care files are body maps, these record any bruising, wounds or injuries on people who live at the home. Injuries are often sustained following a fall or an incident. When reviewing these records we saw that one person had only one sore area on their sacral area recorded on their body map, yet they had experienced six falls, we know from information seen within the daily notes that after two of these falls this person had cuts to their face. Another person had recorded within their daily notes five injurys, three for skin flaps to their arms, another for skin peeled off arm and finally a cut on their right eyebrow. None of these had been recorded on a body map. It is recommended that body map records should be better maintained at the home in order that these areas of injury or wound care can be monitored and appropriate action taken, to respond, as required to enable effective treatment. There are good arrangements for access to health services including dental, optician and chiropody. We saw that the home maintains primary care records and this showed us that people access a wide range of health care support service. Records were kept of the visits that people had with their GPs and other healthcare professionals. Records had been completed after each visit, which provided a good report of the outcome and any action that needed to be taken as a result. During our two days at the home we saw that the nursing staff took the appropriate actions to deal with health care events, ie; supporting peoples admission into hospital after identifying health care concerns and contacting other health professionals for specialist advice. The medication system was discussed with a registered nurse. The procedures in place for the ordering, receipt, storage and administration of medications is safe. We recommend that when medications are being placed in the medicines for disposal cupboard, that a record is kept of what is actually placed in the cupboard. This will ensure that all unwanted medications are then returned through the proper routes. Controlled drugs were checked and all records and stocks held were in order. A number of people are using oxygen therapy and in all but one case, appropriate hazard warning signs were displayed. During the course of the inspection, arrangements were made for the supply of additional signage. During our last visit to the service a requirement was made by us that manual handling risk assessments must be completed for all residents, from this a safe system Care Homes for Older People Page 19 of 44 Evidence: of work must be devised and followed. These must detail how many staff and what equipment it needed. At this visit we reviewed these records and found them to be in place for all of the people whose records we reviewed. The manual handling assessments contained sufficient information in order to ensure people were supported in a safe and appropriate manner with this area of their care. Information was recorded about the number of staff individuals required to assist them and details of what equipment needed was also in place. We found this requirement to have been met. During our two days at the home we noted occasions where people are not always cared for with respect for their dignity. We saw one person with a full to bursting catheter bag strapped around their lower leg and we were told they always have to call for assistance. This could be avoided if the care staff were more vigilant and emptied the bag more often. One person said they always had to wait for them to help you. We were told by relatives who were sitting with their dying mother that they had to keep shoo-ing a distressed and wandering person out of the room as there were no staff about that they could find to help them. On the second day of our visit we saw a gentleman who appeared disorientated, he had food on this top clothing, stains on his trousers with his zip undone, his hair had not been combed and he had not been supported to have a shave. We could not find staff to assist this gentleman as staff were supporting other people with their lunch. We settled this person in their room with their lunch and returned later to see how they were approximately two hours later. We saw that this person was lying on their bed and their personal appearance and clothing had not changed. We also noted that debris of the gentlemans food was on the bedside table and on the floor. We also noted that a resident was speaking to a visiting service provider, the resident said you are not answering me we looked to see what was happening and saw that the staff member was texting on their mobile phone. In one of the dining rooms personal information about peoples dietary requirments is displayed for all to see. This information should be made available for staff in a more discreet fashion. On a more positive note we did see people being assisted to wash their hands and face after a mealtime, being spoken to in a friendly and courteous manner, and being asked about what they wanted to do. We saw that a copy of a patient alert form was kept in one persons care file that indicated that the persons GP had made a decision about their patients ongoing care, and was advising the out of hours medical services. This is good practice. We looked at the care plan for one person who had end of life care needs their support and wishes in this area had been fully recorded and appear to have been dealt with in a sensitive manner. Care Homes for Older People Page 20 of 44 Care Homes for Older People Page 21 of 44 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at the home are enabled to maintain contact with families, friends and local communities. Choices are provided in respect of meals and mealtimes. The home provides those living at Honeymead with structured and meaningful activities and they are able to choose whether they wish to