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Inspection on 12/06/06 for Longmead Court Nursing Home

Also see our care home review for Longmead Court Nursing Home for more information

This inspection was carried out on 12th June 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Relatives spoken with, and comments on survey forms, indicated that relatives were generally very happy with the care and services provided and found the staff friendly and helpful. One relative said that they were "very pleased with the home" and considered that residents were "treated with huge respect". Residents who could express a view said that they were happy with the food. One resident described the food as "excellent". The home was very clean, and staff are to be commended for maintaining such a high standard. One resident said, "The staff are marvellous, you couldn`t be in a better home".

What has improved since the last inspection?

New pillows and duvets had been purchased, and an audit had been carried out of residents` monies.

What the care home could do better:

The home needed considerable improvement in the management of medicines. The home has a range of activities, but this was an area that could be developed. Care documentation needed to be more resident centred, focusing on individual abilities and the preservation of life skills. The standard of cleanliness of some equipment, such as hoists and wheelchairs, needed to be improved. A number of staff training needs were identified.

CARE HOMES FOR OLDER PEOPLE Longmead Court Nursing Home London Road Braintree Essex CM7 8QQ Lead Inspector Francesca Halliday Unannounced Inspection 12th June – 30th June 2006 09:30 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 Longmead Court Nursing Home DS0000015357.V299413.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. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longmead Court Nursing Home Address London Road Braintree Essex CM7 8QQ 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) 01376 344440 01376 330096 Dovecote Care Homes Limited Care Home 30 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (30), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30) Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged between 55 - 65 years, who require nursing care by reason of dementia (not to exceed 30 persons) Persons, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 30 persons) Persons of either sex, aged between 55 - 65 years, who require nursing care by reason of mental disorder (not to exceed 30 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of mental disorder (not to exceed 30 persons) The total number of service users accommodated in the home must not exceed 30 persons 7th March 2006 Date of last inspection Brief Description of the Service: Longmead is located in a cul-de-sac off the main Chelmsford to Braintree Road. It is close to local shopping facilities and a large shopping complex. It has good access to bus routes and there is plenty of car parking at the home. There are close links to the A120 and M11 motorway. The home is a two-storey building and the majority of rooms are single. There are several communal lounge/dining areas. The home is registered to provide nursing care for up to 30 people, over the age of 55 years, with dementia and mental disorders. An extension to the home was in the process of being built at the time of inspection. The home had a range of information for prospective residents and their representatives. At the time of inspection, in June 2006, the fees were £700 for a shared room and £777 for a single room. Additional charges were made for toiletries, hairdressing and private chiropody. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place on 12th June 2006. The inspection process included: discussions with 9 residents (although advanced dementia made communication difficult with the majority of the residents), 2 relatives and 7 members of staff including the new manager. Parts of the premises and a sample of records were inspected. Further information was requested at the time of inspection, which arrived on 30th June 2006, and this concluded the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The home needed considerable improvement in the management of medicines. The home has a range of activities, but this was an area that could be developed. Care documentation needed to be more resident centred, focusing on individual abilities and the preservation of life skills. The standard of cleanliness of some equipment, such as hoists and wheelchairs, needed to be improved. A number of staff training needs were identified. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 6 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. Longmead Court Nursing Home DS0000015357.V299413.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 Longmead Court Nursing Home DS0000015357.V299413.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 not applicable) The overall quality outcome in this area is good. The home has a good preadmission assessment system in place, which ensures that the home can meet the needs of new residents. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Staff carried out an assessment prior to residents being admitted to the home, to ensure that the home could meet their needs. The pre-admission assessments had an appropriate focus on mental health, and were on some occasions supplemented by a social services assessment. The manager was advised to expand the assessment to cover the condition of potential residents’ skin and to record any pressure sores or wounds. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The overall quality outcome in this area is adequate. Relatives consider that residents are treated with respect, and their health and care needs are met. However, care documentation needs to be developed and significant improvements are needed in the management of medicines. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents who could express a view said that the care in the home was good. Relatives spoken with said that they were very pleased with the standards of care and were kept fully informed about any health concerns. The care plans sampled were generally detailed, but there was rarely any evaluation of the care and care needs. A discussion was held about the benefit of making the care plans more resident focused with information on individual abilities, and with an emphasis on promoting independence and the preservation of life skills. Relatives (and residents when appropriate) were not involved in the evaluation of care needs and updating of the care plans. However, the manager said that they were hoping to involve relatives in the near future. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 10 The daily records were of very variable quality, with on occasion statements such as “care as planned”. This did not demonstrate that health and care needs were being monitored, and gave no information on the actual care given, the mental and physical health of the residents or how they had spent their day. There was no evidence that staff were monitoring the condition of residents’ skin when they were identified as being at high risk of developing sores. One resident who was very frail had developed pressure sores, which the manager said were healing. However, it was difficult to assess the size and ongoing condition of the wounds from some of the records seen. Some monitoring of psychological health was seen, but this was not consistent or detailed enough for analysis. For example it was not possible to establish from the records seen whether there were any specific triggers for residents with challenging behaviours, or whether changes in medication had influenced behaviours. Staff confirmed that residents had good access to local health services and regular input from the home’s GP. There was evidence that residents had chiropody, and optical and dental checkups. Staff sometimes recorded the fact that they had spoken to relatives, with no further details. They were advised to record the main issues discussed at these meetings, to aid communication between staff on different shifts. It was sometimes difficult to establish exactly which medicines had been given, from the medicine administration records (MAR) seen. On occasions staff used omission codes without describing the reason for the omission on the back of the MAR sheet. Some staff used an omission code plus their signature, with no information on the back of the MAR, so that it was not clear whether the medicine had been administered. According to the records there were a number of occasions when prescribed medicines were not available for two to six days. A number of drugs including laxatives had been prescribed to be given on a regular basis, and staff were administering them as required. Staff were advised to get the prescription changed if the resident no longer required the medicines so frequently. Staff were also advised to request clear instructions for an antipsychotic, that had been prescribed to be given as required, such as the frequency and maximum dose permitted in twenty-four hours. On a number of occasions prescribed medicines, including antipsychotics, were not given during the daytime as a resident was sleeping, on other occasions staff did not give the dose prescribed by the GP. There were topical creams in a shower room which had the prescription label removed and were being used communally. There was evidence that a resident was having a topical cream administered that had not been prescribed for them. Topical creams, with a limited shelf life when opened, did not have a date of opening on them. Liquid medicines had been dated on opening. One relative said that they had previously had some concerns about the administration of medicines when a resident refused to take them. The Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 11 manager said that the home did not have a policy on the steps that staff should take if residents refused medicines, or the circumstances (if any) that the covert administration of medicines might be considered appropriate. There was evidence that some residents’ medication had been reviewed. The manager said that she was in the process of obtaining a list of signatures from staff to assist in the auditing process. Staff did not have an up to date British National Formulary for reference. Staff were monitoring the temperature of the fridge on a daily basis. However, they did not take any action to defrost the fridge until the temperature had been over the safe limit for a number of days. In the month prior to the inspection the clinical room temperature was frequently recorded as being between 25-30c, which was above the safe storage temperature for the majority of medicines (on the day of inspection the temperature was 29.9c). An air conditioning unit was installed following the inspection. The new manager said that she was aware of many of the above issues in relation to the management of medicines, and was taking steps to address them. A number of nurses had not received recent training in the safe handling of medicines. Staff were generally observed to treat residents with respect and in a caring manner. Cards from relatives were seen that complimented staff on the end of life care that had been given. One relative particularly praised the staff, and said that care had been provided with “kindness and dignity”. Longmead Court Nursing Home DS0000015357.V299413.