Inspection on 08/01/09 for Meadowcare Home

This inspection was carried out on 8th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadowcare Home 02/03/09

Meadowcare Home 30/10/08

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meadowcare Home 2-3 Belvedere Road Westbury Park Bristol BS6 7JG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 43 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 43 Information about the care home Name of care home: Address: Meadowcare Home 2-3 Belvedere Road Westbury Park Bristol BS6 7JG 01179730174 01179739919 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Meadow Care Homes Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 34. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Meadow Care Home opened in the summer of 2008. It is a 34 bed registered care home, with nursing support for people. The home is located near to Clifton and the main Bristol city centre shopping centre. There are good bus routes and the home is within close walking distance to Park Street which has a broad range of shopping and facilities. 34 0 Over 65 0 34 Care Homes for Older People Page 4 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection which focused on the specific standards as laid down by the Commission for Social Care Inspection under its inspecting for better lives program. Areas we have covered have included admission processes, health and personal care, complaints and protection, fire safety, staffing, recruitment, training and the management of the service. This was our second visit to Meadowcare Home. Our first visit was a random visit that we completed on 31st October 2008. The purpose of this random visit was to review some issues of concern that had been raised to us by a health professional who had been visiting and assessing the healthcare needs of an individual at the home. Some of the issues raised to us were upheld and requirements in respect of these were made. Care Homes for Older People Page 5 of 43 Information can be found about this visit within the main body of this report. This visit to the home was conducted over two days the first day was Thursday 8th January 2009, we completed the site visit on Monday 12th January, a total of fourteen hours were spent at the home. During this visit we examined the care and associated records for five of the people who live at the home. We also looked at records relating to fire safety, staff employment and training records. Time was spent talking with people who live at the home. Time was spent with people in individuals private rooms and also in the main communal areas. We spoke with qualified staff, care assistants, the cook, domestic and laundry staff. Time was also spent with the manager and the director of the company. What the care home does well: What has improved since the last inspection? What they could do better: During our last visit to the home on 31st October 2008 we reviewed a sample of care plans for people who live at the home. We were not satisfied with the level of information recorded and made a requirement that the registered person must consult with the service user and should incorporate individuals wishes, preferences and choices within the care plan. This would evidence that individuals have been asked their opinion about how they wish their care to provided. The registered person should develop care plans in order that they are more person centered, rather than task orientated. During this key visit we reviewed the care plans and associated documents for five people who live at the home and found that the quality of information varied within care plans. The requirement remains and quality of information provided in care plans requires more detail in order to ensure that peoples assessed needs are being met, these documents must be kept under review to ensure existing and changing needs are monitored and the service is provided as required. When we visited the home in October 2008 we noted that an individual with complex mental health needs had not had an assessment of their mental capacity and decision making ability. We required that the home contact specialist services for people when a need had been been identified. We reviewed this area for this same individual at this visit and are not satisfied that this requirement had been met. Of the five care files we reviewed there were two people who were in need of specialist services, one for wound care and the other for support with their mental health, the home must arrange for specialist services for these people to ensure their needs are being met and to try to reduce the likelihood of deterioration in their health. Care Homes for Older People Page 7 of 43 Whilst we were at the home we observed staff dressing an individuals wound on their leg in the main lounge area in front of all of the other residents, this is not acceptable. In order to demonstrate that people are treated with dignity and respect it is required that people living at Meadowcare home are supported with any healthcare treatments in private. The home must demonstrate that people are being supported appropriately with their medication. It is required that people receive their medication as recommended by their general practitioner. Furthermore the registered person must ensure that people are fully assisted to take their medication as prescribed. The registered person must also ensure that medication records are fully completed. This is to ensure that people are being given their medication correctly and in line with the general practitioners instructions It is recommended that the home seek information about individuals end of life care, this should be recorded in order that peoples wishes and choices are known, respected and followed. It is recommended that records of individuals weight are better maintained. This is for those people who have been identified as being of high risk of losing weight. This is in order that any specialist advice or intervention can be sought at the earliest opportunity and therefore not put peoples health at risk. The registered person must maintain a record of all complaints and must also maintain a copy of the actions taken by the registered person in respect of any such complaint. This is to ensure that issues raised to the home by service users, their representatives or relatives or by persons working at the home about the operations of the care home are recorded and appropriate action is taken in response. The registered person must have in place full and satisfactory information in place in relation to staff employed at the home. All staff employed at the home must have in place a Criminal Records Bureau Check and two written references in order to ensure the protection of vulnerable people living at the home. Staff at this home have not received sufficient amounts of training in both core and specialist areas. Staff must be trained in the following areas: manual handling, first aid, protection of vulnerable adults and dementia care. It is also recommended that a full audit is undertaken of the training completed by staff. This would provide the registered person with a strategy to ensure that all staff have the necessary skills and knowledge to work in this care environment. During our visit it was found that many of the staff do not have a contract of employment which outlines the terms and conditions of their employment. It is recommended that the registered person ensures that contracts of employment or letters of engagement should be in place for all members of staff employed at the home. The registered provider must appoint an individual to manage the care home.This is to ensure that people live in a home which is run and managed by a person who is fit to be in charge. Care Homes