Random inspection report
Care homes for older people
Name: Address: Miranda House Nursing Home High Street Wootton Bassett Wiltshire SN4 7AH one star adequate service 25/03/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 0 2 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Miranda House Nursing Home High Street Wootton Bassett Wiltshire SN4 7AH 01793854458 01793853951 qualitycarewilts@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Gillian Gray Type of registration: Number of places registered: Conditions of registration: Category(ies) : Quality Care (Wiltshire) Ltd care home 68 Number of places (if applicable): Under 65 Over 65 68 68 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 10 10 No more than 2 persons not less than 50 years in receipt of day care at any one time. Persons less than 45 years of age may not be accommodated. Date of last inspection Brief description of the care home Miranda House is able to provide personal care and nursing care for up to 68 adults. These may be people with dementia or other mental health problems. Miranda House is in Wootton Bassett, near Swindon, Wiltshire. It opened in 1996, and was extended in 2005. The purpose built accommodation is on two floors, with passenger lifts between them. Most bedrooms have en-suite toilet facilities. All bedrooms are
Care Homes for Older People Page 2 of 24 2 5 0 3 2 0 1 0 Brief description of the care home currently used as single rooms. Baths and showers are provided throughout the building. There is also a range of communal space, including lounges, dining rooms and a conservatory. There is a garden and several parking spaces at the front of the building. The fees start at six hundred and sixty eight pounds, with higher rates reported to be charged for people with an increaced dependancy. People are able to request copies of the homes Statement of Purpose and Service Users Guide. Care Homes for Older People Page 3 of 24 What we found:
This random inspection of Miranda House took place on Thursday 29 July 2010 between 10:35am and 4:55pm and on Monday 2 August 2010 between 1:55pm and 2:15pm. The first visit was unannounced. Two regulatory inspectors performed the first day of the inspection and one regulatory inspector the second day of the inspection. These people are referred to as we throughout this report, as the inspection was performed on behalf of the Care Quality Commission (CQC). The registered manager Mrs G Gray, was present on both days of the inspection. The random inspection was performed following information provided to us about serious concerns, including a safeguarding referral, which indicated that the home may not have been meeting the needs of some residents. The random inspection was not a full review of the homes progress in meeting requirements identified at the last inspection. We returned briefly for a second day because Mrs Gray thought that some documents which could not be found on the first day of the inspection were likely to be found. One of the documents was found that day, but not the others. During the first day of the inspection, as well as meeting with Mrs Gray, we met with one resident and observed their care. We met with the registered nurse in charge of the floor where the resident lived and two care assistants who also worked on the floor where the resident lived. They were able to inform us about the individuals nursing and care needs. The deputy manager came on duty during the afternoon and we met with them briefly and discussed ordering of medication and supplies relating to the individual resident. A senior manager from the provider visited the home during the afternoon of the first day of the inspection and provided feed-back to both them and Mrs Gray. During our inspection, it became evident that there was the potential for an offence under our regulations to have been committed, so we seized documents under our established procedures, providing Mrs Gray with information on her rights under legislation. We also provider her with the same information when we seized a document under our legislation on 2/8/10. We were unable to seize all documents that we wished to review as some had been mislaid and remained unavailable, including up to 25/8/10. Homes are required to retain documents for three years from the date of the last entry. Following our management review of service provision at Miranda House, we considered that there was evidence to show that the home were in breach of certain of our Regulations. We therefore decided to issue Statutory Requirement Notices, to ensure that the home does comply with our Regulations, to ensure the health and welfare of residents. If the home do not comply with these Statutory Requirement Notices in the time-frame set by us in the Notices, they could be at risk of prosecution under the Care Standards Act 2000. What the care home does well:
Staff we met with in the home were open and supportive to us throughout the inspection process. The home has very committed staff, who know know about the needs of individual residents and who show a caring attitude towards residents. Care Homes for Older People Page 4 of 24 Two care staff we spoke to were able to fully inform us about of the many of the care needs of an individual resident and how they worked together and with registered nurses to ensure that the individual was comfortable and their needs met. For example a person had complex needs relating to eating and drinking and these care staff were able to describe in detail how they ensured that the resident ate and drank what they wanted and were able to, and the supports the person needed to do this. Registered nurses we met with were able to describe their role and how they received information on meeting residents needs from the care staff. A part-time registered nurse showed a commitment to the home and meeting residents needs. The deputy manager was able to report on processes for ordering medical and other supplies and how they followed up on matters when relevant. The registered manager, Mrs Gray submitted an improvement plan as we requested, following the last inspection, to outline how the home were planning to make developments in service provision. Mrs Gray was very co-operative with us throughout the inspection, working with us and seeking to give the information which we needed to progress the inspection. The senior manager who visited the home during the inspection was keen to work with us and find out more about our processes in the current situation. What they could do better:
At the last inspection, we required that care plans must be put in place whenever a person had a nursing or care need, that care plans must be fully updated when a persons condition changed and that care plans must use precise, measurable language. This was to take place by 28/5/10. The provider responded in their improvement plan that all residents care plans would be audited to identify any areas where care plans may require updating, that where a need for updating was identified, care plans would be re-written so that they met the persons assessed needs. They reported that care plans would provide evidence that risks would be accurately assessed, communicated and documented in each residents care plan. They stated that this had been achieved by 31/5/10 and would be on-going. When we discussed the residents needs with nursing and care staff and reviewed their records we found that there were areas of deficit. A person had been re-admitted following a stay in hospital occasioned by an acute episode. Mrs Gray, the registered manager told us about the homes procedures for re-admission to the home, stating that a nurse to nurse assessment took place to ascertain if the home could meet any changed needs for the resident. There was no written evidence in the persons records that this had taken place for the resident. As the residents condition was reported to have changed significantly before their discharge, including the need for wound care, an assessment was indicated, to ensure that the home could meet the residents changed needs. The resident did have a care plan to direct staff on how some of their individual needs were to be met, however some matters relating to the person were not considered in their care plan. A registered nurse and care staff informed us of pain experienced by the person. This was supported by some records about pain for the person in their daily records. Tissue viability nurses also informed us that the person would have been likely to be in pain, due to the nature of their wound. However there was no assessment for
Care Homes for Older People Page 5 of 24 pain experienced by the person and their care plan did not include areas about how their pain was to be managed. The persons medicines record showed that their GP had prescribed pain-killers for them on more than one occasion, however there was no evidence that the effectiveness of the different forms of pain relief had been reviewed or what a registered nurse and care assistants and tissue viability nurses reported and references in the persons daily records had been taken into account. Care staff were able to report to us on how they encouraged the person to eat and about their response to being supported to take in a diet; this was reflected in the individuals food and fluid charts. However the persons care plan did not reflect this information, stating a different situation from other documentation and what the carers reported. A tissue viability nurse had made specific directions in the persons records about how position change was to be managed and other equipment to be used to prevent pressure ulceration. We noted when we visited the person, that there was evidence that the person had developed tissue breakdown, which we both observed and staff reported. We also observed that interventions had been carried out by the home, including dressings to affected areas. References had been made in the persons daily records at different times to tissue damage and actions taken by staff. When we looked at the persons care plan, this had not been reviewed to reflect what the tissue viability nurse had directed. It had also not been reviewed following documentation in the persons daily records or interventions made by staff. The care plan also did not follow the companys policy on frequency of changes of position for a person who was at high risk of pressure ulceration. We were concerned that the home had not reviewed the persons care plan, so that key areas such as pain was not effectively manged for