Inspection on 29/06/05 for Hungerford House

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hungerford House 15/01/07

Hungerford House 05/12/05

Hungerford House 12/01/05

Hungerford House 26/07/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hungerford House Beechfield Road Corsham Wiltshire SN13 9DR Lead Inspector Sally Walker Unannounced 27 June & 14th July 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hungerford House Address Beechfield Road Corsham Wiltshire SN13 9DR 01249 712107 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of St John Care Trust To be Confirmed Care Home 47 Category(ies) of DE(E) Dementia - 0ver 65 (19) registration, with number OP Old Age (28) of places Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12 January 2005 Brief Description of the Service: The building was originally purpose built by the local authority in the 1970s. The Orders of St John Care Trust took over the care provision on 1st October 2000. There are 47 single bedrooms all ground floor. The home offers 3 respite care beds. The home is registered to provide 19 places for people who have a diagnosis of dementia. The home is divided into three units namely: Roberts, Lilley and Hall. These units have their own sitting room, dining room, small kitchen area, bathrooms and toilets. The building is partway through an extensive refurbishment and improvement plan to the physical environment. There is a separate day service for up to 25 people each day; with 5 places offered to people with dementia. The care staffing rota provided 6 staff including a care leader during the morning, 4 staff for the afternoon and evening and three waking night staff. The home also employs cooks, housekeepers and a handyman. Mrs Diane Gooch has been managing the home since February 2005 and her application to register as manager is in progress. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Gooch was on leave on 27th June when the unannounced inspection was made and the inspection continued on 14th July 2005 to discuss developments since she came to post. The inspection on 27th June 2005 was carried out between 9.40am and 4.45pm. The inspection of 11th July 2005 took place between 3.00pm and 6.20pm. The administrator and one of the care leaders gave access to some of the records. Seven residents and 5 staff were spoken with. The case notes and duty rota were inspected. All of the 6 requirements and 2 recommendations from the previous inspection of 12th January 2005 related to the time prior to Mrs Gooch’s appointment when the home was without a manager to register and a number of different people had been running the home. Since the inspection the home’s application for a Variation in Conditions has been approved. A bedroom has been made of the old staff office which increases the number from 47 to 48 places. Four places for people with a Mental Disorder are now included in the Registration. A Condition has been applied that allows the home, from time to time, to admit people who are between 60 and 65 years of age. What the service does well: What has improved since the last inspection? What they could do better: The current assessment document does not aid full and thorough assessment of potential residents, particularly those residents with a dementia. Risks of Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 6 residents’ potential of developing pressure sores need to be undertaken following staff training in this area. The Commission must be informed of the plans to complete the upgrading of the building. Current staffing levels do not support residents to have good access to the locality, support them with all their personal care needs, i.e. bathing, or allow staff to complete the additional administrative duty expected of their role. Those proposals submitted to the Commission are being considered. Attention needs to be given to the cleaning of the undersides of the toilet surrounds and bath hoist seats. A programme of training in mental health needs to be in place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All potential residents have an assessment prior to coming to live at the home to make sure that the home can meet their needs. Current assessment documents do not aid the assessment process. EVIDENCE: The requirement that residents were assessed as to their care needs prior to admission using the appropriate forms and that if the care management assessment was out of date, the home must carry out their own assessment, was in progress. Mrs Gooch said she was currently assessing all potential residents but intended that senior staff would assess in future. She was also assessing those residents who had had a period of time in hospital and wanted to return. She showed the inspector 3 draft assessment documents which she had produced with other managers in the organisation. The documents were awaiting approval from the organisation. The documents allowed a more comprehensive assessment, particularly with those residents who may have a diagnosis of dementia. All the recently admitted residents had had an assessment. However the organisation’s form has a dual purpose for assessment and care planning. It does not allow the compiler to record the source of the information. One of the residents said they knew of the home before coming to live there from various visits over the years. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 Great improvements have been made to most of the care plans to ensure they direct the care. Social histories will inform the care plans. Residents’ healthcare needs are being met with prompt referral to GPs and district nurses. Residents are not protected by thorough assessment of their risk of developing pressure sores, nutrition or regular weight checks, although pressure-relieving equipment was in place. EVIDENCE: All residents had a care plan and the requirement that care plans were kept under review and updated as necessary was in good progress, although there were variations. Mrs Gooch had reviewed and revised the majority of the care plans and assessments to show good examples to staff of what was needed. She said staff now had a better understanding of the need to have very detailed care plans to direct the care. Many of the care plans showed a thorough review with up to date guidance to staff on how the care should be delivered. A care leader said that they were writing to families for information about those residents who have a dementia to have a better understanding when developing care plans. They also had a list of the forms to be included in the pre-printed case file format and were doing an audit to ensure they were in place. Risk assessments were in place for each resident and incidents Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 10 prompted a review and revision of the assessment. The daily reports were very detailed and showed a good picture of how the care was provided. The recommendation that all care staff should receive training in Tissue Viability from the Specialist Nurse in order to assist them with completing assessments of risk of residents developing pressure sores is made a requirement in this report. The recommendation also included nutritional assessments, dementia as an indicator of risk (the current format excludes dementia) and recording and monitoring of progress. No training had been carried out and those staff asked did not understand the term Tissue Viability. Mrs Gooch later said that the Specialist Nurse could not provide the home with training due to the increased demand. Since this inspection the Responsible Individual has reported that they are now trying to secure this training from other sources. Pressure relieving equipment was in place supplied by the district nursing service. One resident said they could not remember if they were regularly weighed. Another said they were weighed. This backed up by the records which were not always filled out each month. As a matter of good practice body maps were being used for accidents and incidents with good information about time, witnesses and what the subject experienced. One resident was having their nutritional intake monitored but the last entry was three days before the inspection. This resident was also indicated for diabetes which was identified in their care plan. The district nursing service was administering their insulin. Residents had good access to GPs and any concerns were promptly referred to healthcare professionals. One resident said the district nurse dressed a small wound and that it was healing well. This was shown in their case notes. There was a clear care plan and guidance to staff for one resident with regard to protecting them from an identified risk, with good supervision and reporting on how that risk was being managed. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Residents set their own routines and were encouraged to remain independent for as long as possible. Staffing levels prevented some residents from having a bath when they wanted or to go out with staff support. EVIDENCE: Residents preferred times for getting up and going to bed were respected. Those residents spoken with reported different times and some said they could lie in if they wanted. Residents said they set their own routines. Some residents said they went out on their own but did not have their own key to the front door but did not mind being let in by staff. They said they had their own key to their bedroom door. There was little evidence that less mobile residents went out with staff support. One resident said there were not enough staff to have a bath when they wanted one; they said they had only had one bath in the last three weeks. They said their friend had not had a bath for 2 weeks. They said they could not talk to their keyworker as they were on holiday. All of the residents spoken with said they enjoyed the quality and variety of the food provided. Most of the residents knew what the meal choice was for the day. One resident had been indicated for nutritional monitoring and a food and fluid intake chart was available. However it had not been filled out for three days. All of those residents spoken with said that they had been given more cold drinks during the hot weather. One resident said they had a cooked breakfast every day. One resident who was receiving respite care said they always had the same bedroom. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 12 Residents talked about the activities provided; there had been people come to the home and played musical instruments and the residents sang along. Mrs Gooch said she had appointed a member of staff to be responsible for providing activities for 20 hours a week. Residents said they had sherry and biscuits with some of the evening activities. Activities were advertised on the notice board. The dementia unit had a separate programme of activities which were geared to their needs with attention time spans, achievability and memory taken into consideration. The residents had been to other homes in the organisation for parties and dances and had their own party to celebrate the end of the war. There was a shop and which was open each Thursday evening, although drinks, snacks and toiletries cold be purchased at other times. The daily records and shift plans showed that at least one activity was provided each day. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Policies and procedures were in place to enable residents to complain and be listened to. Staff were trained to ensure they were familiar with protecting residents from abuse. EVIDENCE: The home works to the organisation’s complaints procedure which was posted at various points in the building. The recommendation that potential barriers to some resident being able to openly express their dissatisfaction with the service appeared to have been resolved. On this visit residents appeared to be more confident in making comments to their keyworkers. Mrs Gooch was well known to residents. The situation at the last inspection may have been a symptom of not having the continuity of one manager in place for five months. The home worked to the local Vulnerable Adults procedure entitled “No Secrets in Swindon and Wiltshire”. Mrs Gooch said that nearly all of the staff had received training in the procedure. Care plans were very clear with strategies for protecting residents from potential abuse where indicated. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 & 26 Parts of the home had benefited from recent upgrading and new furniture. This is in contrast to those areas which remain untouched. Much effort has been made to ensure residents’ bedrooms are personalised and comfortable. EVIDENCE: One of the units had been refurbished with new carpets, redecoration and new furniture. Staff said that the manager had done an audit on the condition of the fittings and furniture of each bedroom with a view to replacement. The home was well in to a 5-year refurbishment plan and many of the areas had been upgraded. In contrast some of the areas, particularly carpets, bathrooms, toilets and serveries were looking shabby and would be difficult to keep looking clean. Mrs Gooch was advised that the Commission must be informed of the current situation with regard to upgrading these areas. One of the staff said that an audit of all the wash hand basins in the bedrooms had been carried out with a view to replacement. Mrs Gooch confirmed that quotes had been sought for replacement together with work required by the Chief Fire Officer’s representative. It was noted that where replacement pipe work and electrical work had been carried out in the ceilings some of the areas were still Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 15 exposed as the tiles had not been replaced. Mrs Gooch said she had referred this to the organisation for action. The old care office and adjacent bathroom had been refurbished to provide a further bedroom and bathroom. The care office was now in the old staff rest room. This was very hot even though a large fan had been provided. The cleanliness of the building was to a reasonable standard. The requirement that residents should benefit from the regular cleaning of their bedrooms had been actioned. However some attention needs to be given to the undersides of raised toilet seats, bath hoist seats and bars surrounding toilets. Many of these had been cleaned to a good standard on the surface; but brown drip marks were noted on the undersides. One resident said their bedroom was not cleaned every day. Another said that quite often there was no toilet paper in the toilet nearest to their bedroom. All of the radiators had been fitted with guards to ensure guaranteed low surface temperatures. The lighting in most of the toilets comes on automatically when the door is opened. One of the bedrooms did not have a light shade. Mrs Gooch showed the inspector the laundry area which she had reorganised to be more efficient. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Current staffing levels do not support residents to achieve all that they might wish for example, going out or having a bath when they wish. Staff are not supported to achieve the administrative duties exclusive of the care. The home has a robust recruitment procedure. Staff had a good understanding of the needs of people with dementia, but not necessarily of those people with a mental disorder. Residents are supported by a committed and caring group of staff. EVIDENCE: The staffing rota provided for a minimum of 6 care staff, including a care leader during the mornings with 5 care staff including a care leader until the night staff came on duty at 10.00pmduring the week. At the weekend there were only 3 care staff and a care leader between noon and 3.00pm. There were 3 waking night staff. The staff were very busy, particularly the care leaders as Mrs Gooch was on leave; one care leader stayed on to finish their paperwork. Care leaders said that an on call service was available in Mrs Gooch’s absence with support from other managers in the organisation or the care services manager. Care leaders said they each had a delegated area of responsibility, for example the rotas or medication. Mrs Gooch said that staff were receiving computer training to be able to do some of the delegated administrative work. The requirement that the allocation of staffing hours must be considered to ensure that residents’ care, social and environmental needs are met with full provision of care staff, laundry staff, and cleaning staff was in progress. The requirement included the management and administrative tasks which care staff were expected to complete exclusive to care. The organisation has submitted a staffing proposal to the Commission Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 17 for all of its care homes in Wiltshire and this is currently under consideration. Care