Inspection on 31/01/09 for Regents Court Care Home

This inspection was carried out on 31st January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Regents Court Care Home 16/06/08

Regents Court Care Home 06/11/07

Regents Court Care Home 23/11/06

Regents Court Care Home 20/10/04

Regents Court Care Home 30/04/04

Regents Court Care Home 12/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Regents Court Care Home 128 Stourbridge Road Bromsgrove Worcestershire B61 0AN Lead Inspector Sally Seel Key Unannounced Inspection 31st January 2009 08:45 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 Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Regents Court Care Home Address 128 Stourbridge Road Bromsgrove Worcestershire B61 0AN 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) 01527 879119 01527 872631 c.wood@alphacarehomes.com www.alphacarehomes.com Alpha Health Care Ltd Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2008 Brief Description of the Service: Regents Court is a purpose built, two storey home, located close to Bromsgrove town centre and provides personal and social care to a maximum of 37 older people with dementia. Accommodation is on two floors. Access is provided to both floors by way of either stairs or a central passenger lift. The home is divided into two separate units, Victoria and Albert. All bedrooms are fully furnished and include a wash hand basin; some rooms have en-suite facilities. All baths and showers are assisted and hoists are used where necessary. The home has three lounges, two dining rooms and a Snoozelan room. Residents are free to access all communal rooms on both floors. A garden including a patio area is available. Car parking is available to the rear of the property. The home is part of a group of homes owned by Alpha Health Care limited. Information regarding the current level of fees was not included within the Service Users Guide. The reader may therefore wish to contact the service directly for up to date information. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home, over an eleven hour period. The manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were twenty-nine people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Three people were “case tracked” and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there. Improvements and plans for further improvements have been taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. We received two completed staff surveys. Information from these sources was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking three individual people’s care provided at the home. For example, the people chosen had differing levels of care needs. The atmosphere within the home is inviting and warm and we would like to thank everyone for their assistance and co-operation throughout the day we visited. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? People are cared for in a respectful manner by staff working in the home so that people’s self-esteem and dignity are upheld at all times. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 7 People have access to a varied range of health care professionals so that they can be reassured that their health care needs are met in a timely fashion. There have been some improvements made in the area of the home’s procedures and practices in respect of medication. This goes some way to safeguard people. The manager told us that staffing ratios are now being determined upon the dependency levels of people who live in the home and the manager is able to raise staffing levels as required. Staff have now received adult protection training and staff we spoke with demonstrated that they would be able to recognise forms of abuse and know how to report this so that people living at Regents Court can be confident that they will be protected from abuse by a knowledgeable staff group. The manager has now developed a training matrix and has a separate training folder which displays all staff members training certificates so that staff training needs are able to be monitored, tracked and refresher courses planned in advance. This will ensure that people living at the home can be reassured that they will be supported and cared for by a skilled and knowledgeable staffing team. The manager has now made an application to register with Commission for Social Care and Inspection and is therefore showing a commitment to her role within the home to make further improvements to add quality to the lives of the people who live there. What they could do better: We have found many improvements to outcomes for people living at Regents Court and it is important now for these improvements to be maintained and for the service development to continue. For this reason we have made a number of good practice recommendations (as detailed at the back of this report). These refer to the information available to prospective residents, practices and procedures in person centred care planning and the recording of care needs, medications, end of life care and wishes, specific staff training particularly in dementia care and challenging behaviour, continuation of redecoration programme and quality assurance systems. Addressing these issues will help to ensure that the home continues to provide a good quality service and to develop as a specialist service for people with dementia illnesses. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 9 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 Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given some information to enable choices to be made as to whether Regents Court is the right home for them but this now needs to reflect fees charged and views of the people who live at the home. Individual’s health and care needs are assessed prior to the home acknowledging that these can be met. EVIDENCE: The home have produced a statement of purpose and service user guide which provide people with information about the home, such as, accommodation type, staff qualifications, how people’s needs will be met, activities and how to make a complaint. On the cover of the service user guide it states that this document can be made available in large print if requested. We discussed with Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 11 the manager the idea of producing the homes statement of purpose and service user guide in audio format. This will ensure that these information guides will be accessible to people with visual impairments so that individuals will know what the home can offer if they choose to live at Regents Court. At the home’s last inspection it was recommended that the fees charged by the home are documented within the service user guide and this still remains outstanding. We therefore urge the home to consider this as good practice so that people are able to see how much the fees are to live at Regents Court prior to making a decision about whether the home is the right place for them. The statement of purpose needs to include how the home can specifically meet the needs of people who experience dementia as the home specialises in this area. This would ensure that individuals and their