for Older People Page 8 of 43 The registered person must fully complete an Annual Quality Assessment of their service and re submit this to us. This will enable the registered person to review the level and quality of the service which is being provided. In order to provide evidence of the financial viability of the business we have requested that the Annual accounts of the care home, certified by an accountant, are forwarded to CSCI. It is also required that a reference is to be obtained from the bank expressing an opinion as to the registered providers financial standing. The registered person must ensure that incidents which adversely affect the wellbeing of individuals living at the home are reported to us. This is to ensure that incidents which adversely affect the wellbeing of individuals living at the home are responded to appropriately. Information recorded must show that (where possible) all actions have been taken by the home to prevent a recurrence. The registered person must consult with the fire authority in order to take adequate precautions against the risk of fire.This is to ensure that weekly and monthly safety checks are being completed, as required. This is to ensure the safety and protection of those who live and work at the home. The registered person must consult with the fire authority in order to take adequate precautions against the risk of fire. The registered person must ensure that the home has a suitable, effective fire risk assessment in place.This is to ensure that those living and working at the home are not at risk. The registered person shall ensure that the unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. It is also recommended consent should be obtained for the use of bed rails to demonstrate that consultation over the use of this equipment has taken place and consent has been obtained. In order to ensure the safety of people living at the home it is recommended that hot water temperatures are checked each week, and that these checks are recorded. This is to ensure that hot water temperatures are safe for those who live and work at the home. The registered person must also make suitable arrangements to provide a safe system for the moving and handling of service users, this is to ensure people are assisted in line with their assessed needs using safe techniques and equipment where needed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 43 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about the service and facilities provided at this home. Peoples needs are assessed prior to their admission in order to determine whether these are able to be met by the home. Evidence: During this visit we reviewed the statement of purpose for the home. We saw that this document contains information about the aims, objectives and philosophy of care for the home and also gives information about the services and facilities available for those who live at the home. The manager informed us that this information is given to people upon request when they enquire about the services that the home are able to offer. We reviewed the service users guide, this encourages people to visit the home before continuing their application for a placement at the home and also informed people that Care Homes for Older People Page 11 of 43 Evidence: they would be provided with an information pack which contains further information about the accommodation and services provided. The guide provides information about the key contract terms of admission, occupancy and termination of the contract. We asked to view terms and conditions of the placement for people who live at the home. We were told that contracts for all of the people living at the home had been sent to relatives and/or their representatives within the past month, no copies of these were available on individuals files. We will review this area again at our next visit to the service in order to ensure that suitable contracting arrangements between the home and individuals who live at Meadowcare Home are in place. The manager on duty on 8th January 2009 informed us about the homes admission process and gave full information on how individuals needs would be assessed prior to coming into the home. We viewed the care records for five people living at the home and saw that each person had a care management assessment provided by the placing local authority. The manager told us that this information is used during the first month of placement in order to direct and guide staff practice. This first month of placement at the home is a trial period in order that decisions can be made as to whether the home is able to meet the individuals assessed needs and is also an opportunity for the individual to decide if they wish to stay at the home. During the months trial period staff monitor and review how individuals wish to be supported and this is recorded in peoples daily notes. The manager told us that the home use this information in order to develop their own plans of care for people living at the home. Care Homes for Older People Page 12 of 43 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place for people who live at this home, however they are not always kept under review and more detailed information is required to ensure that individuals specialist needs, wishes and choices are recorded with additional information needed on how these will be met by the home. Improvements are required with medication administration to ensure that people are supported appropriately in this area. People must be supported better to ensure that their health needs are being met by both the home and that specialist services are accessed when a need has been identified. Evidence: During our last visit to the home on 31st October 2008 we reviewed a sample of care plans for people who live at the home. We were not satisfied with the level of information recorded in order to demonstrate that peoples needs were understood and Care Homes for Older People Page 13 of 43 Evidence: were being met by the home. We made a requirement that the registered person must consult with service users and should incorporate within care plans individuals wishes, preferences and choices. This is to evidence that individuals have been asked their opinion about how they wish their care to be provided and to develop care plans in order that they are more person centered, rather than task orientated. During this key visit of the service we reviewed the care plans and associated documents for five people who live at the home and found that the quality of information varied within care plans. Within individuals care plans the home had recorded information about individuals personal hygiene, dressing, nutrition, mobility, communication, continence and sleep needs, however, for some people with complex needs there was nothing in the plan on how to support them with their dementia, with reality orientation of where they were, what day it was etc. There was insufficient information about how to support people who have special needs due to their dementia, mental or physical health. Of the five peoples records we reviewed we saw that they all had in place nutritional risk assessments in place. For two of these people the assessment identified there was cause for concern and for a third person they had been assessed as being at a very high risk of losing weight. For these people it is recommended that records of weight are better maintained for those people who have been identified as being of high risk to lose weight. Within the five care records for people living at the home that we reviewed we did not find that people had been asked about what their end of life wishes were and these were not recorded. Whilst we acknowledge that this is a sensitive area it is