Inspection on 20/08/07 for Maiden Castle House

This inspection was carried out on 20th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maiden Castle House 10/02/09

Maiden Castle House 22/02/08

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

CARE HOMES FOR OLDER PEOPLE Maiden Castle House Maiden Castle House 12-14 Gloucester Road Dorchester Dorset DT1 2NJ Lead Inspector Val Hope Key Unannounced Inspection 20th August 2007 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 Maiden Castle House DS0000069062.V348114.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. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maiden Castle House Address Maiden Castle House 12-14 Gloucester Road Dorchester Dorset DT1 2NJ 01305 251661 01305 251102 maidencastle@care-south.co.uk www.care-south.co.uk Care South 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) Mrs Margaret Houston Tomlin Care Home 66 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (31), Old age, not falling within any other of places category (35) Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 10 service users may be accommodated for intermediate care in separate ground floor accommodation. A maximum of 5 of these service users may be between the ages of 55 and 64 years. May accommodate up to 10 service users aged between 55 and 64 years on admission and whose primary need on admission relates to their dementia. None. This is a new service. 2. Date of last inspection Brief Description of the Service: Maiden Castle House is a new purpose built property located in a residential area in the town of Dorchester. This building replaced an older property located elsewhere in Dorchester and retained the name of Maiden Castle House. Twenty-three people transferred from the old premises into the new home. The previous home in Maiden Castle Road accommodated service users under the category of Old Age only, the new premises however, was purpose built and is registered to accommodate not only the category of Old Age but also Dementia and Intermediate Care (Rehabilitation) services. Maiden Castle House is registered to Care South a not-for-profit registered charity, formerly the Dorset Trust, which is an established provider of care services in the south of England, principally in Dorset that has been in existence since December 1990. Care South currently has 19 care homes registered with the Commission. The Responsible Person is Mr Roger Fulcher and the Registered Manager is Mrs Margaret Tomlin. In total there are 66 en suite bedrooms, with all the accommodation divided into designated units. The home is set out over two floors with the physically frail units, Maumbury A and B and the Intermediate Care Unit [which provides short term care] on the ground floor. Each unit has its own facilities, including communal dining-room/lounge, kitchenette and sluice room. The purpose designed Dementia unit is on the first floor and is similarly split into two smaller units, Eggardon A and B. These two units were designed and are utilised specifically to care for people with dementia; they include a range of communal rooms and areas, enabling residents to readily access their bedrooms and WCs. Built-in display cabinets form part of the corridors in some Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 5 areas, providing the opportunity for memorabilia and items of interest to be installed for residents’ interest. Outside space is within an enclosed courtyard / patio area at ground floor level and there are balconies with safety glass at first floor level serving the Dementia Unit. There is car parking facilities to the front of the property and a narrow grassed/landscaped strip with a perimeter fence to the rear of the property. Information relating to fees is contained within the home’s Service User Guide which is currently subject to review. Up to date information relating to fees should be sought directly from the home. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided and to assess the home’s compliance with the Care Homes Regulations 2001 and key National Minimum Standards for Older People. In May 2007 the home was subject to a multi agency Safeguarding Adults investigation with Dorset County Council taking the lead. The Adult Protection Strategy Meeting (which includes the Commission for Social Care Inspection) requested that an officer from Dorset County Council should take part in the next inspection of the home. This inspection was therefore conducted jointly with the following Monitoring Officer, who has agreed that her name and contact details being included within this report: Julie Ayles, Dorset County Council, Contacts Monitoring Officer, 01305 224853. The investigation focused upon care practice and associated care records; during the investigation two other referrals were made and investigated. A number of shortfalls were identified and a large proportion of the time taken on this inspection was spent monitoring the actions put into place as a result of the investigation at the same time, assessing the homes performance against National Minimum Standards. This unannounced inspection was undertaken over a period of three days. • Monday 20th August 0930 – 1615 hours Val Hope and Amanda Porter (CSCI Regulation Inspectors) and Julie Ayles (Dorset County Council Contacts Monitoring Officer); Tuesday 21st August 0930 – 1715 hours Val Hope (Regulation Inspector) and Julie Ayles (Dorset County Council Contacts Monitoring Officer); Wednesday 21st August 0930 - 1700 hours Val Hope (Regulation Inspector), Christine Main (CSCI Pharmacist Inspector) and Julie Ayles (Dorset County Council Contacts Monitoring Officer). • • At the time of the inspection occupancy levels were 10 people in the intermediate care unit, 22 in the dementia care unit and 24 in the elderly care unit. Feedback in relation to the findings of this inspection was given to Debbie Eadie Care Services Manager for Care South on the afternoon of Thursday 22nd August 2007 1500 – 1730 hours. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 7 The inspection process included the time spent in the home (as specified above) inspecting the premises, examining of a range of the home’s records, talking with residents, visitors and staff. In addition to this, time was spent reviewing the Commissions records relating to the service, time planning the inspection, examination of the Annual Quality Assurance Assessment document completed by the home and reading, collation and analysis of surveys and comment cards received by the Commission. In addition to direct contact during the visit completed surveys were received from 3 General Practitioners, 2 Community Nurses, 7 residents and 4 relatives. The views and comments of people using the service and other stakeholders are reflected within this report. What the service does well: What has improved since the last inspection? What they could do better: Amend for accuracy the home’s information documentation provided to residents. Continue to work towards ensuring care plans contain sufficient detail and provide care staff with the necessary information they need to ensure a comprehensive and safe delivery of care. Ensure regular reviews of all care planning documentation takes place and that all documents are signed and dated. Action must be taken to ensure that the privacy and dignity of people accommodated is at all times protected and promoted. Ensure that health care needs including special dietary needs are fully met. