Inspection on 31/01/06 for Peartree Care Centre

This inspection was carried out on 31st January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Peartree Care Centre 10/07/08

Peartree Care Centre 08/11/07

Peartree Care Centre 01/11/06

Peartree Care Centre 17/08/06

Peartree Care Centre 07/08/06

Peartree Care Centre 01/06/06

Peartree Care Centre 13/07/05

Peartree Care Centre 08/12/04

Peartree Care Centre 13/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Peartree Care Centre Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT Lead Inspector Kate Matson Unannounced Inspection 09:00 31 January and 2 February 2006 st nd 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 Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 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. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Peartree Care Centre Address Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT 020 8488 9000 020 8333 5399 debbieann.bailey@excelcareholdings.com 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) Springmarsh Homes Ltd Care Home 75 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 20 patients, elderly, frail persons aged 60 years and above (female) and 65 years and above (male) 55 persons aged 65 years and above, and persons aged 60 years and above who are physically disabled, or have a mental health disorder 13th July 2005 Date of last inspection Brief Description of the Service: Peartree Care Centre is a care home providing personal care and accommodation for up to 75 older people. Of these, 20 older people are provided with nursing care. At the time of this inspection, there were five residential vacancies and no nursing vacancies. The home is owned and run by Excelcare Holdings Ltd, a private provider with several other homes in the nearby area, as well as outside London. The Head Office of the company is in Bromley. The home is located close to the centre of Sydenham and is easily accessible by public transport. It is also close to community facilities, shops, cafes and pubs. The property is purpose built with accommodation on four floors. On one floor nursing care for 20 people is provided; one floor is designated to provide residential care to older people with Dementia; the other two floors provide residential care to frail older people and older people with Dementia. There are 65 single and five double bedrooms. However double rooms can only be used where service users have made a positive choice to share. All but seven single rooms and one double room have en-suite facilities. There is a passenger lift. The home has a car park and a small paved area at the rear of the property. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced statutory inspection was conducted by two inspectors over two days. The inspection included discussion with 4 service users, 8 relatives, the manager, the regional manager, the acting head of care and operations and five staff members, a tour of the premises, and examination of eight care plans, five staff files, and other records. The CSCI pharmacist inspector also conducted an inspection on the first day. The inspection revealed improvements in some areas but evidence at and incidents prior to the inspection highlighted new areas of concern. Some requirements have now remained unmet over several inspections and enforcement action is being taken by CSCI to address these issues. What the service does well: What has improved since the last inspection? Care plans were more detailed and reflected that changing needs were being recognised; however, some areas are still not covered and the involvement of service users and relatives remains superficial. The home has made good progress to address the significant number of serious medication shortfalls noted at the last inspection. Medication handling and recording is now of an acceptable level. Although an activities coordinator is now in post and more activities are offered, there was evidence that some service users remain un-stimulated and recommendations made by an occupational therapy report had not been fully implemented. Service users’ autonomy had been promoted by the provision of keys to their rooms where they wanted them; however, service users and their relatives were still not involved in care plan reviews in a meaningful way. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 6 Several improvements had been made to the environment including; the development of the outside space into an attractive area where service users were reported to be looking forward to spending time in the warmer weather; an additional assisted bath to allow for a choice of bath and shower on each floor; the provision of a hearing loop on each floor; the abolishment of room sharing unless service users have made a positive choice to do so; the provision of carpet unless service users prefer linoleum; the ability for service users to control the heating in their own rooms and the provision of blinds for the top floor conservatory style roof. What they could do better: Information given to service users is still inaccurate and misleading. It needs to be reviewed to ensure that it is accurate and that it truly reflects the service offered. Most service users now have a statement of terms and conditions or contract but some of these do not include required information. Some service users’ needs had not been assessed prior to admission and information about service users’ past lives needs to be more actively pursued in order to aid communication. Although there was evidence that some healthcare needs are met, their was insufficient evidence available that all service users are encouraged to take part in any exercise and recent incidents in the home highlight problems in recording care and concerns about the level of supervision provided. Although few complaints were recorded at the home repeated complaints from a service user’s relative indicated that complaints are not promptly investigated or recorded appropriately. Although more staff had undergone training in adult protection, recent incidents at the home raised concerns about staff’s knowledge of the whistle blowing procedure and the home’s ability to protect service users. A record of cases referred for investigation under adult protection procedures was now being kept though two recent cases had not been included as required. Although an occupational therapy assessment of the premises had been completed in accordance with previous requirements, signs on doors had not been provided as recommended. Although water temperatures were now being tested it was found that one service user who had stated at the previous inspection that they were unable to shower due to the water temperature being too cold was still unable to shower due to water temperature. The provider was asked to take action on the day of the inspection to ensure that showers are also checked and appropriate action taken where necessary. There were unpleasant odours noted in a couple of areas of the home and this must be addressed, as it is unpleasant for service users, visitors and staff. It was also found that few staff had undergone training in infection control and sluice doors were not kept locked as required at previous inspections. Staffing levels do not reflect those quoted in the statement of purpose and continue to be insufficient to meet service users individual care needs. Recent incidents at the home highlighted that handover procedures are inadequate and must be addressed to ensure effective continuity of care. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 7 One staff member had started work before being checked against the list of people considered unsuitable to work with vulnerable adults, which continues to place service users at risk of abuse. It was also found that staff had not undergone any training in recruitment, which is essential if the quality of staff is to be improved. The home’s assessment of staff training needs, training plan, and induction and foundation continue not to ensure that the needs of service users are met. It was found at the inspection that one service user had not had any money for over nine months and the home had taken no action to address this. Also a recent social worker review had highlighted that a service user was not aware that they had a personal allowance at head office and were instead using savings to live on. This indicates that the home does not ensure that service users’ financial needs are addressed and as a matter of urgency a review of service users’ finances must be conducted and referrals to social services or an independent advocate must be made for anyone not receiving any income. Although within the last month efforts had been made to offer the majority of staff supervision, this did not ensure a frequency of two monthly supervision, as required by previous inspections and will continue to be monitored for compliance. Although there were improvements in the organisation of health, safety and maintenance records and fire alarms were now being tested appropriately, there was still inconsistency in recording of accidents and incidents and it appeared staff were unclear about how occurrences should be recorded. The provider is required to ensure staff are clear of the distinction between accidents and other incidents, that occurrences and actions are recorded in the appropriate format and that CSCI is notified of all incidents covered under Regulation 37. Please see requirements at the end of this report for details of outstanding requirements from previous inspections and new requirements. 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. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 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 Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 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): 1, 2, 3 and 4. Information provided to service users is inaccurate and misleading. Most service users now have a statement of terms and conditions or contract but some of these do not include required information. Some service users’ needs had not been assessed prior to admission and information about service users’ past lives needs to be more actively pursued in order to aid communication. The home’s staffing level, staff training and activities provided do not ensure that the needs of service users are met. EVIDENCE: Previous inspections had noted missing and incorrect information in the statement of purpose and service user guide. At this inspection the service user guide still quotes incorrectly that there are 72 single rooms and 5 shared rooms. There were still discrepancies between information included in the documents and evidence gathered at the inspection. For example the statement of purpose states staffing levels that were not reflected in the homes duty rota’s (see standard 27) and states that in emergencies, “the home manager will obtain as much information….in order to identify the facilities and care required to meet their short term care needs”, and that a placement review will take place six weeks after admission arranged by the Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 10 home if the service user does not have an allocated care manager. However, it was found that two service users had been admitted without any information being obtained by the home and one service user who had lived at the home for over nine months had not had a placement review. This information continues to be misleading for prospective service users. It had been noted at previous inspections that although most service users had a contract with the local authority, they did not have a statement of terms and conditions from the home. At this inspection a “contracts matrix” showed that statements of terms and conditions were in place for most service users but 5 service users had not been issued with one and some of the contracts issued did not include all of the areas required. This means that the rights of service users are not properly protected. All eight of the service users files examined included a care management assessment, where appropriate, and an assessment completed by the home. However, it was found in discussion with staff that emergency admissions had been accepted without any information being obtained by the home in order to assess whether their needs could be met. The manager stated that assessments were carried out as soon as possible after admission but appeared not to know that admissions must not be made without any information being supplied. (There was already a requirement in place covering this issue under Standard 4). At the last inspection it was found that some service users had a life review in place though these were not always fully completed. These documents are important in aiding communication with service users and the provider was required to ensure that information is actively sought and attempts to gather information recorded on the file. At this inspection it was found that all of the files examined had a life review in place though where there were gaps in information there was no evidence of how these were being chased up. At previous inspections concerns had been expressed about the home’s ability to meet the needs of service users particularly those with dementia. Concerns were around staffing levels, staff training (particularly around dementia and adult protection), activity provided and the absence of environmental assessment to ensure that the home meets the needs of this service user group. Prior to this inspection and as a result of several recent vulnerable adult investigations, CSCI took action to prevent the home from admitting any further service users until such a time as it can demonstrate its capacity to meet the needs of the existing service user group through the provision of staff training, good record keeping and competent staffing. At this inspection it was noted that staffing levels had not increased (see standard 27) and although the level of activity provided had increased, insufficient evidence was available to show that service users individual needs were met (see standard 12). At least 50 of staff were trained to NVQ level 2 and most care staff had undergone some training in adult abuse; however, only 13 staff had undergone training in dementia which is inadequate for a service registered for such service users. An occupational therapy assessment of the premises focussing on the needs of people with dementia had been completed though the recommendations of this had not been fully implemented (see standard 22). Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 11 Two service users had been without any money and no action had been taken to address this (see Standard 35). Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 12 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 and 11 Care plans were more detailed and reflected that changing needs were being recognised; however, some areas are still not covered and the involvement of service users and relatives remains superficial. Although there was evidence that some healthcare needs are met, recent incidents in the home highlight concerns about the level of supervision provided and problems in recording care. The home has made good progress to address the significant number of serious medication shortfalls noted at the last inspection. Medication handling and recording is now of an acceptable level. The privacy and dignity of service users are promoted and protected. Service users had been consulted about their wishes in terms of death and these were recorded on their files. EVIDENCE: Previous inspections had noted that care plans did not cover all areas of need, service users were not involved in care planning and that reviews did not reflect the changing needs of service users. At this inspection, care plans were more detailed though none of those examined included a care plan around mental health, which is essential because of the prevalence of dementia and depression in older people. Also, although sexuality was included in care plans there was little meaningful information provided including one man where issues around this had been identified. Signatures of service users or relatives Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 13 were evidenced on files but several relatives stated they had not been invited to care plan reviews. Although the review date was still written prior to the review being conducted on some floors and then staff initialled to state care was reviewed, reviews generally reflected that changing needs were recognised appropriately. However, as already stated one service user had not had a placement review for over nine months and another relative stated that although they had been consulted in the initial care planning process they had not been involved in any care review. The home has a GP who visits the home on a weekly basis. Care plans indicated that service users had intervention from specialist services including tissue viability nurse, older adults mental health team and district nurses. The Care Home Support Team also provides input to the nursing floor. At the previous inspection it was noted that advice from the GP had not been followed and that where concerns about service users intake of food or fluid or weight had been identified this was not appropriately monitored. Also not all service users had access to organised exercise activity to ensure that they keep physically active. At this inspection evidence was found of GP instructions being followed and food and fluid charts being completed where there were concerns about service users weight or intake of food or fluid; however, a recent incident at the home had highlighted that food/fluid charts had not been completed correctly and also that a service user with an infection required closer supervision than was provided. CSCI is taking enforcement action regarding this issue. It is recommended that following examination of a service user the GP be asked for more detailed instructions for how care is to be carried out. It was also found that although some exercise was now included in an activities programme there was insufficient evidence that all service users who were able were encouraged to take part. Service users confirmed that their privacy and dignity are protected whilst receiving care. Staff stated that medical examinations were completed in private. Screening was seen in the only room that was being shared at the inspection. Previous inspections had noted that the wishes of service users in terms of their death were not being sought. At this inspection it was noted that all of the files examined included information around this sensitive issue. Below is CSCI pharmacist’s inspection report. 14 requirements relating to medication were made at the last inspection. 13 requirements have been met, and 1 partly met. The home has made a good effort to improve handling and recording. The supplying pharmacist has provided training and conducted medication audits. A medication competency audit has been carried out and there is now an authorised signature list of those staff deemed competent to administer medication. The home is also carrying out daily audits to identify issues and have implemented a corrective action sheet to ensure issues are dealt with. Compliance with prescribed medication is good. On the rare occasions when medication is refused or not administered, comments are now being made on the back of the MAR chart to explain why, and any action taken. No prescribed items were out of stock. The use of all prescribed medication is now recorded, including food supplements Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 14 and external products. One item brought in by the District Nurse two weeks earlier was not yet on the MAR chart as separate records are kept for these items. To avoid confusion, all prescribed items should be recorded on one chart. Facilities for storage were in good order and temperature monitoring is being done. On one occasion the fridge was out of temperature range and there was no record of any action taken. Stocks of homely remedies for minor ailments are kept on the nursing floor, and are issued from there to the residential floors. A tablet was found on the floor of a resident’s bedroom. A risk assessment is already in place as this resident occasionally refuses medication. Staff spoken to said that they do wait until medication is swallowed, however staff must be reminded of the need to do this. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 15 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 and 15 Although the level of organised activities offered in the home had increased there was insufficient evidence that it meets service users’ individual needs for stimulation and fulfilment. Community contact is maintained by visits from service users’ relatives, friends, church visitors and external entertainers who visit the home. Service users are given better information to exercise some choices though information provided to service users and relatives still does not ensure their involvement in the care planning process. Although a food survey indicated greater satisfaction with meals provided, this could be further improved by requesting more details from service users about their preferences. EVIDENCE: Previous inspections had noted that the amount of organised activities taking place in the home was insufficient to meet service users’ individual needs for stimulation and fulfilment. At this inspection it was found that an activities coordinator was in post and as a result the amount of activities had increased; however, one service user stated that activities were not offered and another confirmed this and stated staff did not have time even to chat. Also the recommendations made by