Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Langton House Wharf Road Wroughton Swindon Wiltshire SN4 9LF The quality rating for this care home is:
two star good 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: Roy Gregory
Date: 1 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect 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 39 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home
Name of care home: Address: Langton House Wharf Road Wroughton Swindon Wiltshire SN4 9LF 01793812661 01793845439 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Alice Jane Blackett Type of registration: Number of places registered: Swindon Borough Council care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Intermediate care may only be provided for 11 people in the area known as the rehabilitation unit; 9 of which do not exceed 8 weeks and 2 of which do not exceed 16 weeks in any one episode. The Home may offer up to 2 places on a permanent basis at any one time if people receive intermediate care, short term or respite care. The Home may provide care and accommodation for up to 2 service users aged over 55 years and under 65 years at any one time, who are intermediate care, short term care or respite care. Date of last inspection Brief description of the care home Langton House is a two-storey purpose built care home providing care and accommodation for up to 41 older people. Twelve of the places are within a rehabilitation unit that provides short-term care for people leaving hospital, to enable Care Homes for Older People
Page 4 of 39 Over 65 40 0 Brief description of the care home them to regain independent living skills and thus return home. The home is situated in the village of Wroughton, South of Swindon. There is some parking on site and in a nearby cul-de-sac, and public transport in the area is good. Local amenities include doctors surgeries, shops and a library. The home is one of a number owned and managed by Swindon Borough Council, and most residents are placed by that authority. Those living in the home have single bedrooms. Five of these have en-suite facilities, otherwise there are convenient toilets, all unisex, around the building. All bedrooms have wash hand basins. The two floors are connected by passenger lift. The home sits in large grounds and includes an enclosed courtyard that is easily accessed from one of the sitting areas. The weekly fee is £405. Care Homes for Older People Page 5 of 39 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: two star good 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: We visited Langton House unannounced on Wednesday 8th October 2008 between 9:50 a.m. and 6:05 p.m. and returned the following day from 9:30 a.m. to 4:30 p.m. Our pharmacist inspector visited on Friday 10th October 2008 between 10:15 a.m. and 4:00 p.m. to look at all aspects of medication practice in the home. During the inspection there was direct contact with a number of residents, in the communal rooms and individual rooms. We joined four residents for lunch in the dining room on the first day, and three rehabilitation unit users on the second day. This allowed for observation of the service of meals as well as conversation with people about different aspects of their experience. We visited all parts of the home. Jane Blackett, the registered manager, was unavailable throughout the inspection time, Care Homes for Older People
Page 6 of 39 but was available for a lengthy feedback telephone call the following week. We spoke with various staff on duty, including team leaders, support and senior support workers, housekeepers, and the chef. Documentation examined during the inspection included a sample of care plans and records of care, medication records, evidence of activities provided, complaint records, accident records and records of staff training and supervision. Prior to the inspection, Jane Blackett had returned the home’s Annual Quality Assurance Assessment, which gave some descriptive and numerical information. We also sent out a number of survey questionnaires. These were returned to us by two members of staff, two GPs and an unidentified health professional. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visits to the home. They take into account the views and experiences of people who live there. What the care home does well: The rehabilitation unit is a part of the home that accommodates people for a short period after a hospital stay, to help them regain and practice daily living and mobility skills before moving back to their homes in the community. As well as care staff provided by Langton House, the unit had nurse staff and occupational and physiotherapists provided by the Primary Care Trust. This meant people got coordinated professional help, including staff liaison with their community-based counterparts. People had weekly goal-setting meetings. We looked at the discharge summary for a person who was going home from the unit. It demonstrated how they had made progress in each assessed area of need, so that they were ready to resume independent living. The purpose and success of rehabilitation could be tracked from the initial hospital-based assessment, through monitoring records in the home, to the discharge summary. People staying in the rehabilitation unit told us they had a clear understanding of what they were trying to achieve. A person said they were impressed by the co-ordination of services. They expected to return home shortly. They were sure this was to be sooner, and more successful, than if they had remained in hospital. The home’s care plans were written in person-centred terms, starting with communication needs. Through the different sections of care plans there was some emphasis on peoples abilities and strengths, as well as identifying needs and wishes. Peoples diverse needs were recognised and planned for. A senior support worker had responsibility for reviewing care plans every month. Members of staff told us they found the plans meaningful and accessible. Residents we spoke with were aware of care plans, and said staff carried out agreed care tasks. One resident spoke of some particular needs they had at the time. We found their care plan reflected their own concerns and set out strategies for working with the person. Care workers kept good records of the care they provided, which demonstrated care plans were followed. There was a comprehensive handover of information between shifts of carers. It was apparent from the daily work of the home, and from records, that staff were attentive to indicators of ill health, and that there were good relationships with a range of health care professionals in the community. This was helped by the fact some health care staff work in the rehabilitation unit. We observed safe medication administration. We checked some weekly medicine dose boxes with medicine records and found these agreed, indicating people living in the home were receiving their medicines correctly. People told us of a recent