Inspection on 01/12/08 for Nether Hall

This inspection was carried out on 1st December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nether Hall 18/12/06

Nether Hall 10/02/06

Nether Hall 02/10/05

Nether Hall 25/01/05

Nether Hall 30/09/04

Nether Hall 09/09/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nether Hall Nether Hall Road Hartshorne Swadlincote, Derby Derbyshire DE11 7AA     The quality rating for this care home is:   two star good 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: Helen Macukiewicz     Date: 0 1 1 2 2 0 0 8 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 27 Information about the care home Name of care home: Address: Nether Hall Nether Hall Road Hartshorne Swadlincote, Derby Derbyshire DE11 7AA 01283550133 01283819262 netherhall@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashbourne (Eton) Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Adults with physical disabilities (PD) to be accommodated in Bedroom Nos. 1,3 and 8. Nether Hall care home is registered to provide nursing and personal care to service users whose primary care needs fall within the following categories:- Old age, not falling within any other category (OP) 47 Physical disability (PD) persons aged 44 years and over (3). The maximum number of persons to be accommodated is 50. Date of last inspection Brief description of the care home Nether Hall Nursing Home provides personal care with nursing, and can accommodate 50 people, all of whom must be over 65 years of age. However, the Home can also provide places for 3 people with disabilities, aged 44 years and over, within the total of the 50 places. The Home is in a rural setting, near to the village of Hartshorne. The property was originally a private dwelling that has been extensively converted and extended into a care home. Accommodation is provided to a good standard across two Care Homes for Older People Page 4 of 27 Over 65 47 0 0 3 Brief description of the care home floors. The upper floor is accessible via a passenger lift, a chair lift or via staircases. Bedrooms are attractively decorated and have been personalised by the current occupants. All except two bedrooms have ensuite facilities. The Home provides a number of lounges and dining areas, as well as a separate smoking area. Information about the service is provided in the Statement of Purpose and Service User Guide; both of these documents are made available to people through copies kept in the foyer. The manager stated that the fees for the home commenced from 364.00 GBP to 800.00 GBP per week depending on peoples needs and funding arrangements. Items not covered in the fees include hairdressing, chiropody,some toiletries, and newspapers. Care Homes for Older People Page 5 of 27 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: two star good 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: We last Inspected this service on 18 December 2006. An interim Annual Service Review took place on 21 January 2008. The purpose of this was to assess how well the service was operating in between our visits. This involved consultation with people who use the service and a self-assessment which was completed for us by the manager. We sent our findings to the home and used this information to help us identify when we next needed to visit the home. This Inspection was unannounced and lasted eight hours during one day. The Manager had completed a self-assessment of the home and information from this was used in the planning of this inspection. Computer held records of all contact between the Home and us since the last Inspection were also referred to in the planning of this visit. Care Homes for Older People Page 6 of 27 During this Inspection discussion with people who use the service and their relatives took place. Time was spent in discussion with the Manager and staff. Six peoples care files were looked at in detail and their care was examined to see how well records reflect care practices within the home. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. Throughout this report us/we refers to the Inspector and/or the Commission for Social Care Inspection. What the care home does well: What has improved since the last inspection? 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 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 8 of 27 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 9 of 27 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. People have enough information to choose a home that can meet their needs. Preadmission assessment and procedures ensure that people are not inappropriately admitted to the home. Evidence: The information provided about the home and services offered was contained within the brochure, Statement of Purpose and Service users guides. These were on display in the foyer and were provided for each person in their bedroom upon arrival to the home. People and their relatives told us that they had the right amount of information about the home before they moved in, so they knew what to expect. In her completed pre-inspection self-assessment the manager wrote From the first visit to the home, the pre-assessment process incorporates their views, the prospective service user and any professionals involved. Service user guides are Care Homes for Older People Page 10 of 27 Evidence: available in large print, audio tape and pictorial editions. Contracts are issued clearly defining the services offered. The home encourages family and Services users to spend time in the home before they are admitted. We saw that care records contained a pre-admission assessment and that this was completed in sufficient detail to allow the person to judge whether their needs could be met by the home. All people we asked, and their relatives told us that a member of qualified staff from the home visited them before they moved in, to conduct an assessment of their needs. Care documentation clearly showed that once the person was admitted to the home, their needs were assessed in further detail, and this formed the basis for any plan of care that was to be used by staff. People told us they had been pleased with the services offered by the home and one said if you need a home, this is the place to come. The manager confirmed that the home did not provide intermediate care. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their care needs met and their right to privacy is upheld. Evidence: In the care files seen, people had their needs assessed in areas such as continence, skin care and moving and handling. These assessments had been updated as needed and regularly reviewed for changes. Each persons file contained a plan of care that set out clearly the actions needed by staff to meet peoples physical care needs, although one needed more detail in terms of emerging mental health needs and interpersonal relationships that may impact on care. Social care plans also needed to be kept with physical care plans to ensure cohesiveness of records and so they could be brought in line with reviews of other care needs. Care files showed that people were regularly being seen by their G.Ps and that they attended hospital appointments. Staff recorded their ongoing medical checks including nutritional monitoring and blood sugar checks. Professionals who were visiting the home on the day told us that the home worked co-operatively with them, and that Care Homes for Older People Page 12 of 27 Evidence: relatives had always been satisfied with the care given to the people in the home. Care files contained signatures of people or their advocates to show they had been involved in the planning of their care. People told us they were regularly seen by the chiropodist and care files showed that people received optical checks. People told us that the care was good and one said that they were being well looked after. Among the qualified staff stated on the staffing rotas, there was a mix of general and mental health trained staff, which was appropriate to the needs of the people living in the home. Therefore people and care staff had access to nurses with relevant knowledge and experience for advice and support. People told us that they were treated with respect and that they had their privacy needs met, even in shared bedrooms. Staff showed us privacy notices that they displayed on bedroom doors when they were assisting people with personal care, to ensure they were not interrupted. Staff were observed routinely knocking on bedroom doors to request permission to enter. People confirmed that staff always knocked before entering their bedrooms. People also had the option of having a bedroom door key. A check of the medication records showed that people were getting the treatment they needed and that staff were vigilant in recording this. Medications were stored appropriately with the exception of two tubes of hydro-cortisone that needed to be discontinued and removed from a persons bedroom. Some pots of topical creams needed labeling to identify who they belonged to and when they expired. There was plenty of equipment available to assist staff in meeting peoples needs including specialist mattresses, beds and hoists. One person told us that the hoist was comfortable and had helped them with their mobility. One person said that the home was arranging a new specialist chair for them, to make them more comfortable. Care Homes for Older People Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead a varied lifestyle of their choosing. Evidence: In her completed pre-inspection self assessment the manager told us We have two activity organisers to extend our services through the day. A weekly bus trip, organised with the service users and were they wish to visit. This has been the most innovative activity this year and the home is looking to extend this. Meal planning has changed to meet individual service users needs. the chef will visit on a daily basis if required. The tables are set out to encourage Service users to integrate in the home, offering sherry and bread baskets as part of the service users requests. More effort has been taken to ensure service users who wish to stay in their own rooms have a good level of social activities. People told us there was plenty to do during the day. One person told us they were part of the residents committee and that they had been discussing what outings people wanted at the last meeting. The minutes of this meeting were displayed on a notice board that also displayed photographs of recent events. People had access to large print library books, talking newspapers, daily newspapers and most had a television in Care Homes for Older People Page 14 of 27 Evidence: their bedrooms. One person said theres always something going on. One of the activities co-ordinators told us that they had planned several events on the run up to Christmas and one person showed us some window decorations they had made. The activities co-ordinators had records to show what activities they did with each person on a daily basis and had also undertaken an individual assessment of their likes and dislikes. People said they had been on trips out to local garden centres and two people went out with one member of staff each week to attend a community activity. People told us that they could come and go as they pleased around the home. They could spend time in their bedrooms if they wanted. Those people who did choose to spend more time in their bedrooms, had lots of their personal possessions around them and forms of entertainment such as records, radio and televisions. A few people told us they liked to sit and watch their surroundings from the window and that they enjoyed the views. Visitors told us they were welcome anytime. The home had two members of staff who acted as dignity champions one on nights and one for days. They were a point of reference for issues that may arise with dignity, equality and diversity. People and their relatives told us that staff upheld their dignity and felt that they were treated as equals. One person said we have a good laugh with staff. The cook and assistant cook had a good knowledge of the individual dietary needs of people living in the home, the kitchen area was clean and tidy and we saw plenty of food supplies. People told us they liked the food and described it as very good and tasty, one person said they particularly liked the fried fish. People had the option