Inspection on 20/04/09 for Milverton Nursing Home

This inspection was carried out on 20th April 2009.

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

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

Milverton Nursing Home 22/04/08

Milverton Nursing Home 17/12/07

Milverton Nursing Home 28/06/07

Milverton Nursing Home 22/05/06

Milverton Nursing Home 04/01/06

Milverton Nursing Home 04/10/05

Milverton Nursing Home 15/09/04

Milverton Nursing Home 05/04/04

Milverton Nursing Home 27/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ Lead Inspector Jon Fry Unannounced Inspection 10:15 20 and 23rd April 2009 th DS0000026253.V375241.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milverton Nursing Home Address 99 Ditton Road Surbiton Surrey KT6 6RJ 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) 020 8399 4663 F/P 020 8399 4663 milvertonhome@btconnect.com Surbiton Care Home Limited Manager post vacant Care Home 31 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (31), Physical disability (31) of places Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Physical Disability - Code PD 2. Dementia - Code DE (maximum number of places: 10) The maximum number of service users who can be accommodated is 31 22nd April 2008 Date of last inspection Brief Description of the Service: Milverton provides nursing care for up to thirty-one older people, ten of whom may have dementia. The home is in a residential area of Surbiton near to shops and public transport links. Accommodation is provided within a mixture of single and shared rooms on the ground and first floor. There is a passenger and stair lift in use within the home. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We spent just over eight hours in the home over two separate visits and spoke to nine people who live there, one visitor, the manager and four staff members. We looked at records and documents kept by the service including three people’s care plans. A previous unannounced inspection was made to the home in February 2009. This was to follow up concerns arising from a Safeguarding issue being looked at by the Local Authority and this report includes information from that visit. The service sent us an annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. This also gave us some numerical information about the service. What the service does well: “They are looking after me alright”, “everyone is very good”, “it’s very nice” and “it floats and flows easily” were all comments from people living at the home. People we spoke to like the staff who work there and say they are polite and respectful. Comments about the food were positive and the mealtime we saw was unhurried. What has improved since the last inspection? The environment is homely and has been improved over the last year. The new extension is very impressive providing a large communal space and eight new bedrooms. More activities have been introduced and we saw some nice interaction between staff and the people who live there. Staff are spending more time with people than seen at previous visits. A new more person centred format for care planning is being introduced. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 6 What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good up to date information is available about the home. The assessment process requires improvement to make sure that the service can meet the needs of people who come to live there. EVIDENCE: “I chose it because it’s homely”, “it feels homely” and “I’ve been well looked after” were comments from people who live at Milverton. A relative, friend or advocate commented that ‘they are unfailingly welcome’ when I visit. We saw that a new guide is being produced that gives people good information about the home. The manager told us in the AQAA that they were still looking at introducing other formats for this guide such as audio tape, DVD or a picture Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 9 version. This is recommended to make sure that as many people as possible can understand and use the guide. We previously visited the service in February 2009 and looked at the assessments carried out by staff for three people. The assessment was blank for one person admitted in January 2009 and only partially completed for another individual admitted in the same month. The care file for a third person showed that an assessment had been fully completed before their admission. During this inspection visit we again looked at the care files for three people. Written assessments had been completed by staff for two people but not for a third individual. We did see that the manager had visited this person in hospital and had received a copy of the assessment completed by the placing authority. It is very important that the home completes its own full assessment of each person to make sure that their individual needs can be met. A Safeguarding issue has recently been looked into by the Local Authority. One of their findings was that the home’s pre-admission assessment for the individual concerned was inadequate particularly as this person’s needs were quite complex. This shows how important it is for the home to have a thorough assessment process. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are being improved by the home. Practice around wound care and medication requires further improvement. EVIDENCE: “It’s very friendly and helpful”, “they are looking after me alright” and “they’re alright” were comments from people living there about the care provided. In the AQAA, the manager told us that each person is registered with a GP upon admission if required and baseline health assessments are completed. Assessments are also then completed for areas such as moving and handling, risk of pressure sores and nutritional needs. At the February inspection visit, we looked at the care files for three people. Two people had a care plan in place but the documentation for a third Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 11 individual was blank. This was of concern as this person had come to live at the home in early January 2009. We asked the home to make sure that each person had a care plan in place and this was the case during this inspection visit. The care plans are currently a work in progress as the manager is moving to a new system for recording information and has devised a person centred care plan format. One staff member is also due to attend training around ‘the Eden Alternative’ model of care that may also change the approach to care planning within the service. The three care plans we looked at during this visit gave some good information but need more detail. Phrases such as ‘assist with all aspects of washing and dressing’ or ‘shower once or twice weekly’ are too general. The new formats need to clearly say when, where, how and by whom whilst also reflecting the persons