CARE HOMES FOR OLDER PEOPLE
Shouldham Hall Nursing Home Shouldham Norfolk PE33 0DF Lead Inspector
Frances Chatten Announced 3 August 2005 9.30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Shouldham Hall Nursing Home Address Shouldham Norfolk PE33 0DF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01366 347276 01366 347658 ACC (Shouldham Hall) Limited Natasha Obolewicz Care Home 48 Category(ies) of Dementia (1) registration, with number Dementia - over 65 (34) of places Old age (14) Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate forty-eight (40) people in total, all of who are older people. Of these, thirty-four (34) Service Users will fall in the category of dementia and fourteen (14) Service Users will have needs associated with old age, not falling in any category. 2. One Service User under the age of 65 years who has dementia and is named in the Commissions records may be accommodated. Total number not to exceed 48. Date of last inspection 22 June 2005 Brief Description of the Service: Shouldham Hall is a 48 bedded care home with nursing for the elderly, and elderly mentally frail. The home consists of two wings, the original hall, and the new wing. There are a total of 44 single rooms and 2 double rooms on the ground and first floors. The home receives its medical services from the local G.P. centre. There is an enclosed garden and large grounds, and ample car parking on the front drive to the home. The home is situated at the edge of the village of Shouldham, which is 10 miles from Kings Lynn. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and resulted from concerns raised by a whistleblower at the home. The inspection team consisted of two inspectors from the Commission as well as a Nurse from the Complex Care Team of West Norfolk Primary Care Trust. The inspection comprised a tour of the building, discussion with residents and visitors, a look at care planning documentation, policies and procedures of the home as well as extensive discussions with the management and owners of the home. The management and owners cooperated fully with the process. Comment cards had been sent to the home prior to the inspection being carried out, but only one card from a relative has been received by the Commission. One inspector visited the home a second time to complete the interviews with the staff. This visit took place on 9th August 2005. The inspector spoke to care staff, domestic staff the recently appointed training officer and gave feedback about the day to the Manager. What the service does well:
The individual care offered to the residents is good and the inspection team as well as one visitor were able to record that some people have physically improved since being placed in the home. The staff group are positive and committed about their work, and the small group seen by the inspector demonstrated insight and understanding about the individual needs of people with dementia. As a group and as individuals they said that they do offer good nursing care to residents, and recognise that the care input is not always as it should be; especially if there are staff shortages or sudden staff absences which means the service is not always as well defined and personal as they would like it to be. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The owners and manager of the home recognise that there is an urgent need to upgrade the care planning of the home. The care plans do not look at all aspects of care and there is a need for staff to be trained in the use of care plans so that they become a meaningful document which informs the care offered. The upgrade should incorporate a review of needs for the current resident group to ensure that everyone is receiving the right level of care and the staffing level reflects a good delivery of the service. The one comment card received indicates that they are not happy with the care provided to their relative and that there are not enough staff on duty. The owners and management of the home need to ensure that the upgrading of the home takes account of the overall safety of the environment as well as ensuring that the home retains a domestic feel. The exclusive use of laminate flooring is convenient for staff and ensures that any accidents can be dealt with out any unpleasant after effects, but it does add dramatically to the ambient noise level which is difficult for people who are hard of hearing and can present hazards when wet. It also does not offer any choice for the service users. The management need to review the current call bell system which is constantly in use, is loud and discordant (during the day time) and does not promote a peaceful and calm environment for people. This may be of particular importance for people with dementia, who can quickly become anxious if the environment is discordant. The management of the home also need to consider carefully the need for stimulation of the residents, with individuals as well as groups. The owners of the home need to ensure that the systems for monitoring the service are robust and include all aspects of the home’s functioning. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 7 The management of the home need to implement a staff structure that establishes a good process of delegation for all staff at every level. The management need to recognise and acknowledge the expertise and experience of the care staff and provide and offer opportunities for them to develop and use their skills to promote and support others and deliver a consistent and personal standard of care. The management need to explore with the care staff group current key practices to identify any and all institutional practice or poor performance at any level. The management of the home need to look at ways in which day to day supervision including basic care practice can be effectively monitored to ensure every resident’s care is being provided in the best possible way. The management need to re-establish formal supervision processes for all staff which will evaluate training and development needs and monitor personal performance and progress. The management need to review the staffing levels especially at crucial and recognised social times of the day to ensure that the special care and nursing needs of residents can be met well. The management need to ensure that there are sufficient numbers of staff on duty so that staff can proactively plan individual care and activities which will stimulate and divert and discourage aimless wandering and meaningless activity. The management should consider setting out additional protocols for agency staff to ensure that they have a well defined work schedule for each designated shift and clear instructions regarding standard work patterns, with particular emphasis on infection control and the management of soiled materials. Agency staff should also be made aware that they are expected to meet the management’s expectations and standards whilst they are on the premises. 