of up to three hot meals per day, with drinks and biscuits in between. A system of catering called the Nutmeg system was in use. The manager described this as a way to judge the nutritional value of each meal they provided, to ensure menus provided people with the right nutritional balance. Care Homes for Older People Page 15 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective complaints procedures and staff training ensures that people are kept safe in the home and have their rights upheld. Evidence: The complaints procedures were on display and gave accurate contact details for people both within the organisation and outside agencies such as us. People told us they would have no problem raising concerns with the staff in the home should they need to. One said if Id got a complaint I would complain, a visitor told us I would see the manager if there was a problem. In her completed pre-inspection self-assessment the manager told us that they had received 15 complaints since the last Inspection, eight of which had been upheld. Also that there had been 1 safeguarding incident. Complaints records showed that the staff were open to receiving concerns and that they recorded, and addressed minor concerns in the same way. Staff training records showed they had all received safeguarding training in the past year and staff were also able to confirm this was the case. Both local and Southern Cross safeguarding procedures were on display in the office. The manager was able to give a verbal account of the safeguarding incident that had occurred which showed Care Homes for Older People Page 16 of 27 Evidence: that she had worked co-operatively with health and social services to successfully resolve the issue. The manager and many of the staff had attended training on the mental capacity act and deprivation of liberty. The local IMCA (mental capacity advisor) had been to the home to talk to staff about their role and staff responsibilities. Information about this service was on display in the administrative area of the home. People who needed mechanical forms of restraint for their safety had this documented in their care files and signatures were present to show that people or their advocates had been involved in the decision. Care Homes for Older People Page 17 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout of the home meets peoples needs. Current systems for storing waste increases risk of infection to people. Evidence: In her completed pre-inspection self-assessment the manager told us that the following improvements had been made to the facilities since the last Inspection The new high/low bath as been installed. All new patio furniture is in place. A shower trolley has been purchased for our more physically disabled Service users, and told us that all the beds in the home were now specialist ones. Also that there were future plans to review all the en suites to take out baths and look at possible wet rooms. Redecorate the high/low bathroom. We conducted a brief tour of the home. Bedrooms on the new wing were all en-suite and decorated to a good standard, people had a letter box on their bedroom door and inside, bedrooms were personalised with belongings. One person told us they had brought their own furniture and chair in from home. People also confirmed that they were offered a bedroom door key, and we saw that there was individual lockable space in shared rooms. Although bedrooms were personalised throughout the home and comfortable, the Care Homes for Older People Page 18 of 27 Evidence: standards of decor and furnishings in the older part of the building were of a lesser standard than the newer part. However, there was redecoration taking place on the day and the manager was aware of the need to undertake further improvements. Some people were living in shared bedrooms as a single bedroom had not been available at the time of their admission, these people were given the option to move into a shared room when one became available. Not all shared bedrooms had full privacy screening, in one a portable screen was used. However, the person living there said that it afforded enough privacy, but was not fully sound proof which worried them as they did not want to disturb the other occupant. Some people were happy to share a bedroom. Two bedrooms identified during the inspection contained a urine odour, which impacted on the dignity of the occupants and those in surrounding rooms. The manager was looking at an alternative bedroom for one person and staff had addressed the other issue with the persons relatives with a view to removing odours. Sluice areas were not locked, but had the capacity to be locked. Inside we found that the clinical waste bins were overfull and that there was a mix of clean continence wear, dirty and clean laundry and clinical waste being stored. This increased the risk of cross infection within these areas. Designated storage areas for clean and dirty items would reduce risks and the provision of foot operated clinical waste bins would also reduce the risk of lids getting lost or falling off. People told us they were satisfied with the laundry service. There had been new equipment provided in the laundry, washers and dryers. The washer was able to sluice soiled items. There was health and safety information available for staff who worked there and gloves. Not all staff wore aprons when dealing with soiled items and this would assist in reducing risk of cross infection. Care Homes for Older People Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of well trained and experienced staff ensure that peoples care needs are met. Evidence: Staffing rotas showed that there were 2 nurses provided during the day and one at night. There was additional qualified staff support from the manager who was on the rota Monday to Fridays. There was a mix of mental health and general trained nurses to meet the needs of the people living in the home. A consistent number of care staff were provided in the mornings and the afternoons, with three each night. Rotas showed there was no use of agency staff, regular staff filled gaps. There had also been a very low staff turnover since we last visited, so there was consistency