cheese and wine evening with music, which they had enjoyed. Some people described a Christmas shopping trip that had been arranged in 2007. They hoped this was to be repeated. Sometimes entertainers were arranged to come in to the home. There was a church service every Sunday. We saw that visitors came to the home throughout the day. People chose between communal and private rooms for seeing visitors. An internal quality survey in August 2008 had shown that people living in the home, and their visitors, were equally satisfied that arrangements for keeping in contact with families and friends were good. In terms of everyday living, people said they got up and went to bed when they chose. Some people liked to spend a lot of time in their own rooms whilst others had favourite sitting places around the Care Homes for Older People Page 8 of 39 home. The home’s chef has worked there for several years. He confirmed that he had regular meetings with a dietician who visits the rehabilitation unit. There was clear guidance in the kitchen about individual dietary needs. People could choose to have meals delivered to their rooms, and these were served first, and individually labelled, to ensure they were delivered hot. Most food served was locally sourced and cakes were homemade. In the dining room, service by staff was individual and attentive. Where anyone needed assistance to eat, this was given carefully and discretely. There was a pleasant atmosphere and people were unhurried. We saw some good examples of people being provided with meals early or late, to fit with other demands on their day. The homes log of complaints and concerns showed in each case how matters had been pursued and what the outcomes had been. Complainants were sent letters to summarise how their complaint had been investigated and what had been done about it, including apologies as appropriate and details of any changes made to the home’s practices to ensure avoidance of similar shortfalls in the future. Issues above a certain threshold of seriousness were referred on to the Swindon Borough customer liaison officer. A resident told us they would have no difficulty raising any complaint with management. There was evidence of individual members of staff receiving re-training and being committed to improvement plans as a direct result of complaints by people using the service. We found high standards of cleaning in all parts of the home. There were no unpleasant odours anywhere. The home provided eight support staff on morning shifts and seven on the later shift. In each case, shift numbers included a senior support worker. We observed very good interactions between staff and residents. Staff at all levels displayed motivation to provide a good service. Staff told us they saw staffing numbers as appropriate to the demands on their time. Our observations were that staff were not rushed, and there were plenty of staff at meal times. Residents told us staff were readily available, and responded promptly to call bells. Staff in the home had access to a wide range of relevant training. Team leaders were qualified to NVQ (National Vocational Qualification) level 4 and there were high rates of NVQ achievement among the whole staff group. Staff that we spoke with saw training availability and quality as a strength of the home. Training records showed that staff members undertook essential training, and regular refreshers, as necessary. There was an effective chain of management, so in the absence of Jane Blackett, the registered manager, team leaders were familiar with accessing and activating all the management systems in use. The senior team were backed up by line management from Swindon Borough Council, whose regular monitoring reports showed attention to detail, and recorded a lot of direct contact with residents and visitors. Staff received one-to-one supervision approximately six-weekly. Support workers confirmed they were required to take the care plans of their key residents to supervision meetings, which is good practice as it puts an emphasis on the difference Care Homes for Older People Page 9 of 39 the support worker can make to the residents quality of life. What has improved since the last inspection? What they could do better: We found some shortfalls of information in care plans. For example, a person was in receipt of prescribed nutritional supplement drinks, but there was no mention of this in their plan. Monthly review of plans is a substantial task, and it may be appropriate to particularly concentrate on one different area of care, such as nutrition, community contact and so on, each month. All key workers could be asked to consider and report on the issue as it related to their key residents. Where people had specific medical conditions, such as Parkinsonism, this would be shown at the front of the care plan, but subsequent contents rarely made any reference to the condition. Care workers would benefit from knowing why, in the light of a condition, a person may have particular needs in how care should be provided, and how certain care needs were linked. It would be preferable to always institute a discrete pressure area risk assessment. This should show in detail how risk was assessed, when and how decisions were made about how to reduce risk, and what preventive care could be undertaken to avoid risks arising, for example by promoting mobility, use of skin creams or ensuring regular review of nutritional needs. Care Homes for Older People Page 10 of 39 Staff supported some people to self-administer their medicines. When medicines are given to people to look after, the safe practice is to leave them in the containers as supplied and labelled by the pharmacy. For one person, liaison with the pharmacy was desirable rather than staff transferring medication to other containers as was happening. Records for the application and use of some prescribed skin and topical treatments were often not recorded, particularly when staff providing personal care applied these. In some cases there were no specific directions about using these creams in the care plans we looked at. These records are important in order to see that each person is receiving the correct treatment. Some medicines were prescribed to use only when required. Staff we spoke to had a good knowledge of people living in the home and were able to explain about when these medicines were used. However, there was not sufficient information on the medicine records or in the care plans to give clear written direction to all staff about how such medicines were intended to be used. Care plans must have protocols for ‘as needed’ or variable dose medicines, for the protection of both residents and staff. The home had made recent attempts to gather activity suggestions from residents, both by residents meetings and a questionnaire exercise. This had yielded some ideas, which in turn had been addressed by way of an action plan. For example, people had wanted better information about churches in the area. If the