Inspection on 13/11/08 for Oaklands Nursing and Residential Home

This inspection was carried out on 13th November 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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: Oaklands Nursing and Residential Home Talbot Street Harle Syke Burnley Lancashire BB10 2HR     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: Marie Matthews     Date: 1 3 1 1 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 30 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 30 Information about the care home Name of care home: Address: Oaklands Nursing and Residential Home Talbot Street Harle Syke Burnley Lancashire BB10 2HR 01282411948 01282448251 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Pauline Deeming Type of registration: Number of places registered: Grosvenor Care (South) Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 43). Physical disability - Code PD (maximum number of places: 1). The maximum number of people who can be accommodated is: 44. Date of last inspection Brief description of the care home Oaklands is a listed building that has been extended to provide accomodation for up to forty-four people who require nursing or personal care. It is situated in a quiet residential area in Harl Syke on the outskirts of Burnley. There are two floors that can be accessed by a passenger lift or stair lift. All rooms are single occupancy and some offer en-suite facilities and there are a variety of comfortable communal areas.There Care Homes for Older People Page 4 of 30 0 1 Over 65 43 0 Brief description of the care home are attractive garden areas and adequate parking for visitors. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. on the day of the inspection the fees ranged from £422.00 to £675.00. Items not included in the fees include private chiropody, newspapers, some personal toiletries and hairdressing. Care Homes for Older People Page 5 of 30 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: The key unannounced inspection, including a visit to the home, took place on 13th November 2008. The inspection process involved looking at records, a tour of the home and discussions with the registered manager, two care staff, one visitor and five residents who lived in the home. Information was also included from survey forms filled in by five staff, one visitor and five residents. The registered manager had sent us their annual quality assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved since the last inspection and where further improvements were needed. The inspection also looked at things that should have been done since the last inspection visit and a number of areas that affect peoples lives. Care Homes for Older People Page 6 of 30 There were thirty-seven people living at the home on the day of the inspection. This key inspection follows a recent change to the registration certificate to monitor how this has affected the running of the home; a review of the service (annual service review) had been completed on 4th April 2008. What the care home does well: What has improved since the last inspection? What they could do better: Staff need to ensure that information regarding residents health and care needs was recorded, as the detail in the care plans did not always reflect the attention that was being given; this could result in care needs not being met. The care plans should include more information about residents likes, dislikes, routines and preferences as this would ensure they are involved in decisions about the care they Care Homes for Older People Page 8 of 30 want. The care plans should include more information about residents lives before they were admitted to the home; this would help to provide appropriate activities and support for them. There should be a record of activities that had taken place including the date, activity, attendees and whether it was enjoyed; this would ensure residents social needs and expectations were beong met. Staff should be provided with formal safeguarding adults training to make sure they have the skills and knowledge to respond to and recognise abuse and neglect. Systems to monitor whether staff were following policies and procedures should be formalised and further developed. There should be a training and development plan for all staff; this would identify the skills and knowledge of staff, the training needed and when it was due or had taken place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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 had sufficient information about the services available at Oaklands to enable them to decide whether the home was suitable for them. Detailed information was collected about residents before they were admitted to the home to determine whether their needs could be met. Evidence: The information about Oaklands was detailed and gave people an understanding of what services were available. People said they were given enough information and one relative said they were shown around and introduced to staff. The information was not yet available in other formats such as large print, audio or braille but the registered manager said this would be considered. The files of three residents were looked at in detail; the records showed that information had been collected from various sources to ensure residents needs could be met. People had received confirmation that their needs could be met prior to Care Homes for Older People Page 11 of 30 Evidence: moving into the home; this reassured people that they would be looked after properly. Survey information and review of records showed that each resident was provided with a contract or terms of admission; the information was clear and ensured people were aware of what their rights and obligations were whilst living at Oaklands. The information was not yet available in other formats. Staff records showed they had a range of skills, ability and qualifications to help them to meet the needs of residents in the home; there were registered nurses available to provide specialised nursing care. It was recommended that an training matrix or plan should be developed to clearly record an overall view of training provided for all staff, see standard 30. Care Homes for Older People Page 12 of 30 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. Residents health and personal care needs were met although the detail in the care plans did not always reflect the care and attention given. Residents medicines were managed safely. Evidence: Three individual care plans were looked at in detail. Residents care plans had been developed from the initial assessment