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 8 A number of aspects relating to medication management need improvement. Put into place a wide and varied range of social activities and events designed to meet residents social, emotional and psychological care needs and provide mental stimulation to enhance their social well-being. Recruitment and selection processes must be more robust. A programme of regular individual staff supervision should be introduced and maintained. Chemicals must be locked away. The programme of training commenced must continue and systems must be in place to ensure staff receive sufficient training and support on an ongoing basis. Staffing levels should be kept under constant review and flexible according to the number and care needs of people living in the home. The home should be able to demonstrate how staffing levels are set. A review of the home’s policies and procedures should commence. 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. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 9 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 Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 10 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): Standards 1, 3, 5 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Information relating to the services provided at the home needs amendment for accuracy. The home is unable to guarantee that every resident’s needs can be met because some assessments are not sufficiently thorough. EVIDENCE: The home has a Service User Guide which incorporates the home’s Statement of Purpose. The manager reported that this document is in the process of being amended/updated for accuracy and a draft copy was provided for inspection. The draft document examined is in need of further amendment for accuracy purposes as follows:• Page 24: the frequency of inspection by CSCI is not necessarily twice yearly one announced and one unannounced; Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 11 • • References to NCSC needs to be changed to CSCI; Section relating to provision of social activities is inaccurate, the home had not actually provided the vast majority of the social activities/events as advertised [reported upon later in the report under Daily Life and Social Activities] Some residents spoken with could not remember having received the information and asked the inspector questions that could have been answered by the home’s own documentation if it had been to hand for them. There was evidence that assessments of need are carried out prior to admission. The home had obtained a copy of single assessment documents where appropriate and had in some cases carried out their own assessments of need prior to agreeing to admission. However, care needs assessments did not in every case sufficiently identify all essential needs [i.e. bathing preferences see standard 7]. There was evidence of consultation and/or participation of prospective residents and also with other professionals. The offer of a placement at Maiden Castle House was confirmed in writing. Residents are able to visit and reside at the home for a trial period in order for both parties to determine whether the home is suitable and able to meet their needs and expectations. The purpose of the intermediate care unit is to provide a maximum of 10 persons at any one time with short term [generally ranging between 1 – 6 weeks] rehabilitation services in order to maximise their independence and enable them to return to their home. There was evidence to demonstrate that residents in the intermediate care unit had been assessed and referred to Maiden Castle House solely for short term rehabilitation purposes. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Care plans contain insufficient detail to ensure consistent comprehensive care delivery. A lack of privacy for residents fails to promote and support dignity. Some aspects of the handling, recording and administration of medicines need improving to safeguard residents and ensure that their healthcare needs are met. EVIDENCE: In total the care records of 9 residents were examined. For the most part care plans were found to be of a poor standard in the physically frail unit, failing to contain essential information in relation to how care needs were to be met by staff of the home. Care plans for residents in the dementia unit had recently been subject to considerable improvement since the recent Adult Protection investigation. To date 18 care plans relating to residents in this unit have been subject to extensive review and improvement. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 13 Improved assessments introduced as part of the improved care planning process include a wide variety of risks including: Falls, Leaving the grounds, Contact with hot surfaces/liquids, Poisoning, Self-medicating, Moving and handling, Safety, Communication, Physical health, Medication, Mental health, Mobility, Food/drink/nutrition, Daily routine, Continence, Leisure and Relationships. Not all risk assessments have been subject to regular review as part of the care planning process. Time was spent in the dementia unit observing residents daily life and care practice. It was observed that staff were very patient, always took time to ask residents questions rather that deciding for them and people were encouraged to be active, but could also sit quietly if that was their wish. Care South have seconded one employee to work specifically upon behaviour assessments contributing towards the development of detailed care plans, in order to provide an effective working tool for care staff. Once this work has been completed the home should be able to ensure that all residents care needs are identified and a comprehensive plan put in place to ensure and evidence that the care needed is actually provided. The behaviour assessments undertaken thus far are very informative and provide the reader with a good insight on what a day in the life of each resident would be like. Shortfalls in care practice/care records identified during this inspection included: • Lack of specific information for example, the District Nurse had visited a resident that morning to renew a dressing but the care plan did not contain information on a wound or what to look out for or what action to take. However staff spoken with were aware of the dressing and reason for visit; No evidence was produced to demonstrate that nutritional assessments had been carried out [although it was later confirmed by the company that they had been] and not all manual handling assessments had resulted in the development of a manual handling care plan; There is no specific care plan in place for the management of one resident’s catheter carer. Staff