home were able to develop an activity leader role, and perhaps use one of the under-used sitting rooms as an activities base, this aspect of care provision could be better co-ordinated and individual needs and wishes pursued to a greater extent. The ambience of the dining room at lunch time was let down by people being asked immediately after their meal, what choice they would like to make for lunch the following day. If it is necessary to gain an idea of quantities in advance, people should be asked to make a choice at a more appropriate time, but ideally the home should aim to provide for choice at the table. The home had records of the use of bed rails, but staff were not fully aware of the Department of Health guidelines and they should be revisited. There was a large lounge/dining area between the kitchen and entrance hall. The home had two other sitting rooms, one upstairs and one down, which were said to be little used. This was not surprising as each was being used partly for storage, and they had mismatched, unattractive furniture. The downstairs sitting room had a potentially attractive view of the garden through picture windows, but the chairs were arranged to be inward-looking. One person liked to sit in the entrance hall, as it was an airy space with a lot of comings and goings. This was a business-like rather than homely area. There was a lot of scope for making it a welcoming room in its own right, where information about activities and menus could be displayed. It would also be worth creating a separate entrance for the rehabilitation unit, to reduce the impact of its use on the permanent residents of the home. Doors to toilets and bathrooms each had the same rather childish signage, which did Care Homes for Older People Page 11 of 39 not differentiate those rooms that contained toilets from those that did not. Although people were welcome to bring in personal possessions including items of furniture, bedrooms generally looked as if they belonged to the home rather than to the individual. The chairs provided to rooms were often also commodes. The hairdressing room had been refitted with a back wash sink, but there was no attempt to make it an attractive place to receive a service. Some colour and posters would make a considerable difference to peoples experience. The rehabilitation unit had some adjustable height beds, but these were not available to all rehabilitation rooms. This could impact on whether a place could be provided at the right time for a potential rehabilitation resident, and also has implications for the health and safety of staff working in the unit. It was noted that access to sluice rooms and the hairdressing room was not restricted. It is recommended to assess the risk posed by unrestricted access to such parts of the home, for example by a disoriented person on their own, and to implement any precautions indicated by such an assessment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 12 of 39 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 13 of 39 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are admitted only after an assessment that demonstrates the home can meet their needs. People admitted solely for short-term rehabilitation are helped to maximise their independence and return home. Evidence: The manager and team leaders share the task of assessing prospective residents. There was a requirement at the previous inspection that assessments must always contain certain core information. We found this requirement had been addressed. We saw a very full assessment of a person who had recently moved into the home. It was based largely on a visit to them whilst they were in hospital, which they recalled. Another resident we spoke to did not recall much of the assessment process, but records showed they had visited the home together with their care manager, when a full assessment had taken place. Shortly afterwards they were sent a letter confirming
Care Homes for Older People Page 14 of 39 Evidence: the home would be able to meet their needs. Almost all people at the home were funded by Swindon Borough Council, so there were also community care assessments that demonstrated why there was a need for a care home placement. The homes assessments dovetailed with these, but also showed that some referrals were declined because the home would not be able to meet all the needs presented by an individual. Placements were reviewed after four weeks to ensure they were appropriate. One person told us they already knew the home well when they were admitted as a resident, because they had previously stayed in the rehabilitation unit. This is a part of the home that accommodates people for a short period after a hospital stay, to help them regain and practice daily living and mobility skills before moving back to their homes in the community. The unit comprised nine places for people likely to be rehabilitated home within six weeks, and two places for people with higher dependency levels, who might stay up to twelve weeks. A high dependency respite room, which had mostly regular users, was also looked after by the rehabilitation unit. As well as care staff provided by Langton House, the unit has a nurse staff and occupational and physiotherapists provided by the Primary Care Trust. This means people get co-ordinated professional help, including staff liaison with their communitybased counterparts. People have weekly goal-setting meetings. The unit has a lounge where there are some group meetings and activities, including information sessions about pressure area care, hydration and so on, to further promote self-care. A kitchenette enabled people to practice getting drinks and meals, although main meals were taken in the dining room of the main home. The bedroom area merged into the main part of the home. We looked at the discharge summary for a person who was going home from the unit. It demonstrated how they had made progress in each assessed area of need, so that they were ready to resume independent living. Arrangements were in place for the community nurse to continue providing some necessary treatment. The purpose and success of rehabilitation could be tracked from the initial hospital-based assessment, through monitoring records in the home, to the discharge summary. One of the team leaders in the home was assigned to the rehabilitation unit. She said there was reliance on hospital assessments, but she visited people if there appeared to be special circumstances that might undermine the prospects for rehabilitation. For example, acceptance of a current referred person was dependant on additional information being provided by the hospital about mobility issues. The team leader also told us that discharge home from the unit could be held back whilst community mental health support was sought. In particular, they had found that not all people could develop competence to self-administer medicines, and it was unsafe to discharge them until a community support for this issue was in place.