leaders said they had up to 4 residents that they were keyworker to. One of the care leaders said they had transferred to be responsible for the dementia unit. The requirement that a programme of regular staff supervision is carried out to ensure at least 6 sessions each year was in progress, although staff reported that they had had only 1 session since Mrs Gooch came to post. Care leaders said they had received training in supervision. Care leaders said they had been on a care leaders development day run by the organisation where they had updated their knowledge of recording and the organisation’s procedures. Staff said they had recently attended a course on dementia run by the organisation which was most useful. There had been no training in mental health to support the Variation in Category to include 4 places. Mrs Gooch said she had requested mental health training from the organisation. She was advised to seek outside training from the visiting mental health professionals. Staff were seen to engage with residents and had time for a chat even though they were busy. Residents were very positive in their comments about the staff. The staff personnel records showed that a robust recruitment process was in place with all of the documents and information in place before potential staff started working. Mrs Gooch was in the process of putting together a separate file to show each staff’s qualifications and training. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The home now benefits from a permanent manager to be registered. The home is run in the best interests of the residents. Mrs Gooch is clear about the areas which need to be developed. EVIDENCE: Mrs Gooch has achieved much in the short time that she has managed the home. She had a clear idea of how she wished the service to develop. Her application to register as manager is in progress. The requirement that a programme of regular supervision was is place and that all staff receive a minimum of 6 supervision sessions a year was in progress. Staff said they had received one session and Mrs Gooch said that a plan was in place for the year with senior staff attending training in supervision. The requirement that the records were up to date; with forms being filled out in full, signed and dated, photographs of residents, details of current care needs and details of how needs were to be met, was in good progress. However some newly admitted residents did not have photographs and some dates of admission were not recorded. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x 2 x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x 2 x Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 7 Regulation 15(2)(b) & (c) Requirement The person registered must ensure that care plans are kept under review and updated as necessary. (Good progress has been made). The registered person must ensure that the records are up to date and accurate. this should include: forms being filled out in full, forms signed and dated, photographs of residents, details of current care needs and details of how needs are to be met. (Good progress has been made). The person registered must consider the allocation of staffing hours to ensure that residents care, social and environmental needs are met, with full provision of care staff, laundry staff and cleaning staff. This should also include management and administrative tasks which staff carry out exclusive to care. (The organisation has submitted a proposal which is currently being considered). The person registered must ensure that a programme of regular staff supervision is carried out so that all staff Timescale for action 1st September 2005 1st September 2005 2. OP 37 17 3. OP 27 18(1)(a) 27th June 2005 4. OP 36 18(2) 27th June 2005 Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 21 5. OP 8 18(1)(c)(i ) 6. OP 19 & 21 23(2)(b)& (d) 7. OP 26 23(2)(d) 8. OP 30 18(1)(c)(i ) receive a minimum of 6 supervision sessions a year. (Some progress has been made). The person registered must ensure that all care staff receive training in Tissue Viability in order to assist them in completing assessments of residents risk of developing pressure sores and know what action to take when risks are indentified. As well as pressure relieving equipment, this will include nutritional assessments, dementia as an indicator and recording and monitoring. (The Responsible Individual has reported difficulties in obtaining this training from the Tissue Viability Specialist Nurse). The person registered must submit a plan showing the timescales for the refurbishment of the remaining parts of the building. The person registered must ensure that those areas of the home that not always visible are cleaned to infection control standards. the person registered must ensure that staff have a programme of training in mental health in order to meet the needs of those 4 in this Category 1st October 2005 1st September 2005 27th July 2005 31st October 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP 16 Good Practice Recommendations The person registered should consider any potential barrier to some residents being able to openly express Version 1.30 Page 22 Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc 2. OP 37 dissatisfaction with any aspect of the service. Consideration should be given to adopting the draft preadmission assessment document as it is more comprehensive than the current format. Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hungerford House D51_D01_S28283_HUNGERFORDHOUSE_V187459_290605_Stage4.doc Version 1.30 Page 24 - 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!