participate or not. Evidence: During this visit we saw that staff were friendly, polite and caring in their approach. They were seen to be supportive. We saw them listening to people and answering questions, providing reassurance and information as requested. We saw within the homes statement of purpose that visitors are welcome to the home. There are currently two activity organisers, one responsible for each floor. There is a weekly timetable of events and this is displayed throughout the home. This includes arts and crafts, readings and bingo, various games and painting, one to one sessions and quizzes. In addition outside entertainers are brought to do dancing, singing and to play music. Menu themes are organised on a monthly basis and authentic cuisine is provided to celebrate St Davids Day, St Georges Day and, Halloween and Burns Night Care Homes for Older People Page 22 of 44 Evidence: for example. There was a busy atmosphere and a lot going on. We saw photographs of previous events. During the inspection there was a slide show arranged about Bristol and many people went along to watch. One person said Its not really my cup of tea but it was enjoyable, another said It breaks up the boredom. A hairdresser visits the home twice weekly. For one person their care plan stated that they were unable to participate in social activities and entertainment, and this was felt to be a negative and sweeping statement as discussions with the staff and relatives indicated that this was not the case. The home should consider how this persons needs could be better met. The home has four week menu plan and at midday there is a choice of two main meals. Over the two days braising steak, salads, roast chicken and a vegetarian leek and ham meal were served along with vegetables and puddings, We saw that homemade biscuits and caked were served in the afternoons and that a supply of fresh fruit and drinks were available in the lounges and dining rooms. People who were spoken with during the inspection said that the meals were generally good. We spoke with the cook who was on duty, they were able to demonstrate to us a sound understanding of the dietary needs of people who live at the home and spoke about individuals likes and dislikes, they confirmed to us that fresh supplies of meat, fruit and vegetables and provisions such as milk, eggs bread etc.. are delivered on a daily basis. The cook also told us that they have a good budget for food and that they are able to manage this effectively, balancing the needs of the service as well as the people who live at the home. We also saw within individuals files that there is a menu checklist and also a diet requisition and special needs records. They outline the type of diet individuals require as well as information such as individuals special likes and any additional instructions for staff such as the use of specific assistance aids. We also saw that the home had recorded information obtained from a dietitian, the information supplied had been incorporated within this persons care plan, demonstrating the importance of this persons areas of their care. Prior to our visit a relative of an individual who lives at the home had contacted us and had commented that there had not been any relatives meetings at the home for sometime and that the last meeting which had been arranged had been cancelled. This relative also commented that communication about their relatives care can been at times poor at the home and felt that people benefited from these meetings. The area manager and other relatives spoken with during our visit confirmed that there had not been a meeting at the home for sometime. We could also find no record of any meetings held in order that the people who live at Honeymead can comment and raise ideas and suggestions about the service being provided. It is recommended that meetings are held with those who live at Honeymead and also with relatives of individuals who live at the home to provide a forum in which information can be shared. Care Homes for Older People Page 23 of 44 Care Homes for Older People Page 24 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information for people on how to make a complaint about the service, however, known complaints have not been recorded and there is little evidence to demonstrate that concerns have been investigated and findings/outcomes recorded. There are clear systems and protocols in place to protect those who live at the home from abuse, however not all staff have received training in protection of vulnerable adults. Evidence: During our last visit to Honeymead in February 2008 due to furnishings in the entrance area it was difficult to see the homes complaints procedure; A recommendation was made that consideration should be given to the relocation of this document in order that it is more visible and accessible to people. At this visit we saw a copy of the homes complaints procedure is displayed in the main reception area and is also included in the information provided to everybody who lives in the home. We saw this information displayed in some peoples bedrooms. The procedure details the processes that will be followed if concerns or formal complaints are raised. We noted that the procedure informed people about who would respond to complaints made at the the home, however the person named as the manager no longer works at the home and this should be changed in order that people are provided with correct information. We looked at the complaints log and found that the only information recorded was in Care Homes for Older People Page 25 of 44 Evidence: respect of very recent complaints made. We have been directly notified of the issues raised within the complaint via safeguarding adults procedures, and each of the complaint issues are being separately investigated by senior Mimosa staff. One person told us that if