Care Homes for Older People Page 15 of 39 Evidence: People staying in the rehabilitation unit told us they were very comfortable. They had a clear understanding of what they were trying to achieve. A person said they were impressed by the co-ordination of services. They expected to return home shortly. They were sure this was to be sooner, and more successful, than if they had remained in hospital. A visitor to another person in the rehabilitation unit also spoke about the successful joint working of different disciplines. They thought their relatives stay had made all the difference, both physically and mentally. Forms used for monitoring peoples rehabilitation included their own daily estimates of progress made against agreed targets. If, after four weeks, rehabilitation appeared to be an unlikely outcome, a family meeting was held to plan an estimated discharge date, and to begin considering residential or nursing care options in case a return home proved not to be possible. A person staying for rehabilitation told us they did not know how they would have managed without this opportunity. They spoke of clear improvement made in a week. Their visiting relative also remarked on evident progress. They were impressed by the quality and number of staff devoted to the rehabilitation function. Care Homes for Older People Page 16 of 39 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual care plans direct how care is to be provided and receive regular review. There is prompt awareness of and response to health needs, including good liaison with health professionals and emergency services, although care planning with regard to specific medical conditions can be improved. The approach to the care task is based on respect for diversity and privacy. There are generally safe arrangements in place for the management of medicines but we highlight a few weaknesses where more attention to detail is needed so as to always protect people living in the home from any unnecessary risks with medication. Evidence: Following requirements made at the previous inspection, care plans were much improved in content and usability. They were signed by the people they related to, along with their key worker, to show they were agreed documents. Key workers were required to take care plans to their individual supervision meetings, to discuss how the home was working to achieve care plan aims. The plans were written in personcentred terms, starting with communication needs. Through the different sections of
Care Homes for Older People Page 17 of 39 Evidence: care plans there was some emphasis on peoples abilities and strengths, as well as identifying needs and wishes. Peoples diverse needs were recognised and planned for. A senior support worker had delegated responsibility for reviewing care plans every month. If changes were indicated, the relevant part of the plan would be re-typed, so the plans in place were known to be current. Replaced pages were archived, so changes could be tracked if necessary. In addition to the full care plans, people had short plans for daily living as a quick reference for care workers to ensure essential day-to-day needs were met. These included night care plans, for example, one persons night plan showed they would be checked on at two-hourly intervals through the night. Members of staff told us they found the plans meaningful and accessible. Residents we spoke with were aware of care plans, and said staff carried out agreed care tasks. One resident spoke of some particular needs they had at the time. We found their care plan reflected their own concerns and set out strategies for working with the person. Their key worker was able to discuss the persons needs in depth, and had in fact arranged a review meeting with the person and relevant external advocates on the day of our visit. Records of a review for another resident, which had included their social worker, a relative, key worker and home manager, showed a lot of ground had been covered. Amendments to the care plan had been made, and the outcome matched with what we were told by the person concerned and by staff. All care plans considered whether people had needs in certain defined areas, such as oral health and feet issues. The question of hearing loss was notably absent and it was undertaken as a task that this would be added right away. Where people had specific medical conditions, such as Parkinsonism, this would be shown at the front of the care plan, but subsequent contents rarely made any reference to the condition. Care workers would benefit from knowing why, in the light of a condition, a person may have particular needs in how care should be provided, and how certain care needs were linked. We found some shortfalls of information in care plans. For example, someones nutritional needs were considered and planned for, but the plan did not show that they needed assistance to cut up their food, which was very important to them. Another person was in receipt of prescribed nutritional supplement drinks, but there was no mention of this in their plan. Monthly review of plans is a substantial task, and it may be appropriate to particularly concentrate on one different area of care, such as nutrition, community contact and so on, each month. All key workers could be asked to consider and report on the issue as it related to their key residents. There were moving and handling assessments for all people to ensure care was
Care Homes for Older People Page 18 of 39 Evidence: delivered safely. There was a general risk assessment, from which more specific assessments could be generated if indicated. Pressure area care was included in the general risk assessment. We saw how an assessed medium risk had been reduced to low risk by use of pressure relieving equipment and daily monitoring of skin integrity. However, it would be preferable to always institute a discrete pressure area risk assessment. This should show in detail how risk was assessed, when and how decisions were made about how to reduce risk, and what preventive care could be undertaken to avoid risks arising, for example by promoting mobility, use of skin creams or ensuring regular review of nutritional needs. Care workers kept good records of the care they provided, which demonstrated care plans were followed. There was a comprehensive handover of information between shifts of carers. It was apparent from the daily work of the home, and from records, that staff were attentive to indicators of ill health, and that there were good relationships with a range of health care professionals in the community. This was helped by the fact some health care staff work in the rehabilitation unit. Free chiropody was readily available. Two GPs, from different surgeries, returned survey forms to us. Each indicated complete satisfaction with the way the home works. They experienced clear communication and partnership working with the home. They saw medications as appropriately managed and considered the home took appropriate decisions if a persons needs could no longer be met. One added, Very caring staff; residents appear happy and well cared for. We asked a number of residents if they felt their privacy and dignity were well provided for. All were very satisfied about this aspect of living in the home. People were offered the choice of a key to their bedroom. They could install a telephone in their room. A public telephone was available, but not well positioned to provide for privacy. However, we were told that in practice, if people wished to make or receive a phone call, they were assisted to do so in the privacy of an office. Peoples choices of using communal facilities, or remaining in their own rooms, were respected. Care and health-related tasks took place in the privacy of bedrooms or bathrooms. We were concerned about an overheard interaction between a member of staff and a resident. Senior staff shared the concern and acted upon it swiftly. This contrasted with all other observations of communications between staff and residents. People in the home, and members of staff, spoke in positive terms about the key worker system, through which individual needs and experiences were recognised and promoted. As part of this key inspection but on a separate day one of our (The Commission for Social Care Inspection) pharmacist inspectors looked at some of the arrangements for