recommended that the home seek this information and record this in order that people wishes and choices in respect of their end of life are respected and followed. In two of the five care plan files we reviewed we found that these people had in place a life history questionnaire. These recorded what people did for a living, where they went to school, if they had any children and also recorded what their favorite food, drink and books were. This home is registered to provide care for people with a dementia and although this information is useful there was nothing to show us how this information would be used to benefit the individual and further work is needed by the home in this area. During our last visit to the home we found that not all of the people living at the home had information on how they would like to be supported with their manual handling needs. We made a requirement that the registered person must ensure that manual handling risk assessments are in place for all who live at the home. This is to record how individuals will be supported in a safe manner, it would outline individuals needs, Care Homes for Older People Page 14 of 43 Evidence: staff support and any equipment which is needed. At this visit we saw that manual handling assessments were in place for four of the five peoples records we reviewed. Of the assessments which were in place we found that information within these assessments were unclear and confusing. One persons assessment had recorded that they were able to manage independently when transferring from their bed and to use the toilet. This person had a falls risk assessment in place and within this the question was asked whether the individual had any underlying conditions such as arthritis, acute illness or had experienced a previous stroke which may contribute to a higher risk of falls, the assessment recorded no, yet within this persons pre admission medical history it records that the individual had arthritis and had also had a hip replacement. This persons falls assessment dated for 26th November rated their level of risk as being one of extreme risk. We reviewed accident records and saw that this person had had falls in the past yet their care plan had not been updated to reflect this information. This requirement will remain. Manual Handling risk assessments must be in place for all. The manual handling assessments that are currently in place must contain clear, accurate information in order that individuals are supported in the manner most appropriate for them. During our last visit to the service we made a requirement that specialist support services must be requested for one individual who lives at the home. This was to ensure that this person had an assessment of their mental capacity undertaken and to further demonstrate that any decisions made had been done so through consultation and in line with the individuals assessed needs. On records we saw that the home had contacted the placing local authority in order to request a re assessment of this individuals needs. However, the home had not made a referral to request that a mental health capacity assessment is undertaken and that a best interest meeting be arranged in order to discuss how this persons needs can be met. The requirement that specialist support services be requested for this person has not been met and the requirement remains. Within another persons review records for a meeting that took place in October 2008 we saw that this person can become very distressed at times and that their relative had asked for a referral to be made to the general practitioner for a community psychiatric assessment and to arrange for further support for their relative. The care manager involved with the placement had requested that the manger of the home deal with this. There was no evidence on any records we saw to demonstrate to us that any action had been taken to meet this request. Staff confirmed to us that specialist help had not been requested. We saw in this persons notes that there are occasions where this person becomes anxious and distressed and this specialist support may provide guidance and advice to support this person. Action must be taken by the home to ensure that when a specialist need has been requested this should be acted upon in order to ensure the best interests, health and welfare for people living at the home. Care Homes for Older People Page 15 of 43 Evidence: At this visit we reviewed how people are supported with their pressure area care. We saw that the home had completed waterlow and nutritional assessments for all five of the people whose records we reviewed. On one persons care plan we saw that it had been recorded about two areas of pressure care, and recorded that one of the strategies to support this person was that they have a pressure relieving mattress on their bed and a pressure relieving cushion when sat in a chair. We saw that the mattress was in place and was in good working order, however, during our two days at the home on not one occasion did we see this person sat on a pressure relieving cushion, furthermore there was no specific plan for this persons pressure area care, there was no information recorded about how the wounds would be monitored or what treatment was required. This person requires specialist advice from a tissue viability nurse and the home must arrange this. When a need for equipment, such as a pressure relieving cushion has been identified this must be provided by the home, furthermore the home must have a clear plan in place to record how pressure areas and wounds will be monitored, what treatments will be given and how this will be kept under review to ensure the most effective outcome for the individual involved. This same person was subject to a safeguarding strategy meeting in December 2008 due to concerns raised over a wound to this persons shin. The wound on the shin was still evident, the care plan had not been updated to incorporate this information and there was no evidence to show how this person would be supported in this area of their care. This is a home for people with a dementia. We saw that within peoples records there were assessments in order to determine an individuals level of capacity, a checklist for assessing the best interest of people and a form to show how decisions have been made under the Mental Capacity Act. Of the five peoples records we reviewed none of them had full completed information within these areas. Most of the documents were blank or had not been fully completed. Staff confirmed to us that they have not undertaken any Mental Capacity training and were unable to demonstrate to us their understanding in this area of the rights of people with a dementia who are living in the home. We were also concerned to note that within one persons records they have signed to state they do not wish to be resuscitated. This form was signed by the resident who has a dementia, their relative and the former manager of the home. There was no evidence to show us that a general practitioner or a mental health advocate had been involved in the decision making process based on the best interests of that person. During out visit we sat with residents as they had their morning drink. We noted that none of the residents within the lounge were asked what they would like. All were given a cup of tea, a rich tea biscuit and a bourbon biscuit. When we asked staff if people are able to have something else to drink, and if were people asked what they Care Homes for Older People Page 16 of 43 Evidence: wanted to drink staff told us yes. Whilst we were there staff then asked people what they wanted. People living at this home have a diagnosis of dementia, this does not mean they they are not able to choose what they