they had any complaints they would tell the manager but said because there was no manager they did not know who to refer to. They added I dont want to tell the nurse because she is working so hard and doing all the other jobs. We are concerned that because there is currently no manager of this service, and that there has been no home manager for 10 months, that issues of concern are either not being raised or have not been handled correctly. We have received five complaints since November 2008. For two recent complaints we have asked the area support manager for Mimosa to look into and report back the findings to us. Two of the complaints are being dealt with following safeguarding adult protocols, and as yet the investigations are not complete. The information we received in one other complaint we used to formulate our inspection plan and have resulted in a number of requirments and recommendations of good practice being made. The home has a POVA policy (Protection of Vulnerable Adults) and information is displayed about what staff should do if they have any concerns that they want to report. Those staff we spoke with during the course of the inspection demonstrated a good awareness of adult protection or safeguarding issues, but each staff member said they had not had recent refresher training. We looked at the training records in respects of POVA training and found them to be wholly inadequate. The staff training matrix was not able to provide a clear picture of when staff last had instruction. We were advised that a training session is already booked for the end of the week, but this will only capture a number of staff who need the refresher training. The area support manager has, in light of this, taken prompt action to arrange additional training sessions for the staff. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, references, protection of vulnerable adults checks and satisfactory Criminal Record Bureau disclosures. Care Homes for Older People Page 26 of 44 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. People at Honeymead live in a clean, homely, safe environment. Evidence: Honeymead is located within the residential area of Bedminster, it is well positioned within the local community. It has local facilities nearby which include shops, churches, pubs and restaurants. There is a pleasant garden area at the rear of the home which residents have access to, this area has a pond, and a vegetable patch we spoke to someone who was enjoying the sunshine and they told us that they liked coming into the garden and spending time there on warm days. The home has sufficient toileting and bathing/showering areas for individuals use. People have access to private en suite facilities, communal toilet areas are close to peoples rooms. The temperature in the home at the time of our visit was warm and comfortable. The home is appropriately adapted to meet the needs of the current group of people who live in the home. Specialist equipment has been obtained for individuals following identified need; examples of these include mobility, sensory aids, continence aids and Care Homes for Older People Page 27 of 44 Evidence: equipment to assist with manual handling. We also saw a passenger lift and hoists are in place to support those with limited mobility. The rubber matting on the floor in the passenger lift is lifting and could potentially be a trip hazard. This was identified in the last maintenance check by the lift company (14/04/09). Attention must be given to this matter. Since our last visit we found that lounge flooring had been replaced with wood effect flooring, this looked nice and is easily cleanable. During our visit we generally found the home to be clean, tidy and odour free. During our last visit to the home in February 2008 we reported that the standard of bed making was very poor, with linen hanging on the floor, mattresses hanging over the bed bases and bed rail equipment was not always positioned correctly. We recommended that care staff needed to take more care when making beds to ensure that beds and rooms were left looking nice and also that the position of bed rails is checked on a daily basis. At this visit we spoke with a number of people in their own rooms and did not note any concerns. The standard of bed making was much improved and bed rails were in correct position, staff confirmed to us that these are checked on a daily basis to ensure they are fitted correctly and are safe. We also noted that the home has purchased some new bedding/covers for the bedrooms to make them look nicer . Peoples rooms had been personalised with photographs, ornaments and plants in order to reflect individuals personal tastes and personality. During our time at the home we found that some areas of the home appear to be tired, some freshening up of paint work needed in particular in toilet and bathroom areas and skirting boards. We saw evidence that the home is well maintained; see the management section of this report for further information in respect of this. Care Homes for Older People Page 28 of 44 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. The home ensures that all staff have been employed following robust recruitment and selection processes. Staff receive training in the home, however, improvements must be made to ensure that all staff undertake mandatory core training, and specialist training as required in order that staff have the skills and knowledge to support individuals who live at the home. Evidence: There are currently a number of staff vacancies plus a significant level of last minute staff absences (particularly noticeable at the weekends) that means that the home often has to rely upon agency cover in order to have enough staff on duty. We were told that there are always two registered nurses on duty during the day. Permanent staff members will often pick up extra