Care Homes for Older People Page 19 of 39 Evidence: the management of medicines in both units. The pharmacist looked at some stocks and storage arrangements for medicines, some medication records and procedures. We visited some bedrooms and saw carers administer some medicines at lunchtime. We talked to six members of staff who were involved in some way with medication. Staff who have undertaken training about the safe handling of medicines were responsible for the management and administration of medicines for people living in this home. Staff supported some people to look after and self-administer their medicines when a risk assessment showed this was safe for everyone in the home. Lockable storage was provided in bedrooms to keep these medicines safe for everyone in the home. When medicines are given to these people to look after, the safest practice is to leave them in the containers as supplied and labelled by the pharmacy. We saw that the risk assessment for one person showed a week at a time was best supplied to them. Liaison with the pharmacy about alternative arrangements may achieve this rather than staff transferring medication to other containers. We observed safe practices on one unit at lunchtime when two carers checked each other and administered some medicines, each recording this appropriately. We checked some weekly medicine dose boxes with medicine records and found these agreed, indicating people living in the home were receiving their medicines correctly. We looked at some of the records the home keeps for each person about the medicines received, administered and leaving the home or disposed of through the pharmacy. Complete and accurate records about medication are important so that there is a full account of the medicines the home is responsible for on behalf of the people living here and so that people are not at risk from mistakes, such as receiving their medicines incorrectly. The sample of records we looked at generally appeared to be up to date and indicated that the medication needed was available in the home. We found information about allergies in care plans, but we advise that the section on the medicine administration charts should be completed rather than left blank so that this information is readily available when staff are dealing with medication. Some other exceptions were that where variable doses were prescribed (10 to 15ml for example), the actual doses administered were not always recorded, so it was not clear what quantity of medication these people had received. Records for the application and use of some prescribed skin and topical treatments were often not recorded, particularly when staff providing personal care applied these. In some cases there were no specific directions about using these creams and we could not find this in the care plans we looked at. These records are important in order to see that each person is receiving the correct treatment. Two members of staff signed handwritten entries on medicine charts, indicating they
Care Homes for Older People Page 20 of 39 Evidence: had checked the details were accurate. We found this was the case except for one tablet for one person where the recently dispensed box of tablets was labelled with a different dose to that on the medicine chart. Staff immediately contacted the hospital pharmacy to check this. So that all medicines can be accounted for, the records for items returned to the pharmacy must be complete with information about the strength and formulation of each product. All medication returned must be accounted for, including any doses returned in the weekly monitored dose system boxes that were used in part of the home. These were not recorded at the time of the inspection. Some medicines were prescribed to use only when required. Staff we spoke to had a good knowledge of people living in the home and were able to explain about when these medicines were used. We found, however, there was not sufficient or any information on the medicine records or in the care plans to give clear written direction to all staff about how such medicines were intended to be used to meet identified needs in a consistent way and in taking into account the provisions of the Mental Capacity Act 2005, (for example for pain relief, night sedation or laxatives). We saw that following the last inspection medicine records now included details about individual administration methods. There were also risk assessments for medication, but these were often generalised and not particularly clear. We looked in some care plans where people had particular health needs, for example diabetes. In one plan there was no mention about this or information about how to manage this. In another plan there was no information about possible special considerations because of treatment with anticoagulants. There were safe arrangements for storing medication centrally in each unit and we found this was well organised. The fridge may need some adjustment as records showed the maximum temperature was sometimes above 8°C (the safe maximum for a medicine fridge). Checks we made with the controlled medicine record book were in order. We noticed that opened containers of some creams and ointments that were in use, were kept in bedrooms. These arrangements must be checked on an individual basis as being safe for everyone in the home. Liquid medicines, drops, creams and ointments had dates of opening written on the containers to help with making sure that these were replaced after appropriate periods so as to reduce risks from microbial contamination. We recommend this practice be used for any containers of tablets or capsules as this also helps with stock control and audit checks that the right quantities have been used. Staff can also keep better
Care Homes for Older People Page 21 of 39 Evidence: control of medication if the quantity of each medicine remaining (if any) at the end of the month is carried forward with a record on the next medicine chart. In discussion, staff told us there were no equality or diversity issues that would impact on medication and we saw in some care plans people’s choice noted for staff to look after and administer their medicines. Information supplied to us before the inspection on the Annual Quality Assurance Assessment form indicated there was a policy for the control, storage, disposal, recording and administration of medicines that was reviewed in September 2004. We saw different policies on each unit so that staff had guidance about how the provider expected medication to be handled in a safe way. We recommend that these are reviewed and updated so as to provide specific up to date guidance related to this home. For example one policy (that had no date to show when written) made reference to the Registered Homes Act 1984, which was succeeded by the Care Standards Act in 2000. Care Homes for Older People Page 22 of 39 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. The home seeks to identify people’s social, religious and recreational needs, and goes some way to provide for these. There are no barriers to contact with family and friends, and people are able to make some decisions about every day life. People are offered a choice of good quality meals, which take account of dietary needs and preferences and are served in a pleasant environment. Evidence: The home had a policy of promoting some organised activity each day. There was a rolling two-weekly cycle of suggestions for staff to use, including music and movement, gardening, reminiscence, word games and skittles. Mostly, activities were offered to people in the main sitting room and led by a senior carer. An activities log showed that something was made available most days, and recorded who had taken part. We saw a game of hangman taking place with ten people. The member of staff recognised people were not fully engaged and offered a quiz instead, which was accepted. When one person digressed about something that caught their imagination, the worker was able to give time to this and developed a conversation. Care plans included quite full personal history information. For one person, for