have merely written that the catheter is managed by the local district nursing services. Staff within Maiden Castle House are ultimately responsible for the day to day management of the service user’s catheter and provide care in changing night/day bags and ensuring that the catheter is flowing adequately. None of this information has been detailed within the care plan and this is of particular concern; There is no care plan in place for wound/pressure sore care for another resident; DS0000069062.V348114.R01.S.doc Version 5.2 Page 14 • • • Maiden Castle House • • • • • • • • • Discussion with staff ascertained that one resident started to get agitated after lunch, and this behaviour was observed during the inspection and staff responded well to him/her. However the persons care plan mentioned the agitation but not the pattern of it; that information would be essential in enabling staff to take pro active action to reduce and/or minimise upsetting episodes for the resident; Leisure activities were loosely referred to and none had taken place. There was no life history on which to base activities, which were likely to interest this individual. It is recommended that a life history of the resident is included in order to provide staff with information about who the person is as a result of their life experiences; Care plans relating to the management of continence are not specific enough i.e. what type of pad to use day/night and how many are generally used and when; Staff appeared to know a lot more useful information about some residents than the care plans could tell them; A pressure pad in situ for one resident gave no indication in the care plan as to why because the resident was seen to be quite immobile. Staff were later able to say that he/she sometimes managed to sit him/herself on the edge of the bed and could attempt to get out and fall; Numerous documents in place were not dated and/or signed by the person making the record or the resident involved where their agreement was necessary; Care Plans failed to provide sufficient detailed information as to how specific care needs were to be met, when, how, by whom and with what equipment if any; One resident admitted into the home within the last two weeks said that their preference for bathing had not been requested. The resident had been told he/she could have a bath or shower and said that only one had taken place so far since admission. This was clearly not the individual’s preference. The records supported this statement. The residents personal preferences are actually for a bath 3 times per week and this should have been identified during the pre admission assessments [as previously reported in standard 3]; People using the service in need of a diabetic diet were of the belief that an appropriate diet to meet their special dietary requirements was being provided at all times. However, discussion with catering staff, examination of food records, food stocks held and food purchased records established there was no evidence that this was routinely the case. On the day of the inspection the records evidenced that one diabetic resident was experiencing particularly high blood sugar levels. This caused concern, although it should be noted that it was not established whether the lack of food suitable for diabetics was a contributory factor or not. The manager immediately stated that she would contact a dietician to visit the home and talk to the kitchen staff about the special dietary Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 15 needs of people with diabetes. In addition, the manager also said that local GP surgeries would be contacted and a review would be requested for all people with diabetes in the home. The programme of improving the standard of care plans and associated documents is yet to be completed and a realistic timescale of 31/10/07 was agreed with Care South’s Care Services Manager. Throughout the inspection it was apparent that the home receives frequent visits from the District Nursing team to assist with the health care needs of residents. There was evidence from records and contact with health professionals that some problems exist relating to communication. Comments received by health professionals included: • • • “Advice is sometimes sought but then not acted upon, resulting in recurrence of problems”; “Due to the larger team [from the previous property] and the geography, messages often do not get passed on therefore advice is not always acted upon. Therefore health care needs are not met”; “Have had several meeting with the home and care manager when there have been concerns from both sides. An appropriate response is promised but as we are not made aware of outcome it is difficult to know if this is acted upon!!” Catheter and pressure area care needs updating”; “The health care needs physically are improving. The home is more aware of the importance of fluids and bowel care in relation to health. Catheter and pressure area care needs improvement”. • • Examination of records during the inspection found that fluid charts had been kept up to date as had weight charts. Inspection of care records of those accommodated in the intermediate care unit found that records relating to residents were kept by both the Primary Care Trust [who partially fund stays in the rehabilitation unit] employees and staff of Maiden Castle House. The home’s records relating to residents consist of a weekly plan of goals to be achieved with the aim of enabling people to return to their own homes and daily case notes. Medication Management: The home encourages residents to self-medicate where appropriate but risk assessments did not accurately reflect and address the risks of current storage arrangements to safeguard other residents. The home has a medication policy and information about medicines for staff to refer to. There were recorded competence assessments for some staff who Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 16 give medicines and the deputy manager said that some staff would be doing a further course in the safe handling of medicines. There had been concerns or complaints reported about staff not administering or appropriately managing two residents’ medication to meet their healthcare needs. From the records examined on the day some medicines were not given as prescribed. For example two medicines were out of stock for a few days. One person’s eardrops were not given for 8 days because there was no dropper bottle available and another’s eye drops were signed as given for 8 days instead of 5 as directed by the doctor. Procedures for providing medicines due when residents were out for the day were not always followed so 2 people missed some doses. The home has systems for recording receipt, administration and disposal of medicines and a good system for recording the skin care provided to residents. Sometimes staff did not clearly record the reason for not giving medicines, or the dose given when there was a choice (e.g. 1 or 2 tablets) so that the person’s response could be monitored. There were good written instructions about the special arrangements