would like to drink. It is recommended that staff are reminded to support and encourage people to make choices which affect their life. This must be part of staff normal routine and practice. Prior to visiting the home we received a letter from a relative of an individual who lives at the home, they informed us that they were concerned about how people were supported to take their medication. They told us that when visiting they had seen staff give a resident their medication and then they witnessed the resident put this medication in their handbag. At 11:00 am we sat talking with the residents in the lounge, we were sat besides a lady who opened her hand and a tablet fell to the floor. This tablet was congealed and appeared to have been in this persons hand for sometime. We alerted staff to the tablet and they appeared unconcerned. Staff knew what the medication was and disposed of the tablet as required. In order that people living in the home take their medication as prescribed it is required that people must be supported fully with this area of their care. We reviewed medication administration, recording and storage at this home. The staff member who showed us the systems in place, however they were not able to evidence to us that stock held medication is audited and recorded in the home. We checked three different residents stock held medication, we asked staff what amount of a specific medication for each person should be in place. What staff told us should have been in place did not correspond with medication we counted and records of this stock medication was also different. Records and systems for auditing stock held medication must be improved. We saw in medication records that some residents are given medication to be taken as and when prescribed, this medication has been prescribed for agitation and anxiety. When we asked a member of the nurse qualified staff in what circumstances this medication would be given they were not able to tell us. It is recommended that staff are provided with clear guidance for each person as to when it is appropriate for them to be given medication which has been prescribed as to be given as and when prescribed. We reviewed the records for an individual who takes warfarin, this medication dose can vary on a daily basis and monitoring of medication is essential. We saw that there were six occasions since November 1st 2008 that this persons chart had not been completed. Records of medication must be improved. Within the main lounge we saw five pairs of residents spectacles on a dresser. We looked at the spectacles and saw that they were all in need of a clean, furthermore three of these pairs of glasses had individuals names on them. We asked staff about Care Homes for Older People Page 17 of 43 Evidence: this and they were not able to tell us why people were not wearing their glasses. These spectacles belonged to people with poor mobility and poor sight it is essential that people are supported to wear aids prescribed to assist them. It should also be noted that the home have in place a daily check list, on this list staff record if they have assisted people with areas of their personal care such as, cleaning and ensuring people are wearing spectacles, we noted that for the people we reviewed none of them had recorded that staff had assisted them to wear, or clean their spectacles. Care Homes for Older People Page 18 of 43 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The cook was knowledgeable about the dietary needs of people living at the home. Meals provided are of a good standard. Evidence: Due to time spent focusing on the health and welfare of people living at the home these standards were not fully reviewed by us at this site visit and will be looked into in depth at our next key visit to the home. We reviewed the daily records in depth of the five individuals whose care records we were were reviewing, we also sample checked the daily records of other people living at the home. Within daily records there was very little information to inform us about the social activities or community contact that residents were involved with, as reported within care plans we could find very little evidence to demonstrate that people living at the home have been supported and encouraged to make decisions which affect their life. There was an activities co ordinator employed at the home, however this is no longer the case. We were informed by staff and the director at the home that this person had Care Homes for Older People Page 19 of 43 Evidence: left. On the second day of our visit an entertainer was at the home playing an electric organ and those residents who were listening appeared to enjoy this. We viewed the visitors book and saw that those living at the home are able to receive visitors at any reasonable time. During our visit we spoke with relatives of people who live at the home, one person told us that in the main lounge that there were often not enough comfortable chairs for people to sit in, we also noted this, please see the environmental section of this report. Of the four relatives we spoke with no concerns or complaints were raised to us. People living at the home who we spoke to told us they were ok and that staff were kind. During our visit we spoke with the cook, he told us about choices and alternatives that are offered to people at the home, the Cook informed us about special diets which are catered for and gave us a number of examples of how individuals wishes are met in this area. We saw the kitchen to be clean and tidy. People we spoke to who live at the home told us that they enjoyed their food. Care Homes for Older People Page 20 of 43 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at this home are not protected by the homes recruitment processes. Complaints have not been dealt with effectively and there has been no monitoring of complaints at this home. Staff at this home have not completed protection of vulnerable adults training. Evidence: We asked the home for evidence of how they deal with, monitor and respond to complaints, issues and concerns which have been raised with them. We asked for this information on Thursday 8th January and also on our return visit on 12th January 2009, on each occasion these records were not available to us. We were told by the manger that the home does not have a complaint logbook. Within the management section of this report we have included information about the completed Annual Quality Assurance Assessment, AQAA, which was completed by the home and sent to us prior to this visit. Within the completed AQAA there is no information provided about complaints which have been raised to the home. The home have recorded not applicable within the complaints and protection section of this AQAA yet we know of at least two separate issues of concerns that have been raised to the home. Care Homes for Older People Page 21 of 43 Evidence: Prior to our visit to the home we forwarded to the manager a copy of new concerns which had been raised to us by a relative of an individual living at the home, we were given a copy of the homes response to this when we arrived at the home on Monday 12th January 2009. The response provided by the home demonstrated that there had been some confusion over medication recording practices at the home. Which the home were working to improve. A few days prior to our visit to the home we received additional information from a relative of another individual who lives at the home. This information outlined a number of concerns in respect of medication practices at the home, residents being ignored, people being left in wheelchairs for long periods of time and that the lounge TV was often set to inappropriate MTV music channels, some of which can be seen