them and pressure ulceration prevented. We therefore issued the home with Statutory Requirement Notices on 10/9/10 so that the home did revise residents care plans to ensure that their health and welfare needs were met. When we visited the individual at 11:00am on 29/7/10, their turn chart showed no entries for that day. At the previous inspection, we had required that records of care given must be accurate and completed when nursing and care are provided, by 14/5/10. The provider responded in their improvement plan about this area but did not report on how they were going to ensure the accuracy and contemporaneous completion of such records. When we asked staff about why the record had not been completed for this individual, they reported that they often did not have time to complete such records and would therefore complete them later on during their shift of duty. When we visited the individual later on in the day, the record had been completed with two entries prior to when we had visited the person. When we looked at older turn charts, while the individual did have their position changed two hourly at times, at other times, records indicated that they were left in the same position for periods exceeding six or seven hours. The homes policies and procedures on prevention of pressure ulceration state a range of interventions to prevent risk of pressure ulceration, which conform to guidelines from bodies such as the National Institute for health and Clinical Excellence (NICE). This included that a person at high risk needed their position changing at least two hourly. Turn records for the individual also stated yes to the prompt question on the record about correct settings for the mattress. We observed that the setting on the persons air mattress was well above their weight. Tissue viability nurses report that incorrect settings on an air mattress can increase risk and discomfort for the person. Care Homes for Older People Page 6 of 24 The person was discharged from hospital with a wound. There was information from the hospital as to how their wound was to be re-dressed. Records showed that the home had not followed this advice and had used a different type of dressing at re-admission to the home. Following this, the type of dressing was changed again by the home. Both dressings used were not included in the agreed local dressings formulary for Wiltshire. The home had three copies of this formulary available. The reasons for these different dressings being used were not documented in the persons records. The home did refer the person to the local tissue viability service. The tissue viability nurse set out clear directions in the persons records as to what the wound was to be redressed with. On the tissue viability nurses second visit a week later, they found that the home had not followed their instructions and were continuing to use dressings which were not included in the local formulary. The tissue viability nurse reported that neither of the dressings used by the home were suitable for a wound of the type the resident had. They also reported that there was not an issue with supply of the type of dressings they had documented for use for the resident, and if a home did have problems with obtaining dressings that it would be appropriate for the home to contact them for further advice on wound management. We were concerned about the homes failure to meet the residents health and welfare needs in relation to their wound, so we issued a Statutory Requirement Notice on 10/9/10, to ensure that the home would meet residents needs in relation to wound care. Miranda House is registered as a care home with nursing, specialising in dementia care and mental disorder. We reviewed the homes Statement of Purpose to see how it stated it would meet the needs of people with more general nursing care needs. The statement of purpose did not do this. As the current the focus for the home is on meeting the needs of people with complex mental health conditions, potential purchasers of care need to be informed of how the home can meet the needs of people with general nursing care needs, such as wound care and pressure ulcer risk, so that they can ensure people are placed in a home which can meet their needs. When we last inspected the home, we required that practice and equipment in relation to prevention of spread of infection must be improved to ensure that all relevant equipment be provided, that it be intact and fully wipable, by 28/5/10. We also recommended that equipment and furnishings should be surveyed and an action plan drawn up to up-grade areas and replace items before they deteriorate further. In their improvement plan, the home responded that all staff would be trained in infection control policies and procedures and that bed rail bumpers (protectors) would be replaced with bumpers that are easily cleaned. They reported that one of their outcome measures would be that no infection control issues would be evidenced. This would be achieved by 28/5/10 and replacement of bumpers would be ongoing. When we visited the individual, we observed that they had safety rails on their bed, which were covered with protectors to prevent damage to the individuals limbs. We observed that the protectors were in a deteriorated condition with areas where the surface of the bumpers were not intact and would therefore not be wipable. We noted that the person had staining with bodily fluids on their bedding, due to their wounds. We observed yellow bags for disposal of clinical waste in the persons room and asked about disposal of any waste. We were informed that any waste would be placed in a white bag and secured. This would then be placed in a yellow bag for infected waste and removed from the room,