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The overall quality outcome in this area is adequate. The home has activities and some links to the local community, but these are areas that still need developing. Residents are able to maintain good links with family and friends. Staff need to provide more evidence that they were promoting choices and independence as an integral part of resident centred care. A varied and nutritious diet is available. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home had an activity organiser, who also worked part time as a care assistant. There was a weekly activity programme, which included some arts and crafts, games and one to ones. Care staff also provided social interaction and some activities. However, a few staff were observed sitting for some time with residents without engaging with them. There was some documentation of activities, but this also needed to be developed. Staff reported that the home had entertainers into the home about twice a year, and that the library service came to the home once a month. The manager said that the home was planning an outing to Maldon for some of the residents in July. The home also had occasional clothes and shoes shows, at which residents could purchase Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 13 new clothes and shoes. Staff said that relatives were always notified so that they could be present to assist residents if they wished. Relatives said that the home had unrestricted visiting and that they were made to feel very welcome when they visited. The home has some links to the local community, but this is an area that could be developed. As stated in standard 7, staff needed to provide more evidence that they were promoting choices and independence and helping to preserve residents’ life skills on a daily basis. Residents who could express a view said that they were happy with the food in the home. Relatives confirmed that the standard of food was good. Staff said that alternatives were always available when there was only one choice on the menu. Staff were observed assisting residents with their meals in an appropriate and unhurried manner. There was evidence that staff were meeting residents’ differing nutritional requirements. The kitchen looked clean and well organised. However some food in the freezers and fridges was not labelled or dated. Two of the windows needed fly screens. Longmead Court Nursing Home DS0000015357.V299413.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The overall quality outcome in this area is adequate. Staff address concerns and complaints promptly, but do not always document the issues raised and the action taken. Some staff do not have sufficient understanding of the different types of abuse that could occur to ensure that residents are protected. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A complaint had been received about lack of response to the front doorbell. A new doorbell was fitted within twenty-four hours and feedback was given to the complainant. There was evidence that staff were not always documenting verbal complaints or concerns, which could result in the manager being unaware of problems or issues that staff were dealing with. The home had a protection of vulnerable adults (POVA) policy. None of the ancillary staff had received training in the protection of vulnerable adults (POVA), and a few nurses and care staff needed the training. Some staff spoken with were not familiar with the different types of abuse that could occur, and therefore might not respond appropriately to any poor practice they observed. The manager was advised to obtain a copy of the Essex guidance “Protecting Vulnerable Adults” for all staff. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The overall quality outcome in this area is adequate. The use of furniture in the lounge/dining room needs to be reviewed, and a risk assessment of residents’ access to the stairs carried out. The home was very clean but systems for cleaning equipment need to be put in place. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: On the day of inspection some areas of the home were extremely hot, and a temperature of 31.6c was recorded in the conservatory. Residents were being given additional drinks on this very hot day, and an additional fan was purchased for the conservatory following the inspection. A discussion was held with the manager about the need for risk assessments of the stairs, as a resident in a very distressed state was found at the top of one of the flights of stairs. On some occasions residents were seen sitting in low armchairs next to dining tables, rather than being provided with small tables or transferred to dining chairs of a more appropriate height. A few armchairs were seen with Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 16 very damaged armrests. The manager said that the home was planning to redecorate one of the sluice rooms, a resident’s bedroom and the wheelchair storage area, in the near future. She said that they were also hoping to develop the garden, and purchase a gazebo to provide a shaded area for residents. The home environment was very clean and no unpleasant odours were noted. The ground floor sluice room was in need of a thorough clean, but this did not directly impact on residents. Some equipment such as wheelchairs and hoists were in need of a clean. A discussion was held with the manager as to why there was a separate toilet designated for staff use, and whether staff might be more vigilant with standards of cleanliness if the toilets were all for communal use. The laundry looked well organised, with suitable equipment for the size of the home. The washing machines had sluice cycles, and the laundry assistant confirmed that soiled linen was appropriately transported and washed in red bags. Staff confirmed that the damaged pillows and duvets had been replaced since the last inspection. The laundry staff provided a service for labelling and mending residents’ clothes. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The overall quality outcome in this area is adequate. The home has an appropriate number and skill mix of staff, but training needs were identified. The home has sound recruitment practices. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The staffing levels were appropriate for the size of the home and the dependencies of the residents. The home had a mix of general and mental health trained nurses. Staff said that they had formal supervision and found it helpful. Staff were generally observed to interact well with residents (see standard 12). During the inspection it was noted that residents were being supervised in all the different areas of the home. Eleven care staff had completed National Vocational Qualification (NVQ) at level 2. Two of these staff had also completed NVQ level 3, and another carer was undertaking the course at level 3. Six care staff were awaiting a start date to commence NVQ level 2, and 2 care staff were awaiting a start date to commence NVQ level3. The home had good systems in place for recruitment of staff, but there was only evidence of an induction for some members of staff. A number of nurses needed training in dementia care and the management of challenging behaviour. Only one of the nurses had completed a more in-depth ENB dementia care course. The majority of care staff had received in-house Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 18 training in dementia awareness and challenging behaviour. Staff had not received any training in the care of residents with Parkinson’s disease. 20 nursing and care staff were due to attend a seminar on loss and bereavement in June and July 2006. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 The overall quality outcome in this area is adequate. There is an open and supportive management style at the home. A quality assurance process is being developed. A number of staff need training in safe working practices. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A new manager had taken up post just prior to the inspection, and had received a handover from the previous manager. She was an experienced nurse with considerable management experience, and was in the process of applying to be registered with the Commission. Staff described the new manager as supportive and approachable, and said that she “sorted problems out immediately”. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 20 The home surveys relatives each year on the quality of services and care. The manager said that a quality assurance programme with internal audits was being set up, and a quality assurance report would be sent to the Commission when the audits and surveys were completed. The home held a small amount of money for residents, which was used to purchase toiletries and pay for services such as hairdressing and chiropody. Receipts were available and balances were correct for the records sampled. The home was advised to obtain two signatures when money was deposited or withdrawn from residents’ accounts. An accountant had carried out an audit of the system since the last inspection. The handover sheets and the GP book contained personal and care information on a number of residents together. These documents did not meet the requirements of the Data Protection Act 1998. Staff had completed an accident record for each of the accidents noted in the care records sampled. However, the section on recommendations to prevent similar accidents had not always been completed. A discussion was held about the benefits of auditing accidents on a regular basis, in order to establish whether any trends were highlighted that could be addressed. There was evidence of servicing and maintenance of equipment in the home. However, according to the records fire drills and fire alarm tests had not been carried out regularly. Staff who used chemicals during their work needed to be provided with appropriate information under the Control of Substances Hazardous to Health Regulations (COSHH) 1988, and provided with COSHH training. A number of staff, particularly nurses and ancillary staff needed training in health and safety. The majority of staff needed food hygiene training. The majority of staff had received fire safety training, but a number of staff needed an update. None of the staff had received training in infection control. The majority of nurses and care staff had received moving and handling training, but some were in need of an update. None of the ancillary staff had received moving and handling training. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X 2 1 Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 22 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. All the requirements below were discussed with the manager at the time of inspection. No. 1 Standard OP7 OP14 Regulation 15(1)(2) Requirement The registered person must ensure that: 1. Care plans are more resident centred with information on individual abilities, and with an emphasis on promoting independence and the preservation of life skills. 