of care. People told us staff are very nice and very kind, theyll do anything for me, they are very good, Ive only got to call the bell and theres someone there straight away and the staff are very caring. In her completed pre-inspection self-assessment the manager told us that the home had obtained new comprehensive induction packs. She also recorded that all staff had received infection control training, food hygiene and nutrition training. We saw completed inductions in staff files, but also the new foundation training package which Care Homes for Older People Page 20 of 27 Evidence: was proposed. This was very detailed and would provide staff with a useful insight into their role. Most staff were trained in National Vocational Qualifications to levels 2 or 3. In addition, the manager had an excellent training programme for staff covering not only mandatory training areas such as moving and handling and fire safety, but also courses such as dementia care, equality and diversity and nutrition. Her training plan recorded that all staff had achieved their required levels of training, and above. Staff also confirmed that they had high levels of training provided by the home. Staff training was recorded by the manager on a training matrix and staff files also contained certificates of qualifications obtained. We looked at the recruitment files for two staff to see how well people were protected through recruitment practices. Due to low staff turnover these were the only ones who had been employed since we last visited. We saw that improvements had been made in terms of gaining references and proof of qualifications. The needs to explore gaps in employment history and gain confirmation from previous employers why the person had left were the only areas where recruitment practices needed to be tightened. Care Homes for Older People Page 21 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home is effective in keeping people safe, and is user focused. Evidence: In her completed pre-inspection self-assessment the manager told us the Manager and Deputy have over 12 years in service with NVQ Registered Managers Award and NVQ 4 in Management. The manager had certificates to show that she was regularly updating her knowledge and had recently attended training on the deprivation of liberty and mental capacity act. A managers surgery was advertised for the second week of each month, this was advertised as an opportunity for people to see the manager individually with any issues that they may want to discuss. More formal monitoring of quality took place at intervals of weekly, monthly, six monthly and annually. This took the form of Company audits and satisfaction questionnaires. The manager also worked occasional shifts and attended care reviews to ensure she was abreast of current issues affecting care of Care Homes for Older People Page 22 of 27 Evidence: people and also to monitor the quality of care provided. We saw some of the audits undertaken, these covered care planning, medication and health and safety. Positive feedback was seen in the last satisfaction survey responses that we saw. The system for handling peoples personal allowances had been reviewed since we last visited in line with Southern Cross policy. We saw that two signatures were being obtained and receipts were being kept. Financial records were also audited by Southern Cross to ensure safeguards were in place for people. People told us they were happy with the system for obtaining their money. Staff supervisions were regularly recorded in staff files and showed that staff performance was being monitored by the manager. There were daily maintenance arrangements in place and all service records that we saw were up to date, supporting that the environment and equipment people used were kept safe. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 24 of 27 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 9 13 2) The prescribed creams that are no longer required must be removed from the persons bedroom. Prescribed creams must be stored in a designated medicines cupboard or in line with a self-medicating policy. This is to ensure people do not continue to receive medicines that are no longer required. Also to ensure people do not have free access to prescribed medications. 31/12/2008 2 26 13 3) Separate facilities for the storage of clean and dirty linen, clinical waste and continence wear must be provided. This is to reduce risk of cross infection. 31/12/2008 3 29 19 and schedule 2) Written confirmation why, in previous employment 31/12/2008 Care Homes for Older People Page 25 of 27 working with vulnerable adults or children, a person ceased working there, must be obtained from previous employers prior to employing staff. To assist, gaps in employment history must be explored and this must be recorded in the staff file. This is to ensure people are not exposed to potentially unsuitable workers. 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 7 Care plans should identify emerging mental health needs and any interpersonal relationships that may affect care, to ensure all care needs are met. Social care plans should be included with physical ones so care plans provide a complete picture of care needs and to ensure social care needs are reviewed. 2 9 Topical creams should be individually labeled and dated to reduce cross infection risks and to identify when they might expire. Action should be taken to remove the urine odour from the two bedrooms identified to ensure the dignity of people living in the home. The use of portable screens should be reviewed in shared bedrooms. Fuller curtaining may reduce the transfer of sound around the room and create less intrusion for the people living there. Lidded, foot operated clinical waste bins should be provided in sluice areas to ensure effective protection of stored waste. Clinical waste bins should not be overfull and should have a lid to reduce the risk of cross infection. 3 19 4 19 5 26 Care Homes for Older People Page 26 of 27 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 © (2008) 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 27 of 27 - 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!