shifts. On day one of the inspection one of the registered nurses had been supplied by a nurses agency and they told us that it was their first visit to the home. On day two of the inspection, the shift was being covered by a bank nurse who does not permanently work at the home. From looking at the staff rotas and from discussions with staff, and visitors to the home, we are informed that the home does not always have two registered nurses on duty. We have also Care Homes for Older People Page 29 of 44 Evidence: concluded that the numbers of staff on duty do not take in to account the collective dependency levels of all the people living in the home. At times when the work load is significantly increased for example when people are really poorly, there is no extra allocation of staff. In the absence of a home manager there is an expectation that the registered nurses will take on some of the management tasks, however they are not released from their clinical duties to do this. The nursing and care staff are supported in meeting peoples daily living needs by catering, laundry, domestic, maintenance and administrative staff. It is required that the registered person must ensure that sufficient numbers of staff are on duty at all times. This is so that staff have the time to do their job properly and peoples care needs can be met in a timely manner. New recruits to the home are expected to complete an induction training program and we were told that this includes practical fire awareness and practical manual handling training. We were told that care staff have a workbook to complete, but there was not one available for us to look at. We could not evidence that new staff will have received fire and manual handling training at the start of their employment and this is not good practice. One person confirmed that they were working through their book and that they are supported by a Learning Skills Adviser. We were told that registered nurses do not have to complete this full induction program, but that they are supernumerary for a number of shifts. During our last key visit to Honeymead we made a requirement that all new members of staff must complete the organisations induction training program and evidence how their competence has been achieved by recording it. We were informed that since December 2008 the organisations training department had sent to the home five induction program workbooks, however these were not available to us. We received the Annual Quality Assurance Assessment prior to our visit to the home. Within this assessment it asks the home to inform us about staff training and qualifications, when asked by us for the number of staff who have completed the induction program expected, described and recommended by Skills for Care this section of the report had not been completed. During a review of staff recruitment documentation we are aware of at least six new members of staff employed at the home since December 2008. As evidence has not been provided the requirement remains, action must be taken by the organisation to address this shortfall. During this visit we looked at the recruitment files for six staff members, five of whom had been taken on since December 2008. Each person had completed an application form and then attended for an interview. In all cases two written references were obtained from previous employers but one reference did not contain any information apart from dates of employment, and there was no evidence that this had been followed up with a telephone call. For another person the references obtained were different from those stated on the application form. All 5 staff had only started work after a POVA 1st check had been received. One of these staff were spoken with during the inspection and could not recall being allocated a mentor to supervise their work practice until their Care Homes for Older People Page 30 of 44 Evidence: CRB disclosure was returned. Whilst there are good recruitment procedures in place, they could be doing things better. New staff whose CRB has not yet been received by the home, must be allocated a mentor to work with who will supervise and oversee their work. References that do not provide much detail should be followed up During this visit we were provided with the up to date training matrix, which shows what training each staff member has had. We were not able to see when training had previously been attended in respect of annual mandatory training (fire awareness, manual handling, protection of vulnerable adults(POVA) and health and safety. Many of the staff do not have an individual training file whilst others do. Individual training files should be in place for all staff, this could be where certificates and evidence of induction training could be maintained. We could see that some staff have received training in specific clinical issues such as catheterisation, venepuncture and infection control. We are aware that there has been recent training in health and safety, and food hygiene, and that there are further training sessions in POVA, fire awareness and first aid already scheduled. The training matrix shown to us recorded that out of fifty two staff there are only seventeen staff who have up to date manual handling training and there are twenty five staff who have not completed protection of vulnerable adults training. We were also concerned to note that there are twenty seven staff that have not received any fire safety instruction, training or drills within the past twelve months and a requirement has been made about this within the management section of this report. There is a need for staff to be trained in core training such as manual handling, first aid and basic food hygiene. It is further required that staff are trained in specialist areas such as dementia care awareness and also dealing with challenging behaviour. four staff