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. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The management of the home are not in a position to say they are able to meet the needs of the service user prior to their admission to the home, nor has the service user been reassured that this is the case. EVIDENCE: Pre-admission assessments are done and examples of these were seen. However, these were not completed fully in all cases and on those observed there was little in the way of a social history to help staff understand what the resident’s life style had been prior to admission to the home. The home does not confirm in writing to the service user or their representative that they are in a position to meet needs, prior to admission. Time did not permit the possibility of discussing the pre-admission arrangements with any service users or their representatives. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 The home does not have individual plans of care which set out the health, personal and social care needs of each individual. The home are not in a position to say that they are meeting the health care needs of the service users. EVIDENCE: The management of the home had worked hard in anticipation of the inspection at upgrading the care plans for the service users and it is acknowledged that it is hard work changing from one system to another. However, the new system of care planning needs some further work. The care records do have a named nurse for each service user and pictures of the service users are included on each file. The care plan goals need to be more specific and care needs to be taken to ensure that they are realistic. The life history for each service user must be completed and the relatives of the residents could be included in this piece of work. The care plans do need to be signed by the person completing the documents. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 11 The care plans do not always indicate a review date and whether the service users and/or their representatives have been involved. The reviews do not always follow up on the original goals for intervention which were identified. Training sessions with the care staff group should be identified to ensure that staff have a clear understanding of the role and purpose of care plans and can confidently contribute to the recording and use them in their work. The risk assessments for each person must be more detailed and where incidents have occurred there must be some follow up apparent in the care notes. Many of the residents would appear to have high waterlow scores, which means that their skin integrity could be poor, but there is no follow up in terms of equipment that may be needed to ensure that pressure sores do not develop. Given the inability of many of the residents to speak up on their own behalf, it is essential that routine monitoring of weights is undertaken and recorded. This will enable the staff of the home to identify if there is a problem with the residents maintaining weight given the possibility that some will engage in wandering for large portions of the day. The management of the home do make good use of the community resources that are available to them, such as the District Nurses (for implementation of care for people needing residential care), the Continence Advisor and on this visit the Complex Care Nurse was able to advise that they should make use of the wound tissue viability nurse who would assist re a wound dressing formulary. This would mean that the home had the right dressings in stock. The Nurse also offered to ensure that the staff at the home were made aware of training initiatives which the PCT were offering. The manager reported that she had not audited the needs of the service users against the skills of the nurses and this needs to happen to ensure that the training of the staff is up to date in all areas. The home does have pressure relieving mattresses, but an examination found that these were not always set to the right pressure and were not linked to the provision of pressure relieving cushions for day time use. It was discussed that this should be addressed as a training/education issue. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 12 Some of the rooms in the rooms where residents who are mentally frail are accommodated have charts for turning and care. These charts record, amongst other things mouth care, eye care, turns, catheter care, passed urine and drink given. However, not all of these charts were completed and where they were completed this was not done consistently. The areas which were listed are essential for health and wellbeing, especially if the resident is not able to speak for themselves, so staff need to be trained as to the importance of recording the care given. The Nursing and Midwifery Council Code of Conduct says that if it is not written it did not happen. Residents in the new wing did not appear to have these charts at all. It was indicated that this is because they can advocate for themselves. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The management of the home are unable to say whether or not they meet the residents’ expectations in terms of lifestyle, but the food on offer is served in pleasing surroundings although these may be noisy. EVIDENCE: The care documentation looked at did not offer many indications as to what would be the expectations of the residents in terms of their social and cultural needs. There are sections in the documentation for recording this but it was not routinely completed. A tour of the building did not evidence any posters which showed what activities might be on offer and the home do not, as yet, have an activities organiser. There was little going on to entertain the residents on the morning of this inspection. There had, however been entertainers in the home twice in the previous month and one outing to Heacham. A Barbecue was planned for later in the month and a volunteer comes into the home three times a week to spend time with the residents on a one to one basis. This is good practice. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 14 The menu for the day was displayed on two boards in the home. The cook said that she is aware of people’s likes and dislikes and talks to the residents when they first move into the home to establish this. It is suggested that a more positive choice could be offered to people by offering an option for the main meal of the day, rather than catering for known preferences. The people who live in the wing which caters for mentally frail residents need a higher degree of assistance than some of the other residents. The manager said that there are four staff on duty in this area at meal times and five people need feeding. There did not appear to be any chairs for these members of staff, although it was stated that these would be brought in at mealtimes. It is suggested that additional seating is provided as a matter of routine to ensure that help can be provided in an appropriate,(seated) discreet and timely manner. All of the dining areas are covered with laminate flooring and whilst this is a very practical surface, from a cleanliness point of view, the management of the home are encouraged to consider ways in which the noise levels in these areas can be lessened to ensure that meal can be taken in an unhurried manner. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed on this occasion EVIDENCE: Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 26 Not all aspects of the building were considered to be safe and well maintained and some items of furniture and equipment needed replacing. Extensive work has been carried out to redecorate and upgrade the interior and exterior of the home, which was still ongoing at the time of this inspection. Arrangements are in place for the management and control of infection in the home. The system for monitoring the appropriate and safe handling and management of soiled or infected materials and laundry is not always applied and could place staff and service users at risk. EVIDENCE: The owners and management of the home have put extensive efforts into redecorating and upgrading the building and grounds. It is regrettable therefore that some aspects of the routine maintenance of the home, needed some urgent remedial attention. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 17 The metal ramp into the dining area in the old part of the building had lost the rubber anti-slip strips and was dangerous. Some of the bedding and mattresses needed replacing as do some of the chairs and over bed tables. Care needs to be taken to ensure that the conservatory in the new wing, does not become a wheelchair park as this detracts from the overall appearance of the room and makes it appear very uninviting to residents and their visitors. This was not the case on the second visit to the home, however. The use of low wattage light bulbs also needs to reviewed to ensure that lighting is adequate and domestic in appearance The management of the home are gradually moving to the provision of laminate flooring throughout the home, in all communal areas as well as bedrooms. This is seen as a practical solution to the problem of dealing with the problem of accidents and spillages and certainly there was no smell of urine in the home. However, the noise levels in the corridors and communal areas were quite high, especially at times when the tea trolley was going round the home. The overall appearance of some of the rooms also lacked colour, due to the neutral colours of flooring and walls. It is suggested that the management and staff of the home consider a risk assessment approach to the issue of carpeting and consider alternative ways to deaden the sound, if laminate flooring is indicated by the high risk of constant wear and tear. The home does allow residents to smoke and at the moment, there is no designated area for this to happen. Special arrangements are made for the one resident who does smoke. Staff can smoke and this is allowed in the staff room. There is no choice for the staff who choose not to smoke as there is currently no separate area for this. The manager of the home was able to show the inspectors orders for anti-slip tape, additional lighting, over bed tables, chairs and works detailed in the maintenance book. The call bell system is in constant use, as observed on the days the home was visited, and has a range of different signals so that the call area (room) can be identified. The system is noisy, distracting and discordant and does not provide a calm and quiet environment. There is an infection control policy in place in the home and staff are clear and confident about the management and day to day care of residents who have MRSA. However, the inspector was made aware that not all the staff follow the clear guidelines in place about the handling and management of waste materials and soiled linens. The management should address the nonadherence to safe practice through direct supervision and training to emphasise the need to handle infected or soiled materials appropriately and be made aware of their personal responsibility to ensure good practice is followed so that the health and safety of all staff and residents is not compromised.
Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Staff have a good understanding of residents personal needs but are not always able to meet them due to minimum staffing levels and absences. There is no clear staffing structure in place to promote accountability and personal responsibility for standards and practice. Some progress is being made to address staff shortages but the constant use of agency staff is impacting on the consistency and continuity care for residents. The home has a satisfactory recruitment system in place which provides safeguards for residents. The systems for providing and promoting staff training have not been consistently in place, and this is impacting on staff practice and performance. EVIDENCE: There is a satisfactory recruitment process in place and a small sample of staff files were seen on both visits to the home, which included the criminal records disclosure details and POVA first results. The management group are giving a high priority to recruiting nurses and care staff. Current vacancies are being filled by agency staff and the management acknowledge that the situation is not ideal. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 19 There are no processes in place for monitoring performance or progress of staff, especially agency staff, to ensure consistency and continuity of a planned service. It is all the more relevant in this home as the resident’s have limited understanding of their own needs and are not able to express realistic views or satisfaction about their care or how it is delivered. Based on the discussion with the staff, they are committed and caring and have a good understanding of the unpredictability of caring for people with dementia or behavioural problems, and want to get it right. They also acknowledge and recognise their own shortcomings in meeting individual needs of residents, because at times they do not have sufficient numbers of staff on duty which does not allow for regular input of social and emotional time. The recent appointment of a new training officer has prompted a review of staff training needs and personal development. Training sessions will be reestablished, once the assessments have been completed. Mandatory training is also under review and updates and refresher courses will be introduced as soon as possible. The management will also need to consider ways in which the competency levels of the staff can be measured so that immediate and future training sessions can be tailored to dovetail with established skills and expertise. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 There is no consistent supervision process in place to provide staff with the support and guidance to evaluate standards of care and promote best practice. EVIDENCE: There is no formal identified supervision process in place, and the routine care practices and standards of services are not being evaluated to monitor the professional development of the care staff. The recently appointed training officer is carrying out introductory/supervisory interviews to initiate individual training needs and expectations, and this is being positively received by the staff. Formal supervision should be reintroduced as a matter of some urgency in line with the National Minimum Standards for older people. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 2 x 2 x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x 1 x x Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 (1)a,b,c,d Timescale for action The registered providers must Immediate ensure that a full assessment of and by need for each resident is September completed prior to admission and 30th 2005 confirm in writing that the service can fully meet their assessed needs. The registered providers must Immediate implement a care planning and by 30th process which provides a written November 2005 plan of care drawn up in consultation with the resident and or their representative, signed by them and reviewed on a regular basis. Immediate The registered providers must review and implement a process and by September which ensures that residents receive appropriate specialist 30th 2005 equipment which is monitored and managed appropriately to protect against the development of pressure sores and to promote tissue viability.This process should form part of the overall clinical audit and review of services. The registered providers must Immediate implement a process for and by 30th assessing the social and November emotional needs of the residents 2005
Version 1.40 Page 23 Requirement 2. 7 15(2) 3. 8 12(1,2,3) 4. 12 16(2)i,m, n Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc 5. 19 23(2) 6. 20 23(2) 7. 22 23(2) 8. 26 13(3) 9. 27(3) 18(1,2) 10. 30 18(1)i in a planned way. Social stimulation should be offered and provided by staff both individually as well as in group form to promote meaningful activities and interests The registered providers must continue to complete the planned upgrade of the premises and establish a designated area for staff who do choose to smoke.Ongoing repairs and replacements should also be completed to ensure the health and safety of residents and staff. The registered providers must continue to implement the refurbishment and replacement of furniture and fittings including carpeting and lighting throughout the home The registered providers must ensure that the home is equipped with appropriate aids and adaptations to promote the health and well being of residents with special needs.The registered providers must also review the alarm facility to reduce the constant noise and intrusiveness of the system The registered persons must ensure that all staff including agency staff are fully conversant with the homes own infection control policy and are clear about the safe handling and management of soiled or infected materials and laundry. The registered persons must ensure that at all times suitably qualified,competent staff are working in such numbers as are appropriate for the health and welfare of the residents. The registered persons must ensure that there is a staff training and development Immediate and ongoing Immediate and ongoing Immediate and by December 31st 2005 Immediate and by 31st August 2005. Immediate and by September 30th 2005 Immediate and by March 31st
Page 24 Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 11. 36 18(2) programme in place which will meet training targets and achieve the aims and objectives of the home, including care planning, report writing. The training should also reflect the specialist needs of the resident group. The registered persons must ensure that formal supervision arrangements for all staff are implemented to monitor and maintain professional development and competency 2006. Immediate and by 31st december 2005. 12. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 27,29 Good Practice Recommendations It is recommended that the management consider ways in which the staffing structure can be revised to provide a framework in which staff with experience and skills can be offered more accountability and responsibility and undertake the monitoring of day to day practice, and service delivery to ensure that good standards of care are achieved, maintained.The review should also consider changes to the pay structure which recognises and rewards qualification,care skills and leadership qualities. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V242496 030805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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