Care Homes for Older People Page 7 of 24 so there would not be any need for a disposal bin in the persons room. We asked about disposal of the persons bed linen and were informed that it was laundered in the homes laundry. When we asked if it was placed in red alginate disposal bags for infected laundry as we did not observe any in the room, we were informed that the persons bed linen went in with the general laundry for the home. If this was the case, as the persons bed linen was visibly contaminated with bodily fluids, there would have been a real risk of cross infection for other residents in the home. A foot pedal operated sack holder to prevent hand contamination, would be needed in the persons room to place the red alginate bags in, to ensure that bed linen could be safely disposed of and stored in the persons room, prior to removal to the laundry. The tissue viability nurse reported to us that they were concerned that the home did not have sterile gloves available to perform clinical dressings. The homes own procedures stated that aseptic procedure must always be performed using sterile gloves. We looked for sterile gloves in the home but were not able to identify any. The person needed dressings to be cut to the size of the wound, therefore the dressings would need to be cut to size with sterile scissors to ensure sterile procedure. As more than one resident had a complex wound and needed a sterile dressing procedure, the lack of sterile gloves and scissors was of concern. Two of the registered nurses we met with were male and we are aware that the home employs several female registered nurses, so a range of different sizes of sterile glovers would be needed. Sterile gloves and scissors can be purchased from chemists when needed. Not using sterile gloves and scissors puts the resident and other residents at risk of infection. We were concerned that the home did not have sterile gloves and scissors available and issued a Statutory Requirement Notice on 10/9/10 to ensure that the home did hold stocks of sterile gloves and scissors. At the last inspection, we required that the home must develop a training plan to ensure that increased members of staff undertake training in dementia care and common conditions for the elderly, such as dietary needs, diabetes, stroke and communication needs by 30/6/10. In their improvement plan the home responded that a staff training plan would be developed along the lines stated. They reported that their outcome measure would be that a training plan was in place and that training would be shown to correlate with the needs of residents by 2/7/10 and on going. We discussed training in pressure area care with care assistants. They reported that they had been trained in the area at some point during the past year. The fact that they were not aware of a range of areas, such as the importance of regular changes of position and settings on air mattresses indicates that they may need up-to-date training in the area. We discussed wound care training with two registered nurses. Both reported that they had not had recent training by the home in wound care. One registered nurse was a dual registered mental health nurse and learning disabilities nurse and as such would have needed training in wound care to ensure that they met current standards in this area. We asked Mrs Gray about staff training, particularly in relation to prevention of pressure ulceration and wound care. As evidence of what they were doing, she provided us with the homes most up-to-date training matrix on the homes computer record. This matrix did not provide evidence that staff had been trained in pressure area care or wound care. The matrix showed that of the 49 permanent registered and nursing care staff, 29 had been trained in reporting and recording. As deficits had been identified at the last inspection in reporting and recording, more training should have taken place. Forty two nursing and care staff had been trained in infection control but of these 15 had been
Care Homes for Older People Page 8 of 24 trained in the area in 2008 or before. Evidence at this inspection shows that staff may not fully understand their responsibilities in this area. During the inspection we observed during the early afternoon on the ground floor that staff were standing in a group round an open door in a corridor area of the home. We asked staff what they were doing. We were informed that they were receiving handover report. Some of the information being passed between shifts was of a personal nature relating to residents and was confidential. We asked why they did not give report in a more private area. Staff reported that this was because they had no other area available to perform handover on the ground floor of the home. They had used to have a room available for this, but