CARE HOMES FOR OLDER PEOPLE
Nutley Lodge 43 Sherford Road Elburton Plymouth Devon PL9 8DA Lead Inspector
Anita Sutcliffe Unannounced Inspection 10th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Nutley Lodge Address 43 Sherford Road Elburton Plymouth Devon PL9 8DA 01752 402024 01752 408059 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) Mr Jeremy Woodcock Mrs Lynwen Miles Woodcock Mrs Allison Thompson Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Age range 55yrs Date of last inspection 21st December 2005 Brief Description of the Service: Nutley Lodge is a detached, extended property, situated in the village of Elburton. It is set in its own grounds with easy access for service users. The Home is registered to provide accommodation and personal care for up to 25 service users over the age of 55 for reason of old age, physical disability and dementia. The home is registered for the categories OP (Older Person), PDE (Physical Disability Elderly) and DEE (Dementia Elderly).The home is owned Mr Jeremy and Mrs Lynwen Woodcock and the registered manager is Mrs Allison Thompson. The home has 23 single bedrooms and 1 double bedroom, 14 of the single bedrooms and the double bedroom have en-suite toilet facilities. On the ground floor there are two lounge rooms and a large dining room with a further seating area in the entrance lobby. A shaft lift and a stair lift provide access to the first floor. There is a call bell system throughout the home. Service users are enabled to access any health or social care services they require and various social activities are arranged by the home. The garden is attractive, spacious and has physical disability access. Current fees are: £320 - £365 Additional costs are made for hairdressing and chiropody. The most recent report is made available on request at the home. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Collection of information toward this key inspection started in April and the home has provided the Commission with current information about the service. Opinion was sought from service users (residents), staff and health care professionals through anonymous survey. Very few response were received. The home received two unannounced visits. On both occasions the home was toured, residents spoken with and staff observed in the course of their work. The care of three residents was examined in detail; most residents were met, some talked to in detail. The manager was available for both inspection visits. What the service does well: What has improved since the last inspection? What they could do better:
Caring for confused residents who wander raises risk. This has not been recognised or managed sufficiently. Residents had access to cleaning chemicals and very hot water pipes during the first visit. The risks were pointed out to the owner’s representative and manager, but several days later nothing had changed and an immediate requirement to ensure resident safety was issued. There are sufficient numbers of staff with knowledge and expertise, but the manager works as a member of care staff, rather than management, much of her time (either through the rota or because residents need her attention). She does not have time to fulfil her responsibilities. This is affecting standards. A care plan was out of date; she is not able to supervise staff who
Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 6 ‘slip into’ poor practice. Formal staff supervision of staff has also “slipped” and staff want the opportunity to raise some issues with ‘management’. Low staff morale will ultimately affect resident well being. A district nurse said that, although care is still good at weekends, she has less confidence when the manager is not in the home. It was a previous recommendation that arrangements for monitoring quality at the home should be extended. This was not done; staff and residents want, and must have have, the opportunity to have their views about the home heard. A resident said the food “isn’t as good as it was”. Although the food preparation was praised residents felt the menu was too traditional and repetitive. Neither was there a choice at either lunch or tea, but an alternative found “if requested”. Residents should be consulted on the menu and offered real choice on such an important part of their daily lives, not just alternatives. Residents are not protected through safe recruitment practice of staff. Strict adherence to the regulation would protect residents from staff who might be unsuitable to work with vulnerable people, but those checks had not been carried out robustly. Residents and family need to know that they can contact the Commission ‘at any stage’ of a complaint. The home’s complaints policy should make this clear. A previous recommendation to train staff in the protection of vulnerable adults from abuse has not been carried out and has now been changed to a requirement. Staff should have the contact details for the Local Authority Adult Protection team available to them. Concerns about a resident’s well fare could then be raised outside the home, should staff feel that is appropriate. Steps must be taken to mend the home’s boiler to ensure that there is hot water and heating available. Any adaptations to the home should take into account the specialist needs of residents with dementia as these can help them to interpret their environment more fully. Hygiene at the home needs reviewing to ensure that infection control is adequate. Poor staff practice must be addressed. Staff must be able to wash their hands after providing personal care, even when they have worn protective gloves. The home’s owners need to take expert advice on the suitability of their domestic washing machines to handle to laundry requirements at the home. Medication storage and transfer around the home must be made safe. Insulin must be kept in a lockable fridge and medicines carried around the home must be in a lockable container so that they are secure should the staff member be distracted. The mystery of the missing freezer thermometer needs to be solves and fridge and freezer temperatures should be taken regularly, recorded, and staff clear what to do should the temperature not be correct. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 8 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 Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4 (6 does not apply to Nutley Lodge) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care needs are met following assessment and planning. Residents specialist needs are met by the way the home is run, but this could be further improved for those with dementia. EVIDENCE: Resident/staff interaction appeared kind and professional, with challenging situations sensitively managed. The admission of two recently admitted residents was examined. Professional assessment information had been provided prior to admission in both cases. From this risk were identified, assessed and managed. The home’s own assessment contained very little additional information but using both a plan had been produced on how care was to be delivered. There was an additional excellent assessment of the likes and dislikes, hobbies and interests of a third resident. This information is no longer being sought which is a shame as it is
Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 10 extremely important, especially for residents with dementia, who may not be able to provide the information themselves as the condition develops. The manager detailed the admission procedure for both new residents. In each case she had visited them prior to admission, family had looked around the home and written information about the home was given. The manager had liaised with the mental health team to ensure all needs could be met. Neither resident was able to tell the inspector how their admission had been handled, but both appeared settled at the home. Staff have recently undertaken training in dementia care and the manager was aware of good dementia care practice. Unfortunately recent changes to the décor in parts of the home are contrary to current teaching, the main example being the heavily patterned carpet. Any change within the home should take into account the specialist needs of residents. (See also Standard 19). Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and care needs are fully met by well informed staff, but planning review is not always up to date, which might lead to inconsistencies in the care delivered. The system used for the storage and administration of medicine had the potential to place residents at risk. Residents are treated with respect and with full regard for their privacy and dignity. EVIDENCE: Few residents were able to give an opinion of the care they received, but one said she had “absolutely no complaints at all”. A district nurse said that the care is mostly excellent and information she gives staff is followed “to the letter”. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 12 Care plans contained important detail and were informative. However, the information in one was out of date, the resident’s condition having changed. It was therefore of limited use. Others clearly demonstrated that the home works hard in cooperation with resident, family and health care professionals to meet the diverse needs of residents, in one case to manage behaviour which might challenge residents and staff at the home and cause distress. Medication at the home is not kept fully secure. Although the majority are stored in a locked cupboard, regular medication for refrigeration is in the food fridge, and a tea trolley is used to take medication around the home to be administered. Residents must be protected from the potential risk this presents, especially as confused residents were seen wandering throughout all parts of the home. The home receives good Pharmacy support, staff receive training in how they should handle medicines safely and the administration/record keeping of medicines was generally satisfactory. Residents said that staff always knock before entering their room. This was also observed. Staff appeared polite and respectful to residents and this was further confirmed through reading records written by staff. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a relaxed atmosphere at the home, organised activities, and are supported to lead life as they wish, but real choice could be better promoted. Food is nutritious and tasty but the menu lacks imagination. EVIDENCE: A staff survey mentioned the need to get a set number of residents up earlier “to help the day staff” but residents said that they make genuine daily decisions about how they spend their day. Residents’ care plans provided information to inform staff of preferred routines. Residents and staff share time to celebrate special events and there are regular weekly activities, such as piano recital, quizzes, gentle exercise and manicure. No resident spoken with expressed a desire for more activities and a survey response said there were ‘usually’ sufficient. Residents’ bedrooms were very individual, with much effort taken to make residents feel ‘at home’. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 14 Residents agreed that the standard of cooking was good. A meal shared with them was very tasty, the meat in particular very tender. Fresh fruit and vegetables are used and there is home baking. However, there is no choice at lunch or tea time, and the menu is traditional and uninspired. Residents said they had no involvement in designing the menu but if they didn’t like something an alternative would be found. It was clear from residents’ response that a menu improvement, and real choice, would be appreciated. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have confidence that any complaint would be taken seriously and resolved promptly. Residents are protected from abuse, but this should be further improved. EVIDENCE: The one resident survey returned said that any problems are listened to. Five residents spoken with said they felt quite comfortable to speak with the manager of any concerns they had. Another said: “I’m quite happy to talk to matron. Everything would be investigated and looked into”. Neither the home nor the Commission have received complaints. The manager showed great empathy with residents, was known by them, and was available to speak with them when they wished to. The complaints procedure should make it clear that the Commission can be contacted at any stage of a complaint, not only should the complainant be unhappy with the home’s response. Five residents asked said they felt safe at the home, and all opinion about staff was positive, mentioning their kindness. The manager was clear how any allegation of abuse should be handled and had information for guidance. However, the previous recommendation that staff should receive training in the
Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 16 protection of vulnerable people from abuse has not been met and records showed that this is not part of the home’s induction. Due to the particular vulnerability of residents with dementia this has therefore been made a requirement. The whistle blowing policy, which would inform staff what do should they have a concern which they do not wish to take to the manager, contained the Commission’s address. It should also include the contact details for the Local Authority Adult Protection team. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, pleasant and homely environment, which they enjoy, but it is not always safe and has maintenance problems. Residents are not fully protected from the risk of cross infection. EVIDENCE: All communal rooms and bedrooms were pleasantly decorated. A resident said she was very happy with her room and each of those visited was clearly individual to the resident and well furnished. Radiators were guarded and, where a risk had been identified, hot water temperature controlled to protect residents from scalds. However, at the first visit two cupboards containing very hot pipes were found accessible to residents, posing a risk from burns. (See also Standard 38).
Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 18 One resident was unhappy that her hand basin water was not hot and she had been recently been cold because the radiator was faulty. A free-standing radiator was now in use. The manager said the boiler had been faulty for “about two weeks”. Much of the home did feel warm, but one communal area (not in use at the time) felt cool. The home was found to be very clean and fresh smelling on both visits. A resident said it is always clean. However, improved measures to prevent cross infection are needed. Used staff protective gloves were found discarded on a bedroom floor. No bedrooms contain hand washing facility for staff who should be able to wash and dry their hands before leaving the room, after providing personal care. Domestic washing machines are used for soiled laundry rather than those with the ability to disinfect or designed to handle soiled linen. Staff instruction read ‘soiled items should be soaked and/or swilled by hand‘. For a home proving care to 25 residents with continence issues these measures may not be sufficient to control the risk of infection. Infection control practice needs to be reviewed in line with current good practice for care homes, and additional steps taken to reduce risk as necessary. An environmental health officer recently made recommendations and requirements. The manager was unsure whether these had been fully achieved. Fridge/freezer temperature records could not be found. At the second visit the freezer temperature recorded was questionable, but the cook was unable to find the thermometer to check this despite having recorded the temperature herself the day before. This raises the query as to whether the recording was actually being done. In many ways the home lends itself well to the provision of care for service users with dementia and physical disability; for example, its size and layout. Research now highlights many ways in which service users with dementia can be helped to understand their environment. Any future improvements to the home should take those guidelines into account. (See also Standard 4). Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are appropriate to meet the needs of current residents. Staff are experienced and knowledgeable. Recruitment practice does not fully safeguard residents. EVIDENCE: Residents said there were enough staff at the home and on both visits there were plenty on duty and needs appeared to be met. A district nurse said she always found staffing numbers sufficient. It was however felt that care was best during the week and when the manager was on duty. (See also Standard 31). The one resident survey returned said there were always staff available when she wanted them. Two staff surveys were returned. One staff member felt that there was not enough time allowed to provide the care required and saying: “We are expected to cope with clients we have had no training to cope with”. Many of the care staff have been with the home many years. This should provide continuity of care for residents and stability at the home. New staff receive an induction and are then shadow an experienced carer. However,
Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 20 they are not an additional member of staff at that time which must add to staff workload. A high proportion of care staff have achieved the National Vocational Qualification (NVQ) in care, which demonstrates a recognised standard of competence. Staff receive training, the most recent being safe handling of medicines, first aid refresher and positive dementia care. Staff surveyed said they would prefer more. The recruitment records of three staff appointed since the last inspection were examined. Only one contained a reference from the most recent employer, but that didn’t include the dates of employment. One reference was in Polish, and unlikely to have been understood by the manager. One was a character, not work reference, despite three places of employment being listed. No written reference examined could have fully informed the manager about the applicant but some had been followed up by telephone. Two of the three appointed staff had not had been checked through ‘police’ (Criminal Record Bureau) records by Nutley Lodge itself wrongly believing that those checks are transferable from one care home to another. No checks on the list of persons unsuitable to work with vulnerable adults had been made. Recruitment practice at the home falls short of robust, safe recruitment. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by a knowledgeable, hard working and committed manager, but she is not always able to fully discharge her management responsibilities. Quality assurance the home is not currently benefiting residents. The health and safety of residents is not fully promoted. EVIDENCE: The manager is considered the linchpin of the home. A representative of the owners said the home “runs itself” and residents referred to her throughout conversations. She is clearly a capable manager dedicated to the care of residents. She undertakes training with staff but found that her own certificate
Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 22 to teach moving and handling is now out of date. Much of her time, even when that time is allocated for office work, she was observed working directly with residents. She says that formal supervision with staff “has slipped”. The recommended improvements in the home’s quality monitoring were not achieved. The quality of care planning was good, but not always up to date. She attributes these problems to lack of time. A staff member felt that staff were not given the opportunity to express their feelings, saying there had not been a staff meeting for a year. There are issues at the home concerning allocation of time for effective management and the opportunity of residents and staff and the manager to express their views and influence the way the home is run. Residents are able to have money kept for them at the home and the manager is diligent in ensuring the balance is kept correctly and the money kept securely. Some unnecessary risk to residents have not been identified and managed. The risk from unsupervised access to very hot water pipes (see standard 19) and cleaning chemicals, both posed a risk to confused residents. Having been mentioned during the first visit nothing had changed by the second and so Immediate requirements for improvement were issued. Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 23 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 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 1 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 1 Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 31/12/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. (This refers to insecure storage and handling of medication). The registered person shall make 31/01/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm. (This refers to the lack of training for staff in the prevention of abuse, and the need for the Local Authority Adult Protect team contact details to be included in the whistle-blowing policy). Hot water pipes must be guarded 19/10/06 and service users must be protected from the hazard of burns. Immediate Requirement The registered person having 28/02/07 regard to the size of the care home and the number and needs of service users must make
DS0000003484.V309393.R01.S.doc Version 5.2 Page 25 Requirement 2 OP18 13(6) 3 OP25 OP38 13 4 OP26 16(2)(j) Nutley Lodge 5 OP29 19 Schedule 2 6 OP33 21 7 OP38 13 suitable arrangements for maintaining satisfactory standards of hygiene in the home. (This refers to the poor disposal of gloves used for personal care, lack of hand washing facility for staff, the use of domestic washing machine in a care home of the this number and category of service users, and hand sluicing by staff). The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 – 7 Schedule 2 and he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. The registered provider must make arrangements to enable staff to make their views known about any matter, which will affect the health or welfare of service users. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This refers to unsupervised access to cleaning materials by confused residents). Immediate Requirement 19/10/06 30/11/06 19/10/06 Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 26 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 OP4 Good Practice Recommendations The provider should ensure that all aspects of good dementia care are considered and managed. (This refers to: - environmental adaptations to help residents with dementia make sense of the environment - the inclusion of social interests, hobbies and all information of importance to the resident as an individual within their assessment and care planning). Care plans should inform staff how the current needs of residents are to be met by being kept up to date. There should be a secure method for transferring medicines around the home and a lockable medicines fridge for their storage. The menu should be influenced by residents’ preferences and there should be a second option listed to promote real choice. The home’s complaints procedure should make it clear that complaints can be made to the Commission ‘at any stage’ not only if unhappy with the home’s response. Adequate hot water and heating should be assured at all times. The quality assurance process should be expanded to ensure comments are gained relating to the services provided and an annual development plan drawn up to ensure standards are maintained and improved upon. This recommendation has been repeated. 2 3 4 5 6 7 OP7 OP9 OP15 OP16 OP25 OP33 Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nutley Lodge DS0000003484.V309393.R01.S.doc Version 5.2 Page 28 - 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!