families/representatives would gain some insight into what the home can offer to a person who experiences dementia. Also the home needs to include the views of the people who use their service. We were told by relatives that they were able to look around the home prior to their family member moving there. This is also confirmed within the homes completed Annual Quality Assurance Assessment (AQAA), ‘We encourage preadmission visit by family and clients if possible. We offer the client to spend the day and eat with us before making a decision about moving to Regents Court’. This provides people who are considering living at the home an opportunity to see what Regents Court has to offer and staff are able to gain an insight into meeting their needs prior to individuals moving into the home. One family member told us, ‘We came to look around the home and we were even able to choose the room’. We sampled the care records of a person who had recently moved into the home. Use is made of assessments provided by health and social services to determine whether their needs can be met. We found a preadmission assessment completed by the home indicating the persons care needs so that the home could be sure they could meet these prior to the individual moving into Regents Court. The home has positively improved their practice in respect of completing care plans in a timely manner. In a day of the individual moving into the home care plans were in place. This practice gives staff clear instructions to follow in relation to the person’s needs and what action is required to meet these. This ensures that people have the right care to meet their needs and are not neglected and or placed at risk due to care plans not being available. The homes registration certificate and public liability insurance are displayed in the reception area next to the front door as you walk into Regents Court for people to view if they wish. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 12 People told us:‘I like it here’. ‘It’s alright’. Family members told us:‘Best home around here’. ‘ Staff are very caring, endlessly cheerful’. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides health and personal care but this does not always reflect a person’s individual needs and choices. Therefore efforts to introduce person centred plans will offer further opportunities for individuals to play an active role in planning the care and support they receive. Medication practices have improved but the home now needs to be consistently maintaining hygiene practices when giving medication and regular audit checks so that any potential errors can be managed in a timely manner to protect people from harm. EVIDENCE: This inspection found that care provided and care records were much improved and with plans in place to ensure that improvements continue, this gives greater assurance that people living in the home receive the care that they Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 14 need. We looked at three individuals care plans and risk assessments in some detail. Each person has care plans which cover various aspects of their daily life. These are individualised plans about what the person is able to do independently and state what assistance is required from staff in order for the person to maintain maximum independence. For example, in one care plan it stated, ‘one member of staff to assist with personal care, to maintain individuals dignity and privacy at all times, person is independent and is able to have a full strip wash herself although will need encouragement’. In another care plan we found, ‘staff need to fill the bathroom sink with soapy water and pass X the flannel so she can wash herself. Afterwards pass X a towel so she is able to get dry’. There is now some room for further improvements in relation to planning the care individuals receive which we discussed with the manager at the time of inspection. For example, care plans need to show they have been completed with the person living in the home and/or their representatives. This will ensure that individuals are receiving the care they need, in the way they prefer and at times to suit them. This will also give people the opportunity of stating whether they would like a female or male member of staff to assist them with their personal care tasks. This shows that people’s independence, dignity and preferences are recognised and promoted. The AQAA echoes the homes ambition to improve in these areas, ‘Greater participation of residents and families in the care planning and use the Mental Capacity Act within care planning for clients best interest. We will plan our service around identified agreed needs and desires of the individual rather than them fitting into our service’. Positively, we found that care plans are evaluated ensuring that staff are recognising if a person’s needs have changed and care given remains appropriate for the individual. We looked at the daily records of the three people we ‘case tracked’. These records should confirm personal care tasks that have been completed; activities’ that the individual takes part in, any recognised illnesses and individual’s psychological and emotional wellbeing on that day. The home must improve the contents of their daily recordings to include the care and support given to people living in the home. This will make it much easier to determine if needs are being met. For example on one daily record it noted an observation made by staff, ‘her feet are swollen’ but there was no record to confirm what action had been taken. Another daily record stated, ‘X was aggressive today. All well apart from that,’ but no description of what action staff followed to manage this behaviour which would be useful if patterns emerge and action taken was helpful. People have key workers who get to know the person, their likes and dislikes, and individuals are able to share their concerns or worries with a familiar person. We found in all of the care records that we sampled visits had been made to the home by doctors, district nurses and chiropodists to attend to individual’s health and care needs. For example, a doctor visited when an individual was Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 15 particularly anxious and medication was prescribed. The home recognised signs that the medication was having a negative effect upon this person which showed in their behaviour and contacted the doctor. Medication was stopped for the benefit of the person. Chiropodists visit every six weeks or when required so that individuals can feel reassured that their foot care will be upheld in a timely manner. Family members spoke about the care at the home:‘We are always telephoned if there is a problem’. ‘Quite impressed, care is amazing’’. ‘Staff do a good job, people always look well dressed’. ‘Sometimes not their own washing but this is put right immediately and staff never dress X in anybody else’s clothes’. Staff told us:‘We provide care that improves their wellbeing and are offered showers and baths’. ‘We try our best to give a good standard of care’. We observed people walking around the home freely some individuals required