Care Homes for Older People Page 23 of 39 Evidence: example, there was information about where they had previously lived, their interests and previous activities, important relationships and pets. There was little evidence of active use of such detail to promote activity and occupational needs. One person told us they had a particular interest in all sports and would like to join others for watching sports events on television, or to have a sports quiz. We saw that the home had made recent attempts to gather activity suggestions from residents, both by residents meetings and a questionnaire exercise. This had yielded some ideas, which in turn had been addressed by way of an action plan. For example, people had wanted better information about churches in the area. If the home were able to develop an activity leader role, and perhaps use one of the under-used sitting rooms as an activities base, this aspect of care provision could be better co-ordinated and individual needs and wishes pursued to a greater extent. People told us of a recent cheese and wine evening with music, which they had enjoyed. Some people described a Christmas shopping trip that had been arranged in 2007. They hoped this was to be repeated. Sometimes entertainers were arranged to come in to the home. There was a church service every Sunday. Information about activities in the home was not well displayed, but there was a newsletter for residents that could be further developed. We saw that visitors came to the home throughout the day. People chose between communal and private rooms for seeing visitors. An internal quality survey in August 2008 had shown that people living in the home, and their visitors, were equally satisfied that arrangements for keeping in contact with families and friends were good. In terms of every day living, people said they got up and went to bed when they chose. Some people liked to spend a lot of time in their own rooms whilst others had favourite sitting places around the home. A shop in the dining room was open each lunchtime to enable people to buy sweets, toiletries and so on. There was also a hairdressing room. The home had the benefit of a chef who has worked there for several years. He confirmed that he has regular meetings with a dietician who visits the rehabilitation unit. There was clear guidance in the kitchen about individual dietary needs. People could choose to have meals delivered to their rooms, and these were served first, and individually labelled, to ensure they were delivered hot. Breakfast was available to 11:00 a.m. Lunch was the main meal of the day. Most people chose to eat lunch in the dining room. There was a choice of two lunches served, and on Fridays, three choices, although all of fish. One person told us they would prefer a non-fish option to be available then. Otherwise, there were only positive comments about the food. At tea time there were two choices of meal. Most food served was locally sourced and cakes were home-made. In the dining room, service by staff was individual and attentive.
Care Homes for Older People Page 24 of 39 Evidence: Where anyone needed assistance to eat, this was given carefully and discretely. There was a pleasant atmosphere and people were unhurried. The ambience was let down by people being asked immediately after their meal, what choice they would like to make for lunch the following day. This was done to assist with quantity estimation, but the chef said that in fact realistic estimates could be made. If it is necessary to gain an idea of quantities in advance, people should be asked to make a choice at a more appropriate time, but ideally the home should aim to provide for choice at the table. Minutes of residents meetings showed that meals were regularly discussed. A person told us that they had requested a particular meal be tried, we saw this in the minutes and the chef said this suggestion had been incorporated into the menu. People did not know before lunch what the choices were to be. The menu of the day was written on a white board, but it was difficult to read and was near the kitchen, rather that near the entrance to the dining room. We saw some good examples of people being provided with meals early or late, to fit with other demands on their day. People staying in the rehabilitation unit took their meals alongside residents of the home. One person staying for rehabilitation said he felt a bit of an intruder on account of this, but it did not present as an obvious issue for residents of the home. Care Homes for Older People Page 25 of 39 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. Evidence: The homes internal quality assurance exercise showed that all relatives who were asked, and most residents, knew how to make a complaint. There was a sound complaints policy and procedure in place. The homes log of complaints and concerns showed twelve had been received and investigated since our previous inspection. In each case it was clear how matters had been pursued and what the outcomes had been. Complainants were sent letters to summarise how their complaint had been investigated and what had been done about it, including apologies as appropriate and details of any changes made to the homes practices to ensure avoidance of similar shortfalls in the future. Issues above a certain threshold of seriousness were referred on to the Swindon Borough customer liaison officer. A resident told us they would have no difficulty raising any complaint with management, and the record showed they had in fact done so, and were satisfied with the response. There was evidence of individual members of staff receiving re-training and being committed to improvement plans as a direct result of complaints by people using the service. There was evidence that all staff received training in abuse awareness and how to
Care Homes for Older People Page 26 of 39 Evidence: respond to any suspicion of abuse. There was prominent information in the entrance hall about how to access external advocacy services. Advice and assistance had been given to a person in the rehabilitation unit to enable them to pursue a complaint about health care issues through the local hospital Patient Advice and Liaison Service. There was some use of bed rails in the home. As these entail some degree of restraint the Department of Health (DoH) has issued guidelines about their safe use, based on a risk assessment approach. The home had records of the use of bed rails, but staff were not fully aware of the DoH guidelines and they should be revisited. Care Homes for Older People Page 27 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well-maintained environment, although there is considerable scope for making it more welcoming and homely. Personal accommodation is functional. Communal and private areas are kept clean & hygienic to a high standard. Evidence: The hub of activity was the lounge/dining area, a large room with the dining tables and chairs next to the kitchen servery and armchairs next to the entrance hall. There was good access from here to an enclosed patio. Views out to the front of the home, and road outside, were obscured by net curtains and not helped by considerable glare from the sun. An external awning would make a difference here. The home had two other sitting rooms, one upstairs and one down, which were said to be little used. This was not surprising as each was being used partly for storage, and they had mismatched, unattractive furniture. The downstairs sitting room had a potentially attractive view of the garden through picture windows, but the chairs were arranged to be inwardlooking. A fridge in the room was not switched on and had mould inside. One person told us they sometimes had a meal in this room, and others said they occasionally met with visitors there. One person liked to sit in the entrance hall, as it was an airy space with a lot of comings and goings. This was a business-like rather than homely area. There was a lot of scope for making it a welcoming room in its own right, where information about activities and menus could be displayed. It would also be worth