2. There is a monthly evaluation of care and care needs, which involves residents and relatives when appropriate, and that this is used to update the care plans. The registered person must ensure that the daily records demonstrate a continuing process of monitoring and assessment of residents’ mental and physical health, and that staff document the actual care given and how the resident has spent their day. The registered person must ensure that staff monitor the condition of residents’ skin when they have been identified at high risk of developing pressure sores, and ensure that the documentation of wounds clearly identifies the size and condition DS0000015357.V299413.R01.S.doc Timescale for action 01/08/06 2 OP7 OP8 OP12 14(2) 01/08/06 3 OP8 14(2) 01/08/06 Longmead Court Nursing Home Version 5.2 Page 23 4 OP8 OP30 18(1)(c) 5 OP9 13(2) 6 OP9 OP30 18(1)(c) of the wounds and the progress of healing. The registered person must 01/09/06 ensure that nursing and care staff receive training in the prevention and management of pressure sores. The registered person must 01/08/06 ensure that: 1. Staff give medicines at the doses and times prescribed, and provide evidence that they have consulted the GP about any changes required, or if they need to deviate from the prescription for clinical reasons. 2. There are good systems in place for ordering medicines, so that residents do not miss doses of prescribed medicines. 3. Staff provide clear and unambiguous information on the reason doses of medicines have been omitted. 4. Staff are provided with clear instructions on medicines to be given “as required”, particularly medicines such as antipsychotics. 5. Residents only have topical creams administered if they have been prescribed for them, and that topical creams are dated on opening and discarded within the recommended timescale. 6. The home has a clear policy on the steps to take if residents refuse medication. 7. Staff take prompt action if the temperature of the fridge or clinical room exceed the safe limits for storage of medicines. Some of the above were requirements in the previous inspection report – the timescale of 31/04/06 was not met. The registered person must 01/09/06 ensure that all nursing staff have DS0000015357.V299413.R01.S.doc Version 5.2 Page 24 Longmead Court Nursing Home 7 OP12 16(2)(m) (n) 8 OP15 16(2)(j) 9 OP16 22 10 OP18 13(6) 11 OP19 13(4) 12 OP19 16(2)(c) 13 OP26 13(3) 14 OP30 18(1)(c) 15 OP33 24 training in the safe handling of medicines. The registered person must ensure that staff have training in the range of activities and social interactions/stimulation suitable for residents at all stages of dementia. The registered person must ensure that food in fridges and freezers is labelled and dated, and that fly screens are provided for all windows in the kitchen. The registered person must ensure that staff document verbal complaints and the action taken to investigate and resolve them. The registered person must ensure that all staff, including ancillary staff, have training in the protection of vulnerable adults. The registered person must ensure that a risk assessment is carried out of residents’ access to the stairs. The registered person must ensure that there are sufficient dining chairs and small tables for residents’ needs, and ensure that damaged chairs are repaired or replaced. The registered person must ensure that systems are put in place to ensure that equipment in the home is kept in a clean and hygienic condition. The registered person must ensure that all nursing and care staff receive training in dementia care and the management of challenging behaviour and care of the older person with Parkinson’s disease. The registered person must send a copy of the quality assurance report to the Commission when DS0000015357.V299413.R01.S.doc 01/11/06 01/08/06 01/08/06 01/09/06 01/08/06 01/09/06 01/08/06 01/01/07 01/11/06 Longmead Court Nursing Home Version 5.2 Page 25 16 OP37 17 17 OP38 13, 17, 18, 23 it has been completed. The registered person must 01/08/06 ensure that records in the home comply with the Data Protection Act 1998 01/01/07 The registered person must ensure that: 1. Accident forms are fully completed with immediate effect. 2. Fire drills and fire alarm tests are carried out regularly, with immediate effect. 3. All staff are up to date with their fire safety training. 4. All staff receive health and safety training, and that staff who use chemicals during their work receive COSHH training and are provided with information on each of the chemicals used. 5. All staff receive moving and handling training. 6. All staff who handle food receive food hygiene training. all staff receive infection control training. 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 2 3 4 Refer to Standard OP8 OP9 OP29 OP35 Good Practice Recommendations The registered person should ensure that staff record the key issues discussed with residents’ representatives, in order to promote good communication between staff. The registered person should ensure that staff have access to an up to date copy of the British National Formulary for reference. The registered person should ensure that all staff receive a documented induction, which is specific to their role. The registered person should ensure that two signatures are obtained for all transactions of residents’ personal DS0000015357.V299413.R01.S.doc Version 5.2 Page 26 Longmead Court Nursing Home monies. Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Longmead Court Nursing Home DS0000015357.V299413.R01.S.doc Version 5.2 Page 28 - 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. 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