information and it was clear from discussion and survey information that residents were happy with the care they received and staff were aware of residents individual needs. Staff needed to ensure that information regarding residents individual health and care needs, including short term health needs, should be recorded in detail as the information in the care plans did not always reflect the care and attention that was being given; this could result in residents not getting the care they need. The care plans could be improved to include more information regarding likes, dislikes and preferences; this would ensure residents would receive the care that they wanted. There was evidence that care plans were reviewed each month but there was limited evidence to support residents and their Care Homes for Older People Page 13 of 30 Evidence: representatives had been involved in decisions about care. Residents said they received the medical care they needed and one resident said she had been visited by her General Practitioner (GP) when she had needed. Records showed that residents health needs had been assessed and monitored and that appropriate professional advice had been sought if needed. Any risks to residents health and safety had been monitored and appropriate action had been taken to reduce or remove any risks. Residents nutritional needs had been assessed as part of the pressure risk assessment although it was recommended that a seperate assessment was completed that would identify any specific nutritional needs. Two of the residents were identified at risk of falling and bed rails had been provided following discussion with relatives; it was recommended that the bed rail assessment should include more detail regarding potential risks to ensure that the use of this measure of restraint was appropriate. The registered manager said a sample of care plans were reviewed each month to ensure they were completed correctly and residents needs were being met; it was recommended that this was recorded in a more structured way. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence where possible. Residents said that staff listened to and acted on what they said; this ensured residents were given choices about their care. Staff were given training in health care matters and also with maintaining peoples privacy and dignity; staff were observed knocking on doors and waiting for a response and responding in a friendly but respectful manner to residents and visitors to the home. One resident said she had been visited by her GP in the privacy of her bed room. Residents were appropriately dressed and received visits from the hairdresser each week. During a tour of the home it was noted that staff had displayed personal care instructions on a residents bedroom wall; this practice should be reviewed as this impacts on residents privacy and dignity. It was also noted that un named toiletries such as soap, shampoo and foam bath were stored in bathrooms suggesting these were used for a number of residents; this practice should be reviewed to maintain residents dignity and reduce the risk of cross infection. Medication procedures were clear and supported staff with safe practice although a procedure to support staff with handwritten entries needs to be developed as there was evidence that entries had not been witnessed and this could lead to error. Otherwise records were completed accurately and medicines were managed safely and stored securely. There were no residents who were able to or preferred to manage their own medicines although there were no records to support that residents had consented to staff managing their medicines. Monthly checks of medication practices had been introduced to identify whether staff were following safe practices and procedures. Care Homes for Older People Page 14 of 30 Evidence: Staff were supported with detailed information regarding how to support and care for dying and deceased residents and their friends and family. Personal requests regarding after death arrangements had been recorded as part of the admission process to ensure residents needs were fulfilled. Care Homes for Older People Page 15 of 30 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. The provision of activities and entertainments could be improved to ensure residents diverse social and recreational needs were met. Residents received a healthy, varied diet that was suited to their individual preferences and dietary requirements. Evidence: The records and discussions with residents supported that the provision of activities had improved; however this was mainly dependent on availability of staff who could be called away to attend to other residents. There was a programme of activities which was displayed on the notice board but no records to support who had attended, whether the activity had been enjoyed or not or whether residents had been involved in the planning of the activity programme. One resident said she was able to maintain contact with her family outside the home but generally residents were unable to leave the home without the support of family and friends. The information in the care plans was limited in terms of hobbies and interests, likes, dislikes and preferences and could be improved through discussion with residents and their relatives; this information would help staff to provide suitable activities for each individual and would ensure residents received the care they preferred. Residents spiritual needs were met by regular visits from ministers each month. Care Homes for Older People Page 16 of 30 Evidence: Visitors were made to feel welcome and could visit at any reasonable time and in any area of the home and mobile phones were provided for residents to maintain contact with their family and friends. Records showed that the meals were varied, well balanced and nutritious; residents confirmed they were offered choices at each mealtime and had been consulted about menu changes. There were records of food served although these had not been completed in full and did not show that all residents had received a nutritious diet. Residents made positive comments about the meals; comments included the meals are excellent, the food is very good and the food is fantastic. The home had recently achieved the recipe for health award which showed the home was committed to providing residents with a healthy, well balanced diet. The dining areas had been improved and appropriate utensils were provided; staff were seen providing appropriate assistance to residents who needed extra support and mealtimes were unhurried and residents were able to finish their