the Occupational therapy report regarding reminiscence activities had not yet been implemented, though the activities coordinator had attended some training on this. It is recommended that Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 16 reminiscence materials as recommended by the OT report be purchased for the home in order to deliver activities in accordance with good practice. A list of visitors from the community was provided following the inspection and showed that a catholic priest visits every month and in a two month period there had been four visits from entertainers, a carol service by a local school, and a Christmas party including a variety show. Previous inspections had noted that the information provided to service users and their relatives, including information about meal choices was insufficient and that service users were not encouraged to use kitchenettes on each floor to maximise their independence. At this inspection risk assessments had been on whether service users could hold the keys to their rooms and some had been given the keys. Risk assessments had also been done on whether service users were safe to use the kitchenettes and none had been deemed safe to do so. Information about meal choices was now available on each floor, (although in some cases this was in a small font and not appropriate for people with dementia), and although a newsletter had been started (Jan 2006) some relatives were not aware of the care planning process in the home and information in the statement of purpose and service user guide still contained inaccuracies and was misleading (see standard 1). At previous inspections feedback about the food had been varied but there had been negative comments. The manager was required to conduct a food survey and quickly action the results of this. Also at the last inspection one service user had stated that although water was always available in service users rooms it was not served at meal times. The manager was required to ensure that it was. At this inspection it was found that water was now available at mealtimes and a meal satisfaction survey had been conducted. However, although this indicated greater satisfaction with meals it did not ask service users details about their preferences and it is recommended that this is done to ensure that food provided meets those preferences as far as possible. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 17 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 and 18 Complaints made by a service user’s relative were not promptly responded to and were not recorded in the home’s record of complaints. Recent incidents at the home had raised concerns about the home’s ability to protect service users. EVIDENCE: At the last inspection the complaints record showed that no complaints had been received since December 2004. However, three complaints had been received by CSCI and forwarded to the provider to investigate though these had not been recorded in the home’s complaint book. No response had been received regarding one of these and another was only partially responded to and the provider was required to ensure that complaints are fully and promptly investigated. Prior to this inspection a social work review highlighted a number of concerns that had been raised repeatedly by a relative that had not been addressed or recorded as complaints. The home had since taken action to address the concerns, but these were still not recorded in the complaints record. Previous inspections had found that the home has some appropriate adult protection policies and procedures in place. It had been required that all staff undergo adult protection training. At this inspection it was found that 38 of the 54 nursing/care staff and 8 of the 12 non-care staff had undergone training in this essential area. Recent incidents at the home had raised concerns about the home’s ability to protect service users and staff’s knowledge of the whistle blowing procedure. In one instance a staff member had not removed a chemical from a service users room despite a relative pointing this out. The service user suffered harm as a result of applying it to their skin. A record of Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 18 cases referred for investigation under adult protection procedures was now being kept though two recent cases had not been included. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 19 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): 20, 21, 22, 23, 24, 25 and 26 The home has sufficient indoor communal space and the outdoor space has been developed to make it an attractive space for service users. There are sufficient toilet and bathing facilities for service users. An occupational therapy assessment has been carried out to ensure that the home’s environment meets the needs of service users, though recommendations of this have not been fully implemented. Service users have their own rooms unless they make a positive choice to share. Service users bedrooms are furnished appropriately. Service users are now able to individually control the temperature of their bedrooms but problems with hot water temperatures being too cool persist. The home is clean though unpleasant odours were present on one floor and service users could be at risk of infection from an unlocked sluice and a low number of staff having had training in infection control. EVIDENCE: There is a lounge and separate dining room on the 1st, 2nd and 3rd floors. On the ground floor the lounge area and adjacent dining space are close to the reception area. There is also a smoking room on each floor and a kitchenette, used by service users’ relatives. On the ground floor there is also a chapel and Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 20 a hairdressing salon. The paved outside area at the rear of the building has now been developed in accordance with recommendations made in the recent occupational therapy report and as required at previous inspections. Service users were reported to be looking forward to the summer months when full use of the outside space could be made. There are toilets situated close to communal areas on each floor. All but seven single rooms and one double room have en-suite facilities. These consist of a toilet, washbasin and a shower suitable for wheelchair users. There is a standard bath on each floor and an assisted bath has now been fitted on the ground floor as required at previous inspections in addition to those on the other floors. The home has a lift and is accessible to wheelchair users. Previous inspections had noted that the premises had not been assessed by an occupational therapist (OT) with specialist knowledge in dementia care to ensure that the premises met the needs of service users with dementia. It was also required that the need for hearing loops in some rooms is reviewed and that door signs are designed to maximise the independence of service users with dementia. At this inspection it was found that an OT assessment focussing on the needs of service users with dementia had been carried out and the outside space had been developed in accordance with recommendations in the report. Hearing loops had now been provided on all floors and signs on doors provided; however, the OT had recommended a different type