Inspection on 28/03/08 for Le Brun House

This inspection was carried out on 28th March 2008.

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

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

Le Brun House 11/03/09

Le Brun House 15/05/07

Le Brun House 28/06/06

Le Brun House 13/02/06

Le Brun House 10/05/05

Le Brun House 29/10/04

Le Brun House 01/06/04

Le Brun House 07/07/03

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

CARE HOMES FOR OLDER PEOPLE Le Brun House 9 Prideaux Road Eastbourne East Sussex BN21 2NW Lead Inspector Kathryn Emmons Unannounced Inspection 28th March 2008 10:30 X10015.doc Version 1.40 Page 1 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 Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 2 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. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Le Brun House Address 9 Prideaux Road Eastbourne East Sussex BN21 2NW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01323 734447 01323 438528 enquirieis@lebrunhouse.co.uk Mrs Ilona Austen Mira Adams Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty (20). Service users accommodated must be older people aged sixty-five (65) years or over on admission. Service users only with a dementia type illness to be accommodated. Date of last inspection 15th May 2007 Brief Description of the Service: Le Brun House is a care home providing care and support to up to twenty people who have dementia. The home changed its registered in 2006 to accommodate people who have dementia prior to this it was care home for older people. The home is situated approximately one mile from Eastbourne town centre, with a main bus route within easy walking distance. The premises are a detached domestic house that has been extended over the years. Accommodation is provided on three floors with a passenger lift providing access to the first and second floor. Resident’s accommodation consists of twenty single bedrooms eighteen of which have their own toilet ensuite facilities with six bedrooms also having shower facilities. The communal facilities include a large combined lounge dining room, separate lounge leading into a conservatory and a small rear secure garden. The home statement of purpose states that it aims to provide quality tailored care to meet the needs of elderly service users with dementia. The fees for residential care are currently £400 to £650 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport, dry cleaning toiletries are additional costs. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A visit to the service took place on 28 March 2008 2007. This visit was unannounced and took place over 6.5 hours. The registered manager assisted the inspector during the visit. Care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Staff were spoken with and the care they provided was observed. We received 9 comment cards from residents and 3 from staff. We sent these out before the visit. We also received a completed self-audit document completed by the manager, to provide information before we did a site visit. We also looked at how the provider makes information about their service, including CSCI reports available to prospective service users. During the visit we spoke to 3 staff 8 residents. There were no visitors at the home during our visit. What the service does well: Residents are assessed before they come to live at the home so the manager can be clear needs can be met. Daily records and care plans inform staff how to deliver care per resident’s choice. There is an acknowledgement that residents are individuals and activities and hobbies are encouraged. There is an understanding from staff on how to interact with residents who may not use much verbal communication. The physical environment is of a high standard and meets resident’s needs. Staff recruitment is comprehensive and the manager ensures all checks are carried out before someone is offered employment. A quality assurance programme enables residents, relatives and other people involved with the service to make their views known. We received comments such as “I am satisfied”, “I have enjoyed working here and would be happy to come back” “my relative is a lot better since being here”. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Through pre admission assessment systems residents and relatives can be confident that residents assessed needs can be met when they are admitted to the home. Up to date information enables residents to make an informed choice regarding living at the service. Residents need to have written confirmation that their needs can be met if they chose to live at the service. EVIDENCE: Since the last inspection the statement of purpose and service user guide have been updated and a copy of the service user guide is in each bedroom. These two documents are available to residents and their relatives and inform them of the services they can expect if they live at the home. Details also include who the staff are and what jobs they do, what the environment is like and what to do if they have any concerns. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 9 All files we looked at had a copy of a contract, which had been signed by the resident or their relative. The manager confirmed that all residents were assessed prior to being admitted to the home but currently residents did not receive written confirmation that their needs could be met. The manager confirmed that this would now happen. Residents are able to visit the home before an offer of admission is made. The manager was able to demonstrate during the visit that she was able to understand resident’s needs and that would only admit residents who she was confident could have their needs met by the staff team. The service does not offer intermediate care. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments enable residents to have their needs met. Lack of incorrect recording of medications not given or lack of recording of additional dispensing instructions places residents at risk of not receiving their medication correctly. Systems in place provide access to health care professionals. Resident’s dignity and privacy is maintained. EVIDENCE: Through case tracking we looked at three residents care files. These gave a clear history of each resident’s life and this is used to plan the care needed and also to gain a better understating of each residents individual preferences. Care notes are written in at least three times a day and risk assessments clearly identified how much support each resident needed to be kept as safe as possible. Examples of this were 15-minute location checks on each resident. A key worker system is in place and each shift staff are responsible for 3 to 4 Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 11 residents for the entire shift. This enables staff to ensure all the residents in their care have received the support they need. The manager told us that there is a good rapport with care managers, local doctors and the community psychiatric nursing team. Advice is always available and doctors will attend the service when asked to. A chiropodist attends the home every six weeks and we saw from files that a resident had recently seen an optician. We saw from pre inspection self audit information and the manager told us that residents attend the dentist when needed. Medication records were seen for all residents. Generally records had been competed correctly but we saw that there were a few occasions when medication had not been given but no reason why this had happened. A coding system is in place but staff were not always using this. One resident had been given some medication on two occasions, which they were not normally prescribed. The manager told us that the doctor had given instruction for the medication to be given but a record of this could not be found in the resident’s notes. It is important that clear records are kept of any change to medication to ensure residents receive their medication in a safe manner. We saw examples of residents being able to have their rights upheld such as being able to walk around the home whenever they wanted to, being given choice over which meal they took for lunch, where they sat around the home and what clothing they wore. Staff were seen speaking to residents in an appropriate manner and at a level of understanding which was valuing to the resident. Residents would very often ask where they were and where they were going and staff answered them in a sensitive manner. One comment card received from a relative said their relative “feels a lot better since living here”. A resident we spoke to on the day on the visit said, “Im satisfied”. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13.14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with appropriate activities and are supported to continue with hobbies they enjoyed before living at the service. Staff have an awareness of residents spiritual and emotional needs. Residents have control over who visits them. Dietary needs and preferences are catered for. EVIDENCE: An activities programme is in place and a record is maintained weekly of activities that residents have engaged in. Due to all of the residents having a dementia type condition activities are varied to provide at least one activity a day which all residents can join in. At the time of the visit a game of dominoes was taking place in the dining area. One resident requested to carry on their hobby of gardening and has part of the garden so they can grow their own plants. This was seen during the visit. Outside entertainers visit the home and weekly a motivational group visit the home. They provide monthly reports to the manager on how all of the residents engaged with the activities they did. A comment card received from a Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 13 relative stated that their relative “really enjoys the activities and gets a lot of out them”. Cultural needs are identified and respected. Currently Parche communion takes place weekly and 2 other residents are assisted to attend church in the local community. The home employs both male and female staff and there are both male and female residents living at the service. Female residents were noted to have their nails painted and a hairdresser visits the home weekly. The manager said where possible residents were encouraged to pick their own clothing, some were able to say what they wanted to wear and others were shown their clothing and they were able to chose that way. We could see that there were friendships between residents and residents were seen engaging with staff in friendly discussion. Staff were able to sit and join in discussions with residents. Comment cards received back indicate that food was of a very good standard. The kitchen was clean and tidy and the manager spent a lot of time with residents discussing menus and food choice. Two chefs work at the home and they both have an understanding of the nutritional needs of older people. We could see that some residents needed assistance to take their meals and this was offered in an unhurried way and sensitive manner. Residents were able to leave the dining table have a walk around and them come back. Staff had an understanding of each resident and how they like to take their meals. Residents were supported to change their clothing after meals if they had taken their meal without wearing a protective apron. This means that residents have choice over how they take their meals and their dignity is maintained by the staffs support. One resident we spoke with said they didn’t always get up for breakfast and that staff would bring their breakfast to their room. We could also see and we were told that residents chose where to have their meals. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints policy on display enables people to know how to make a complaint. A Safeguarding adult’s policy and staff training provides staff with a working awareness of what constitutes abusive practice and how to prevent this. EVIDENCE: Since the last inspection 2 complaints have been made, one directly to the service and one to the commission. The issue raised with the commission was an allegation that staff had walked through the kitchen with dirty laundry rather than walking around the outside of the building. This was discussed with the manager who confirmed that all staff had received training in infection control and that this issue would be raised at the next staff meeting with reiteration regarding infection control. The second complaint was regarding the presentation of a residents clothing. This was resolved to the relative’s satisfaction. A complaints procedure in on display in the entrance hall to the service and details are also contained in the terms and conditions and the service user guide. Pre inspection self-audit information informed us that safeguarding adult training had taken place for all staff since the last inspection. Staff told us they Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 15 had received this training in July 2007 and that a policy is in place. The manager informed us that the policy had recently been updated. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident live in clean, comfortable and safe surroundings. They are able to personalise their rooms and staff support residents to keep their rooms safe from unauthorised entry. EVIDENCE: The home is situated in a residential area near to Eastbourne town centre. The building is a large extended Victorian building. There is a lift to each floor and stairs to the first and second floor. Symbols are placed on the kitchen and bathroom door so residents are visually prompted. At the previous inspection there was an issue regarding resident’s bedroom doors being locked during the day. This was carried out because residents would enter another resident’s bedroom and remove their personal possessions. Through working with residents and relatives and writing risk Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 17 assessments a system in now in place whereby residents bedroom doors are locked and staff are able to assess the indications residents give if they want to enter their rooms, if they are unable to use a key. The manager reported that the arrangements have been working well and residents appear to be less anxious when they see another resident walking past their bedroom door. One resident gave permission for us to look at their room. This room had an ensuite, and the resident had personalised the room with their own pieces of furniture and personal effects such as books, paintings, and photographs. A call bell system is in place and one resident we spoke to said the bell was answered quickly. We also heard call bells sound during the visit and these were responded to promptly. All areas of the home were well decorated and spacious. Residents were able to walk around the home without any obvious hazard in their way. The kitchen door is normally locked but the manager is placing a gate at the kitchen entrance so residents can observe what is happening in the kitchen without being at risk of harming themselves if they go into the kitchen without support. The manager told us that on occasion residents assist with baking as an activity which staff support them with. Since the last inspection a new bathroom with a bath hoist has been installed. A maintenance person is employed to undertake minor repairs when needed. A new carpet had been fitted to one of the rooms where there had been an odour problem. The home smelled fresh throughout. Since the last inspection a laundry assistant has started work for three hours a day. All laundry was clean and residents clothing was well ironed and in good repair. There is a policy for infection control in place and staff told us they had received training in this area. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff are on duty at all times to meet residents needs. Staff are recruited safely and residents are protected by the home recruitment procedures. All staff need to attend mandatory training to ensure they are able to provide care in a safe and knowledgeable manner. EVIDENCE: Three recruitment files were looked at. A recruitment policy is in place and all files seen contained the correct checks such as references, completed application form and Criminal Record Bureau checks and identification. This means that staff have been recruited safely and residents can be confident that they are cared for by people who have the necessary skills and attitude to be employed at the service. We were told on one comment card that staff had not received an induction. This was discussed with the manager who was able to show us files which all contained an induction except for a member of staff who was recruited before the manager started work in the home. The manager said that no staff were enrolled on the Skills for Care induction programme as all staff after their months trial were enrolled on a National Vocational Qualification in Care. The manager needs to ensure that all new staff receive an adequate induction Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 19 while they are waiting to commence on to NVQ. This means that residents and relatives can be confident that care staff have the right skills and knowledge to care for residents. An issue raised at the last inspection was that staff did not seem to have a clear understanding of how to care for residents with a dementia type condition we could see from staff files and the manager told us that most staff had attended another study day. It is important that all staff have a working understanding of the needs of residents with a dementia. We were present for part of the handover from morning staff to afternoon staff. Clear information was given and staff spent time discussing possible solutions to any issue raised regarding the progress of residents. We saw from staff files and from pre inspection self audit information that a training plan was in place and staff have attended training in various areas. Two examples were moving and handling and heath and safety. One member of staff told us that they had been shown how to move a resident with a mobility need and they felt that the instructions they had received were unsafe. This was bought to the managers attention who told us they would look into the matter. We spoke with an agency member of staff who said they enjoyed working at the service and would return if asked to work another shift. A comment card received back from a staff member informed us that they thought “The service does well at looking after the residents” and another informed us “we do well looking after the clients and keeping them happy and contented”. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Low morale within in the staff group does not promote a positive environment for residents to live in. The manager may not be effectively managing staff issues and providing purposeful supervision sessions where any unprofessional behaviour can be identified and addressed. Polices and procedures updated by the manager enable residents and staff to live and work in a safe environment. A quality assurance programme enables the manager and provider to review the service and to develop further. EVIDENCE: The homes Registered Manager is Mira Adams. Ms Adams has many years experience of working with people who have dementia type conditions and has Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 21 been working at the service for two years. The manager said she had a good relationship with the registered provider and spoke to her most days. Ms Adams attends training sessions with staff and other study days, which are appropriate to managing a care home for people with dementia conditions. We looked at the comment cards we had received. Residents indicate that the manager was available for them to speak with and when we toured the service with the manager we saw she had a very good rapport with all residents and was clear on what their needs were. Comment cards from staff informed us that the manager sometimes gives support and one comment card indicated some confusion around receiving supervision sessions. The manager informed us that supervision sessions were carried out but these are delegated to a senior care staff who has not received any training in undertaking supervision sessions. This issue was raised at the last inspection as it was noted by the inspector that poor practice was taking place and supervision sessions were not addressing this. We looked at supervision records and saw than generally staff were receiving supervision but one person has not received any for 4 months. The manager informed us that she was intending to no longer delegate out the task of supervision. Two staff spoken with said that staff morale was low. One felt this was due to “a load of women working together” another felt it was due to the manager not dealing with a culture of bullying and unprofessional behaviour between newer staff and staff who had worked at the service for sometime. This staff member had raised this with the manager and they felt nothing had been done to address it. The manager informed us that she was not aware that issues had been raised but did confirm there was a situation where bullying may be taking place but was going to address this straight away. Following our visit we were sent written information from the manager regarding how she was addressing the issue. Both staff and the manager acknowledged that low morale might have an impact on the quality of the care residents receive. Staff we spoke we said the manager “Is alright” and “will always work with us if we are busy” and “has a good way with the residents and knows what they want”. Residents told us they saw the manager every day and “she is kind and friendly” “I like her she always comes and sees me”. The service has a quality assurance system in place and questionnaires are sent out every six months to residents relatives and other stake holders such as care managers, local doctor surgery’s and Community Psychiatric Nurse teams. Weekly checks on fire safety points, medication and the nurse call system as examples, are undertaken and recorded. The provider writes a report on a monthly basis to report on the conduct of the service. Residents meetings do Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 22 not take place as the manager speaks with all residents every day and felt that this is sufficient and the best way to obtain residents views. Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 x x 2 x 3 Le Brun House DS0000021154.V359374.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP4 OP9 Regulation 14 13(2) Requirement Residents need to have written confirmation that their assessed needs can be met at the service. Medication records need to clearly indicate why medication has not been given. Records need to be clear when additional medication has been prescribed. This is so that residents are given their medication in a safe way. The issue of lack of audit trial was a requirement in the last inspection report with a timescale 30/08/07 3 OP31 8 The registered manager needs to take action to address allegations of low morale and bullying as this has an impact on the care resident receive and the environment residents live in. Staff need to receive purposeful supervision sessions from someone who has the knowledge and skills to do this task. This means that staff training needs will be identified and staff are DS0000021154.V359374.R01.S.doc Timescale for action 31/05/08 31/05/08 01/05/08 4. OP36 18(2)(a) 31/05/08 Le Brun House Version 5.2 Page 25 able to raise any issues they may have, in a professional and confidential way. 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 OP30 Good Practice Recommendations That further dementia care training be undertaken for all staff in order to keep staff updated on changes in legislation and good practices in the care of people who have dementia. 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