Care Homes for Older People Page 28 of 39 Evidence: creating a separate entrance for the rehabilitation unit, to reduce the impact of its use on the permanent residents of the home. Corridors were wide and well lit, but lacked interest. Doors to toilets and bathrooms each had the same rather childish signage, which did not differentiate those rooms that contained toilets from those that did not. These rooms were well designed for effective cleaning and we found high standards of cleaning in all parts of the home. There was evidence of use of DoH Essential Steps infection control guidance and there were no unpleasant odours anywhere. In one bathroom there was a chest of drawers containing an assortment of skin creams and hair products, none of which were labelled. This could represent a compromise of infection control standards. Sluices were kept very clean and commode liners were numbered, although we saw one commode liner in a room of a different number. The laundry, although upstairs, was well equipped and a laundry worker was employed, so it worked efficiently. Bedrooms met National Minimum Standards for size, but only just in many cases and configuration of furniture was dictated by vanity unit placement. Although people were welcome to bring in personal possessions including items of furniture, rooms generally looked as if they belonged to the home rather than to the individual. The chairs provided to rooms were often also commodes. Residents were asked if they would like two chairs in their room, which is the National Minimum Standard, and several had declined the offer, probably for space considerations. Rooms were lockable and also had lockable drawers and wardrobes. Housekeepers told us it was rare for any resident to choose to lock their rooms. The rehabilitation unit had some adjustable height beds, but these were not available to all rehabilitation rooms. This could impact on whether a place could be provided at the right time for a potential rehabilitation resident, and also has implications for the health and safety of staff working in the unit. There was a hairdressing room upstairs, which was used a great deal. This had been refitted with a back wash sink, but there was no attempt to make it an attractive place to receive a service. The mirror behind the sink was too high for most people to see themselves in. Some colour and posters would make a considerable difference to peoples experience. There were records of routine checks to ensure call bells were working and hot water was delivered at a safe temperature. Maintenance audits ensured attention to problems arising before they became significant. Care Homes for Older People Page 29 of 39 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have support from competent staff who are provided in numbers sufficient to maintain care. People are protected by sound recruitment practices that ensure nobody works at the home until checks on their background are complete. The provider invests in the development of staff, to maintain a trained and mainly qualified team. Evidence: The home provided eight support staff on morning shifts and seven on the later shift. In each case, shift numbers included a senior support worker. They sometimes included bank workers, employed by Swindon Borough to work in any of its homes, or agency workers. From 10:00 p.m. the home had four support staff on duty through the night. One of these came on duty at 9:30 p.m. to take a handover from day staff, and one of the morning staff started half an hour before the others for the same purpose. We observed very good interactions between staff and residents. Staff at all levels displayed motivation to provide a good service. Feedback from staff members responding to our survey was that they felt part of a supportive team, and provided with good training and supervision. There were no negative comments relating to staffing or management. The staff group included team leaders, who took a lead on care planning, supervision
Care Homes for Older People Page 30 of 39 Evidence: of staff and liaison with outside agencies. The home had been developing core staff groups for the main home and rehabilitation unit respectively, and the manager and team leader for the rehabilitation unit said the benefits of continuity were being seen. In a small group discussion, staff told us they saw staffing numbers as appropriate to the demands on their time. Our observations were that staff were not rushed, and there were plenty of staff at meal times. Residents told us staff were readily available, and responded promptly to call bells. There was a system for automatic recording of call bell response times, which the management reviewed regularly to ensure people did not go unattended. As part of the Swindon Borough, staff in the home have access to a wide range of relevant training, provided in the home and with staff from other homes in the borough. Of 26 permanent support staff, 19 had obtained National Vocational Qualification (NVQ) in care to at least level 2 and others were working towards this through the Borough Councils rolling programme of NVQ training provision. Team leaders were qualified to NVQ level 4. Support workers had opportunities for progression to seniority. They also each acted as key workers to a small number of residents, which required them to ensure individual needs and wishes were met. People we spoke with in the home usually knew who their key workers were. Staff that we spoke with saw training availability and quality as a strength of the home. Training records demonstrated that staff members undertook essential training, and regular refreshers, as necessary. There was a sound induction procedure in place for new staff, closely followed by attendance at mandatory training. For example, a person who had begun employment in January 2008 had completed induction, and over the following six months completed training in manual handling, medication practice, principles of care, abuse awareness, emergency first aid, food handling and general health and safety. The homes training plan showed that a number of places on courses were booked for staff over coming months. Gradually staff were attending Swindon Borough Councils, Yesterday, today and tomorrow course in dementia care. When new staff were recruited, the process was conducted by Swindon Borough Council, so it was from there that reference requests, for example, were sent out and subsequently retained, along with evidence of interviews. However, the home retained copies of application forms, together with evidence of Criminal Records Bureau (CRB) disclosures having been received prior to people commencing duties. There was evidence that due regard was paid to diversity issues in the recruitment process. The home had a good record of staff retention. Care Homes for Older People Page 31 of 39 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from an effective chain of management. The views of people living in the home are sought and acted on to help run the home in their best interests. The support people receive is enhanced by regular supervision of the workforce. People are safeguarded by the arrangements made for handling their finances. The environment is safe for residents and staff because of sound health and safety policies and practices, subject to enhancing the safety of some identified places. Evidence: There was an effective chain of management, so in the absence of Jane Blackett, the registered manager, team leaders were familiar with accessing and activating all the management systems in use. A GP, responding to our survey, wrote, The manager Jane is responsive to suggestions and any issues raised. It appeared senior staff worked well as a team, with appropriate delegation of tasks. They were backed up by line management from Swindon Borough Council. Regular monitoring reports from there showed attention to detail, and were directed at improving the service received