for administering one resident’s medicine but the directions for when residents could be given some medicines “when required” were not clear enough to inform staff. Some were given regularly, but there were no entries in the daily records to indicate why, so people may be having more medication than they need. The home had taken action to address identified errors in administering medication. There was a good audit trail for medicines supplied in monitored dosage packs but the correct administration of other medicines could not be checked, as there was no system for recording a recent stock balance or the date of opening a new pack. The blood test for monitoring one resident’s medicine dose was overdue and there was no evidence that staff had followed this up to safeguard their wellbeing. Medicines were stored securely and there were suitable arrangements in place for medicines that required special recordkeeping and storage. One person’s eye drops were still available for use 3 weeks after the expiry date potentially putting the resident at risk of infection. Some medication that has a short shelf life was not dated when opened to ensure it was safe to administer to residents. No action had been taken when the medicines fridge temperature was too cold putting medicines at risk of deterioration due to freezing. The rapport between staff and residents was observed as kind and friendly and it is clear that staff are caring and understanding in their role. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 17 No concerns were identified in relation to communication between staff and residents when the dementia unit was visited. However, some issues were identified during the visits within other areas of the home that will need to be addressed in order to ensure that service users privacy, dignity and modesty are promoted and protected at all times. Shortfalls identified included: • • Staff were observed hoisting residents in the lounge without providing appropriate cover or screening to protect residents’ dignity; Incontinence products were openly stored on top of a resident’s wardrobe in full view of residents and visitors walking past the room. Action should be taken in ensuring that suitable facilities are available to store service users’ incontinence products so that they are not left in full view; One service user was being helped to eat, another supported to drink and both care workers were seen standing over them in an unsupportive and distant manner while this assistance was provided; Puréed food being fed to two residents had been mixed together and looked very unappealing and undignified. It was ascertained from discussion with catering staff that puréed constituents to meals had been puréed individually to make the meal look appetizing, however, care staff feeding residents had clearly mixed the food. • • Comments received from Health professionals included: • • • “Privacy and dignity is usually respected but there have been occasions when confidentiality has been disregarded”; “Continuity of communication could be better”; People are not always adequately covered by towels/covering etc when being bathed or bedrooms cleaned and tidied and carers do not always knock when entering a room”; It was noted that the doors of most rooms in the intermediate care unit open directly on to the lounge and dining area. Two people were visible from lounge seating resting on their bed, uncovered, with their doors open. Discussion about dignity issues took place with staff who said that the residents had their doors left open by choice. However, it was clear from comments received from three ladies sat in the lounge at the time, that their dignity had not been given consideration and that they found themselves in an embarrassing position which was very clearly, not to their liking. The privacy and dignity of both sets of residents had clearly not been considered and protected. It was established that there is one screen stored Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 18 on the unit however, staff were unaware of its location and had to search for it giving a clear indication that it was rarely used. Action must be taken to ensure that at all times, the privacy and dignity of all persons living in the home is protected and promoted. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 19 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): All the above standards were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. The lack of mental stimulation and opportunities for residents to participate in varied, meaningful activities and social events fails to promote their social wellbeing. A varied and nutritious diet is provided of sufficient quality and quantity that meets the expectations and needs of the majority of people in the home. EVIDENCE: The home’s service user guide (brought forward from the previous Maiden Castle home) states that a wide range of social activities and events are offered at Maiden Castle House. However, it was found that this has not been the case since registration of this new service. Discussion with residents, staff and examination of records established that opportunities for structured, meaningful social interaction or activities had not been provided by the home. A significant number of residents commented that they were bored and that there was little social interaction from staff and that contact with staff was task orientated and only through the delivery of personal care. This was seen to be the case throughout the duration of the inspection [with the exception of the dementia unit]. Some residents said they enjoy bingo and this is the one Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 20 event that is usually held on a weekly basis. Other events held periodically include the memory box and quizzes. Some outside trips and one to one walks are organised and these have become more frequent in the warmer weather. A number of residents in the intermediate unit spoke with the inspector; all said they were really bored with “little to do” - one particularly stressed that he/she was “bored rigid!”