meals at their own pace. Care Homes for Older People Page 17 of 30 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. People were protected by clear and effective complaints and safeguarding procedures. The provision of safeguarding training could be improved to ensure all staff had the skills and knowlege to respond to any suspicions of abuse or neglect. Evidence: The complaints procedure was clear and accessible to people. From survey information and discussions with residents and a visitor it was clear that people knew who to speak to if they were unhappy and were confident their complaint would be responded to. The safeguarding adults procedures were clear and staff were aware of how to respond to any suspicion of abuse or neglect. In the absence of a training matrix (see standard 30) it was unclear how many staff had received safeguarding training; the manager advised that eight new employees had attended training as part of their induction and all other staff had discussed safeguarding as part of their one to one supervision. The registered manager was strongly advised to ensure all staff were provided with formal training to increase their awareness and to help them to recognise and respond to any abuse or neglect. A number of staff had attended training to help them to respond appropriately to any challenging behaviour; this would ensure staff and residents were safe from harm. Staff had access to clear procedures to support them with reporting any bad practice in the home which would protect residents from harm. There were procedures to ensure residents finances were safeguarded. Staff were Care Homes for Older People Page 18 of 30 Evidence: aware of the appropriate and safe use of bed rails and equipment was subject to regular checks to ensure residents were safe. Care Homes for Older People Page 19 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lived in a safe, clean, comfortable and well maintained environment. Evidence: During a tour it was clear that the home was well maintained, safe and comfortable and was equipped with the specialist equipment and adaptations to meet residents individual needs. A maintenance person was employed to ensure the home was well maintained and records showed that repairs had been responded to promptly and improvements had been maintained. The home met the requirements of fire safety and environmental health departments; this ensured residents lived in a safe environment. The gardens were well maintained and could be accessed through the patio doors: seating areas allowed residents and their visitors to enjoy the gardens in the warmer weather. There were a selection of comfortable communal areas to enable people a choice of where to sit and meet with family and friends; the fittings and furnishings were of good quality, comfortable and met the needs of the residents using them. Residents rooms were clean and bright and most had been personalised with treasured possessions; rooms were fitted with locks to promote residents rights to privacy. All rooms were fitted with an alarm for residents to summon the help of staff; residents said staff always came when they needed help. Care Homes for Older People Page 20 of 30 Evidence: Residents said they were happy with their rooms. There was a development plan that supported ongoing and future improvements; which would ensure residents continued to live in a pleasant and safe environment. Residents surveyed said the home was clean and free from odour and this was observed during the tour of the home. Staff had access to clear infection control plans to ensure the risk of cross infection was reduced. Some bedrooms had en suite facilities whilst others were provided with commodes; well equipped bathrooms and toilets were easily accessible from bedrooms and communal areas. It was noted that the cleaning cupboard was unlocked allowing residents and visitors access to hazardous substances; these areas should be locked to ensure people were not at risk. See standard 38. Care Homes for Older People Page 21 of 30 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. The staff team were suitable, competent, well supported and provided in sufficient numbers to meet peoples needs. However recruitment records need to be improved to ensure the process was safe and training records must be improved to ensure that staff have the skills and knowledge to meet peoples needs. Evidence: The staff rotas were clear and staff and residents said there were sufficient staff to meet peoples needs. Records showed there was an established staff team which provided consistency of care for residents and their families. Residents appeared to know the staff team well and they made positive comments about the them; comments included staff are lovely, staff are excellent and If I cant be at home Im glad Im here. The majority of staff had achieve a recognised qualification in care (NVQ) this ensured that staff had the skills and knowledge to meet the needs of the residents in their care. The home did not have a formal training plan which made it difficult to determine the skills and knowledge of staff currently working in the home. There was evidence that new staff had been given initial training to give them the basic skills that they needed and existing staff had received ongoing safety training that would kepp themselves and others safe. Staff confirmed that other training had been provided but there were no records to support this. Care Homes for Older People Page 22 of 30 Evidence: Staff said they were supported by senior staff and they were able to discuss any issues during regular meetings with their manager. Staff said they did not have meetings but were able to discuss issues either at staff handover periods or at supervision and were provided with a staff newsletter; it was recommended that staff meetings were arranged to give staff the opportunity to meet and discuss any issues as a group. There were a clear recruitment procedures and three staff files were looked at in detail. It was clear that safe procedures had been followed although there were concerns that the application form did not allow applicants to record their full employment history resulting in gaps in employment that had not been explored and the reference form did not clearly detail the company name or the name of the referee or the date on which the reference was supplied. There were procedures to support staff with equal opportunities although it was recommended that an interview record should be developed to show a fair selection process had been used. Residents were not yet involved in the interview and