Inspection on 30/06/06 for Lulworth Residential Home

This inspection was carried out on 30th June 2006.

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

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

Other inspections for this house

Lulworth Residential Home 06/11/07

Lulworth Residential Home 26/10/05

Lulworth Residential Home 30/08/05

Lulworth Residential Home 05/01/05

Lulworth Residential Home 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Lulworth Residential Home Lulworth House Queens Avenue Maidstone Kent ME16 0EN Lead Inspector Maria Tucker Key Unannounced Inspection 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 Lulworth Residential Home DS0000024085.V300293.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. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lulworth Residential Home Address Lulworth House Queens Avenue Maidstone Kent ME16 0EN 01622 683231 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) Nellsar Limited Mrs Mary Frances Lyons Care Home 42 Category(ies) of Dementia - over 65 years of age (42) registration, with number of places Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Services users between 60 and 65 years of age that have a diagnosis of dementia may be admitted to the home. The home may provide service to two persons with the category of MD whose dates of birth are 06/07/1926 and 29/11/1934. 26th October 2005 Date of last inspection Brief Description of the Service: Lulworth Residential Home occupies a large detached property located in a quiet residential area of Maidstone within easy reach of the main road into the town and the M20 motorway. Local shops are nearby and the centre of Maidstone is approximately one mile away. Accommodation is provided on three levels with two shaft lifts giving access to upper floors. The home has a garden surrounding the property with a patio area. Four of the bedrooms are equipped with en suite facilities. There are two lounge areas, a sun lounge and dining room all located on the ground floor. The home was substantially renovated and extended in 2003 when a new wing was added. The current fees range from £401.26 to £525.00 per week. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key inspection. The visit lasted from 08.40am until 16.40pm. The visit was spent talking directly with the manager, area manager and care staff. Service users were spoken with collectively, some service users did not engage with the inspector but were observed throughout the visit. A partial tour of the building and grounds was undertaken. Some judgements about the quality of life and choices were taken from direct conversation with service users and observations followed by discussions with care staff and evidencing records held at the home. Additional information was obtained through the receipt of the pre inspection questionnaire and comment cards received. Comments from the comment cards included: • “I am very happy with the care my (service user) receives”. What the service does well: What has improved since the last inspection? Mrs Mary Frances Lyons has successfully gone through the process of registration with the CSCI to become the Registered Manager. New care plan formats have been introduced. It is acknowledged that it takes time for these to be completed fully. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 6 Staff are clear that the medication trolley must be kept secure at all times action has been taken to address this. The changing health care needs of service users are monitored closely by the home and with the support and assistance of the health professionals. Net curtains have been put up for dignity. There is a more stable staff team providing consistency for service users. An occupational therapist assessment assessing the adaptations and equipment available at the home has been conducted. Some action has been planned and taken to address potential risks and hazards. The environmental health officer visited no further action is required by the home a comment on the report stated, “Good hygiene practice observed, keep it up”. What they could do better: Firming up of the PRN medication procedures. Risk assessments need to be more specific to include behaviour and activities. The menu board could be more accessible if it was in pictorial format. Service users whom have difficult behaviours during meals need closer monitoring and a review as to compatibility in respect of their seating arrangements. The double rooms need to have guidelines developed for admitting criteria to ensure that service users are compatible and the decision to share a room is made in the best interest of service users. The furniture in the lounges need to be replaced, as they are tatty and need to be of a type that can be easily washed without having to have plastic seat covers that do not match and are undignified. The home would benefit from having an assessment made by the infection control nurse to ensure best practice and any recommendations for equipment or environmental improvements. Some of the mattresses and bed frames are in need of replacing due to the age and usage. The home would benefit from purchasing mattresses for pressure relief and designed to support service users whom may be incontinent. The smoking area needs to be identified and stated in the statement of purpose / service users guide. Policies and procedures and risk assessments for smoking need to be developed. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 7 Complete all work for identified potential hazards to the environment identified in the occupational therapist assessment. 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. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 8 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 Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 9 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): 2, 3, 5 Quality on this outcome area is good this judgement has been made using available evidence including a visit to the service. Service users can feel confident that they will have their needs assessed and with support from representatives / relatives have information to decide as to move into the home. EVIDENCE: The statement of purpose and users guide was not inspected. This was met during the last inspection. It will need to be updated following changes i.e. smoking area, registered manager. A FAN (financial assessment) from social services was seen this detailed fees. The service users are not requested to sign contracts as stated they are supported via family and social services. Contracts were seen to be contained in service users files. Assessments are conducted prior to service users being admitted. The manager undertakes these at the service users place of residence. Assessments from health and social services are sought as part of this process. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 10 For private funded service users the manager undertakes an assessment. Relatives are invited to provide a written history so that a full picture of the service user can be gained. A copy of this was contained in a service users file. During the inspection relatives were viewing the home. Service users are invited to visit the home and move in on a trial basis. The home does not provide intermediate care. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 11 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 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users can expect their medical and health needs to be met. To be treated with dignity and respect. EVIDENCE: New care plan formats have been introduced. These are more comprehensive and detailed. As with all new formats the home are in the process of transferring information across and updating records. Staff spoke of how the care plans were “very helpful”. The manager expressed that the staff were more engaged in doing care plans that she was “Very proud of them”. Staff were completing care records during the site visit. The risk assessments were primarily around the environment. It was discussed that specific assessments for behaviours and activities should be undertaken and form part of the care plan. The risk assessment format may need to be varied according to risk. Staff were familiar with risks and good evidence during the inspection was noted to have been taken by staff in supporting a service user practically with a perceived risk. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 12 Discussions were held with a visiting health professional. When visiting the health professional meets with an allocated staff who takes the responsibility for supporting them during their visit and acts as a link during that time for sharing of information. Comments from the health professional that “I am happy that they are doing what they can” and discussions around service users medical and health needs evidenced the home are pro active in seeking advice and support. The health of service users is met and monitored via visiting professionals. Nutritional guidance has been given to the home i.e. for complementary build up drinks to be given when needed. The health professional confirmed in put is not currently needed as the home is taking action as recommended. Staff are familiar with specific needs around nutritional intake and the particular difficulties behaviours can present. Care plans indicate frequent discussions with general practitioners and routine medical and health appointments. Specialist services such as psychiatrist are used. The nomad system has been introduced as it was found that the medication round was taking too long. A staff member who takes responsibility for medication detailed the homes policies and procedures and general routines. There is a fridge for medication and the clinical room was found to be in good order. It was discussed that the PRN medication procedure needs to be firmed up to ensure that there is clear written guidance as directed by the general practitioner as to when and what is required for PRN and if possible a means to establish service users pain or other needs i.e. pictorial format. Staff evidenced through discussions that they were familiar with this. Privacy and dignity was seen to be adhered to with staff actions in the way they responded and reacted with service users. A net curtain has been fitted as identified during the last inspection. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 13 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): Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have a good range of activities on offer to choose from either individually or collectively. They can expect a good wholesome balanced diet with supplements snacks and drinks available day and night. EVIDENCE: The activities co-ordinator was assisting service users with recreational activities during the inspection. Activities include a pianist every Monday; monthly outing in the mini bus; visiting dog and visits by priest / vicar. A service user spoken with commented “I watch other people, I really enjoy and if I agree I laugh”. When discussing the visiting dog a service user commented “Glad, dog cos he knows he’s getting a biscuit”. The activities co-ordinator explained that they work flexible hours as if service users are engaged they continue for longer and take time back. Staff support with activities. During the inspection service users were seen to be exercising choice by their actions i.e. wandering freely. Staff were familiar with individual choices i.e. food and routines. A service user was still in bed as it was discussed they preferred to get up later as frequently awoke at night. Food and drinks were Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 14 seen to be by the bed and through discussions with staff as part of the case tracking these were provided by night staff. Service users private accommodation contained plenty of personal effects. During breakfast a service user ate with their hands and used the spoon upside down. Another service user commented, “That’s not the way to treat your lunch, where did you learn your manners from”. This was discussed with staff who was aware that this service user had a tendency to use their hands. Other measures such as supporting with feeding had been tried but discontinued as it was expressed the service user got upset. It was discussed that practical support and verbal guidance with prompting and correcting should be offered and a review of seating arrangements made. The menu offers choice and variety cooked by the homes cook and served in the dinning room. Some service users are supported with meals in the lounge areas. Finger foods are given to service users. It was discussed that the menu board could be made more accessible with the use of pictures. There were no visitors spoken with during the inspection. Comment cards received back were positive with service users being able to be seen in private, relatives aware of the home’s complaint procedure and all considered there to be enough staff. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 15 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 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users can feel confident that the staff are familiar with adult protection procedures and that any complaints made will be addressed. EVIDENCE: The pre inspection questionnaire lists 2 complaints, 1 of which was partially substantiated, 1 is still outstanding. There have been no complaints made since the last inspection. There have been 10 service users admitted to A & E. The manager monitors accidents, 14 were recorded during May most of which were minor or no injuries. There has been 1 adult protection alert raised. The conclusions of which are almost complete. Staff receive training on adult protection and first aid. The administrator who invoices for items such as chiropodist or hairdressing manages service users’ finances. The home has a charitable bank account set up which monies are deposited into and records individually kept. No interest or charges are made for this account. No service user manages their own affairs; this is via the client financial affairs officer or relatives. Lulworth Residential Home DS0000024085.V300293.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 22, 23, 24, 25, 26 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users live in clean, comfortable and homely surroundings. EVIDENCE: Lulworth was found to be clean and tidy with no offensive odours. The home has had a general de-clutter of equipment and has reviewed and rearranged storage facilities and areas, which has created more space and more appropriate storage arrangements. The service users’ private accommodation varied with what they contained they were personal to taste. The shared rooms should have a policy and procedure written to evidence that the decision to share has been made in the best interest of the service users; compatibility i.e. service users do not share if they have nocturnal disturbances or aggressive behaviours and that a positive choice to share has been evidenced. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 17 The occupational therapist has undertaken an assessment on 22nd August 2005. The report covers the external and internal environment. Many of the items pointed out within the report have been completed and others outstanding are planned. As identified during previous inspections and in the occupational therapists report the front access to the property is via a gravel drive, which is unsuitable. The manager confirmed that work was due to take place on the following Monday to address this and have the flat roof repaired. The environmental health officer conducted a visit to the home on 23/08/06 no further action was needed to be taken by the home. The report contained the comment “good hygiene practice observed, keep it up”. The designated smoking area must be identified as listed in the statement of purpose / service users guide. A policy and procedure and risk assessments must be undertaken to ensure safety and good practice. The furniture in the lounges need to be replaced as they are tatty and need to be of a type that can be easily washed without having to have plastic seat covers that do not match and are undignified. Some of the mattresses and bed frames are in need of replacing due to the age and usage. The home would benefit from purchasing mattresses for pressure relief and designed to support service users whom may be incontinent. The laundry is located in an outbuilding next to the main house as identified during the last inspection it has been equipped with a new ozone laundry system. The home would benefit from having an assessment made by the infection control nurse to ensure best practice and any recommendations for equipment or environmental improvements. Lulworth Residential Home DS0000024085.V300293.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality on this outcome area is adequate s judgement has been made using available evidence including a visit to the service. Service users are supported by an appropriate staff mix and a good staff ratio. EVIDENCE: The pre inspection questionnaire lists policies and procedures most of which had been ticked to say they were last reviewed in 2005. It has not been possible to calculate the staffing levels required in accordance to the DOH residential forum as the service users needs have not been completed. Within the general service users information in the pre inspection questionnaire it does list that 42 service users need help with washing/bathing, dressing/undressing; 14 service users require 2 or more staff to undertake their care day and night. The staffing consists of 6 care staff am shift and 5 care staff pm shift. During each shift there is a senior carer on duty. The manager works 9 to 5pm and is supernumerary. There are extra staff for administration / finance; handy person; cook; kitchen assistant; laundry; activities and cleaning. Currently vacancies for cleaners have led to staff doing extra hours to cover this. Agency staff are not currently being used. It was discussed that in the interest of best practice if the home are intending to use agency again a policy and procedure / protocol for using agency staff including induction; functions Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 19 and tasks be made. So that regular staff provide consistency and agency staff are utilised effectively. The pre inspection questionnaire lists training undertaken these include first aid; medication; fire training; COSH; challenging behaviour; manual handling and dementia care. The home does not have 50 of care staff with NVQ level 2 or above. The manager stated that they are finding it difficult to obtain courses but are addressing this. Lulworth Residential Home DS0000024085.V300293.