. The home’s manager did advise that they are able if they so wish, to join in with activities within the main home. The home has not undertaken social or life histories of all residents within Maiden Castle House and as a result, staff are unaware of residents previous lifestyle, interests and hobbies, which would enable them to instigate interaction. The use of Social Support Workers, a new role, has recently been introduced into the home. Social Support Workers are predominantly responsible for facilitating and providing opportunities for social one to one or group activities within the dementia unit and some activities were observed there during the inspection. However, there is no formal programme or structured activities within the dementia unit, and the two records examined by the inspector on that unit failed to include any entries of any participation in activities in August. Residents said that for the most part, they have the choice of when to rise and go to bed. There was evidence from residents and visitors that visitors are made welcome at any time and that they are able to spend time privately in residents rooms if wished. A recently introduced ‘Relatives Meeting’ was in the process of being held during the inspection; contact with relatives found that they felt this was reassuring and informative. Most rooms viewed were personalised with pictures and some ornaments and the home’s information states that people can bring with them items of furniture if they so please. There is a four week rotational menu which offers a varied and nutritious diet. A choice of three main meals is offered each day along and there are a range of options for both breakfast and supper time meals. Residents may eat in their rooms if they so choose but are encouraged to join other people in the dining area. The meals are transported by hot trolleys to each unit; residents said that their meals are always hot, of sufficient quality and quantity and generally suit their individual tastes. Shortfalls were identified relating to the provision of special diets for people with diabetes, the presentation of liquefied meals and the manner that assistance is provided to people who need feeding. These issues have already been commented upon in the previous section entitled Health and Personal Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 21 Care. The home has experienced difficulty in recruiting a full time head chef since the previous chef left the home in May; it was reported that this would be rectified with the employment of a new chef due to commence work on 3 September. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 22 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): All the above standards were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Residents are not sufficiently safeguarded due to lack of staff training in adult abuse awareness. People’s right to be involved in civil processes was not evidenced. EVIDENCE: There are appropriate policies and procedures in place for examining complaints. This information is contained within the home’s service user guide. People using the service said that they know who to complain to and felt comfortable that they could raise concerns. There was no evidence in care plan files examined to demonstrate that residents are enabled to participate in government elections and other civil processes. The home’s adult protection policy and procedure is in need of review and amendment as it does not provide the necessary safeguards; the inspector was advised that a review of a number of the home’s policies and procedures is imminent. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 23 In May 2007 a letter of complaint was received by the Commission raising a number of concerns relating to poor care practice; the complaint was referred to the local authority for investigation under the Safeguarding Adults procedure. During the course of the investigation a further two referrals were made. The adult protection investigations into the three separate referrals were undertaken in partnership with the home and it is acknowledged that the provider co-operated fully with the agreed adult protection plan that was instigated. Two of the three complaints were partially substantiated. During the investigation process it became evident that a significant number of staff had not received training in the subject of adult abuse awareness. It was recognised that this topic is briefly covered during the Skills for Care induction programme, however based upon the training matrix provided by the manager, it would appear that only two staff have received this standard of induction. A high proportion of staff have attended the Care South five day induction programme however there was no evidence that this programme includes any details in relation to adult protection issues. Since the investigation the home has provided a session for staff on this subject and 19 members of staff attended. All staff working within the home, including ancillary workers, should be provided with comprehensive training in the subject to ensure they are fully aware of their responsibilities and to be certain that people who use the service are fully protected. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 24 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): All the above standards were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Maiden Castle House offers an extremely comfortable environment for people to live in. EVIDENCE: There are 66 bedrooms with en-suite shower and WC rooms. All rooms are of regular shape, very large en-suite toilet facilities, with “walk-in” showers, including grab rails. Bedrooms are all decorated to a good standard, with suitable floor coverings (either carpet or alternative non-slip surface). Communal rooms include lounge/dining areas, a faith room, activity room (featuring a “mini”car) and a quiet/visitors’ room, a “treatment” room and a hairdressing salon. Total amount of communal space is in excess of National Minimum Standards. Outside there is a path and grassed areas. External facilities are predominantly the courtyards with seats and additional features. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 25 The intermediate care unit is situated at one end of the building and includes its own facilities, including communal dining-room/lounge, kitchenette and sluice room. Bedrooms lead directly off the communal room providing the opportunity for compromising privacy and dignity [previously reported upon in the section Heath and Social Care]. The design of this unit means that the only natural light on the communal areas is provided by ceiling skylights. People using the service commented negatively upon the fact that there is no outlook from the communal areas, which along with a lack of social stimulation contributed to their boredom [previously reported upon in the section Daily Life and Social Activities]. Comments received from people in the intermediate care unit included:• • “There is nothing to look at but doors and bare walls – nothing interesting at all”; “I feel very shut in there are no windows to see what it is like outside I have to go into my room to do that, but then I am on my own and I can only see cars under the window anyway”. The two dementia units at first floor level have been designed in such a way as to assist orientation of people with dementia; they include a range of communal rooms and areas, enabling people to readily access their bedrooms and WCs. Built-in display cabinets form part of the corridors in some areas, providing the opportunity for memorabilia and items of interest to be installed for interest. There are 3 aided bathrooms, 2 aided shower rooms and 12 disabled communal WCs distributed around the building. Other personal aids have also been obtained for individual residents. Large windows and wide expanses of glassed areas (e.g. looking out into courtyards) provide plenty of natural light in all areas (except the intermediate unit). Artificial lighting levels in all areas are sufficient. All water outlets accessed by residents are controlled to close to 43 degrees centigrade. All radiators have controls to enable residents to vary temperature and all have low heat surfaces. A personal alarm system is in place with moveable handsets in bedrooms and fixed points and pull cords in communal areas, including en-suites and bathrooms etc. Source of calls is displayed electronically on each unit. Staff carry pagers to enable them to identify and respond to calls quickly. There was evidence that the requirements of Dorset Fire and Rescue Service and the Environmental Health Department were complied with. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 26 There was a very high standard of cleanliness throughout the home and there was evidence to demonstrate that basic training in infection control procedures is included within the home’s initial induction programme and ongoing training plan for staff. Sluice rooms are available for staff to dispose of and clean equipment and these areas are kept clean with suitable ventilation. Comments received from people living in other areas of the home included: • • • “It is very new and quite posh, everything is lovely”; “It is quite different to the old house it is a bit big and you can get lost but it is very nice”; “They have done a wonderful job here, I have much more room for my things and my own toilet, which I love having”. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 27 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): All the above standards were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. Recruitment and selection practices must be more robust to ensure people are protected. Lack of comprehensive and updated training across the staff team fails to ensure residents care needs can be safely met. EVIDENCE: The adult protection investigation established that the home at that time did not have a comprehensive staff rota in place. As a result it had proved extremely difficult to identify how many or which staff were on duty at any one given time. The system implemented since as a result of this, does not provide sufficient clarity to easily identify who is working at a given time as there were several rotas in use [one for each staff group i.e. Care Assistants/Care Team Managers/ Night Shift Leaders/ancillary staff etc] in order to be able to establish this. It was suggested that a rota for each unit be compiled to enable clear and swift identification of who is on duty, during which shift and in what unit of the home. From information provided at commencement of the inspection, examination of staffing rosters, observation throughout differing periods of the day between 0930 and 1900 hours it was considered that with the current ratio of residents, Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 28 staffing levels are sufficient throughout the day. Although this is a difficult subject as care records at present do not accurately reflect the care needed. However, contact with people using the service, relatives and health professionals found that it is a general perception that the home is shortstaffed. Comments received included: From health professionals: • “I think they are understaffed greatly – it’s often difficult to find staff”; • “There seems to be a lack of morale and high level of stress amongst the staff which is affecting the quality of their care. Despite this they do appear to care about the patients welfare”; • Greater communication is needed between management and the ‘hands on’ care staff. The former could also support the care staff more. A more relaxed style of management might help staff morale and improve the atmosphere for residents”; From Residents: “It seems to me that more staff is required very thin on the ground at times”; “Depending if they are not needed in other places”; “They are always very busy and don’t have much time to do things, but they are so kind and willing – there is just not enough of them”. From Relatives: In response to the survey question ‘How do you think the care home or agency can improve’? • “By having more staff, it seems to be very stretched at times, although they have been advertising”; • “By having more staff for they are truly stretched at times”; • “More care staff. One key worker who knows the medical & social history of each resident. More trips out for those who are not too introverted with dementia. How about a layer of workers under care workers who could chat – a bit like teaching assistants do for teachers”? Upon further admissions it will be expected that the home be able to demonstrate the rationale should a decision not to increase staffing levels alongside an increase of occupancy. It was not possible to make a judgement about night staffing levels due to the lack of detailed information within care plans relating to residents night care needs. The home should undertake a dependency assessment of the night care needs of all residents and document the rationale for the level of night staff deployed. Staffing levels must be flexible to ensure all residents care needs are comprehensively met. The Primary Care Trust currently employs in the intermediate care unit a physiotherapist who works 14 hours per week and an occupational therapist who is contracted for 20 hours per week. In addition, health and social care assistants are provided by the Primary Care Trust to work within the unit, the Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 29 majority of the time there is one on duty although this can increase depending on the needs of the patients. It was acknowledged that since the conclusion of the adult protection investigation there have been considerable changes to the staffing structure within the home and it was noted that some changes had already commenced prior to the adult protection referrals being made. Information supplied to the Commission prior to the inspection demonstrated that 50 of the staff group have achieved NVQ Level 2 in Care or above, meeting National Minimum Standards. The management have acknowledged that there is a substantial amount of training to be delivered across all levels of the staff team. Due to the lack of accurate training records at the home it was not possible to evidence all the training reported to have been delivered. There is a programme of a wide variety of in house training scheduled to take place throughout the year. Since the Adult Protection investigation care workers have received dementia awareness training. Care South has the benefit of their own in-house training department that provides a number of mandatory and specialist training courses to staff employed within the organisation. Maiden Castle has to apply for places on courses alongside candidates from Care South’s other 18 homes. New staff members attend an initial 5 day structured induction programme that includes moving and handling training and infection control procedures. The home’s records demonstrated that two staff have completed the Skills for Care Induction programme although evidence of a certificate to prove that they had been assessed as competent once completing the programme, could not