selection of staff. Care Homes for Older People Page 23 of 30 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. People benefited from a well managed home and their health, safety and welfare was promoted and protected. People were involved in decisions about how the home was run. Evidence: The registered manager is Pauline Deeming; she has the required qualifications and experience and is competent to run the home and people made positive comments about her. There is a strong ethos of being open and transparent in the running of the home and the staff team is well established which provides consistency of care for residents and their families. The registered manager sent us their annual quality assurance assessment (AQAA); this gave us a good picture of how the home was improving and where further improvements were needed. There were policies and procedures to support staff in all aspects of their work and these had been reviewed in line with current thinking and practice. Care Homes for Older People Page 24 of 30 Evidence: A system of regular checks had been introduced to help to determine whether staff were working to procedures; however not all of these checks were recorded. Records were generally completed in detail although some gaps had been identified under specific outcome areas. Two residents finance records were checked; records were clear and accurate and showed that finances were safeguarded by the systems and record keeping. The home had achieved the Investors in People award; this is a recognised quality award that monitors the standard of training and development of staff and management systems within the home. People were consulted about whether their needs and expectations were being met; this was done by user surveys and six monthly meetings. Systems and equipment were maintained and serviced to ensure they were safe to use. Staff were trained in safety matters and this would help them to keep themselves and others safe. It was noted that the cleaning storage cupboard was unlocked; the potential risks of this was discussed with the manager at the time of the visit and action taken at that time. Care Homes for Older People Page 25 of 30 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 26 of 30 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 7 15 The residents individual care 22/12/2008 plan should include all aspects of residents needs and detail how these needs will be met. This will ensure residents needs will be met and staff are aware of the care needed. 2 18 13 All staff must be provided with safeguarding adults training. This would ensure staff have the skills and knowledge to recognise and respond appropriately to any signs of abuse or neglect. 22/12/2008 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 The care plans should include more information regarding residents likes, dislikes and preferences; this will ensure residents receive the care they want. Page 27 of 30 Care Homes for Older People 2 7 Residents and their representatives should be more involved in the development and review of the care plan; this will ensure residents are involved in decisions about their care. The system to monitor the quality and content of care plans should be improved; this will help to determine whether care needs are being met and whether policies are being followed. The nutritional assessment should be seperate to the pressure risk assessment; this will ensure that any risks are specific and appropriate interventions can be recorded. The decision to use bed rails as a form of restraint should be supported by a more detailed assessment of potential risks; this will help to determine whether the use of bed rails is in the residents best interests. Permission for staff to manage medications should be obtained from those residents who are unable or prefer not to manage their own medicines. Any handwritten directions recorded on medication records should be witnessed by a second person; this will reduce the risk of error. A procedure to support staff with recording handwritten directions on medicine records should be developed; this will reduce the risk of error. Toiletries should be removed from bathrooms after use to prevent communal use and to reduce the risk of cross infection. The practice of displaying care instructions on residents bedroom walss should be reviewed as this impacts on residents privacy and dignity. The care plans should include detailed information about residents life prior to admission to the home, hobbies, interests, likes, dislikes and preferences; this will enable staff to provide suitable activities and to meet residents diverse needs and expectations. There should be a record maintained of activities provided including the names of residents who participated and whether the activity was enjoyed; this will enable staff to monitor whether activities were appropriate and whether residents social needs and expectations were being met. Records of meals served should be completed in full to support that all residents are receiving a healthy and nutritious diet. A record of interviews should be maintained to demonstrate Page 28 of 30 3 8 4 8 5 8 6 9 7 9 8 9 9 10 10 10 11 12 12 12 13 15 14 29 Care Homes for Older People a fair process was used. 15 29 Consideration should be given to involving residents in the interview and selection of new staff; this would allow residents to be more involved in the running of the home. The reference request form should be reviewed to record the referees details including the company name, name and role of the person supplying the reference and the date of signing; this would help to identify whether the reference was appropriate. The employment application form should be reviewed to ensure there is sufficient space for applicants to record a full employment history; this would identify any gaps in employment that need to be explored. Consideration should be given to introducing staff meetings; this would enable staff to formally discuss issues as a group and to receive any updates or changes that may affect them. There should be a training plan or matrix that indicates staff training needs and development and skills and expertise of current staff. Systems to monitor whether staff are following procedures and whether residents needs are being met should be developed. The cleaning cupboard should be kept locked at all times to reduce the risk of harm to residents and visitors. 16 29 17 29 18 30 19 30 20 33 21 38 Care Homes for Older People Page 29 of 30 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 30 of 30 - 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!