have completed training in dementia awareness in March 2009, no staff have completed training in behaviour which can challenge. From observations made during the inspection we do not consider that the staff have the necessary skills and experiences to deal with people who have these needs. When we reviewed the care and support required for some people who live at the home . For two people who are in need of emotional support we found that staff had recorded a number of incidents where these people had been very aggressive aggressive to carer kicking staff, shouting and screaming. We also noted that one of these people had recorded within their daily notes that they had; dug their nails into another resident today, as they believed the other resident had pulled their hair. When we spoke to staff about dealing with behaviour which can challenge and be difficult to manage some were able to demonstrate a better understanding of those with mental health difficulties than others. We saw that the home have an Aggression and Violence policy, within this it records: For a staff member to feel confident, the Care Homes for Older People Page 31 of 44 Evidence: manager must ensure staff have been trained in what to do. The home should adhere to their own policy and ensure that training in this area is provided. People who live at the home told us that staff are kind and helpful, some are more willing than others. Care Homes for Older People Page 32 of 44 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. There has been no registered manager in post at the home for sometime and this has impacted on the overseeing of monitoring the effectives of processes and the maintaining of the required standards. The home has systems in place to ensure the safety of those who live and work at the home, however there are areas, which must be improved upon. Staff are not formally supervised at the recommended intervals. Also there is insufficient evidence to demonstrate that staff have received sufficient amount of fire instruction. Evidence: The home has been without a registered manager since June 2007 despite a home manager being appointed on three occasions they each left before making an application to us for registration. In the meantime temporary management cover has been provided by managers from other parts of the country, the registered manager from another local Mimosa care home and an Area Support Manager who has just Care Homes for Older People Page 33 of 44 Evidence: joined Mimosa. Whilst we acknowledge that Mimosa have made numerous attempts to resolve the long term management arrangement the impact of this is that the staff team are low in morale, some staff are working really hard to ensure people receive the care that they need as well as ensure that the home runs well, and that some management tasks are not being completed at all. There is a clear need for the home to have a sense of direction and leadership and this can only be achieved with the appointment of a strong home manager. We are aware that the recruitment process has already begun for a replacement and once this person is in place they will need to make immediate application to us for registration. We were told by people who live in the home, relatives and staff members that the ability for them to express views is currently very limited. We discussed with staff the current management position, staff told us that they had not had a manager at the home for sometime. One person told us that I cant remember the last time we had a good, effective manager here, its been so long another person said that one of the RGN has tried to do their best, but its too much for them, they are well stressed and are finding it difficult to cope. It is required that a manager be appointed by the organisation in order that the service has clear leadership and direction from a person who is fit to do so. We saw a poster informing staff that a staff meeting had been arranged, There has not been a staff meeting since October 2008. It is important that staff have the opportunity to discuss their role and responsibilities and to be provided with clear direction and leadership from the home in order that their is monitoring of continuity of the service being provided to those who live at the home. Prior to our visiting Honeymead we requested that the registered person complete an Annual Quality Assurance Assessment (AQAA). This was received by us prior to our visiting the home, the AQAA had been completed by the administrator for the home. The quality of information within the AQAA was not of a standard that we would expect. The information provided was not sufficiently detailed and lacked clarity. We discussed this with the Area Manager for the organisation who was present during our site visit who stated that this would be reviewed, amended and resubmitted to us. The home has procedures in place to manage any monies they hold on behalf of the people who live there. We did not check any of the accounts on this occasion however were told that the system has not been changed and we have no reason to be concerned that peoples money is not safeguarded. We looked at the staff supervision matrix. This showed that of 53 staff members, only Care Homes for Older People Page 34 of 44 Evidence: half have received a formal 1:1 supervision meeting with a senior member of staff in 2009. The others have had no recorded supervision at all. A sample of records kept as a result of a supervision session were looked at some had only a very brief recording and did not evidence how staff work performance was being monitored. We were told that it is highly unlikely that any of the staff team have received an annual staff appraisal. Staff confirmed that they had not had supervision for a long time. We were told that senior care assistants who supervise junior colleagues have not received