as provocative. A number of issues within the concerns raised to us have been upheld and requirements in respect of these have been made within this report in order that improvements for people who live at the home can be made. The relative who raised these concerns has since moved their relative out of the home. During this visit we were concerned to find that of the ten staff recruitment files we viewed there were two members of staff that had no Criminal Records Bureau (CRB) checks in place and of these staff seven staff of them did not have all of their references in place. We saw the two staff without CRB clearance were assisting people with their medication and both staff confirmed to us that they assist people with their personal care. This is not acceptable and does not sufficiently protect vulnerable people. It is required that the home have in place full and satisfactory information in relation to staff employed at the home such as two written references and that staff have been checked with the Criminal Records Bureau to ensure they are appropriate to support vulnerable people. During this visit we reviewed the homes policies and procedures in respect of protection of vulnerable adults. We saw that the home have comprehensive documents in place. We asked six members of staff if they have completed protection of vulnerable adults training, three of the staff had only been employed at the home for approximately five weeks and had not completed this training, one person had completed this training with a previous employer. We reviewed the files for staff and found that there are a number of staff who have not completed safeguarding, protection of vulnerable adults training. It is required that all staff must complete this training in order to ensure they have the knowledge and understanding to protect those people in Meadowcare Home and to further ensure that staff are aware of their role and responsibility in this area. Whilst we were at the home we noted one person calling out for assistance and they Care Homes for Older People Page 22 of 43 Evidence: appeared to be in distress. We observed that no one responded and we went into this persons room to speak with them, they told us they needed assistance with their personal care. We explained to the person to use their call bell to summon staff, to which they told us that staff do not answer and that staff pull the call bell out of the wall. Upon examination we saw that this was the case. We checked this persons room on both days of our visit and saw that on each day the call bell had been disconnected making it impossible for this person to summon staff assistance via this method and could only get assistance by shouting out. This is not acceptable. The home must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Staff must not remove call bells and prevent people from requesting assistance. Care Homes for Older People Page 23 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is decorated to a high standard, all accommodation for those living at the home is of a good standard. Homely touches, such as ornaments, cushions, plants and clocks would enhance the environment for people living at the home. Evidence: Meadowcare Home is registered with us to provide care, with nursing, for up to 34 people who have a diagnosis of dementia . The home opened in the summer of 2008. The location and the layout of the home is suitable for its intended purpose, it is accessible to both the front and rear of the premises. The rear of the home is a paved area which has a lift to enable less mobile people to reach all areas of this garden area. Please see management section of this report for information relating to fire service safety compliance requirements. Furnishings within the home are of a high standard. Lighting is domestic in character. On the first floor there is a large conservatory, during our last visit to the service we Care Homes for Older People Page 24 of 43 Evidence: recommended that window coverings, either blinds or curtains should be fitted to this area in order to ensure the lounge is not overlooked by neighbours and also to make the area more homely. When we viewed this area we saw that this recommendation had not been met. The director of the company informed us that he had sought the services of an interior designer who would be providing advice on furnishings for the home. We were not given a timescale when this would be achieved, the recommendation remains, homely touches would enhance the area for people living at the home. At the home there is also a lounge on the first floor, this is divided into three areas, a dining area and two lounges. Each lounge area has their own seating and television and residents were seen making use of both of these areas. Within the main lounge area there is a large wooden dresser, it is a feature of the room and is most impressive. However, it was disappointing to note that the only objects on this unit were a teddy bear, five pairs of residents spectacles and a wedding photo. A relative visiting the home told us that the photo was of their mother and father and they were not sure why it was in the lounge as it should have been in her mothers bedroom. Prior to our visit we received a letter of concern from a relative of an individual who lives at the home they told us that on most occasions when they have visited that television in the communal lounge has been on a young persons music channel with loud inappropriate music. On the ground floor of the home there is a communal area divided into a dining area and two lounge areas. Within each of the lounge areas are televisions. We viewed these areas and returned to the lounges on a number of occasions during both days of our visit. On three occasions during the two days we noted that one of these televisions did have on loud music television channels. We asked the people in this area if they enjoyed watching this program to which one person told us its not up to us. In the other part of this lounge we noted that at 11:00 am the television screen had frozen, we noted that this picture remained this way until 12:10pm.There were a number of staff seen by us in these areas, yet no one did anything about the television picture. The home must ensure that the television is in good working order and that channels appropriate to residents wishes are on the television. We visited the home on 31st October 2008 and a number of requirements in respect of the environment were made. These were that attention must be given to the leaking radiator pipe on the ground floor stairwell. And also that the registered person must provide rails in those areas identified during this site visit, this includes all bathroom areas, and within all individuals en suite facilities. Another requirement was that the registered person must ensure that attention is given to the stair carpet which had lifted. During our visit on Monday 12th January 2009 contractors were on site dealing Care Homes for Older People Page 25 of 43 Evidence: with all of these issues. The carpet was dealt with and contractors were fitting handrails in the areas which they were needed. All three of these requirements had been met. It is important that rails are provided this is to enable people to maintain their independence and to ensure that equipment is provided by the home in line with individuals assessed needs. Within the health and personal care section of this report we reported that within an individuals records it was identified that due to pressure area care concerns this person should sit on a pressure relieving cushion. We checked on numerous occasions over the two days of our visit whether the individual was sat on this equipment. This is an essential aid for this persons