of sign that had not been obtained. There are 65 single rooms and 5 double rooms. All of the rooms are of adequate size. Previous inspections had highlighted the need for shared rooms to be shared by people who had made a positive choice to share together. At this inspection it was found that only one room was being shared and although statements of consent were in place it was found that both of the occupants had dementia and occasionally would be disturbed at night. In addition it was found that one service user (or their relative) wanted carpet rather than vinyl flooring. However, soon after the inspection the manager informed the inspector that a room had now become available on the same floor and both service users would now have their own room. Service users rooms were well furnished and some service users had brought personal items from home. It was noted at previous inspections that not all rooms had comfortable seating for two people, meaning that visitors had to sit on the bed or in some rooms, plastic chairs. It was also noted that the home had a large number of linoleum floors and required that carpet must be provided unless there is a documented reason why it is not. Also incontinence pads were stored visibly in some rooms, which did not respect service users privacy and dignity. At this inspection a furniture audit showed that all rooms had at least two chairs in them and a form in each service user’s file showed that they were consulted about their flooring preference on admission to the home. Supplies of a personal nature were not visible in service users rooms. Previous inspections had noted that hot water temperatures were quite cool and heating was not controllable in service users bedrooms. At the last inspection it was also found that cold temperatures in all rooms were 21oC and Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 21 22oC, which is warm enough for the bacteria Legionella to develop. The home had undergone a Legionella assessment in August 2004 but the manager did not know if there was a contract in place for annual testing and no action had been taken regarding the current increased risk. It was also noted at the last inspection that on the top floor the lounge area had potential to get very hot, as there was a glass roof without any blinds. Also on the top floor it was noted that there were risk assessments in place relating to hot weather that stated, “open all windows”, but this was not in accordance with Department of Health Guidance that states windows must be kept closed until the outside temperature is below the indoor temperature. At this inspection it was found that records of water temperatures were being taken and were adequate but one service user (who had stated at the last inspection that her shower never got hot enough) had not been able to have a shower since she moved in to the home. The inspectors were unable to get any hot water from the shower and reported it for immediate attention to the regional manager. The registered provider must ensure that showers are also tested and action taken where they are not working. It was noted in one service user’s room that the heating was now controllable in the room and managers confirmed that this was the case throughout the building. Guidance regarding the control of Legionella had been obtained and was reportedly being followed. Blinds had been provided for the top floor lounge; other hot weather practices could not be assessed, as it was winter. At the last inspection laundry facilities were assessed as appropriate; however, one of the sluice doors was not locked as required to protect service users from the risk of infection. At this inspection the home was clean and staff were seen to wear gloves and aprons. However, according to the homes training matrix only two staff had undergone training in infection control. This must be addressed to reduce the risk of infection. The sluice door on the 3rd floor was not locked. It was also noted on the 3rd floor that there was an odour, which is unpleasant for service users, visitors and those working at the home. This must be addressed and any underlying reasons tackled. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 22 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 and 30 Staffing levels continue to be insufficient to meet service users’ individual care needs and do not reflect those quoted in the statement of purpose. Elements of recruitment practice continue to place service users at risk of abuse. Although a good number of staff had undergone training to national minimum standards, the home’s assessment of staff training needs, training plan, and induction and foundation do not ensure that the needs of service users are met. EVIDENCE: Previous inspections had raised concerns, also voiced by relatives and service users that staffing levels at the home are insufficient to meet the needs of service users. Prior to the last inspection a situation leading to a vulnerable adult investigation and the dismissal of two staff members highlighted the need for increased staffing and that carers must never be alone on duty. There was also a complaint from a visitor that staffing levels had been decreased. At this inspection, rota’s for the week given to the inspector show that on the ground floor on two days there were only two carers on duty in the afternoon instead of three, and on three nights there was only one carer instead of two, on the 1st floor on three days there were only three carers on duty in the evening and on two days only three carers on duty from 2pm instead of four and on one night there was only one carer on duty instead of two, and on the 3rd floor on one day there were only three carers on duty and on another day there were only two carers on duty instead of four. Although a “night duty relief” rota was included, as there was only one carer on four night shifts to start with staff would still be working alone at night. This is not acceptable for Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 23 service users with such a high level of need and where there has been a number of vulnerable adult investigations. Again at this inspection service users reported that staffing levels were insufficient. One service users said “In my opinion they still don’t have enough staff, I feel another person on duty would make them less harassed”, also they felt they were being rushed when carers helped with their personal care and said “If I talk to them about something other than the task they ask me to hurry up”. One relative stated that they had found food just being left in front of a service user who had lost weight and needed prompting and encouragement to eat. In addition to concerns about service users’ needs not being met, the staffing level does not match levels quoted in the statement of purpose. CSCI is taking enforcement action regarding this issue. Rota’s do not include any time for handover although the inspectors were informed that nurses start each shift 15 minutes early in order to handover information. However, a recent incident at the home had showed that staff on duty were not aware that an ambulance had been called for a service user and were unable to give ambulance personnel any information about the service user indicating