training in supervision, but this was disputed by the area manager. We were not provided with details about supervision sessions that had been arranged up until the end of last year, as these were not available. During our last visit to the service we made a requirement that all care staff working in the home must be formally supervised. That at least one session for each staff member of care staff should be recorded within this timescale. At our last visit we also recommended that staff must receive formal supervision at least six times per year. We do not find this requirement or recommendation to have been met and therefore will remain and will be reviewed by us when we next visit the service. This requirement was not met within the required timescale. As a result of the lack of a management overview of this care home, some of the homes records were not maintained properly. Examples include accident forms that are not always completed for every event and there is no mechanism for recording any follow up activity, a training file for each staff member. There also needs to be an improvement in the recording skills in the daily progress notes for each person - this has been referred to in the health and personal care section of this report, but in addition daily entries are not always made in date order. The maintenance person completes regular checks of the fire alarm system, fire fighting equipment, emergency lighting and water temperatures. The records were all in order. All the necessary service contracts were up to date. Hoists and other mechanical moving and handling equipment is serviced every six months, having last been looked at in March 2009. We received a complaint from a family member who had been concerned that two commodes had broken whilst being used by their relative and that both commodes had been old and corroded. As a result of this a visual check of each commode will be recorded each month along with all other audits, but it is of concern that the condition of both commodes had not been identified by the care staff. During this visit we reviewed the fire logbook. We saw that weekly tests of the alarms and of door guards and exits are undertaken. During this visit we found a door guard on a bedroom fire door was not working, we reported this to the area support manager, the home were not aware of the issue. The manager was prompt to arrange for the guard to be repaired during our visit. We saw records of portable fire fighting Care Homes for Older People Page 35 of 44 Evidence: equipment checks and saw that emergency lighting is checked as required. Contracting arrangements are in place for the maintenance and servicing of fire safety equipment. We saw that the home has in place a comprehensive fire procedure and whilst we were at the home we reviewed the homes fire risk assessment. We saw that that the document recorded identified fire hazards within the workplace and had evaluated the risks and recorded how these risks would be reduced and eliminated, where possible. The home had reviewed the document in December 2008. The home had a service users evacuation list, this records who is in the home and their mobility assistance requirements. This document had been updated on 14th April 09. When we checked the list against the people who were in residence at the home we found that three people were recorded as being in the home when they were not. We also noted that for one person it reported that an individual uses a wheelchair for their mobility, however this person is in receipt of total care support and does not get out of their bed. It is recommended that the home amend the service users evacuation list and ensure that this is kept under review and updated when required in order that this list contains accurate information for the safe evacuation of people living at the home in the event of a fire emergency. Manual handling training is not routinely provided for all new recruits and we were told by the area support manager that manual handling training as part of an induction training program is not arranged for newly appointed registered nurses. This is very unsafe practice and has the potential to mean that people may be moved or transferred by staff who are untrained or who may harm them. We know that one registered nurse who had been working in the home for four months had not received any manual handling training, and their previous job had been non-care related. A relative raised concerns with us about the manual handling competence of one named care worker but we were advised that this person last had training in September 2008. Despite the fact that we did not observe any unsafe manual handling procedures during the course of the inspection, we are concerned that not enough precautions are taken to ensure peoples safety. It is recommended that the registered person check the details of their liability insurance to ensure there is adequate cover in respect of staff requirements. Furthermore it is also recommended that the registered person should review the current induction process for manual handling training in order to ensure that all staff are competent in manual handling and do not potentially put themselves and those who use the service at risk. Accident reporting is not consistently done and we found that not all accidents or falls will result in records being kept in falls records. This means that the frequency of falls is not being monitored which in turn means that staff may not be able to identify any trends and then take preventative measures. This shortfall has the potential to mean that people may be unnecessarily injured. We saw that one fall had resulted in a visit Care Homes for Older People Page 36 of 44 Evidence: by paramedics/ hospital attendance. We (the Commission had not been notified of the event, as we are legally required to be. Care Homes for Older People Page 37 of 44 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 30 18(1)c All new members of staff complete the organisations induction-training programme and evidence of how their competence has been achieved is recorded. 