care, this must be provided and staff must ensure that this individual is supported to use this in order to aid their wound healing process. All of the residents private rooms are single occupancy, all have en suite facilities. we saw that individuals rooms had been personalised by families in order to reflect individuals personalities and taste. Rooms seen by us had good quality bedding, carpets and curtains. During our visit to the home in October 2008 we noted that a bedroom chair was broken and not fit for the residents use. We made a requirement that the registered person must provide a bedroom chair which is appropriate to meet the needs of the service user identified during the visit. This was to ensure that people living at the home have appropriate, safe seating provided. We visited this person in their room and saw that a new chair had been provided. This requirement had been met. The resident told us they were happy with their new chair and that it was much more comfortable. During our last visit to the home we were concerned to find that each floor of the home could only be accessed by use of a key pad, and doors would only open if you knew the key pad number. It was required by us that the registered person must give consideration to the use of key pad systems within the home.This is to evidence that people are not being restricted in their ability to move freely around the home, we saw at this visit that the number code was on prominent display by each keypad and did not appear to restrict peoples movement within the home. During our last visit to the home we reported that communal areas within the home lacked any homely touches such as clocks, ornaments, cushions and plants. We recommended action to be taken to improve this. At our visit we noted no change. The recommendation had not been met. As reported above the director informed us that he is in discussion with an interior designer who will be dealing with this. The recommendation will remain. Care Homes for Older People Page 26 of 43 Evidence: On both visits to the home we found it to be warm, clean, tidy and odour free. Care Homes for Older People Page 27 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered person does not operate a thorough recruitment procedure, the recruitment practices at this home are not robust and put service users at risk. Staff have not received core training or specific dementia awareness training in order fully support those living at the home. Evidence: One the first day of our visit on January 12th the manager was present during the morning, the director of the company was available on both days of our visit. During both days at the home we were satisfied that there were sufficient numbers of staff on duty to support those living at the home. On the first day of our visit the manger was present, also on duty were the administrator, two registered nurse staff, six care staff and ancillary staff. The manager and staff spoken with confirmed to us that there are waking night staff on duty, this was confirmed in the duty rota. Within the complaints and protection section of this report we have reported on our concerns over the poor recruitment practices at this home with staff who are employed at this home who have no Criminal Records Bureau checks in place and staff with no references. Care Homes for Older People Page 28 of 43 Evidence: We reviewed staff files and found that no staff had contracts of employment in place. The director of the company told us that contracts are only issued when staff have completed a successful probation period and have been made permanent. We also saw that of the ten staff files we reviewed only one person had a letter of engagement on their file. This letter outlined the post, the wage and the number of hours for which the individual is employed. On the second day of our visit the administrator informed us that letters of engagement were being sent out to all staff employed at the home. These should have already been in place. It is recommended that contracts of employment or letters of engagement should be in place for all members of staff employed at the home. We will review this at our next visit to the service. We reviewed staff training at the home, in order to do this we spoke with four staff members on duty about their induction and training that they have undertaken whilst being employed at the home. Three staff members told us that they had a brief form of induction and told us that none of this had been recorded and that they had not signed any documents relating to their induction. We reviewed these staff files, and the files of other staff members and only one completed induction form was in place. We were not able to speak with the manager about this as he was not available to answer our questions. Records of induction must be maintained by the home to evidence that this has taken place and also that a review of the quality and content of the induction may be reviewed. It is also recommended that a full audit is undertaken of the training completed by staff. This would provide the registered person with information about the skills, qualifications and knowledge base of the staff team and provide the basis for a strategy to ensure that all staff have the necessary skills and knowledge to work in this care environment. Staff we spoke with told us that they had not completed training in core areas such as first aid, manual handling and dementia awareness. We reviewed a number of staff records and this confirmed to us that training in these areas had not taken place. Requirements in respect of staff training have been made by us at this inspection in order that staff have the appropriate skills to support people living at the home. Care Homes for Older People Page 29 of 43 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no registered manager at this home. People living at this service may be at risk due to uncertainties about the financial viability of this home and also may be at risk due to insufficient fire safety checks being undertaken. Evidence: The manager who had been employed was suspended during our visit. This person had not registered with us and we had not made an assessment pf their fitness to manage a care home, with nursing care, for people with a dementia. It was explained to us by the director of the company that there had been formal meetings with the manager to discuss their performance and that this manager had been suspended pending further investigations. The director put in post a manager from another care home owned by the company. We asked the director to put the management proposal to us in writing in order that we can decide whether this management arrangement is sufficient to ensure that people living and working at the home are supported appropriately and that the home is managed in line with the Care Homes Regulations and the National Care Homes for Older People Page 30 of 43 Evidence: Minimum Standards for older people. We saw on display in the entrance hall of the home a copy of the homes insurance cover which has been put in place for business interruption costs. This insurance also covered the registered persons legal liabilities to employees, service users and third parties to a limit commensurate with the level and extent of activities undertaken. We did not review the business and financial plan for the home at this visit, however, due to concerns raised to us by staff in respect of their wages we wrote to the Registered Provider after our visit on 12th January 2009 and required that information to evidence the financial viability of the home is forwarded to us. Prior to this site visit we received an Annual Quality Assurance Assessment (AQAA) from the service. This had been completed