that handover procedures are inadequate. This must be addressed to ensure effective continuity of care. The training matrix shows that 34 staff had NVQ level 2 and another 7 were currently completing courses. This is above the 50 of the staff team required to have training to national minimum standards. Previous inspections had raised concerns about staff starting work in the home before appropriate checks were completed. At this inspection it was noted that all of the staff files examined had two written references as required and checks with the Criminal Records Bureau (CRB) had been made. However, one staff member had started work with an existing CRB before a check had been made against the list of people considered unsuitable to work with vulnerable adults (POVA list). CSCI is taking enforcement action regarding this issue. In addition it was found that few files had a photo of the staff member as required and although evidence of interviews was available on most files this was insufficient to evidence that interviews were conducted in accordance with equal opportunities policies. In addition staff responsible for recruitment had not undergone training to do so and this is required to ensure that only competent staff are recruited to work in the home. Previous inspections had raised concerns about the assessment of staff training and development needs, the training and development plan for the home and induction and foundation training at the home not meeting standards set by the National Training Organisation (NTO). At this inspection it was noted that a training matrix showed what training staff had undergone, a training plan had been developed but this did not evidence any strategic planning towards meeting training goals for the whole year based on statutory requirements, an assessment of staff needs and the needs of service users and there was no evidence in staff files that they had undergone induction or foundation training to the standards set by the NTO. CSCI is taking enforcement action regarding this issue. No appraisals were available on staff files to show that training needs were assessed on an individual basis. Competency assessments Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 24 were available on some files but these showed discrepancies, for example some areas were deemed not applicable when they were, and where areas of poor practice were highlighted action plans were not always in place. One action plan had not been reviewed to reassess the situation, to see if it was successful or see if additional training was required. Competency assessments must be conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 25 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, 33, 35, 36, 37 and 38 The home’s manager is qualified to run the home though is not yet registered. Quality assurance systems need to be developed much further to evidence that the home is run in service users’ best interests. The home does not ensure that the financial interests of service users are safeguarded. Staff are still not being supervised at the appropriate frequency. The home’s approach to health, safety and welfare had improved but records of some aspects of care given, accidents, incidents and actions taken are inconsistent. EVIDENCE: The home had a new manager who had started in September 2005. She is dually qualified and registered in general and mental health nursing. She has achieved her Registered Managers Award. She had not yet submitted her application for registration with CSCI but stated she would as soon as possible. The registered provider must ensure that the home has a manager who is registered with CSCI. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 26 Financial matters were not inspected, as this standard was considered met at the last inspection; however, it was found at the inspection that one service user had not had any money for over nine months and the home had taken no action to address this. Also a recent social worker review had highlighted that a service user was not aware that they had a personal allowance at head office and were instead using savings to live on. This indicates that the home does not ensure that service users’ financial needs are addressed and as a matter of urgency a review of service users’ finances must be conducted and referrals to social services or an independent advocate must be made for anyone not receiving any income. The home’s annual development plan for 2004/2005 hadn’t been reviewed and no plan was in place for 2005/2006. Although the provider periodically conducts satisfaction surveys these are of relatives views and do not include the views of service users. Also the surveys had not been analysed. The registered provider needs to address this in order to improve the quality of the service offered in accordance with the views of those people using it. It is also recommended that a professionally recognised quality assurance tool be used in accordance with best practice. Previous inspections had raised concerns about the frequency of staff supervision at the home and recommended that those providing supervision be trained to do so. At the last inspection it was noted that all but one staff member providing supervision had undergone some training to do this. At this inspection it was found that supervision had been provided to many staff over the previous month but none had received it regularly over the previous six months. Also staff did not get a copy of their supervision as good practice dictates. Records discussed in other areas of the report included, duty rotas (Standard 27), staff files, (Standard 29), complaints (Standard 16), medication (Standard 9), and records of accidents and incidents and fire drills (Standard 38). The files of eight service users were examined and in addition to discussion under standard 7, it was found that they included assessments that were outdated and contradictory. Recent incidents in the home had raised concerns about record keeping about care given and action taken. For example it was found that there were gaps in recording of 15-minute checks and fluid and nutritional charts and in one instance medication had not been recorded although it had been administered. CSCI is taking enforcement action regarding this issue. Also although the GP was contacted there was no date or time of when this had taken place. The registered provider must ensure that all action taken in response to concerns is recorded and that the Dr’s book includes date and time of contact as well as outcome. At the last inspection it was found that the home had sufficient first aiders to allow one on duty on each floor at all times, and certificates were seen of the training completed. The files for maintenance and health and safety certificates etc were noted to be disorganised with old and new documentation mixed in together. It was recommended that the manager audit the files and archive old documentation so that current information is more accessible. Also at the last inspection it was found that the fire alarms had not been tested since January Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 27 2005 and the fire drill record showed that there had been two drills in the previous three months but there was no evidence of any