this was now used for other purposes. This lack of confidentially did not up-hold a residents dignity and action needed to be taken by the home to ensure that necessary confidential information about residents needs be passed between shifts, without breaching their confidentiality. When we asked for records relating to the resident, were told that earlier records had been archived. When we asked to look at these archived records, they were not maintained in an orderly manner. Some archived records, for example turn charts, were in a pile in the office, not in date order and mixed with other similar records, not relating to the individual. When we asked for daily records relating to the individual for the previous month, the manager was not able to find them. We went with her into a storage room where the photocopier was and found that a range of records were placed on shelves in the room. These records again were not stored in an orderly manner, some were in piles of paper, some held together by rubber bands and others in folders. Many records were not in date order and contained records relating to different people and matters. Despite searching, the manager was not able to find the records that we had requested to view. She reported that if she were given time, she was sure she would be able to find them. We phoned her on 2/8/10 and returned to the home as she thought she might have found the records we had requested to view. However when we visited on this day, while one record had been found, the daily records for the individual for the previous months remained lost. We followed this up with the manager on 25/8/10 and she reported that she still had not been able to find the documents. In order to ensure that all required information is kept in a safe manner and also to ensure confidentially, the home needs to store all records and documentation relating to individuals in a secure, orderly and safe manner. 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 2. Care Homes for Older People Page 9 of 24 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 2 5A The home must provide people with the information required in relation to the breakdown of fees. Not reviewed at this random inspection. This will help to make sure that people and their representatives have access to information about the fees charged by the home. 05/01/2009 2 3 14 Pre-admission assessments must include a full assessment of all of a persons nursing and care needs. Not reviewed at this random inspection. This will ensure that the home can meet the persons individual needs. 28/05/2010 3 7 12 A care plan must be put in 28/05/2010 place whenever a person has a nursing or care need. The care plan must be fully updated when a persons condition changes. The care plan must use precise, measurable language. Care Homes for Older People Page 10 of 24 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Not addressed by the timescale for action. Care plans are needed to direct staff on actions to take to meet individual need, this ensures that care is delivered in a planned and consistent manner. 4 9 13 When any medicine is 01/05/2010 administered to people who live in the home this must always be accurately, clearly and completely recorded. (This particularly relates to recording the actual dose of medicine administered where a variable dose is prescribed and other shortfalls in the records identified in the report). Not addressed by the timescale for action. This is to help to make sure people receive their prescribed medicines correctly and to help reduce risks of mistakes because of poor medicine records. 5 9 13 Put in place safe 01/05/2010 arrangements, in accordance with best practice guidance, for the handling, storage and recording of any medicines that are applied to the skin. Not reviewed at this random inspection. Care Homes for Older People Page 11 of 24 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action This is to help make sure that people receive these treatments correctly and are not put at risk because of inadequate practices and incomplete records. 6 16 22 The home must provide written evidence that they have fully investigated all complaints. Not reviewed at this random inspection. If records are not made of investigations into complaints, the home cannot show that it has fully and impartially investigated any complaint. 7 26 13 Practice and equipment in 28/05/2010 relation to prevention of spread of infection must be improved to ensure that all relevant equipment is provided, that it is intact and fully wipable with all dust and debris regularly removed, particularly in laundry and sluice rooms. The parts of this requirement reviewed at this inspection had been addressed. This is to prevent risk of cross infection. 8 29 19 The home must perform a 28/05/2010 full audit of all its staff files, to ensure that they include all required pre-employment