by the manager in post at the time of our visit. This AQAA provides the opportunity for registered providers to evaluate their service and to demonstrate what they provide and how this impacts for those who live and work at the home. The AQAA we received was poorly completed. Within each of the National Minimum Standards outcome areas very little evidence was given as to what the service believes they do well and for every section; choice of home, health and personal care, daily life and social activities, complaints and protection, environment, staffing and management and administration within the sections of what the home could do better and the homes plans for improvement over the next twelve months the service had responded by saying that they would continue to monitor their progress. No examples were given as to what was being monitored or how this would be measured and by whom. Also within the AQAA the home are required to inform us about complaints, protection and other events. The home had responded to all areas in respect of complaints that this was not applicable, we know that this is factually inaccurate as complaints about the service have been raised to us and in two of these cases had been referred to the home. It is required that the home review the completed AQAA and re submit it to us with more detail. During this visit we reviewed the policies and procedures which were in place at the home. Those we reviewed provided clear guidance and direction for staff. Policies reviewed by us during this visit included staff code of conduct, adult protection and prevention of abuse and accident, emergency and crisis. During this visit we reviewed the firelog book. We saw that the fire alarm is tested on a weekly basis, however, there were no records of any fire safety instruction for staff. We saw that of forty staff employed at the home only one record showed us that two staff participated in a fire drill in September 2008. There were no records for emergency lighting and we do not think that this has been checked on a monthly basis. There was also no evidence to demonstrate that fire safety equipment has been Care Homes for Older People Page 31 of 43 Evidence: being checked each week to ensure it is safe. It is required that the registered provider must consult with the fire authority on the following areas in order to take adequate precautions against the risk of fire. These are to ensure that weekly and monthly safety checks are being completed, as required to ensure the safety and protection of those who live and work at the home and to develop and implement a fire risk assessment which identifies any potential fire hazards at the home and eliminate any identified risks. When we asked about fire training staff staff were inconsistent with their response. The manager who is covering at the home told us that staff had been involved in training, however there was no evidence of this. This manager has been requested to forward evidence that staff have received sufficient instruction in this area. This had not been provided at the time of writing this report. In order to be fully confident that the home are protecting people who live and work at the home in respect of fire safety we have contacted the fire authority and requested that they visit the home to review these areas. We found that the home have a record for weekly checks on the temperature of the hot water in the home. We saw a record that checks have taken place in the bathroom and bedroom areas and also within the kitchen, however the last of these weekly checks was recorded for 10th September 2008. It is recommended that these temperatures are checked each week, and that these checks are recorded in order to ensure that temperatures are safe for those who live and work at the home. Within peoples care files we saw that for those who use bed rails assessments for these were in place. We did note that a number of these assessments were not dated and also consent for the use of this equipment had not been obtained. It was also found that on one persons care plan it identified that they were at risk from falling out of their bed and that bed rails for them were needed, yet this persons bed rail assessment was not dated nor had consent been obtained for the use of this equipment. It is required that bed rail risk assessments are completed fully, to be dated and to record how consent for the use of this equipment have been obtained and from whom, this is in order to demonstrate that all aspects of this equipment use have been evaluated. Whilst we were at the home we sat in the lounge and spoke with residents, whilst we were there we saw that five zimmer frames were in the corner of the room. We observed one person ask three times for help to get up out of their chair. This person was told by a staff member to sit down and was not asked what it was they wanted. Staff must respond promptly to residents requests for help. We noted that it was on the fourth attempt a staff member got this persons walking stick. We observed this staff member pulling the resident up out of their chair from under their arms when assisting them to get up. This was the third time during our visit we had observed staff Care Homes for Older People Page 32 of 43 Evidence: using unsafe manual handling techniques. We asked five members of staff if they had received manual handling training they told us they had not. In the eleven staff files we reviewed only one of the staff had completed manual handling training. In order that people are supported safely with this area of their care it is required that staff must receive training to ensure that people are supported in line with their assessed needs, using appropriate safe techniques and equipment where needed. During our last visit to the service in October 2008 we reviewed the accident reports which had been maintained at the home. At that visit we were not satisfied with the level of recording in this area and a requirement was made that the registered person must ensure that accident reports are fully completed. During this visit we saw that accidents had been well recorded and demonstrated what action had been taken to support individuals. We also noted that there had been two occasions where individuals had been taken to hospital following falls at the home, these incidents had not been reported to us. It is required that incidents which adversely affect the wellbeing of individuals living at the home must be reported to us. Care Homes for Older People Page 33 of 43 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 24/11/2008 consult with the service user and should incorporate within the plan individuals wishes, preferences and choices. This is to evidence that individuals have been asked their opinion about how they wish their care to provided and to develop care plans in order that they are more person centered, rather than task orientated. 2 7 12 Specialist support services must be requested for one individual who lives at the home. This is to ensure that this person has had an assessment of their mental capacity undertaken and to demonstrate that any decisions made have been done so through consultation and in line with the individuals assessed needs. 