Care Homes for Older People Page 32 of 39 Evidence: by people living at the home or receiving rehabilitation. The reports recorded a lot of direct contact with residents and visitors. They included a random audit of care plans, all complaints records were reviewed, and there were checks on staff supervision records, health and safety records including fire safety, residents cash accounts and use of medicines. Links between management and staff were strengthened by staff meetings held twomonthly. Minutes showed they covered a variety of operational and resident-specific issues. Night staff had separate meetings, as did housekeeping staff. A supervision matrix in the office showed staff received one-to-one supervision approximately sixweekly. Written records were kept. Support workers confirmed they were required to take the care plans of their key residents to supervision meetings, which is good practice as it puts an emphasis on the difference the support worker can make to the residents quality of life. Arrangements were made for night staff to receive supervision at the beginning or end of their shifts, sometimes in twos rather than singly. At the previous inspection, we recommended that residents meetings should be held at least quarterly. Four residents meetings had already been held during 2008, with another planned. The most recent had been attended by 19 residents, a good proportion of 28 permanent residents. The agenda had included discussions about meals, activities and possible uses of the amenities fund, with information and ideas forthcoming about all of these. There was also evidence in the home of surveys undertaken to find peoples perceptions of various aspects of life in the home. The newsletter could be developed as another means through which to invite feedback. Many residents accepted the availability of safe keeping for cash, which they could access at any time. A person told us they had asked for their money to be kept safe, and it was a great relief to them that this was done. We saw the cash management system in operation, with the settlement of peoples hairdressing bills. A team leader and another member of staff were double-checking and counter-signing every entry. Health and safety matters were monitored on a monthly basis, with resultant action planning for any shortfalls. There was statistical monitoring of every fall, so that common factors, such as location or time of day, could be identified and addressed. Accident and incident recording forms had body maps on the reverse. These records showed what actions had been taken in response, any outside professional attendance, and what actions were being taken to avoid recurrence. Signage was used around the home to warn of any hazardous activity in progress. However, it was noted that access to sluice rooms and the hairdressing room was not restricted. It is recommended to assess the risk posed by unrestricted access to such parts of the home, for example by a disoriented person on their own, and to implement any precautions indicated by such
Care Homes for Older People Page 33 of 39 Evidence: an assessment. Care Homes for Older People Page 34 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 35 of 39 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 8 12 Care plans must show how any specific medical conditions impact on a person’s care needs, and how needs in respect of the condition are to be monitored. Care workers would benefit from knowing why, in the light of a condition, a person may have particular needs in how care should be provided, and how certain care needs are linked. 30/11/2008 2 9 13 When medication is prescribed for use when required, as directed or with a variable dose, make sure there is always clear written direction to staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure 30/11/2008 Care Homes for Older People Page 36 of 39 there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned action. 3 9 13 Keep complete and accurate 30/11/2008 records for all medicines administered or leaving the home or disposed of. (This particularly relates to always recording the actual dose of medication administered where a variable dose is prescribed, to keeping records for the application of any prescribed medication that is applied topically and to keeping full records for any unwanted medicines that are disposed of.) This is to help make sure people receive the correct levels of medication and that all medicines can always be accounted for. 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 2 7 7 Consider having a special focus in each round of care plan reviews, to help add detail to plans. Pressure area risk and management should be subject of a specialist risk assessment to ensure it is always accorded high priority. Improve the risk assessments for medication so that they are clearer and individual to each person. Where creams or ointments are stored in bedrooms carry out risk assessments to make sure the arrangements are safe for everyone in thehome. 3 4 9 9 Care Homes for Older People Page 37 of 39 5 9 Review the medication policies and procedures to make sure staff have up to date direction that is specific to this home. Write the date on any containers of medicines when they are first opened to use and record the quantity of any stocks of medicines that are carried forward to the next medication cycle. This is to help with good stock rotation in accordance with the manufacturers’ or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. Make arrangements for the allergy box on each medicine chart to be completed accurately. Consider ways to enhance activity and occupational provision in line with individually assessed needs, for example by development of specialist staffing or creating a room as a base for certain activities. Aim to provide for choice of meal to be made at the table, and ensure choices represent true alternatives. Consider how best to display the daily menu. Ensure Department of Health guidelines are followed whenever bed rails are in use. Consider, with residents, how to make all parts of the home more homely, with particular attention to the entrance hall, sitting areas, hairdressing room and corridors. Consider the feasibility of creating a separate entrance for the rehabilitation unit. Personal skin and hair care products should not be kept in shared bathrooms. There should be a risk assessment regarding unrestricted access by residents to any part of the home that poses potential risks to them. 6 9 7 8 9 12 9 15 10 11 18 19 12 13 14 20 26 38 Care Homes for Older People Page 38 of 39 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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 39 of 39 - 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!