drills before that and the times of the drills were not recorded to evidence that they are held at different times of day. There had also been several incidents and accidents that had not been reported to CSCI or there had been a delay in notification to CSCI or to service users relatives. At this inspection it was found that the files had been audited and information was much more accessible. Certificates of inspection/safety were available for the gas, electrical installation, electrical equipment, fire alarm and equipment and the hoists in the home. Fire alarms were being tested weekly and drills had been held appropriately; however, the time of the drill had only been recorded at the last drill. Incidents that had been identified as notifiable under Regulation 37 had been sent to CSCI, however, there was a much greater number of incidents that were recorded as accidents and were not sent to CSCI. The registered provider must ensure that staff are clear of the distinction between accidents and other incidents, that occurrences and actions are recorded in the appropriate format and that CSCI is notified of all incidents covered under Regulation 37. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 28 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 1 2 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 X 3 3 2 3 3 1 1 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X 1 1 1 Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4 and 5 Requirement Timescale for action 30/04/06 2. OP2 5 (b) (c) 3. OP3 14 (1) (c) 4. OP4 12 (1) (d) The registered person must ensure that the statement of purpose and service user guide contain correct information and include all details as required by regulation. (Previous timescales of 31/12/03, 31/10/04, 31/03/05 and 30/09/05 not met) 30/04/06 The registered provider must ensure that all service users are provided with a statement of terms and conditions on admission to the home (or contract if purchasing their care privately) that includes all information listed under Standard 2.2. (Previous timescales of 31/10/04, 31/03/05 and 30/09/05 not met) The manager must ensure that 30/04/06 information about service users past lives is sought and attempts to gather this information are recorded in the service users file. (Previous timescale of 31/09/05 not met) The registered provider/manager 30/04/06 DS0000007038.V281425.R01.S.doc Version 5.1 Peartree Care Centre Page 30 5. OP4 12 (1) (b) 6. OP4 12 (1) 7. OP7 15 (1) 8. OP7 15 (2) (b) (c) 9. OP8 16 (2) (n) must ensure that the home has the required facilities and staff competencies to meet the needs of all service users. (Previous timescales of 01/04/04, 01/08/04, 31/03/05 and 31/10/05 not met) The manager must ensure that the needs of service users are fully assessed prior to admission and proper provision is made to meet their requirements. (Previous timescales of 01/04/04, 01/08/04, 31/03/05 and 31/10/05 not met) The home must not admit any further service users until such a time as it can demonstrate its capacity to meet the needs of the existing service user group through the provision of staff training, good record keeping and competent staffing. The registered provider must ensure that care plans are drawn up in conjunction with service users or their representatives and that they cover all aspects of the service users individual health, personal and social care needs. (Previous timescales of 31/10/04, 31/03/05 and 31/10/05 not met) The registered provider must ensure that reviews take place as planned (including initial 6 week review) and that service users and their representatives are involved in those reviews should they so choose. The registered provider must ensure that all service users are encouraged to take part in organised exercise where they are able. (Previous timescales of 31/10/04, 31/03/05 and 30/09/05 not met) DS0000007038.V281425.R01.S.doc 30/04/06 27/01/06 30/04/06 30/04/06 30/04/06 Peartree Care Centre Version 5.1 Page 31 10. OP8 17 (1) (a) 11. OP9 17 (1) 12. OP9 13 (2) 13. OP9 13 (2) 14. OP12 16 (2) (m)(n) 15. OP14 12 (2) The manager must ensure that advice from the general practitioner is followed and where there are concerns about service users weight, or intake of food or fluid, this is closely monitored and formally recorded. (Previous timescale of 31/08/05 not met) The registered manager must ensure that there is a record of all prescribed medication, including: -The application of all external preparations-The administration of food supplements-Medication given by the District Nurse. (Previous timescale of 31/08/05 not met though progress made) The registered manager must ensure that the temperature of all medication fridges is monitored daily, preferably using a maximum-minimum thermometer and appropriate action is taken if the temperature goes outside of limits. (Previous timescale of 31/08/06 not met) The Registered Manager must ensure that staff witness the administration of medication before signing that the dose has been taken. The registered provider must ensure that organised activities offered in the home are increased to ensure that the individual needs of service users for stimulation and fulfilment are addressed. (Previous timescales of 31/10/04, 31/03/05 and 30/09/05 not met though activities have increased) The manager must ensure that service users and their families are provided with as much DS0000007038.V281425.R01.S.doc 14/04/06 28/02/06 28/02/06 28/02/06 30/04/06 30/04/06 Peartree Care Centre Version 5.1 Page 32 16. OP16 17 (2) 17. OP16 22 (3) (4) 18. OP18 13 (6) 19. OP18 24 (1) 20. OP22 23 (2) (a) (n) 21. OP25 23 (2) (c) information as possible about life in the home so that they can make decisions about the care that they receive. This includes choices available at mealtimes. (Previous timescales of 01/03/04, 31/10/04, 31/03/05 and 30/09/05 not met though attempts made to publicise choices available at mealtimes) The registered provider must ensure that all complaints received about the service, from any source, are recorded in the homes complaints record. (Previous timescale of 31/08/05 not met) The registered provider must ensure that all complaints are fully and promptly investigated. (Previous timescale of 31/08/05 not met) The registered provider must ensure that all staff have appropriate training in adult protection. (Previous timescale of 31/05/05 not met though progress made) The manager must ensure that a record is kept of cases referred for investigation under adult protection procedures. (Previous timescale of 31/08/05 not met though record has been instigated) The registered person must review the need for hearing loops in some rooms, and ensure that the signs on doors are designed to maximise the independence of service users with dementia. (Previous timescales of 1/06/04, 30/11/04, 31/03/05 and 30/09/05 not met though hearing loops now provided) The manager must ensure that DS0000007038.V281425.R01.S.doc 28/02/06 28/02/06 30/04/06 28/02/06 31/05/06 28/02/06 Page 33 Peartree Care Centre Version 5.1 (p) (j) 22. OP25 23 (2) (p) 23. OP25 23 (2) (c) 24. OP26 13(4)(a) 25. OP26 16 (2) (k) 26. OP26 13 (3) 27. OP27 18(1)(a) 28. OP27 18(1)(a) hot water to which service users have access is maintained at a temperature close to 43ºC and that service users are