24/11/2008 3 38 13 The registered person must 24/11/2008 ensure that manual handling risk assessments are in place for all who live at the home. This is to record how individuals will be supported Care Homes for Older People Page 34 of 43 in a safe manner, it will outline individuals needs, staff support and any equipment which is needed. Care Homes for Older People Page 35 of 43 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 The registered person must ensure that a record of any nursing provided to the service user is maintained. This is to record the treatment, monitoring and review of wound and pressure areas care. 16/02/2009 2 8 13 The registered person shall 16/02/2009 make arrangements for service users to receive where necessary, treatment, advice and other services from any healthcare professional. This is to ensure that people are supported with their pressure area, wound care and mental health 3 9 13 The registered person must ensure that records and auditing of stock held medication is improved. Records and systems for auditing stock held medication must be 16/02/2009 Care Homes for Older People Page 36 of 43 improved to demonstrate that medication has been given appropriately. 4 9 13 The registered person must ensure that medication records are fully completed. This is to ensure that people are being given their medication correctly and in line with the general practitioners instructions. 5 9 13 The registered person must ensure that people are fully assisted to take their prescribed medication. This is to ensure that people are receiving treatment as recommended by their general practitioner. 6 10 12 The registered person must 16/02/2009 ensure that the care home is conducted to ensure that people are treated with dignity and respect. This is to ensure that people are supported with any healthcare treatments in private. 7 16 22 The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. This is to evidence that information has been fully evaluated and issues raised have been investigated and 23/02/2009 16/02/2009 16/02/2009 Care Homes for Older People Page 37 of 43 outcomes and any required actions must be recorded. 8 18 18 The registered person must have in place full and satisfactory information in place in relation to staff employed at the home. The registered person must have criminal records bureau checks in place for those staff employed at the home. 9 18 13 The registered person should make arangements by training staff or other measures to prevent service users from being harmed or placed at risk. The registered person should make arangements for staff to recieve training in the protection of vulnerable adults. 10 18 18 The registered person must have in place full and satisfactory information in place in relation to staff employed at the home. All staff employed at the home must have in place two written references. To evidence that suitable staff are employed at the home to support people who are vulnerable. 11 22 23 The registered person shall 16/02/2009 ensure that equipment as may be required is provided. This is to ensure that 23/02/2009 23/03/2009 23/02/2009 Care Homes for Older People Page 38 of 43 pressure relieving equipment is provided when a need for this equipment had been identified. 12 30 18 The registered person must ensure that staff employed at the care home receive training appropriate to the work they are to perform This is to ensure that staff are trained in first aid and are able to support people living at the home appropriately 13 30 18 The registered person must ensure that staff employed at the care home receive training appropriate to the work they are to perform This is to ensure that staff are trained in manual handling techniques and are able to support individuals in a safe manner 14 31 8 The registered provider must appoint an individual to manage the care home. This is to ensure that people live in a home which is run and managed by a person who is fit to be in charge. 15 33 24 The registered person must establish and maintain a system for reviewing and improving the quality of the care provided at the home. The registered person should re submit the Annual Quality Assurance 16/03/2009 30/03/2009 23/03/2009 23/03/2009 Care Homes for Older People Page 39 of 43 Assessment in order to demonstrate how the service delivered is being monitored and kept under review 16 34 25 The Annual accounts of the care home certified by an accountant to be forwarded to CSCI. This is to ensure that those living at the home are suitable protected and to evidence the financial viability of the business. 17 35 25 A reference to be obtained 30/01/2009 from the bank expressing an opinion as to the registered providers financial standing. 30/01/2009 This is to ensure that those living at the home are suitable protected and to evidence the financial viability of the business. 18 38 13 The registered person shall 16/02/2009 make suitable arrangements to provide a safe system for the moving and handling of service users The registered person shall make suitable arrangements to provide a safe system for the moving and handling of service users this is to ensure people are assisted in line with their assessed needs using safe techniques and equipment where needed. 19 38 13 The registered person shall 16/02/2009 ensure that the unnecessary Care Homes for Older People Page 40 of 43 risks to the health or safety of service users are identified and so far as possible eliminated. The registered person shall ensure that those living at the home are able to summon staff for assistance. 20 38 37 The registered person shall ensure that incidents which adversely affect the wellbeing of individuals living at the home must be reported to us. This is to ensure that incidents which adversely affect the wellbeing of individuals living at the home are responded to appropriately. 21 38 23 The registered provider must consult with the fire authority in order to take adequate precautions against the risk of fire. To ensure that weekly and monthly safety checks are being completed, as required to ensure the safety and protection of those who live and work at the home. 22 38 23 The registered provider must consult with the fire authority in order to take adequate precautions against the risk of fire. This is to ensure that those living at the home are no at 09/02/2009 09/02/2009 16/02/2009 Care Homes for Older People Page 41 of 43 risk. To ensure that the home have a suitable, effective fire risk assessment in place. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 It is recommended that records of weight are better maintained for those who have been identified as being of high risk to lose weight. Records of medication to be given as and when required must be improved in order that staff have clear guidance and a consistent approach, tailored to individuals needs. It is recommended that staff are reminded to support and encourage people to make choices which affect their life. It is recommended that the home seek information about individuals end of life care and this should be recorded in order that people wishes and choices are respected. Staff to be reminded to support people with the use of aids in order that individual benefit from their use. It is recommended that contracts of employment or letters of engagement should be in place for all members of staff employed at the home. Records of induction must be maintained by the home to evidence that this has taken place and also that a review of the quality and content of the induction may be reviewed. It is recommended that a full audit is undertaken of the training completed by staff. This would provide a strategy to ensure that all staff have the necessary skills and knowledge to work in this care environment. It is recommended that hot water temperatures are checked each week, and that these checks are recorded in order to ensure that temperatures are safe for those who live and work at the home. Consent should be obtained for the use of bed rails to demonstrate that consultation over the use of this equipment has been obtained. 2 9 3 4 10 11 5 6 22 29 7 30 8 30 9 38 10 38 Care Homes for Older People Page 42 of 43 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 43 of 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!