CARE HOMES FOR OLDER PEOPLE
Sharnbrook Lodge 17a Park Road North Houghton Regis Bedfordshire LU5 5LD Lead Inspector
Leonorah Milton Unannounced Inspection 30th May 2006 11.30 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 Sharnbrook Lodge DS0000014966.V297215.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. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sharnbrook Lodge Address 17a Park Road North Houghton Regis Bedfordshire LU5 5LD 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) 01582 866708 Mr John Philips Mrs Miriam Philips Mrs Jean Flanagan Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (12) Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Sharnbrook Lodge was a privately owned residential care home. The service was registered for twelve older people who may also have dementia and/or physical disabilities. The registration for physical disabilities was not necessary or appropriate. The current service was providing for frail older people. Those with mobility problems and similar that are associated with old age can be provided for under the registration for older people. The building was a detached property situated on a main thoroughfare that provided direct access from Luton, Dunstable and Houghton Regis. The home was in close proximity to local shops and other amenities. There was parking for a few cars to the front of the premises and a large garden at the rear of the building that was be accessible to service users. A large lounge/diner was located on the ground floor. The premises were undergoing major building works to increase the number of bedrooms and facilities throughout. In the short-term the home was only using eleven bedrooms for single occupancy. There was one accessible bathroom/toilet on the ground floor and one toilet on the upper floor. Commissioning of the new build will increase the ratio of bathing/toilet facilities, the size of the manager’s office and the kitchen. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care (CSCI) since the last visit to and public report on, the home’s service provision in November 2005. Reports from the home and other statutory agencies, and information gathered at the site visit to the home, which was carried out on 30th May April 2006, from 11.30 to 18.30 hours, were taken into account. The visit to the home included a review of the case files for two service users, conversations with six service users, a visitor to the home, two members of staff and the manager. Much of the time was spent with service users in the ground floor lounge/diner, where the daily lifestyle was observed. A tour of the building was carried out and other records were reviewed. The home had a friendly, family run atmosphere. Its current organisation was suitable for the care of the small group of service users, totally eleven at the visit to the home. These arrangements will need to be reviewed at the application to increase the size of the home at the completion of the extension. The review will need to take account of staffing arrangements throughout, medication procedures and the management of a significantly larger home. What the service does well: What has improved since the last inspection?
Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 6 Action had been taken on requirements from the previous inspection to improve the home’s complaints procedures and the storage of continence materials. Progress on building works had improved the living space for service users and access to the front of the building. A new laundry room had been commissioned. What they could do better:
There were risks to service users’ safety that must be eliminated quickly. The recently enlarged lounge/diner contained two radiators that had uncovered surfaces that could cause accidental burn. Two fire doors had been compromised because they did not fit fully onto their rebates. Hazardous cleaning products were not stored securely and a razor with an exposed blade was accessible to service users. Privacy arrangements must be improved. The toilets and bathroom used by service users were without locks. Similarly, some bedroom doors were not fitted with locks that had individual keys. The shaft lift had been out of order for three days at the site visit. An engineer’s reports showed the parts were on order for its repair. However previous reports showed that water had also been leaking into the shaft. This situation must be remedied. It was also noted that there were free standing heaters throughout the home in the lounge and service users’ bedrooms. The manager reported that problems with heating supplies were due to the building works in the adjacent extension. These however had been repaired. A risk assessment must be carried out on the risk of accidental burn from these heaters if it becomes necessary to use them again. Service users appeared rather unoccupied. Recreational activities must be arranged to take account of service users’ preferences and that are also appropriate for those who have dementia. It is recommended that staff undertake more detailed training in the care of those with dementia. The manager must undertake training in the best practice for the management of a dementia care service. There was little evidence to show that service users and their representatives had been consulted about the service through a quality audit programme. A service user expressed concerns about communicating with some staff from overseas. The service user stated that some staff spoke English with an accent that was difficult to understand. The same personnel were described as rather abrupt and that they rushed the care given to the service user during the night. The manager must ensure that all staff are able to communicate fully
Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 7 with service users and that staff are advised that personal tasks with service users must take account of service users’ preferences not to be hurried. Where there are problems with communication such staff must work with service users in a supervised capacity only. Staff must not be employed until a satisfactory Criminal Records Disclosure has been obtained. Updated work permits must be obtained when the dates on the documents held on personnel files pass their expiry date. Staff must be issued with contracts of employment. Records must be maintained to show that staff have received induction training to required standards. Service users’ case files must contain all of the details required by the legislation. 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. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Satisfactory information about service users’ needs had been obtained before service users had moved into the home to ensure that the home had the ability to meet assessed needs. Individual contracts were in place to inform service users about the conditions for their accommodation in the home. EVIDENCE: Two case files were assessed at this inspection. Records indicated that sufficient information had been obtained via the care management procedures of placing authorities before service users had been admitted to the home. Contracts were in place on each case file assessed. They had been signed on behalf of service users’ by their representatives. The home did not provide an intermediate service.
Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Care planning documents were not sufficiently detailed, so that there was a risk that some needs would remain unmet. EVIDENCE: It was evident that care-planning documentation was progressing. Files contained a list of service users’ preferences for daily routines and plans in relation to assessed needs. However, plans must contain more detail to show how assessed needs will be met and take account of current risk assessments. For example, one plan showed that the service user should be encouraged to join in activities. Given that the service user chose to remain in their room for the majority of the day it was difficult to see how this gaol was to be achieved. Another plan contained a risk assessment that showed that the service user could only smoke with supervision in designated areas. A carer stated that the service user could smoke unsupervised. The inspector noted that the service users smoked alone in their bedroom. It was also noted that the bed in this
Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 11 bedroom was fitted with bed rails. There was no record of a risk assessment or consent to use this form of restraint. Plans did not contain assessments of nutritional need. The manager also reported that the home was unable to weigh service users who were unable to weight bear. Similarly there were few records of service users emotional and spiritual needs, especially in the event of terminal illness or at death. Records indicated that service users had been supported with their health care needs. Service users confirmed that they had been referred to their doctor as need be and that they had received routine chiropody and optical treatment. The case files seen did not contain a photograph of the service user or details of service user’s belongings such as televisions, radios and similar valuable items. It was difficult at this inspection to readily assess records of healthcare support because documents were not organised into each individual case file. It is recommended that individual, sequential records of healthcare appointments and treatments be maintained in case files for audit purposes. Medications were stored securely in the manager’s office. Records assessed and compared with stocks of medications showed that medications had been given as prescribed. Records were seen that showed that staff with the responsibility of administering medications had undertaken distance-learning courses in safe practice. It was noted that medications for storage under refrigerated conditions were stored in the food refrigerator. Such medicines must be stored securely. Service users’ dignity had been compromised by the practice of using shampoos, soaps and similar for communal use. The ground floor bathroom contained several bottles of shampoo, foam bath and aftershave and two hairbrushes. Also seen was an unlabelled, un-lidded tube of Anusol ointment and two used flannels. The manager must ensure that products for personal hygiene are obtained and reserved for individual and exclusive use. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The arrangements for service users to participate in meaningful activities were inadequate. Service users were unoccupied for much of the day. EVIDENCE: It was evident from observation of the interaction between service users and members of staff that service users were treated with courtesy, respect and that their wishes for day-to-day routines, where practical and safe, were taken into account. Whilst there was an advertised list of activities there was little evidence to show that they had taken place. Service users were observed to converse with members of staff and to listen to music. The manager reported that service users were reluctant to take part in activities when given the opportunity to do so. She was advised that good practice guidelines recommend that activities take account of preferences but also ability. Activities will need to be appropriate for those with dementia. It is recommended that both the manager and the staff undertake training in this area. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 13 Service users confirmed that their visitors had been made welcome in the home. A visitor was complimentary about the care his relative received and stated that his family were encouraged to visit. Menus indicated that service users had been provided with a nutritious diet. Conversations with a carer showed that she was aware of special diets and infection control procedures in the kitchen. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Procedures were in place to enable service users to raise concerns. Service users had been put at risk because protection procedures had not been followed during recruitment of personnel. EVIDENCE: The manager reported that no complaints had been made since the last inspection. Service users confirmed that they felt they could raise concerns if the need arose. The complaints procedure was seen. It covered the details specified by the legislation. Records indicated that personnel had received training in adult protection procedures. However protection procedures in the home had been compromised because there had been a failure to obtain a criminal records check (CRB check) and a similar check via the Protection of Vulnerable Adults Register (POVA First check): the personnel file for one employee showed that they had commenced employment on 26th June 2005. The CRB check on file was dated 5th October 2005. There was no evidence that a POVA First check had been obtained. An immediate requirement notification was issued at the inspection.
Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Failures to ensure a safe environment had put service users at risk of harm. EVIDENCE: It was a pity that the failure to ensure a safe environment that were noted in the summary of this report had resulted in the poor judgement above that should have been “good”. It was evident that the staff had strived throughout the building works to ensure that service users were disturbed as little as possible and that the home was kept clean. However it was worrying that the new lounge had been commissioned for use in December without regard for the uncovered radiators in this room and fire doors that did not close fully on to their rebates. An immediate requirement notification was issued at the inspection visit for urgent action to eliminate these hazards. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 16 The doors to the toilet and bathroom in use at this inspection were without useable locks. Several bedroom doors were fitted with locks that required an “alleyne” type key to secure them. This did not meet the standard for service users to be supplied with individual keys to their rooms. Where it is not practical for service users to hold keys to their bedrooms their case file must contain a risk assessment to qualify the withholding of a key. The kitchen was evidently included in the improvement plan for the home. At this inspection there were signs of building work in preparation for the extension of the room. The staff had however managed to maintain a clean environment in which to prepare food. The new laundry room was a significant improvement on its predecessor. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. There were risks that service users’ needs and requests for assistance may have been misunderstood and therefore unmet by personnel whose first language was not English. Recruitment procedures had not been sufficiently thorough to ensure that service users were cared for by persons of the right calibre. EVIDENCE: It is again a pity that the shortfalls in this section have resulted in the overall judgement. This was a small staff group, the majority of whom had worked in the home for a significant time. Service users had benefited from the continuity of care and the friendly atmosphere. In conversation with the inspector, the two members of staff on duty showed considerable understanding of the service users’ needs and were evidently concerned for their welfare. Service users responded well to the staff on duty. It was positive to note that those service users who had a wish to wander around the home at times were permitted to do so and prompted to return to the lounge only when it was in their best interests to do so. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 18 Staff had been provided with statutory training but initial induction training was inadequate. The personnel file for one carer showed that she had received induction to TOPSS standards, however on enquiry to the carer it was explained that this had been a brief course provided by an agency, which had not met required standards. The record indicated that the carer had not been present for the whole course. There were no records on her file in relation to induction training by the home. Induction must include instruction about the pace at which personal care is delivered. One service user complained that they had felt rushed and stated that at their age and frailty this had “made me worse”. Staff must also be able to communicate with and understand service users. This is particularly relevant to night staff, the current arrangements being one waking and one sleeping in member of staff throughout the night. Training to achieve National Vocational Qualifications (NVQ) was progressing despite the home, in common with others in this area, having had difficulties with a local college, who had failed in its contract to properly assess candidates for NVQs. The manager reported that after this disappointing setback staff had been enrolled with another college and were working hard towards the award. Of the fourteen staff, one held an NVQ at level 3, two held awards at level 2 and four were working towards the qualification at level 2. Recruitment records were assessed for two employees. Neither contained any evidence that CRB or POVA First checks had been obtained before employment commenced. One employee had commenced work in the home in June 2005. One of the references on her file was dated July 2005. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The manager showed commitment to the service users’ welfare and had strived to manage the home effectively. The shortfalls to the service delivery that are within her brief could be readily solved and result in an improved standard of care for service users. EVIDENCE: The manager had held a certificate in management for a number of years and had worked in a management capacity for several years. She explained that she had undertaken a half-day course in understanding dementia care along side her staff. Given the home’s registration to care for those with dementia and indeed the number of service users with cognitive impairment living in the home, the manager must under take more comprehensive training to manage the delivery of such a service. It is also recommended that she undertake
Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 20 other management training to ensure that she is fully prepared for the management of a larger operation when the home doubles its size at the registration of the new build. The proprietor must also properly support the manager. Whilst it was reported that the manager met frequently with the owners of the home there were no systems in place to provide her with formal supervision. The manager was spoken of highly by the service users, the staff on duty and the visitor to the home. Whilst there were no formal meetings with service users to gauge their opinions, the manager showed, during conversations with the inspector, that she was well acquainted with service users and understood their needs. The manager stated, where possible service users had completed quality assurance questionnaires and that these were on case files. However there were none on the two case files assessed at the inspection visit. Formal systems to consult with service users, or where appropriate their representatives, must take place in addition to the informal systems currently in place. A resulting action plan must be made available to service users and the Commission. Records for personal monies held for two service users were assessed and showed that the home held only small amounts of cash to settle bills for hairdressing and chiropody services. Appropriate records had been maintained for these transactions. As detailed in the summary to this report, the operation of the home was suitable for its current occupancy. The increase in the occupancy that will result from the registration of the new build will require a more professional approach to the management of the home. At that point the manager will need to be supported by a skilled senior team, who are capable of taking charge of a large home during the manager’ absence. It is recommended that the proprietor and the manager commence a review of the service and plan for the staffing resources that will be required in the near future. Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 x 2 x x 2 x 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 x x 1 Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1)(a) 14,15 Requirement Care plans must show how assessed needs will be met. This must include nutritional assessments and take account of current assessments of risk. A suitable set of scales must be provided to ensure that each service user can be weighed on a regular basis. Medicines must be stored securely. This must include medicines stored under refrigerated conditions. Arrangements must be made to ensure that all service users receive adequate stimulation to ensure they are motivated. (Previous timescale of 30/01/06 had not been met.) Staff must not commence work in the home until a satisfactory Criminal Records Bureau disclosure, a check from the POVA First register and two written references have been obtained. An immediate requirement notification was issued at the inspection visit.