individuality. We saw that wound care procedures need improvement and there is a Requirement in this report for the home to do this as a matter of urgency. The records we saw were incomplete and did not fully detail the plan of care in place for each wound. Training should also be looked at for the responsible staff to make sure they are up to date with their practice. One person’s care plan we looked at said that they were reluctant to drink and that their fluid intake should be recorded. This record was not being kept and was then started on the day of our visit. We have again made a Requirement about this issue. Medication is generally well managed by the service with most of the tablet or capsule medicines supplied in dossets by a local pharmacist. These are designed to help accurate administration with staff being able to clearly see what needs to be given and when. We did find three issues around medicines that are supplied in boxes where the quantities left did not tally with the administration record. The manager took immediate action to make sure that records were then being kept to help track quantities of medication being given. This needs to be continued. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 offers a good range of activities. People generally enjoy the food provided to them and the mealtimes are pleasant unhurried occasions. EVIDENCE: Feedback from individuals included “I’ve been playing cards today”, “it’s up to me what I do”, “there’s enough to do” and “they sit and chat with people”. A new activities co-ordinator has been working at the home since February 2009 and she is clearly making a difference to people’s daily lives. The hours for this role have been extended to 24 each week. She works alongside the care staff and we saw lots of interaction with people with chatting, singing, playing games all going on. Other things going on include gardening, tea parties, birthday parties and visits by the mobile library. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 13 We think that things are moving forward in this area and the home should continue to support this improvement. We have recommended that the home keeps looking at how to engage, occupy and involve the people living there. Developing the Eden Alternative model of care may also help to support this. Some life story work has been going on and some relatives or friends have been asked for photographs to help with this. The new person centred plans will help to capture this information and help staff to see the person. Mealtimes have also improved since our visit in 2008. We saw that these were unhurried occasions in an improved dining environment. People received individual support where needed and napkins are now used instead of bibs. There are opportunities for improvement and staff should continue to make try to make each mealtime a social occasion. People we spoke to said “the food is quite good”, “good”, “it’s alright” and “excellent”. One person said “sometimes the meat is a bit tough”. None of the people we spoke to could tell us what was for lunch and the whiteboard display in the lounge was not updated until just before lunch was served. We talked to the chef about using pictures to display what was on the menu and also to think about developing the mealtimes at the home. Food and mealtimes could be used as a way of involving people in things like tasting sessions, food preparation, international days and reminiscence. More snacks could also be made available in the lounge area to allow people easy access to food and drink throughout the day. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are listened to and acted upon. Safeguarding training needs to be provided to all staff working at the home. EVIDENCE: The AQAA told us that the home has ‘an open, transparent and robust complaints procedure’ that is displayed by the front door. This procedure is also made available in the guide about the home. A complaints folder is kept and this showed that one issue had been received since our last visit in April 2008. This concern had been successfully resolved. We have recommended that the complaints procedure include pictures of important people in the process such as the manager and the owner. Three Safeguarding issues have been looked into by the Local Authority since the April 2008 inspection. As stated earlier in this report, one issue has recently been investigated by the Local Authority. The home has co-operated fully with this investigation and accepted where there have been identified shortfalls with their practice. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 15 The manager told us that he was auditing staff training records in order to develop a new programme of training for the home. Two of the three staff we spoke to said that they had not yet had training around Safeguarding. Both said they had received induction training but records were not available to show that this had covered all the required areas including protection from abuse. It is very important that all care staff have training in Safeguarding Adults and that this knowledge is regularly refreshed. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. People using the 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 environment is clean comfortable and homely. Recent renovations have extended and improved the living space available to individuals. EVIDENCE: A new extension has now been completed that has added an additional eight bedrooms along with a large lounge and dining area. This new space is very impressive and still retains a homely and comfortable feel. Some of the people we spoke to said that this was why they had chosen the home. People we spoke to were happy with their bedrooms. The rooms we looked at were personalised to the individual and contained many of their own possessions. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 17 Renovations continue with a new lift being added at the time of this inspection as well as renovation of more bedrooms. We saw that the home is kept clean and hygienic for the people who live there. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of people living there. Good recruitment checks help to protect people living at the home. The staff training programme needs improvement. EVIDENCE: People who live there were generally positive about the staff who work there. Their comments included “mostly very nice”, “everyone is very good”, “they help me a lot” and “a nice friendly way”. A relative, friend or advocate said “we always get time”. The AQAA told us that staff ‘undergo mandatory training in moving and handling, infection control, food hygiene, fire safety, first aid and other training programmes such as communication skills, dementia, POVA, DOLS etc’. Full training records were not available in three of the four staff files we looked at. One persons file showed they had received training in food hygiene, emergency first aid, manual handling and infection control. The staff we spoke to said that they had recently received training in manual handling and that Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 19 the manager had told them that further mandatory training was planned in the near future. As stated previously, the manager told us that he was reviewing training needs and developing the programme for the home. We also saw that the home had obtained the Skills for Care common induction pack but had not yet put this into operation. The staff records we looked at were very well maintained with all the required information kept on file. This includes a Criminal Record Bureau (CRB) check. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the 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 service requires stable management to be in place for a prolonged period of time. EVIDENCE: The manager who was in charge at the time of the April 2008 inspection is no longer working at the home. A subsequent manager has also come and gone since then. The new manager is a senior member of staff who has worked at the home for many years. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 21 Feedback from the people who live there confirmed that he is well known to people and comments include “he’s alright” and “he knows the place, he’s been around a long time”. Staff told us that they were able to approach the manager and felt consulted about changes being made. The staff we spoke to said that things were going well under his leadership. We think that the home requires stable leadership for a prolonged period of time in order for the service to make improvements. The change of managers along with the upheaval of major building works have clearly had an effect on the service. There is a quality assurance system in place and user questionnaires were last send out in April 2008 with the results compiled. The home told us that this is an annual exercise and is due to happen again soon for 2009. The AQAA told us that regular meetings are also held with users and their relatives. Minutes were available for a meeting held in October 2008 and the manager said that an informal meeting had been held in early 2009. We have recommended that this area be looked at by the service to make sure that there are regular opportunities for people to voice their opinions and be involved. Health and Safety records looked at were up to date for areas such as Fire Safety and hot water temperatures. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) (a) (c) Requirement In order to ensure that people know that the home can meet people’s needs, the service must ensure that each person’s needs are fully assessed before they come to live there. The home must complete an assessment and this document must be fully documented, signed and dated. 2. OP8 15 (1) 17 (1) (a) Wound care documentation must be improved in order to properly address individual health care needs. A full and detailed care plan must be in place for each wound with up to date records kept of progress / actions being taken. 3. OP8 17 (2) Full records must be kept of individual food and fluid intake when assessed as necessary. This is to make sure that people’s nutritional needs are being addressed. 01/06/09 01/06/09 Timescale for action 01/06/09 Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 24 4. OP9 13 (2) Medication must be administered as prescribed to people living at the home. Quantities of boxed medication must be audited regularly to make sure that people are receiving their medication as prescribed. All staff working at the home must receive training in Safeguarding Adults. This will help to make sure that the people living there are protected from abuse. A training programme must be put in place for the home. Records for all care staff must show that they have completed the Skills for Care common induction standards. Records for care staff must show that they have received training in food hygiene, manual handling and fire safety. 01/06/09 5. OP18 13 (6) 01/09/09 6. OP30 18 (1) (c) 01/10/09 7. OP31 CSA 2000 This will make sure that staff are properly trained to do their jobs. The manager must be registered 01/10/09 with the Care Quality Commission. This will make sure that the home is run by a person who is fit to be in charge. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The user guide to the home should be made available in a DS0000026253.V375241.R01.S.doc Version 5.2 Page 25 Milverton Nursing Home variety of formats. More photographs of staff, the home and local places should be included in the user guide. 2. OP3 The assessment format needs to be developed to make sure that good quality person centred information is captured. This will be important to inform the care plan from when the individual moves in. It is recommended that the home keep developing its alternative care planning formats. This may be important in developing care plans that are more personalised. Care plans need to give specific information about how the person likes the care and support to be delivered. Care plans need to reflect the person and their life. Life story books could also be developed with people living there. Care staff could make their own books for sharing. 4. OP8 The home should regularly consult with a tissue viability nurse to make sure that individual needs are being addressed. Regular access to training around wound care needs to be facilitated for the responsible staff members. This will make sure of their own good practice. The home should continue to develop the mealtimes to be a social occasion. Staff should eat meals with the people who live there where possible. Picture menus should be used to help people make choices and to know what is being provided each day. Food and mealtimes should be used as ways of engaging and interacting with people. Ideas such as international days, tasting sessions, people helping to prepare food and using favourite recipes should be considered. More snacks should be made easily available in the lounge area throughout the day. The complaints procedure should include pictures of important people in the process. All staff should have annual refresher training in Safeguarding Adults. People living there and their friends or relatives could also be briefed on this important area DS0000026253.V375241.R01.S.doc Version 5.2 Page 26 3. OP7 5. OP15 6. 7. OP16 OP18 Milverton Nursing Home 8. 9. OP30 OP33 and the home’s responsibilities. Training in dementia and person centred care should be included as mandatory for all care staff. Regular meetings should be held with the people who live there and their friends or relatives. Milverton Nursing Home DS0000026253.V375241.R01.S.doc Version 5.2 Page 27 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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