walking frames to assist them, others needed a wheelchair and some people required supervision when walking. The home does have hoists which are pieces of equipment that assist staff in moving people who cannot stand and walk safely. Whatever a person’s abilities the staff were observed assisting individuals in a respectful manner ensuring that people’s dignity was maintained at all times throughout the day. For example, one individual was walking along the hallway without their slippers on; a member of staff noticed this and went in a timely manner to get the person’s foot wear. On another occasion we found a person walking around the home with their pyjama trousers undone and falling down. This was rectified by a member of staff being assigned to them in order that their trousers could be done up in privacy. We found only one care record out of the three sampled that documented an individual’s baseline weight when they came to live at the home and two care records where weight is being regularly recorded on a monthly basis. On one care record we found a Malnutrition Universal Screening Tool, (MUST), which provides a recording method in relation to people’s weight. However, this has not being fully completed. Practices in recording people’s weight must become consistent and take place regularly as people living in the home have varying degrees of dementia and are unable to always verbally express how they feel. In addition to this, some individuals may only eat small meals and their health may be poor. Therefore the home must improve their practice in this area so that any weight loss is recognised which may indicate to the home underlying health conditions which could otherwise go undetected. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 16 We sampled some people’s medication to see if it was recorded appropriately on the medication administration records, (MARS). We found that the tablets/capsules/liquid medications that we checked tallied apart from one individual’s tablets which we could not completely audit in connection to how many had definitely been given to ensure that this amount tallied with the MARS. This was due to the tablets not being ‘booked in’ on the MARS. This was discussed with the member of staff and manager at the time. Also one individual’s ‘when required’, (PRN), medication had no protocol format with the MARS for staff to follow. However, we looked at other individuals PRN medications and found that they had a PRN protocol in place. The manager told us that they audit medications regularly and visits are undertaken by the pharmacist who supplies the home’s medication. Also all staff who administer medication have completed the appropriate training. This is further echoed in the AQAA, ‘We have provided training on medication and conducted competencies on Senior Staff’. The home must complete regular audits of prescribed medication and findings must be documented in readiness for inspection. Also staff member’s competency levels must be assessed regularly and evidence supplied for inspection. These actions will ensure that the administration of medication is completed as per the prescriber’s instructions. This can then be measured by examing the MARS together with the blister packs so that people living in the home are protected from any potential medication errors which could harm them. We found one prescribed cream with no date of opening documented on it and/or which part of the individual’s body this needs to be applied for staff to follow. We discussed this with the manager and the senior staff member, all prescribed cream’s need to have the date of opening on them so that manufacturer’s guidelines are followed. We observed medication being given to one person who lived at the home and the member of staff trying to give the tablets to the individual from a ‘tot’ (small container) into their hand but they slipped onto their chair. This resulted in the member of staff almost touching the tablets which is not in line with hygiene guidelines’ and cross infection standards. The member of staff did not have gloves on. We discussed this with the manager who also witnessed this action and suggestions were made, such as, placing medication onto a spoon from the ‘tot’. We witnessed one staff member wearing a tabard confirming that they should not be disturbed whilst giving medication. This is a good initiative introduced by the home to ensure that medication administration and recording are completed in a safe manner to avoid errors. In addition to this we observed medication being given to people in a respectful manner, telling the person what the medication is called, maintaining eye contact and stooping to their level. Also lots of reassurance was provided by staff as some people’s mental health needs meant they could not quite comprehend the taking and swallowing of their medications. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 17 We found no evidence of any plans referring to individuals ‘end of life’ care so that people’s spiritual, practical and religious care are upheld for people in the final stages of their life. The manager acknowledged to us on the day of inspection that this is an area that the home will now be looking to develop and this is further confirmed in the homes, AQAA:- ‘All our clients to have an end of life care plan’. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home are continuing to look at improvements in meeting the social and recreational interests of people who have dementia. Minor improvements in monitoring and recording would ensure people have opportunities that suit their interests. The dietary needs of people are well met, they benefit from meals that are well presented, wholesome and varied but daily portions of fruit and vegetables now require recording for maintaining a healthy diet. EVIDENCE: It was positive to see in each of the care records that we sampled a life history of the individual which provides a good account of their experiences, good and bad, together with the relationships they formed, where they lived, former working life, interests and pastimes. We found photographs in one individual’s life history which shows their relationships with the important people in their lives and the places they had been to. These life histories are particularly Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 19 important where people have dementia and may need a great deal of support to engage in meaningful activity. The home now needs to ensure that it documents who they involve in gaining the persons information and how the individual has been appropriately engaged in this activity. We were told that there has been improvements in the planning of activities and the home have employed two activity coordinators together with two volunteers who come into the home on Mondays and Fridays. We saw an activity planner. Some activities that have taken place are a vegetable garden party, trip to Stourport and a memory walk. The AQAA states, ‘We held a 1940`s style tea party, we had a fish and chip supper in our beach themed garden, we had a large garden opening party. The local MP Julia Kirkbride