26/03/2008 2 36 18(2) All care staff working in the 26/04/2008 home must be formally supervised. At least one session for each member of care staff be recorded within this timescale. Care Homes for Older People Page 38 of 44 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 The registered person must 30/04/2009 ensure that the needs of people are fully assessed, by a suitably trained person, before placement is offered. This is so that people can be assured that their needs will be met and that the home has the appropriate facilities and staff skills to care for them. The registered person must 28/07/2009 make arrangements in order that unnecessary risks to the health and safety of people who live at the home are so far as possible eliminated. Detailed risk assessments must be completed in respect of dealing with, and responding to behaviour which can challenge. This is to ensure that appropriate action is taken to support people in a safe manner. 2 7 13 Care Homes for Older People Page 39 of 44 3 7 15 The registered person shall 28/06/2009 prepare a written plan which will record how the service users needs, in respect of their health and welfare are to be met. The registered person must ensure that care plans must fully reflect the complex and diverse needs of people and must clearly record how people are to be supported on an individualised basis and provide clear direction and guidance for staff in order that people are fully supported in all aspects of their care. The registered person shall make arrangements for the service user to receive treatment, advice and any other services from any health care professional. The registered person must arrange for the falls prevention nurse to be contacted for advice in respect of the individual identified during this visit. 28/05/2009 4 8 13 5 10 12 The registered person shall ensure that the home is conducted in a manner which respects the privacy and dignity of service users. People living at Honeymead should be supported fully to ensure they do not look unkempt. Private dietary information about people 30/04/2009 Care Homes for Older People Page 40 of 44 should not be on public display, people should be supported to maintain their dignity and be treated with respect. 6 16 22 The registered person must ensure that any complaint made under the complaints procedure is fully investigated. This is to ensure that people can be confident that issues raised are responded to and fully investifgaed as required. 7 18 13 The registered person shall make arrangements by training staff, or other measures, to prevent service users from being harmed. The registered person must ensure that staff undertake core and refresher training in adult protection procedures in order to ensure that staff are given the information and knowledge required and to ensure that they are aware of their role and responsibility in this area. 8 31 8 The Registered Provider 28/07/2009 shall appoint an individual to manage the care home. This is in order to provide clear, consistent leadership at Honeymead. 28/06/2009 29/05/2009 Care Homes for Older People Page 41 of 44 9 37 17 The registered person must ensure the records required as specified in schedule 3 are kept up to date. This is to ensure that records required by regulation for the protection of people living in the home and for the effective running of the business are maintained and accurate. 28/06/2009 10 38 23 The registered person must make arrangements for persons working in the care home to receive suitable training in fire prevention and to ensure by means of fire drills and practices at suitable intervals so that they are aware of the procedure to be followed in the event of a fire. This to ensure that staff can be aware of their role and their responsibility in the event of a fire emergency. 28/05/2009 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 7 Incidents of behaviour which may be challenging and difficult to manage for staff should be recorded within the homes incident records. This is in order that situations may be monitored and responded to appropriately ensuring that individuals needs are identified and met. Body maps which record any bruising, wounds or injuries on people should be better maintained at the home in order that these areas can be monitored and appropriate action taken to respond as required to enable effective treatment. Page 42 of 44 2 8 Care Homes for Older People 3 4 9 14 A record of medicines for disposal should be made as items are placed in the disposal cupboard. It is recommended that meetings are held with those who live at Honeymead and also with relatives of individuals who live at the home this will provide a forum in which information can be shared. It is recommended that the registered person check the details of their liability insurance to ensure there is adequate cover in respect of staff requirements. It is recommended that the registered person should review the current induction process for manual handling training in order to ensure that all staff are competent in manual handling and do not potentially put themselves and those who use the service at risk. It is recommended that the home amend the service users evacuation list and ensure that this is kept under review and updated when required in order that this list contains accurate information for the safe evacuation of people living at the home in the event of a fire emergency. 5 38 6 38 7 38 Care Homes for Older People Page 43 of 44 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. Care Homes for Older People Page 44 of 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!