be evidenced during the visits. During the adult protection investigation it was found that the manager did not have a record of the training that staff within the home had received. Since the investigation a training matrix has been compiled by Care South’s head office detailing the dates and courses that staff have attended. This information needs updating and training profiles should be undertaken for each staff member to ensure that individual staff training needs can be assessed and monitored. A shortfall in staff receiving manual handling training was identified during the investigation, however, the home acted promptly and arranged courses as a priority so that now all but two staff have received up to date training. The investigation also identified significant gaps in training for staff in the subject of adult abuse awareness [previously reported upon in the section Complaints and Protection]. Again, the home responded promptly and 19 staff have Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 30 received training since May 2007. In addition training courses in dementia awareness were arranged for 26 staff and a training session in diabetes was organised for 10 care staff to attend. The home acted swiftly and positively in addressing some of the shortfalls and gaps in training identified during the investigation process. Consideration however, must be given to providing the dementia training awareness for all staff working within the home now that priority has been given to staff predominantly working within the dementia unit. All staff who work nights must also be prioritised to attend this training as they will float between units during their shift. Sixteen staff attended a 5 day specialist course in Dementia prior to the adult protection investigation. The inspector was advised that because this particular course is only held once a year it is extremely difficult to source places for other staff. However, consideration is currently being given to the design of an in-house condensed 2 day training course so that staff have access to a more extensive course than the current one day dementia awareness session. There are still a number of staff who have not received training in health and safety and only five staff have received any form of training in challenging behaviour. Examination of five staff files found that the required pre-employment checks had not been properly completed. Shortfalls identified in the recruitment and selection process included:• • • • • • • Two written references had not been obtained for all applicants; The full work history of all five applicants had not been obtained; Gaps in employment had not been explored; There was no record of an interview for one applicant; Dates of previous employment had not always been obtained; There was no evidence of any previous training for one applicant; There was no ID photo for two applicants; Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 31 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): Standards 31, 33, 35, 36 and 38 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and takes into account the views and experiences of people using the service. There are currently occasions when lines of communication and responsibility in the home do not clearly protect and promote the welfare of people living in the home. EVIDENCE: Mrs Tomlin is the Registered Manager of the service and has many years experience. The issues identified during the initial adult protection investigation included the lack of sound management and administration systems in place. The transition from the old premises to the new site has been a considerable contributory factor. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 32 The proposed review of all the home’s policies and procedures [as previously mentioned elsewhere in this report] should be undertaken as a priority and staff should be made aware of changes to support and ensure good practice. The home has some quality assurance systems in place including staff and relatives meetings and monthly visits by a representative of the company [as required by regulation]. Evidence of the home’s quality assurance audit was not made available during the inspection, however evidence that an audit, which included ascertaining resident’s views, had taken place in June 2007 was later produced. No concerns were identified in relation to the management of resident’s money. Record cards are used to record all transactions and a sample check of money demonstrated that these were accurate and that resident’s money was being safely kept. Apart from three staff within the home, no other member of staff has received a supervision session since the home moved to new premises in January 2007. Supervision is considered to be of paramount importance in ensuring that staff are being adequately monitored and supported. It is of concern that this issue was not identified by the manager or any other member of the management team whose responsibility it was to implement the process. Had the system of individual staff supervision been in place, it is possible that the home could have avoided further breakdown in communication and the subsequent failing of systems and standards. Accident and incident forms were examined and found to be completed appropriately including any follow up action deemed necessary. At the time of the inspection there was no evidence of there being a system in place to monitor accidents and incidents within the home to ensure that proactive action is possible and preventative measures can be taken. Care South has since confirmed that there is a process and that bi-monthly reports are issued to the Board of Directors for their comments. The home has a number of policies and procedures in place however a significant number of these have not been reviewed and updated for accuracy for some time. Hazardous chemicals were found unsafely stored; kettle de-scaler was found in one ground floor kitchenette and disinfectant and dishwasher tablets were found in the kitchenette within a dementia unit. Issues highlighted within this report show there are currently problems within the home with regard to ensuring effective management and monitoring. For example there were shortfalls in:- care planning, protection, delivery of care, staff training, staff recruitment and selection and safety. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 33 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 2 x 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 1 18 1 3 4 3 3 3 3 3 4 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 3 x 3 1 x 1 Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 4[1][b] Requirement The registered person must compile a written statement as to the facilities and services provided for service users. This means that the statement of purpose/service user guide must be amended for accuracy as follows:• Page 24: the frequency of inspection by CSCI; • • References to NCSC needs to be changed to CSCI; Timescale for action 30/10/07 2 OP3 12[1][b] Section relating to social activities must actually reflect the services provided. The registered person must ensure that the care home is conducted so as to make proper provision for the care and where appropriate treatment education and supervision of service users. • This means that assessments of need must be comprehensive and clearly identify all physical, 31/10/07 Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 35 3 OP7 15[1] 15[2][b] social, emotional and mental health care needs. The registered person must ensure care plans accurately specify:• All identified needs (including night care needs); • How the needs are to be met; • When; • By whom; • With what equipment [if any]; Care plans and associated risk assessments must be kept under review:• The programme of improving the standard of care plans and associated documents should be completed as agreed with Care South’s Care Services Manager. 31/10/07 4 OP9 13[2] The Registered Person must make arrangements for the recording, handling, and safe administration of medicines received in the care home including: - Having systems to ensure that all residents’ medicines are in stock so that they can be administered as prescribed to meet their healthcare needs. Ensuring that staff administer medicines as prescribed and record the dose given if a choice is prescribed, or the reason medicines were not given, to safeguard residents’ wellbeing. 31/10/07 Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 36 - Having clear directions for how and when any “when required” medicines are to be given so that staff know how to meet residents’ healthcare needs. Ensuring that risk assessments for selfmedication are actively reviewed, and updated where necessary, to safeguard residents. Ensuring that, when necessary, tests to monitor the dose of people’s medication are followed up promptly to meet their healthcare needs. Having an audit trail for medicines not in monitored dosage packs and regularly monitoring medication to ensure that it is given as prescribed and accurately recorded to safeguard residents. Ensuring that medicines are stored at the correct temperature to maintain their effectiveness. Having procedures in place to ensure that medication is not used after it has passed its shelf life to safeguard residents wellbeing. - - - - - 5 OP10 12[4][a] The registered person must make suitable arrangements to ensure that the care home is DS0000069062.V348114.R01.S.doc 31/10/07 Maiden Castle House Version 5.2 Page 37 conducted in a manner which respects the privacy and dignity of all people using the service. This means that:• Appropriate cover or screening is deployed during hoisting operations; Staff must not ‘stand over’ residents who they are assisting to eat and drink; Appropriate storage facilities are available for storing service users’ personal incontinence products. 31/10/07 • • 6 OP12 16 The registered person shall having regard to the size of the care home and the number and needs of people using the service:• Provide opportunities for structured, meaningful social interaction and activities and mental stimulation through the implementation of a programme of activities and social events. 7 OP29 19 The Registered Person must not allow a person who is employed to work at the care home unless the employer has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. This • • • must include:A full work history; Two written references; Gaps in employment must 30/08/07 Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 38 • • 8 OP30 18 be explored with the reason recorded; A record of previous training must be obtained; Proof of identity including a recent photograph The registered person must 30/11/07 having regard to the size of the care home, the statement of purpose and the number and needs of people using the service ensure that at all times suitably qualified, competent and experienced persons are working at eh care home in such numbers as are appropriate for the health and welfare of residents. All staff receive training in:• • • Health and safety; Dementia awareness; All staff working within the dementia unit are provided with training in challenging behaviour 31/10/07 9 OP36 18[2] • The Registered Person must ensure that persons working at the care home are appropriately supervised. A programme of individual staff supervision must be implemented to include: • Those undergoing induction during their probationary period of employment with records kept accordingly; • All staff should receive formal individual staff supervision at least six times a year. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 39 10 OP38 13[4][c] The registered person must ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. This means that all chemicals subject to the Control of Substances Hazardous to Health Regulations are kept in a locked facility. 20/08/07 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 5 6 7 Refer to Standard OP1 OP7 OP7 OP7 OP10 OP12 OP12 Good Practice Recommendations When the service user guide has been updated, a copy should be supplied in each resident’s room. It is recommended that a life history of the resident is included in the individuals care records. Nutritional assessments should be recorded within care plan files. All care documents and records should be dated and signed by the person making the record or the resident involved where their agreement is necessary. Constituents of pureed meals should be presented individually and resemble the appearance of the meal offered. The home should ensure that the programme of activities and social events is published and residents are made aware of all forthcoming events. Undertake a personal profile consisting of resident’s lifestyle, interests and hobbies to aid the planning and provision of meaningful activities and mental stimulation to meet individuals assessed needs. Suitable and appropriate training should be provided for the Activities Co-ordinator and Social Support Workers. The home should be able to demonstrate that residents are enabled to participate in government elections and other civil processes. DS0000069062.V348114.R01.S.doc Version 5.2 Page 40 8 9 OP12 OP17 Maiden Castle House 10 OP18 11 12 13 14 OP27 OP29 OP30 OP31 All staff working within the home, including all ancillary workers, should be provided with comprehensive training in adult abuse awareness to ensure they are fully aware of their responsibilities to be certain that people who use the service are fully protected. Documentary evidence should demonstrate the rationale for night staffing levels provided as a result of an assessment of all residents night care needs. Evidence of an interview and a formal interview record should be kept. Evidence of completion of Skills for Care induction training is retained within the home. The proposed review of all the home’s policies and procedures should be undertaken as a priority and staff should be made aware of changes. Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Maiden Castle House DS0000069062.V348114.R01.S.doc Version 5.2 Page 42 - 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. 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