opened our multi-sensory garden. The residents went out to the Mama Mia film at the local cinema. Local bus passes have been purchased so that we can take our residents out locally’. Also the manager shared with us their passion for supporting people who live in the home to complete life skill tasks, such as, making sandwiches, drinks, cakes, ironing, folding clothes, peeling potatoes and carrots. These are good initiatives which the manager acknowledges must be risk assessed so that individuals remain safe throughout the activities. However, the manager also recognises that people who experience dementia can still participate in skill enhancing activities that not only stimulate but enhance individuals own independence. We found photographs’ displayed on the walls of the home of individuals enjoying and participating in activities The manager also shared with us their vision for further improvements to ensure individual activities are promoted within the home. For example, changing one of the rooms into an activity based area where there is a facility for people to make drinks and a table and chairs to facilitate a variety of activities. The home’s next goals are to purchase a greenhouse so that individuals can participate in growing their own produce and plants. The home has also seen the benefits that owning a pet can be for some people who live in the home who have expressed their passion for animals. One care plan states, ‘X really enjoys spending time with animals and should be given the opportunity to talk about and see animals as it is one of her biggest passions’. Therefore the home wants to get a cat for people to enjoy providing another form of good therapy for people who live at Regents Court. On the day we visited a visitor brought their dog into the home and people’s faces reflected the enjoyment of this occasion. The questionnaires that relatives completed for the home told us:‘’Never seems to be much going on and some of the residents could do with more exercise instead of sitting all day’. ‘More activities at weekend needed’. ‘Gradually seeing staff looking more motivated engaged with residents, caring in their responses’. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 20 Staff survey told us:‘It would be good if we were able to provide more activities for the residents through the day’. In the homes service user guide it states, ‘Spiritual advisors of all faiths and denominations are welcomed to the care home’. We checked with staff about meeting individuals religious needs and it appears that this is an area that the home needs to improve upon as staff were not aware of recent visits from any vicars, priests or lay people. In one care plan it states, ‘Care staff to offer visits to the church if she so wishes’. However, we could not find any record of staff offering this. The home is taking time to redecorate the units with bright colours and visually stimulating things to make it a more inviting and interacting environment for people to live in. For example, we found ‘rummaging’ holdalls which hold a variety of objects and are displayed on the walls for individuals to take the tactile items out as they wish. Also there are two old type royal mail red letter boxes which individuals will remember and be familiar with from their past lives. The home’s sensory room, (snoozelum), has now been completed with relaxing light changes and leather comfy settees which will enhance individual’s wellbeing at times when they become unsettled or just want a peaceful tranquil area to escape to. All of these improvements reflect the ethos of the home in wanting to ensure a person centred interactive environment is developed which will be interesting and stimulate people’s senses. We spoke with staff who shared with us the creative activities that they use to distract individuals when they become unsettled and/or exhibit emotional behaviour. For example, on the day we visited one person was very unsettled for part of the day. However, staff were able to provide lots of reassurance and used distraction tactics, such as, taking the individual for a walk outside, not ignoring the person’s pleas to want to go home but providing reassurance. In their care record we found that on one occasion when this person was unsettled a member of staff took the initiative to help them write a letter to their loved one, another good therapeutic distraction method. While at the home we saw a number of people visiting relatives or friends. Staff were seen to be welcoming and friendly to visitors. Surveys that had been sent to relatives as part of the homes quality review audits confirmed how the home is improving in respect of staff engaging with people who live there. There is still room for improvement; staff need to ensure that daily records include reference to the activities people engage in. This is important to ensure that people who have difficulty in stating their interests are given similar opportunities to their peers. Staff need to be vigilant in monitoring daily records on a monthly basis to ensure that people in the home are being Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 21 offered and taking up a variety of activities. Daily records for one month were looked at and the only reference in this was that the person enjoyed, writing letters and showing staff how to dance, the rest of the entries related solely to the persons’ behaviour. More structured monitoring of records will enable staff to measure to what extent the goals stated in the person’s care plans are being met. This will also ensure that any monthly evaluations of care plans can be done by seeing at a glance from daily records what activities have been offered and what the individual has enjoyed. This will ensure that the care planned for the individual is ‘person centred’ designed to meet their individual needs. We were told that the home are currently waiting publish of a new range of menus which the organisation are adopting across all of their homes. This will be documented in the printed word and with pictures so that all people living in the home will be able to have access to choosing their meals. We observed breakfast and positively individuals were supported to make choices in relation to whether they wanted to sit with others at the table or whether they wanted to sit with a side table to have their meal in front of the television. We saw one person eating their breakfast on a side table and others chose to sit at the table. The mealtime occasion was relaxed and sociable; staff assistance was discrete and supportive. Staff were seen to ask, ‘Are you enjoying your breakfast’ and ‘How are you today’? Individuals had the choice of a cooked breakfast, toast, and cereals. Juice, tea and coffee were offered. We also sampled menus and found that there were two choices offered at each meal of the day but if individuals did not want the two choices their alternative choice would be sought to be provided. This was confirmed by relatives who told us that their family member did not want what was offered but asked for a sandwich which was provided without any fuss being made. Relatives told us:‘Has put on some weight living here’. ‘Meals look tasty’. Meals served looked wholesome and good in portion size. However, staff now need to record individuals fruit and vegetable portions offered and whether these are declined on a daily basis so that people can be confident that they are receiving the recommended ‘five a day’ to maintain a healthy and nutritional diet. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Regents Court are supported to express their concerns but improvements need to be considered in relation to how this is accessed by all. Improvements’ have been made in relation to staff knowledge of abuse awareness as this is particularly important where people are vulnerable due to their dementia and or behaviour. Safeguarding procedures are followed so that people are not placed risk. EVIDENCE: The complaints procedure is in the home’s statement of purpose, service user guide and is displayed in the reception area of the home as you walk through the front door. However, as at the home’s last inspection, the complaints procedure documented in the service user guide must be revised to include a statement which tells people that they are able to make their complaint known to CSCI, (Commission for Social Care and Inspection), at any stage. Although in the home’s statement of purpose it clearly confirms that ‘oral or written complaints can be made at any time to the Regulatory Authority Assigned Inspector’ with CSCI’s latest address detailed. We did not see any formats suited to the needs of older people such as large print and audio formats in Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 23 relation to the homes complaints procedure. Therefore all people who live in the home would not be able to have access to this. The home have documented in their AQAA that they have received eight complaints in the last twelve months. The complaints records show that a record of the investigation, action taken and outcome is maintained, and that a letter informing the complainant of the outcome is sent. This ensures the complainant has the opportunity to say whether they are satisfied or not with the action taken. Some people who live at Regents Court were observed coming into the manager’s office on the day we visited to share their complaints/concerns. This showed that people living in the home were happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. All relatives we spoke with in relation to whether they knew how to make a complaint indicated that they were aware of how to do this. This is particularly important as people who live at Regents Court have dementia and would require a great deal of support or an advocate to act on their behalf. It was pleasing to see that during the course of the day, when some people were clearly confused staff sat with them, conversed, and on every occasion they were welcomed, reassured and redirected. These observations clearly indicate that the majority of people who live at Regents Court would be unable to raise a complaint independently. Staff are accustomed to individual behaviour, which helps to identify when someone is feeling ‘out of sorts’ and there may be a problem. Surveys that we sent to relatives by the home as part of their quality assurance told us:‘My requests, feedback and general comments now seem to be taken seriously (since June 2008) and are usually acted upon promptly’. ‘Gradually seeing staff more motivated, engaged with residents, caring in their responses, willing to deal with our enquiries and requests cheerfully and promptly’. It was positive to hear that a communication book is the rooms of all the people living at the home so that these can be used to state any complaints, concerns and/or any other issues by family members and/or individuals representatives. A suggestion box is situated in the reception area of the home. We discussed with the manager the idea of having another suggestion box in the main part of the home so that this is more easily accessible to people who live in the home and staff. We also urge the home to consider holding regular surgeries whereby people can voice any concerns, complaints and/or other issues on a one to one basis. The monthly regulation 26 visits showed that compliments Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 24 and complaints are audited; this is a good means of quality assurance and another means of the service being able to obtain the views of people in order to make any improvements. The home has documented in their AQAA that they have had seven incidents in the last twelve months that needed to be considered under the local procedures for safeguarding vulnerable adults due to risks to certain people. It was highlighted at the homes last key inspection that staff were lacking in how they would respond to incidents where vulnerable people may be at risk. The manager was required to make improvements in respect of staff gaining knowledge around adult protection procedures. Staff have now received training in adult protection procedures. This ensures that staff have the knowledge required in this area so that people living in the home can be confident that there are measures in place to protect individuals from the risk of harm. Also staff spoken to had good knowledge around abuse issues and knew who to report any incidents of this nature to in order to protect people living in the home. The home now must increase the numbers of staff who have received dementia and managing challenging behaviour training. This is particularly important where staff need to understand the difficulties people may experience due to their dementia, and how this may affect their behaviour towards others. The will ensure staff are able to put strategies in place to reduce conflict between individuals and the risks associated with this. Risk assessments were seen to show how the risk of falls are being minimised. Moving and handling risk assessments were seen to show how people are to be supported this ensures that vulnerable people are not placed at risk or harm when they are supported with the hoist. There are systems in place so that care practices are monitored and the management of risks posed to people is reduced. The manager has ensured that regulation 37 reports are sent to the CSCI to inform us of incidents. However, there are some improvements that need to be made when reporting incidents. For example, we found that some incidents had been recorded but no follow up action had been documented which could potentially place individuals at risk if this information is missing or not followed through. This was discussed with the registered manager who will ensure that any follow up action now becomes part of their incident recordings. We sampled staff recruitment files and in the main these have improved in respect of being well organised with information easily retrievable. However, some minor improvements should be made as we found some missing information. We discussed our findings with the manager who will ensure that staff files are regularly audited so that the home recruitment procedures are robust and therefore protecting people who live at Regents Court. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 25 Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home does not always encourage independence as people living in the home may have difficulty in locating the differing rooms including their own. However, the manager is working hard to find innovative ways of making the home a more person centred environment. There have already been significant improvements to the home making it bright, clean and homely for the people who live there but this needs to be continued. EVIDENCE: We completed a partial tour of the home with the manager and we found that the home is making good progress in making the environment more visually stimulating for the people who live there. The home has been redecorated Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 27 throughout and family members spoken with throughout the day were complimentary in relation to the new décor:‘Décor is lovely, bright and welcoming’. ‘It is clean and bright’. The home is safe and secure for the people who live there as key pads are placed on door entrances and in people’s rooms there are nurse call systems. There is a passenger lift to enable access to the first floor of the home. Keys to rooms are discussed with relatives and noted in care records. Disclaimers’ are then documented in care records. One relative stated in answer to their family member holding a key to their room, ‘might lock herself in and lose keys’ and to having a key to lockable facilities, ‘she won’t be so worried about her personal things’. This shows that the home is valuing individual’s rights and choices that are made in people’s best interests. The manager acknowledged that there have been challenges as the physical layout of the home’s long narrow hallways can be confusing for people who experience dementia as they could easily find themselves lost. However, the manager has shown that they are working hard to improve the hallways and how individuals can be aided to recognise differing spaces and rooms within the home. For example, hallways are differentiated by the use of pastel shades of pink and green painted walls and signage on some doors. The signage on toilet doors is particularly good with the signage showing a red toilet seat which corresponds with the toilet in use. Also the home is divided into two units, Victoria and Albert which makes managing easier for people who live in the home and staff alike. We looked at bathrooms and the manager acknowledged that these were now going to be improved in relation to their decor in order to make them less clinical and more homely for people to use and enjoy. In the main the bathrooms decoration did look tired. In one bathroom we found wheelchairs stored but the manager assured us these would be removed and stored appropriately. We looked at a sample of bedrooms which were personalised to reflect individual’s choices and personality. The manager is now considering new signage on people’s bedroom doors that would be more meaningful to them and reflect their interests in life. This will aid people to find their rooms. In one bedroom we noticed there was a memory box and the manager is now considering placing these by the outside of people’s bedroom doors as another visual aid to individuals recognising their rooms. Lounge area’s are clean and chairs arranged around the room in small clusters for people to sit on which makes the home less institutionalised. The manager is now putting some thought into providing some comfortable settees to compliment the chairs within the home. The manager pointed out the ornaments that they had purchased at charity shops which are more familiar to Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 28 people living in the home to ensure that there are homely touches that enhance peoples living environment. The home has a ‘snoozelan’ room that is new and has changing mood lights and leather sofas. It has been completed to a high standard and will provide people with both relaxation and stimulation. We were shown a small room with table, chairs and facilities for making drinks. This was used as a staff room but the manager told us that they are going to change the use of this room to become an activities area for people living in the home. Individuals will be able to make drinks with support and other activities will be able to take place in an area dedicated for this. Another example of the manager considering a more person centred environment for people to enjoy improving their sense of well being. The laundry room has been significantly improved so that infection control measures are in place and an effective system of organising and working is practised. It looked tidy, organised and clean. There are two commercial washing machines and two tumble dryers. There is also a rollating iron to ensure clothes are laundered for people to wear which is important for maintaining individual’s dignity and self worth. Staff told us that infection control methods employed by the home are good and could identify the equipment staff use within their everyday working lives, such as, gloves, aprons, soap, paper towels, disinfectant and so on. The manager has strategically placed throughout the home antibacterial hand wash dispensers for staff and visitors alike to use. The manager has also improved the infection control practices when staff go and come from the kitchen area by ensuring staff wear the protective white coats when in the kitchen as this has not always been the case. Environmental health have recently completed an inspection and awarded the home three stars for their good hygiene practices when handling food. Family members confirmed that the home always looked clean and smelt fresh to them. We were told that when individuals had accidents in their beds their linen was changed immediately so that people were not left in wet and dirty beds. The garden area is a real credit to the home and is divided into smaller areas with different seating aspects. It has been designed around a sensory theme with a variety of fountains to promote the use of water and scented plants. There is a lawn area and shrubs with secure perimeter fencing. Lights are also incorporated. The manager now wants to incorporate a greenhouse so that people living in the home can grow their own produce with the support of staff. This shows that the manager is continually improving the exterior and interior of the home to enhance the lives of the people who live there. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 29 Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are committed to their roles and improved training opportunities available are developing staff knowledge but all staff need to attend dementia training which will assist in improving care that individuals receive. Staffing levels have improved and provide sufficient numbers of trained staff to meet the needs of the people who live in the home. Recruitment procedures need regularly auditing with clear indications taken and documentation provided for inspection. EVIDENCE: There are currently twenty-nine people living in the home at the time of our visit. Assessment of staffing rotas, speaking with staff and relatives, we found that satisfactory staffing levels are maintained with, seven staff on the early shifts, six completing the afternoon shifts and four staff working through the night. There are two unit leaders and the manager works Monday to Friday and is provided with admin support. We did not find any evidence that people living in the home were waiting long periods of time for staff to assist them on the days we visited. However, we were told by staff that at times it is difficult meeting individual’s needs when there is sickness as cover is required. In Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 31 addition to care staff, the home employs kitchen and domestic staff to ensure that all aspects of people’s needs are met whilst living in the home. There has been a high turnover of staff at Regents Court in the last six months. The new manager has reviewed the way that new staff are recruited which is confirmed in the AQAA, ‘Recruitment has now developed whereby any vacancy advertised states that Dementia knowledge is essential. This has improved the calibre of new recruits’. All new staff receive a detailed induction which lasts over two days alongside a training programme. This ensures that staff are aware of their responsibilities and therefore able to discharge their duties appropriately. The new member of staff is then supernumerary for their first working week at the home. As discussed in section, ‘complaints and protection’ of this report, three staff records were reviewed and were found to have some minor shortfalls. The Criminal Records Bureau checks, (CRB), were only found on one file and we were told that these are maintained at the home’s head office. Also we could not locate a job description on one staff file that we looked at. We did find that the records included application forms, two written references and Protection of Vulnerable Adults, (POVA first checks). The home demonstrates a strong commitment to staff training and development. Staff spoken with also confirmed that the manager enables staff to complete training courses. There are currently nine staff that hold the National Vocational Qualification, (NVQ), level 2 which is under the recommended levels of 50 . Some staff are doing their NVQ Level 3. We reviewed the home’s training matrix which shows us the training staff have completed and what they have left to do. The matrix also helps in ensuring that all mandatory training, such as, , food hygiene, health and safety, infection control, moving and handling, medication training, fire safety, is regularly reviewed and refresher courses are booked. The manager has also got a separate folder with each staff member’s training certificates. This is an improvement that has been made since the home’s last inspection so that appropriate audits are able to take place ensuring that training can be planned and is not overlooked. Staff have completed adult abuse training which has been discussed in, ‘complaints and protection’ section of this report. Positively some staff have received specialist training in dementia but this needs to be increased alongside training in managing challenging behaviour. There has been continued improvement in ensuring that staff receive appropriate training. However, this improvement needs to continue so that people living in the home are reassured that they are supported by a knowledgeable and skilled workforce that can meet their needs individually and collectively. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 32 Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 33 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect. Further work with regards to staff training, quality assurance and completing regular practice audits is needed to ensure the health and welfare of people is fully met. EVIDENCE: Karen Hancox has been in the role of manager at Regents Court since June 2008. Prior to this Mrs. Hancox was a carer and then deputy manager at the home. Therefore Mrs. Hancox has experience in caring for older people who have dementia and her experience in managing a team is continuing to grow. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 34 Mrs. Hancox has made an application to CSCI to become registered manager of Regents Court demonstrating her longer term commitment to the home which will also give greater long term confidence in the home. The manager has achieved the National Vocational Qualification, (NVQ), Level 4 Care and Management Award and the Registered Managers Award, (RMA). The manager has also completed dementia care mapping and is currently undertaking a degree in dementia which shows a commitment in her own training and eagerness to show that she has the best interests of the people who live at Regents Court at heart. The manager came into the home on her day off to assist in the inspection and was seen to have an ‘open door’ policy with staff asking questions, seeking advice or sharing information about people who live at the home. Also the manager was seen to greet relatives as they walked by. People who live in the home were comfortable in coming into the office area to share their day and any frustrations they had with the manager. It was clear to see that both people who live at Regents Court and relatives have a good rapport with the manager on all levels. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment, (AQAA), and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements. Throughout this report the reader will find examples of what the manager told us. In the main we found through looking at paperwork, observations, talking with people who live in the home and staff that the ethos of the home is open and transparent with the views of both staff and people listened to, and valued. As discussed in the, ‘complaints’ and protection’, section of this report the home has a suggestion box which individuals who live in the home, relatives, professional visitors and staff are able to use. Staff spoken to feel that the manager is approachable, supportive and individuals are able to air their views in an open manner. Also relatives spoke with us positively about the relatives meeting which was held; valuing the sharing between each other that it promoted and the opportunity to speak with the manager as a group of people. One relative told us:‘New manager, we have seen a big improvement in the lat six months’. One staff survey states, ‘When first came to the home the standard was not high and I have enjoyed helping with improvement and enjoy coming to work everyday’. Regulation 26 visit reports are completed which reflect on the quality of service being offered at the home. These reports showed that where shortfalls are identified these are acted upon; this ensures that the home can take steps to avoid compromising the care of people using the service. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 35 The manager is now beginning to develop audits to monitor the service provided. For example, questionnaires have been sent out, views of which we have included through this report. Also the manager tells us that they complete medication checks and unannounced visits at night to make sure the staff are following good practices so that people are protected from risks and good outcomes are sought. Positively the manager recognises that auditing is an area that needs further development and confirms this in the AQAA, ‘We need to explore a range of techniques and systems that can be applied to quality audit and monitor our service’. This will ensure Regents Court is run in the best interests of the people who live there. Staff supervision is another area that now requires being more robust and consistent as a large percentage of staff are fairly new. Therefore supervision will be important in relation to making sure staff standards in doing their job do not decline and any concerns/issues staff have are looked at. It was encouraging to hear that staff who we spoke with generally found their supervision valuable in sharing where their practices could be improved and gaining support from the manager in achieving their goals. The arrangements for the safekeeping and financial transactions of people’s personal monies were not checked at this inspection but the manager assures us that these will now be audited to ensure systems are good, preventing financial abuse. The audit documentation must be made available for inspection. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment is in safe and full working order. Records seen matched the servicing information sent to CSCI prior to the inspection. Maintenance checks are completed on the fire system and equipment so that people should be safe in the event of a fire occurring. The manager produced an audit of accidents and these are reviewed to monitor any trends that are occurring. This means that the home are going some way to lessen the risks associated with accidents particularly with the reference to the audit being a good indicator of potential trends. This is positive for the people who live in the home and staff alike as it is protecting all people from unnecessary risks of injuries and/or harm. Since the manager has been in this role we have been advised by family members and staff alike that the outcomes for people who live at the home have improved and we found evidence that is documented throughout this report which confirms this. However, there are areas that require some further improvement which are also noted throughout this report. We are satisfied that the manager has shown commitment to achieve aims in relation to improving the quality of care and support that people who live in Regents Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 36 Court receive so that they can be confident of a home that is run in their best interests. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 37 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 2 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 38 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations Clear information should be included in the home’s service user guide indicating the level of fees charged so that people who are considering living at the home are able to ascertain the financial implications of choosing Regents Court. The registered person should be able to demonstrate capacity to meet the needs of the people who use the service. All care staff should receive training and guidance in dementia care, managing challenging behaviour and other conditions of people in their care. Staff need knowledge, skills and competence to carry out their roles effectively and safely. The home should ensure that all people living in the home and/or their representatives are consulted and involved in relation to care planning processes so that people are able to make choices in relation to how their needs are met. Resident’s baseline weights should be recorded and DS0000004151.V373994.R01.S.doc Version 5.2 Page 39 2. OP4 3. OP7 4. OP8 Regents Court Care Home 5. OP9 6. OP9 7. OP9 8. OP9 9. OP11 10. OP12 11. OP14 12. OP15 13. OP19 14. OP28 consistent regular weights should be recorded to ensure that any underlying medical conditions are identified in a timely manner. All medications received into the home should be checked and details of amounts recorded on the medication administration charts so that any potential risks from medication errors are reduced. The registered persons must ensure that when staff are administering medication good hygiene control procedures are adhered to ensuring any risk of infections are minimised. Medication audits should be completed on a regular weekly basis and recorded so that any potential errors can be identified and managed therefore protecting people from harm. These audits must be made available to inspect. All prescribed creams and lotions should have the date of opening together with a description of the part of the body these need to be applied so the people are safeguarded by the homes administration of these. ‘End of life’ care plans should be sensitively focused upon with individuals and/or their representative so the peoples care, physical and spiritual needs are met in a way they choose and prefer at this stage in their lives. Daily activities that people are offered and participate in should be recorded so that this can be reflected upon ensuring that individual’s goals in their care plans are being met. The home should be conducted to maximise autonomy and choice. Individuals likes, dislikes, preferred routines and other choices need to be recorded on care plans and reviewed with the person and/or their representative so that care can be delivered in the way and at a time of their choosing. People’s intake of fruit and vegetables should be recorded to ensure that individuals are receiving their ‘five a day’ recommended amount to sustain a healthy and nutritious diet is maintained. If individuals decline fruit and vegetables that are offered to them, this should also be recorded. The redecoration of the home should continue paying particular reference to it meeting the needs of people who experience dementia to aid both stimulation and orientation of the interior of the home. The registered person should ensure that at least 50 of staff have an NVQ Level 2 so that people living in the home can be confident that their needs will be met by knowledgeable, skilled and competent staff group. DS0000004151.V373994.R01.S.doc Version 5.2 Page 40 Regents Court Care Home 15. OP33 16. OP37 The quality assurance system should now be evaluated in the light of receiving completed questionnaires from people who use the service and/or their representatives, staff members and stakeholders. This will ensure continued improvements are made so that people can be confident that the home is run in their best interests and good outcomes are achieved. Notifications to the Commission for the protection of service users and the efficient running of the service should have the action taken by the manager documented upon them so that there is clear indication of how people living in the home are being protected from any risks and harm. Regents Court Care Home DS0000004151.V373994.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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