able to control the heating level in their bedrooms. (Previous timescales of 01/06/04, 31/01/05 and 31/12/05 not met though heating is now controllable) The manager must ensure that in hot weather, practices in the home comply with current DoH guidance. (Previous timescale was 31/08/05 but this requirement could not be assessed at this inspection) The registered provider must ensure that showers are also tested and action taken where they are not working. The manager must ensure that sluice doors are kept locked when not in use. (Previous timescale of 31/08/05 not met) The registered provider must ensure that the home is free from unpleasant odours and underlying causes of such odours are addressed. The registered provider must ensure that all staff have appropriate training in infection control. The registered provider must ensure that staffing levels at the home are sufficient to meet service users stimulation, supervision and personal care needs. Contingency plans must be in place to ensure that staff absences can be covered. (Previous timescales of 31/10/04, 31/03/05 and 31/08/05 not met) The registered provider must increase staffing levels, DS0000007038.V281425.R01.S.doc 30/06/06 28/02/06 28/02/06 30/04/06 31/05/06 28/02/06 28/02/06 Page 34 Peartree Care Centre Version 5.1 29. OP27 18 (1) (a) 30. OP29 19(1)(b) 31. OP29 19 (1) (b) 32. OP29 19(1)(b) Sch 2 18 (1) (a) 33. OP29 34. OP30 18(1)(a) (c)(i)(ii) particularly on the second floor, to reflect the needs of service users. There must never be one carer, alone, on duty at any time. (Previous timescale of 30/06/05 and 31/08/05 not met though 2nd floor staffing had improved) The registered provider must develop a more effective handover system between shifts and ensure that this is reflected in the duty rotas for nursing and care staff. The registered provider must ensure that no new staff commence employment in the home before the receipt of a satisfactory CRB disclosure at the appropriate level and CRB checks that are still outstanding for existing staff are actively pursued. (Previous timescales of 31/10/04, 08/12/04 and 31/07/05 not met though all staff now have CRB) The registered provider must ensure that new staff do not commence employment in the home before a negative result has been received from a check against the POVA list. (Previous timescale of 08/12/04 and 31/07/05 not met) The registered provider must ensure that all staff files include proof of identity and a recent photograph. The registered provider must ensure that those responsible for the recruitment of new staff have appropriate training to do so. The registered provider/manager must ensure all staff receive appropriate assessment of their training and professional development needs to help DS0000007038.V281425.R01.S.doc 31/03/06 28/04/06 28/04/06 28/04/06 31/05/06 28/04/06 Peartree Care Centre Version 5.1 Page 35 35. OP30 18 (1) (a) 36. OP30 18 (1) (c) (i) 37. OP30 18 (1) (a) 38. OP30 18 (1) (a) 39. OP31 8 (1) (a) 40. OP33 24 ensure they are able to fully meet the changing physical and mental health care needs of service users. (Previous timescales of 01/08/04, 31/03/05 and 30/11/05 not met) The registered person must ensure that staff receive induction and foundation training in line with standards. (Previous timescales of 31/01/04, 31/10/04, 31/03/05 and 30/09/05 not met) The manager must ensure that there is a training and development plan for the home to ensure that staff fulfil the aims of the home. (Previous timescales of 01/04/04, 31/10/04, 31/03/05 and 30/09/05 not met) The registered provider must ensure that all staff undergo at least annual appraisal of their work and their training needs. The registered provider must ensure that competency assessments are conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. The registered provider must ensure that the home has a manager who is registered with CSCI. The registered provider must ensure that feedback is actively sought from service users, their representatives, and visiting professionals via satisfaction questionnaires, and the results of these surveys are published and made available to all stakeholders. (Previous timescale of 31/12/05 not DS0000007038.V281425.R01.S.doc 28/04/06 28/04/06 31/05/06 31/05/06 31/05/06 31/05/06 Peartree Care Centre Version 5.1 Page 36 41. OP33 24 42. OP35 12 (1) (a) 43. OP36 18 (2) 44. OP37 17 (1) 45. OP37 17 (1) 46. OP37 17 (2) 47. OP38 23(4)(c) (v)23(4) (e) 48. OP38 37 met) The registered provider must ensure that there is an annual development plan based on the views of service users, their relatives and other stakeholders that shows how the home intends to improve and develop over the forthcoming year. The registered provider must ensure that a review of service users finances is conducted and anyone not receiving any income must be referred to social services or an independent advocate as a matter of urgency. The registered provider must ensure that all nursing and care staff receive supervision at least six times per year. (Previous timescales of 31/10/04, 31/03/05 and 31/10/05 not met) The registered provider must ensure that outdated assessments are identified as such in service users files, updated or removed. The registered provider must ensure that records are maintained of all monitoring of service users health status. The registered provider must ensure that all action taken in response to concerns is recorded and that the Dr’s book includes date and time of contact as well as outcome. The registered provider must ensure that fire alarm tests are carried out weekly and that the times of fire drills are also recorded. (Previous timescale of 31/08/05 not met though fire alarms now being carried out weekly) The manager must ensure that notifications of all incidents and DS0000007038.V281425.R01.S.doc 30/04/06 31/03/06 31/05/06 31/03/06 31/03/06 31/03/06 31/03/06 28/02/06 Page 37 Peartree Care Centre Version 5.1 49. OP38 37 accidents are made to relatives and CSCI without delay. (Previous timescale of 31/08/05 not met) The registered provider must ensure that staff are clear of the distinction between accidents and other incidents, that all occurrences and actions are recorded in the appropriate format and that CSCI is notified of all incidents covered under Regulation 37. 31/03/06 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. 2. 3. 4. 5. Refer to Standard OP8 OP12 OP15 OP33 OP36 Good Practice Recommendations It is recommended that following examination of a service user the GP be asked for more detailed instructions for how care is to be carried out. It is recommended that reminiscence materials as recommended by the OT report be purchased for the home. It is recommended that service users be asked details about their needs and preferences in the food surveys. It is recommended that a professionally recognised quality assurance tool be used in accordance with best practice. It is recommended that staff be given a copy of their supervision record in accordance with good practice. Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 38 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Peartree Care Centre DS0000007038.V281425.R01.S.doc Version 5.1 Page 39 - 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. 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