Page 12 of 24 28/05/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action information for the individual. Not reviewed at this random inspection. This is to ensure that the home can provide evidence that they are following safe recruitment practice. 9 29 19 The home must provide evidence of a persons past employment history. Not reviewed at this random inspection. This is to ensure that the home can provide evidence of the prospective member of staffs suitablity for their role. 10 37 12 Records of care given must be accurate and completed when nursing and care is provided. All documents must be dated. Not addressed by the timescale for action. If records are not accurately completed and dated, the home cannot evidence that care has been given as needed by the resident. 11 38 23 The home must make sure 28/05/2010 that the most up to date fire risk assessment is made available for inspection. 14/05/2010 30/04/2010 Care Homes for Older People Page 13 of 24 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Not reviewed at this random inspection. This is to ensure that people will be safe in the event of a fire. 12 38 13 The homes risk assessment 10/05/2010 in relation to bathing/showering of residents must be fully revised, to reflect directives from bodies such as the Health and Safety Executive. Not reviewed at this random inspection. This is to ensure that risks of scalds to residents is prevented. 13 38 13 The homes infection control procedure must be revised and be specific to the home. Not reviewed at this random inspection. This is to prevent risk of cross infection. 30/06/2010 Care Homes for Older People Page 14 of 24 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, 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 3 12 The home must perform a 27/09/2010 full written assessment of an individuals needs prior to discharge back from hospital. This is to ensure that the home can identify any changed needs for the resident and ensure that they can meet these needs. 2 7 15 Residents care plans must 27/09/2010 always be revised, including taking into account relevant written information, relevant verbal information, information from external health care professionals, prescribed medication including for pain relief and observed interventions by staff, including application of dressings and use of equipment, in relation to pain relief, prevention of pressure ulceration and treatment of tissue damage and pressure ulcers. This is to ensure that residents health and welfare Care Homes for Older People Page 15 of 24 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 needs are met 3 8 12 Residents wound care needs 21/09/2010 must be met in full, with clear records of actions taken to meet their wound care needs. Advice from external healthcare professionals relating to the use of wound dressings must be followed. Medical products and prescriptions required to manage and treat a residents wound must be promptly obtained and if not possible, that advice be promptly sought from appropriate healthcare professionals as to how the persons needs are to be met. This is to ensure that you make proper provision for the health and welfare of residents in wound management. 4 8 12 The home must ensure that 27/09/2010 equipment is correctly used and practice in prevention of pressure ulceration is followed, in accordance with their own policies and procedures and national guidelines. This is to prevent risk of pressure ulceration for residents. 5 26 13 The home must ensure that all potentially and contaminated laundry is 27/09/2010 Care Homes for Older People Page 16 of 24 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 safely managed in accordance with principals for infection control. This is to prevent risk of cross infection in the home. 6 30 18 Where the home provides 30/09/2010 care for people at risk of pressure ulceration, the home must ensure that staff are trained in the area. This is to ensure that risk of pressure ulceration is prevented for residents. 7 30 18 The home must ensure that 30/09/2010 when it cares for people with wounds, that all registered nurses are trained and competent to provide wound care. This is to ensure that the needs of people who have wounds can be met. 8 37 17 All records and 27/09/2010 documentation relating to residents and required by us must be stored in a safe and orderly manner. This is to ensure confidentiality for the person and that required archived records can be quickly retrieved. 9 37 17 The home must ensure that 27/09/2010 they retain all required records for up to three years from the last entry on the
Page 17 of 24 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 record. This is to enable full audit of documentation when relevant. 10 38 12 The home must provide an area where necessary sensitive, confidential information can be passed between staff at handover. This is to ensure confidentially and up-hold peoples confidentially. 11 38 13 Effective systems must be put in place at the home to ensure that an appropriate stock of sterile gloves and scissors is maintained. This is to ensure aseptic procedure in wound care so that all reasonable measures are taken to exclude microorganisms which cause infection to a wound and risk of infection and cross infection prevented for the resident. 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 27/09/2010 21/09/2010 1 1 The statement of purpose should have information about how the home cares for people with dementia and those with mental health needs, which should also describe how their privacy and dignity is addressed. The information relating to how to contact us should be up-dated.
