CARE HOMES FOR OLDER PEOPLE
Orchid Lawns Nursing Home Steppingley Hospital Grounds Ampthill Road Steppingley Beds, MK45 1AB Lead Inspector
Linda Cappello Unannounced 30th June 2005 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 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. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Orchid Lawns Nursing Home Address Steppingley Hospital Grounds Ampthill road Steppingley Beds MK45 1AB 01525 713630 01525 718624 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Craegmoor Healthcare Mr. James Minshull Care home with nursing 24 Category(ies) of MD(E) Mental disorder over 65 years - 24 registration, with number DE(E) Dementia over 65 years - 24 of places Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th February 2005 Brief Description of the Service: Orchid Lawns is a purpose built nursing/care home situated in the grounds of Steppingley Hospital. Steppingley is a small village near to Flitwick town in mid Bedfordshire. Flitwick has good public transport and road access but there is a limited bus service to Steppingley. The home is single storey with accommodation separated into three wings each with their own living area and communal space. The home has a large garden and there is a large parking area at the front. Orchid Lawns provides places for up to twenty-four older adults with mental health care needs. All the places at Orchid Lawns are contracted to the local primary care trusts with admission via referral to a placement panel. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 02.30 hrs and 10.15hrs on 30th June 2005. The night staff on duty at the time were welcoming of the inspectors and helpful throughout. The registered manager was on holiday at the time of this inspection but the deputy manager was spoken to before the end of the inspection. The focus of the inspection was to assess the care given to residents and to follow up on some specific concerns which had arisen. The inspection was undertaken by Linda Cappello (Lead Inspector) and Sally Snelson (Regulation Inspector) and included interviews with night duty staff, discussions with day staff, the examination of care records and observations of care being given. Several bedrooms and communal areas were also visited. What the service does well: What has improved since the last inspection? What they could do better:
There are a lot of things which this home needs to do better to make sure that residents are looked after properly. There were so many serious problems at the home that the Social Services Department and health trust, which refers people to the home, have had meetings to decide how to make sure that the home improves quickly and that residents are safe. The company, Craegmoor Healthcare, have also taken action and put in a new temporary manager and immediately put right some of the problems. The home must make sure that all its staff have been trained to look after the people who are admitted who have very special needs and that there are always enough staff on duty at the times when the residents need the most help. It was found that some residents were not getting anything to eat in the evenings and then waiting a long time for their breakfast in the morning
Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 6 because there was not enough staff on duty to look after everyone properly. There must also be enough staff on duty to keep a close eye on residents who are unsteady on their feet and might fall over, or those who might be in danger if they got out of the building on their own. The home has found it difficult to get people to work at the home because of where it is but must not employ people who are too young to look after people or leave the home without a cleaner for a long time so that the home gets very dirty and smelly. The home must take a photograph of all the residents and put a copy on the plan which sets out their care. All the residents had a photo on their bedroom door but it would be very helpful if people’s names were also on them so that new staff can be certain whose room they are in. Some of the residents are very unsteady on their feet and fall over a lot and other residents may also get in their way and cause them to fall so the home needs to look at all these situations and make sure that everything possible has been done to keep people safe. There were some problems with the way the home gives residents their medication. In the mornings, residents were being given their medicine before they had their breakfast and this could mean that some of the medicines don’t work properly or could make the resident ill. There was also some confusion about the medicine that one resident should be taking and the home must be very careful to write down exactly what doctors want residents to take, as well as writing down how much medicine is taken each time. Although many staff were talking nicely to residents, not all staff were and it is very important that residents are always spoken to in a way which is respectful. It was not only found that there could be long gaps between residents being fed, but that people who have to have their food liquidised were not catered for very well. The home must make sure that there is always something available for them and that people who might choke when they are eating are not left on their own and are not given food that they cannot manage. The home must also take care to train their staff to recognise if residents are being abused and to know that they can ring senior managers if they are concerned about anything that is happening in the home. The staff must be trained to deal with situations where residents become very agitated and may hurt themselves or others. The management of the home must be improved because many of the problems which were found during the inspection should have been dealt with more quickly. When serious incidents happen at the home the manager must make sure he is clear about what actually happened and be able to tell the other appropriate people clearly and accurately. He must also recognise how serious things are and do everything possible to find out what happened, what led up to it and deal with staff and other residents who may be affected properly.
Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 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. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 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 standard(s) 4 The staff have not received training in working with people who are suffering from dementia and/or mental disorder and residents needs may, therefore, not be met effectively or appropriately. EVIDENCE: This home is registered to provide specialist care to people who have dementia and mental disorder, however, few staff spoken to had received any training in this respect or had any previous experience in caring for these residents. This could have a significant impact upon the way care is provided and could lead to residents becoming anxious and, potentially, aggressive. The home is supported by a consultant psychiatrist who visits on a regular basis and advises on medication and health issues. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, The care records were, overall, satisfactory so that the care needs of residents were clearly set out, however a number of residents were suffering frequent falls and their care needed to be reviewed. Some important issues were found in relation to the administration of medication which could leave residents at risk and affect the efficacy of the medication given. EVIDENCE: The care records for 6 residents were examined and found to, overall, contain all the relevant plans, assessments and risk assessments which were necessary for each resident. The plans were reviewed monthly but where the review resulted in a significant change to the care plan, this should have been made clear on the front of the care plan. Some comments which had been written on care plans had not been dated which made it difficult to understand what the latest situation was for the resident. Several of the care plans did not have a photograph of the resident and it was further difficult to identify residents because, although most residents had a photograph on their bedroom door, they did not always reflect the current look of the resident and did not have their names on. This could make it difficult for agency staff to identify residents accurately.
Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 11 The care plans and risk assessments for some service users who were very prone to falling needed to be fundamentally reviewed as some residents had sustained a large number of bruises. Risk assessments specifically need to be reviewed for the more mobile residents who are at risk of falling over a resident who lies on the floor for large parts of the day. This resident’s care needs to be reviewed and appropriate measures put in place to ensure his safety and comfort at all times. The morning medication round was observed and it was noted that residents were given their medication before they had had their breakfast which may have affected the efficacy of some drugs. Particularly as many had not eaten since at least 17.00hrs the night before which can mean a gap of up to 15 hours. It was noted that in one care record, there was an entry in the daily log which stated that the consultant psychiatrist had instructed that two drugs for a resident were ceased. However, this instruction had not been changed on the MAR sheet and he was still being administered one of the drugs and the other had not been administered before. Where medication was being administered as required, no protocols were seen which set out under what circumstances the medication was to be given. Also, when the medication was prescribed in variable doses, the record of administration did not clearly state what amount of medication was actually given to the resident on each occasion. Service users were, in general treated with dignity, however, the manner in which some staff speak to residents should be monitored to ensure that the term of address is one which is appropriate and acceptable to the resident. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The home is not providing nutrition for residents who need a liquefied diet at regular enough intervals which may have a detrimental effect on their health and well-being. EVIDENCE: Through discussions with both day and night staff, it became clear that tea was provided at 17.00hrs and consisted of cake and sandwiches which was prepared by the kitchen staff before they went off shift. It was unclear what was provided to those residents who needed a liquefied diet. Residents were offered a snack at 21.00hrs but this was only biscuits or left-over cake and sandwiches and there was no provision for those on liquefied diets. It was also said that some residents slept through tea-time and would miss this meal. The deputy manager was asked whether milky drinks were offered at suppertime as an alternative to tea but she said that they were not provided as older people do not like them. Staff were also asked whether food such as weetabix, ready-brek were offered but they said they were not. The deputy manager said that there were insufficient staff to provide suitable food at suppertime and there were insufficient staff available at breakfast time to ensure that residents were served promptly when they got up. Breakfast was observed as starting to be served at 08.15 hours and there was, therefore, an unacceptably long interval in between the tea and breakfast. Of additional
Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 13 concern, as discussed above, was the fact that medication was administered before residents had eaten their breakfast. In following up a recent incident of choking it became clear that staff were not sufficiently aware of the dangers of giving residents foods which may cause choking and of leaving them unattended while they ate. The care plans and risk assessments for these residents need to be kept under constant review and steps taken to make sure that all staff are familiar with the care plans and risk assessments. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 All staff need to attend training so that they can identify and prevent abuse and so that they can deal appropriately with challenging behaviour to ensure that residents are fully protected and managed appropriately. EVIDENCE: A recent incident at the home when a resident was physically assaulted by a member of staff was followed up during the inspection and it was found that the home needed to take some further action. The member of staff in question no longer works at the home and appropriate action was taken in relation to the employment. However, to ensure that everything possible has been done to prevent a recurrence of this type of incident, the home needs to make sure that any concerns about staff ability to work is managed appropriately and that all staff have received training in recognising all forms of abuse. It is also very important that staff know that they can ring senior management in Craegmoor Healthcare through the Whistleblowing procedure. Many of the residents present staff with behaviour which is challenging and all staff must receive training in how to deal with this effectively and appropriately to each individual. Training for staff so that they understand how to provide care to people who have dementia or mental disorder is also necessary so that all the care given is sensitive and appropriate to the individual. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 15 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 standard(s) 19,20,22,24,26, The home was found to be dirty, some residents did not have adjustable beds and a piece of moving equipment was found to be faulty which placed residents and staff at risk. EVIDENCE: The home had not had any domestic help for two months and the home was found to be generally dirty throughout, with offensive odours in many areas. Care staff had been asked to undertake cleaning as and when they could, but the pressure to meet service users’ needs had meant that cleaning was not being undertaken regularly or thoroughly. Some residents who require help to transfer from their beds to wheelchairs were found not to have adjustable beds which can place residents at risk and place staff at risk of back injury. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 16 It was found that a stand aid which is used to transfer residents within the home was not safe to use because the belt which should hold residents could not be secured. The large communal dining area/lounge is rather institutional in its layout and furnishings and the bathrooms need to be made more homely. Attention must be paid to creating an environment which is suitable to the needs of residents with dementia. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 There were insufficient staff on duty at peak times and staff had insufficient training to provide safe care and meet residents’ needs. Recruitment practices in the home could lead to residents being placed at risk. EVIDENCE: The night shift was found to consist of 1 qualified nurse and 3 care staff. Whilst this number of staff was probably sufficient during the night when residents were in bed, the staff and deputy manager were clear that there were not enough on duty at the peak times of activity such as at suppertime, when there were not enough staff to provide proper nutrition to all residents. It was also observed that there was insufficient staff available to ensure that vulnerable residents were constantly monitored when they first got up in the morning and were taken to the main lounge area to await breakfast. The number of staff coming on duty at 07.00hrs was insufficient to ensure that residents were provided with their breakfast in a reasonable timescale and again, particularly around the time of the handover, residents who had been assessed as being at high risk of falling, were left unsupervised. Staff are not paid for the time it takes for the handover to be given to the next shift and, as the nurse on duty writes up the care notes, the contribution of care staff appeared to be treated as marginal. A member of staff who had been recruited to provide personal care at night was not of an age where it was acceptable or appropriate for her to do so. In addition, the Criminal Records Bureau disclosure which had been submitted in
Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 18 relation to her employment was found to have been completed as if she was a domestic or laundry worker, although she had filled her application in to be a carer. The inspectors noted that there were difficulties in recruiting staff to the home, and several staff spoke about the difficulty in getting to the home because of its location, which is not near to public transport routes, particularly at unsocial hours. None of the staff interviewed had undertaken any training in providing care to people who had dementia an/or mental disorder, nor in how to deal appropriately with challenging behaviour. The home has been concentrating on making sure that staff undertook mandatory training such as Manual Handling and Food Hygiene. Some staff were observed to be talking sensitively with residents, encouraging them and explaining what was happening. The home must ensure that all staff work in this way. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,38 The management of the home has been insufficiently robust which has resulted in a number of serious concerns arising about the safety and welfare of residents. EVIDENCE: The registered manager is a qualified Registered Mental Nurse who had substantial experience of working in the community and in hospitals and had previous experience of managing a nursing home. He has been in post at the home since April 2004. Whilst some staff were clear that Orchid Lawns had improved since his appointment, other staff expressed some reservations about the way specific incidents had been dealt with by the management of the home. The information received, both verbally and in writing, by the Commission for Social Care Inspection about some recent incidents at the home had contained conflicting information. It seemed that the management was not always clear about what actions staff had taken and the events which
Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 20 had led up to incidents and had not always fully appreciated the seriousness of the incidents. The issues of concern which arose during this inspection, such as the faulty stand-aid, the lack of adjustable beds, the lack of domestic staff for 2 months, and the routines in the home regarding mealtimes and medication were matters which should have been addressed promptly by the manager with the support of his management within Craegmoor Healthcare. The inspectors found that staff were not receiving regular supervision which would directly affect the quality of care given to residents. Several issues of concern which arose during this inspection which affected the health and safety of residents and staff have been discussed elsewhere in this report. However, in addition, the home must ensure that all staff and particularly the night staff fully understand and can implement appropriate fire procedures in the home. The home must also review the risk assessments and security of the premises in relation to residents who are at risk if they are able to leave the premises unsupervised. Arrangements for the monitoring and supervision of residents must also be addressed to ensure that the whereabouts of residents is always known to staff and staff are aware of, and take appropriate action, in relation to any absences promptly. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1
COMPLAINTS AND PROTECTION 2 2 x 2 x 2 x 1 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 1 1 x x x 2 x 2 Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? 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 4,30 Regulation 14(1)(d), 18(1)(a) Requirement The home must be able to demonstrate its ability to meet residents needs and, specifically, to receive training in caring for people with dementia, mental disorder and challenging behaviour. Care plans must be updated following review and all entries must be dated. The care plans and risk assessments for all residents who are at risk of falls must be reviewed and appropriate measures put in place to prevent injury. The care plans and risk assessments for all residents who are at risk of choking must be reviewed and appropriate measures put in place to prevent choking. The medication for the identified resident must be reviewed immediately and action taken to ensure that the consultants instructions have been implemented The times at which medication is administered must be reviewed to ensure that it is given at times Timescale for action 30th September 2005 2. 3. 7 7,8 13(4), 14(2), 15(1)(2) 13(4), 14(2), 15(1)(2) 30th July 2005 30th July 2005 4. 7,8 13(4), 14(2), 15(1)(2) 30th July 2005 5. 9 13(2) 30th July 2005 6. 9 13(2) 30th July 2005
Page 23 Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 7. 9 13(2) 8. 9 13(2) 9. 10 12(4)(a) 10. 15 16(2)(i) 11. 12. 18 18 13(6) 19(1)(a) 13. 14. 18 19,20 21(2) 23(1)(a) 23(2)(f) 15. 19 13(4)(a,c) 23(2)(o) 23(2) 16. 22 which ensure its efficacy and safe administration. Where varying dosages of medication are prescribed a record of the actual dosage administered must be kept. Where medication is prescribed as required a protocol must be in place for each medication, setting out the circumstnaces in which it is to be administered. The manner in which staff speak to residents and the terminology used must be monitored to ensure that their dignity is respected and it is the term of address they prefer. Residents must be provided with drinks and nutrition suitable to their needs at regular intervals during the day and evening and particular attention paid to those who have liquified diets. All staff must receive training in the recognition and prevention of abuse The capability of staff to care safely and appropriately for residents must be constantly reviewed and appropriate action taken where there are concerns. All staff must receive training in how to use the companys Whistleblowing procedure. The communal areas of the home must be made more homely and the environment reviewed to ensure it meets the specific needs of residents. A review of the exit doors and gardens must be undertaken to ensure the safety of residents is maintained at all times. The belt for the stand-aid must be replaced immediately and staff must take extra care when using it. 30th July 2005 30th July 2005 30th July 2005 30th July 2005 30th September 2005 230th July 2005005 30th August 2005 30th September 2005 30th August 2005 1st July 2005 Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 24 17. 24 23(2)(n) 18. 19. 26 27 23(2)(d) 18(1)(a) (b) 20. 27,29 18(1)(a) 21. 29 19 (Schedule 2) 9 18(2) 22. 23. 31 36 24. 38 23(4)(c,d, e) Where risk assessments indicate the need for adjustable beds for the safe manual handling of residents these must be provided. Arrangements must be made for the home to be kept clean and free from offensive odour. The number of staff on duty in the home must, at all times, be sufficient and appropriate to meet the health and welfare needs of residents and to ensure that there are appropriate levels of supervision and monitoring of residents who are at greatest risk. Staff recruited to the home who are to provide personal care must be aged 18 years and over and be able to demonstrate that they are suitably qualified, competent and experienced to meet the health and welfare needs of residents. Criminal Records Bureau disclosure application forms must be completed accurately to reflect the exact nature of the staff members role. The ability of the manager must be reviewed to ensure his fitness to manage the home. All staff must receive regular supervision and this must include a review of their performance and competence. Appropriate action must be taken in cases of concern. Staff working at night in the home must be made fully aware of the procedure to be followed in the event of fire. 15th August 2005 30th July 2005 30th July 2005 30th July 2005 30th July 2005 30th August 2005 30th August 2005 30th August 2005 Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 25 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 27 Good Practice Recommendations The procedure for handovers between shifts should be reviewed to ensure that care staff can contribute and to ensure that, during handover, sufficient staff are available to continue to meet residents needs safely.. Orchid Lawns Nursing Home I51 S17684 Orchid Lawns V236111 300605 Stage 2.doc Version 1.40 Page 26 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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