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a home that is well run and managed. EVIDENCE: The pre inspection questionnaire lists maintenance and associated records. These include fire training; gas installation engineer and emergency lighting checks. The environmental health officer has visited the home with no further action required by the home. The home has had a general de clutter and rearrangement of storage areas to increase space. The manager has gone through the fit persons interview to become the registered manager with the CSCI. There are clear lines of responsibility and accountability. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 21 Throughout the inspection staff were open and transparent with the inspector in their discussions. The manager welcomed any suggestions and has worked hard with the staff team in raising the standards of the home since the last inspection. Regular regulation 26 visits reports are conducted and received. A copy of the residential home relatives feedback analysis was given to the inspector. This document is part of the homes internal quality assurance monitoring. The manager stated that she felt the home do well with supporting and communicating with relatives, promoting a warm, relaxed and very transparent atmosphere. Evidenced during the inspection through the ambience of the home, the pace of work with service users being unhurried and supported gently by staff. Service users presented as being relaxed and calm with one service user exhibiting slight agitation this was immediately noticed by staff who gave gentle reassurance until the service user became calm. The home has an administrator who manages service users finances through a charity status bank account and individual accounts of monies deposited. Due to the nature of the service, service users do not manage their own financial affairs. The home does not act as appointee for service users. Staff confirmed they received regular supervision. The interaction between staff was one of mutual respect, with good practice noticed where staff were supporting each other and working together. A staff member commented how much they enjoyed working at the home stating it was a “Job I like”. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 22 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 2 3 2 2 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 2 X 3 Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4b&c) Requirement Timescale for action 28/07/06 2 OP22 23(2)(a)( b)(c) The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. In that risk assessments need to be specific for behaviours and activities. The registered person shall 28/07/06 having regard to the number and needs of the service users ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users, in that the hazards and risks identified in the occupational therapy assessment 22nd August 2005 are addressed i.e. the external access. Full action plan detailing all action including timescales to be forwarded to the CSCI. The registered person shall having regard to the size of the care home, the statement of purpose and the number of service users ensure that the persons employed by the registered person to work at the DS0000024085.V300293.R01.S.doc 3 OP28 18(c)(i) 28/07/06 Lulworth Residential Home Version 5.2 Page 24 care home receive training appropriate to the work they are to perform. In that 50 of care staff must be trained to NVQ level 2 or above. 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 OP9 Good Practice Recommendations It is recommended that the PRN medication policy and procedure be firmed up with written guidance and direction from the general practitioner and a way be devised i.e. pictorial pain chart to be used if possible to ascertain service users needs. It is recommended that service users who have behaviours at meal times that need support and staff guidance and intervention are monitored more closely and the seating arrangements reviewed to ensure compatibility. That pictorial menu formats are made available. It is strongly recommended the furniture in the lounges be replaced and are of a type that can be easily washed without having to have plastic seat covers that do not match and are undignified. It is very strongly recommended that the designated smoking area must be identified and listed in the statement of purpose / service users guide. A policy and procedure and risk assessments should be undertaken to ensure safety and good practice is adhered to. It is strongly recommended that some of the mattresses and bed frames in need of replacing are purchased with mattresses for pressure relief and designed to support service users whom may be incontinent It is very strongly recommended there is a policy and procedure written to evidence that the decision to share a double room has been made in the best interest of the service users and their compatibility i.e. service users do not share if they have nocturnal disturbances or aggressive behaviours and a positive choice to share has been evidenced. That this policy be used as part of the admitting criteria and reviewed individually as care plans DS0000024085.V300293.R01.S.doc Version 5.2 Page 25 2 OP15 3 OP20 4 OP20 5 OP22 6 OP23 Lulworth Residential Home 7 OP26 8 OP36 are reviewed. It is recommended that an assessment made by the infection control nurse to ensure best practice and any recommendations for equipment or environmental improvements. It is recommended that in the interest of best practice if the home are intending to use agency again a policy and procedure / protocol for using agency staff including induction; functions and tasks be made. So that regular staff provide consistency and agency staff are utilised effectively. Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Lulworth Residential Home DS0000024085.V300293.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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