DS0000014966.V297215.R01.S.doc Timescale for action 31/08/06 2 OP8 12(1)(a) 16(2)(c) 12(1)(a) 13(2) 12(1)(a) 16 (2) (m) 31/08/06 3 OP9 30/09/06 4 OP12 30/07/06 5 OP18 12(1)(a) 19 31/05/06 Sharnbrook Lodge Version 5.2 Page 23 6 OP19 12(1)(a) 23(2)(4) 7 8 9 OP19 OP21 OP24 12(1)(a) 12(1)(a) 23(1)(a) 12(1)(a) 14 10 OP27 12(1)(a) 18(1)(a) 23(2)(b) 12(1)(a) 19 11 OP29 Fire doors must close fully onto their rebates. An immediate requirement notification was issued at the inspection visit. The persistent water leak into the lift shaft must be repaired. Doors to toilets and bathrooms must be provided with appropriate locks. Where it is not practical for service users to hold keys to their bedrooms their case file must contain a risk assessment to qualify the withholding of a key Members of staff who are unable to communicate fully with service users in spoken English must only work with service users in a supervised capacity. Staff must be issued with contracts of employment. Work permits must be valid. Where dates have expired, the home must obtain a copy of an updated permit to work. Staff must receive: Instruction on the pace at which personal care is delivered so that service users do not feel hurried. Comprehensive induction training. The manager must undertake training in relation to the management of a service to those with dementia. Procedures to assess the quality of the service on at least an annual and which involve formal consultation with service users and their representatives must be introduced. Service users must not have access to razor blades or
DS0000014966.V297215.R01.S.doc 14/06/06 31/08/06 30/06/06 30/07/06 30/06/06 30/07/06 12 OP30 12(1)(a) 18(1)(c) 30/07/06 13 OP31 12(1)(a) 18(1)(c) 12(1)(a) 24 30/09/06 14 OP33 31/08/06 15 OP38 12(1)(a) 13(4) 30/06/06
Page 24 Sharnbrook Lodge Version 5.2 16 OP38 12(1)(a) 13(4) hazardous cleaning products. Unprotected radiators (that pose a risk of accidental burn to service users must be covered. An immediate requirement notification was issued at the inspection visit. 30/06/06 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 Refer to Standard OP9 OP10 OP12 OP27 Good Practice Recommendations It is recommended that that a medication refrigerator is provided for the secure storage of medicines. Products for service users’ personal hygiene should be obtained and reserved for individual and exclusive use. The manager and staff should undertake training in the provision of recreational activities for older people, to include appropriate activities for those with dementia. It is recommended that the proprietor and the manager commence a review of the service and plan for the staffing resources that will be required in the near future at the increase in the size of the home. Arrangements should be made for the manager to be appropriately supervised on a regular basis. Carried forward from the previous inspection. The manager should consider embarking of further care planning training. Carried forward from the previous inspection. The manager should consider undertaking training to achieve the Registered Manager Award. Arrangements should be made to ensure the wishes of service users in the event of their death are recorded. Noted at the previous inspection. 5 6 7 8 OP31 OP31 OP31 OP11 Sharnbrook Lodge DS0000014966.V297215.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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