Page 18 of 24 Care Homes for Older People 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 Parts of this recommendation was identified at the inspections of 6/4/09 and 25/3/10. It has not been addressed. 2 3 All subsequent assessments after admission should contain sufficient attention to detail to help ensure that peoples dignity is respected. This recommendation was identified at the inspection of 6/4/09. It has not been addressed. Not reviewed at this inspection. 3 3 Assessments of need or risk should take place in a timely manner, in accordance with research-based guidelines. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 4 7 Where a persons first language is not English, care staff should be advised of key words for that person, so that they can explain care being provided and actions taken. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 5 9 Obtain and check the guidance published by the National Patient Safety Agency about Safer lithium therapy and actions that can make anticoagulant therapy safer. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 6 9 Review the storage arrangements for insulin injections once these have been first used to make sure these are in accordance with the manufacturers directions. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 7 9 Write the date on containers of medicines when they are first opened to use to help with good stock rotation in accordance with the manufacturers good practice directions and to help with audit checks that the right amount of medicines are in stock. Care Homes for Older People Page 19 of 24 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 This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 8 9 Review and update the medicine policy and procedures to include up to date information about all aspects for the management and handling of medicines in this home so that staff have access to good information about the way in which they are expected to handle medicines. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 9 9 Review medicine records and care plans to make sure that any medicines prescribed with a direction when required or with a variable dose have clear, up to date written guidance available to staff that clearly describe how to reach a decision to administer the medicine at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure all people living in the home receive the correct amounts their medicines in a consistent way in line with planned actions. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 10 9 Make arrangements to include an appropriate entry in the allergy section on all medicine administration records as an additional action that can reduce the risk of people being supplied with a medicine to which they are known to be allergic. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 11 10 Residents underclothes should be regularly reviewed and relatives approached to replace items which have deteriorated. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 12 10 The persons preference for sex of carer to provide personal care should be documented. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection.
Care Homes for Older People Page 20 of 24 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 13 10 Staff should use the residents own name when addressing them and not use generic terms of endearment, without also using the residents name. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 14 14 Clothes protectors should be provided individually to residents and only provided when assessed as being needed by a resident. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 15 15 An audit of plastic cups and place mats should take place and any that are stained or deteriorated be replaced. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 16 15 The people who cook meals should be provided with training on how to meet the dietary needs of people who are frail, have dementia and conditions such as diabetes. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 17 15 Where it is necessary to change the menu choice, information about this should be provided in areas where residents can be made aware. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 18 15 Residents should be given a choice of meal and drinks. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 19 16 All verbal concerns and the actions taken to resolve them should be recorded. A written reply to relatives about the outcomes of any concerns should be completed. This recommendation was made at the inspections of 6/4/09 and 23/3/10. It was not reviewed at this inspection. 20 19 Improvements should be made to the garden areas of the
Page 21 of 24 Care Homes for Older People 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 home, including removal of debris and broken items and planting, to improve views for residents. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 21 19 All of the home, equipment and furnishings should be surveyed and an action plan drawn up to up-grade areas and replace items before they deteriorate further. This recommendation was identified at the inspection of 23/3/10. It had not been addressed. 22 24 Staff should check bath/shower water temperatures and maintain a record, prior to bathing/showering a person. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 23 26 Used laundry should be separated at source, not in the laundry. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 24 26 The cleaning schedule should be fully revised to make it fit for purpose. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 25 28 The home should consider how it supports and encourages more care staff to undertake National Vocational Qualifications. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 26 32 An observational tool could be used for quality assurance purposes as many people are unable to comment about the home. This recommendation was identified at the inspections of 6/4/09 and 23/3/10. It was not reviewed at this inspection. 27 33 Reports on visits to the home by a senior manager should review care plans in more depth and more care staff should
Page 22 of 24 Care Homes for Older People 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 be met with on each visit. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 28 33 The results of any quality assurance surveys are given to the people completing the surveys, for example relatives, which could take the form of a newsletter about the home where improvements are highlighted. This recommendation was identified at the inspections of 6/4/09 and 23/3/10. It was not reviewed at this inspection. 29 35 The homes safe should be secured to a load-bearing wall. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 30 38 The home should consult the Fire and Rescue Authority about the use of locks on residents room doors. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. 31 38 Individual fire evacuation plans should be developed for residents. This recommendation was identified at the inspection of 23/3/10. It was not reviewed at this inspection. Care Homes for Older People Page 23 of 24 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 24 of 24 - 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!
