Inspection on 02/06/05 for Stainsbridge House

This inspection was carried out on 2nd June 2005.

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

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

Other inspections for this house

Stainsbridge House 19/11/08

Stainsbridge House 08/11/07

Stainsbridge House 12/12/06

Stainsbridge House 09/06/06

Stainsbridge House 09/01/06

Stainsbridge House 28/02/05

Stainsbridge House 13/10/04

Stainsbridge House 18/03/04

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

CARE HOMES FOR OLDER PEOPLE Stainsbridge House Gloucester Road Malmesbury Wiltshire SN16 0AJ Lead Inspector Jacqui Burvill Announced 2 June 2005 nd 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. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Stainsbridge House Address Gloucester Road Malmesbury Wiltshire SN16 0AT 01666 823757 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) mail@treasurehomes.co.uk West Country Care Limited Wendy Parker Care Home 24 Category(ies) of DE Dementia 1 registration, with number DE(E) Dementia over 65 of places 24 Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated in the home at any one time is 24 2. Only the named female service user with dementia referred to in the application dated 29 November 2004 may be aged between 18 to 64 years. Date of last inspection 28th February 2005 Brief Description of the Service: Stainsbridge House is a home providing care and accomodation for service users who have dementia. Stainsbridge House is one of a number of homes owned by West Country Care. There is a new manager in place, who was appointed in March and completed registration process on 4th May 2005. The home is situated on a main road on the outskirts of Malmesbury. The house is Victorian and there are large grounds to the rear. The accomodation is on three floors and there is a passenger lift, as well as a main staircase. There are bedrooms on the ground, first and second floors. There are 4 double or shared rooms and 16 single bedrooms. 3 single rooms have ensuite toilets and 1 double bedroom has an ensuite bathroom with toilet. There are 2 other bathrooms, one of which is an assisted bath and an assisted shower room. There is a large sitting room and a dining room next to each other on the ground floor, overlooking the garden. There is a small smoking room on the ground floor. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spoke to five staff and five residents the manager and the responsible individual. Three hours of the inspection was spent in the lounge/dining room talking to residents, staff and observing the care practices. Lunch was sampled. Records examined included care plans, risk assessments, complaint records, staff training records, medication, menus, staff rota and some policies and procedures. Three residents were case tracked, with a further two care plans being examined. No visitors were seen during the inspection. There were 20 requirements set at the last inspection and 19 recommendations. A considerable part of the inspection was spent looking for evidence that these had been met since the last inspection. The owner plans to extend the home by 16 beds, making 40 beds in total. The inspector explained that until the requirements and other issues of concern had been addressed, the new beds would not be registered, until the CSCI was assured that practices had improved in the home. This work is not expected to be completed until the end of 2005 and has not started yet. 11 out of 24 relative surveys were returned. 3 out of 24 resident surveys were returned. Comments from relatives included; ‘ Staff are always on hand to answer any questions or worries. I have never had to use the complaints procedure.’ ‘I am made to feel welcome any time I call. I know all the members of staff are genuine when giving care’. ‘I often call at mealtimes and the food is excellent and cooked to perfection.’ ‘The home never smells.’ ‘ Staff numbers are not always adequate at the weekend, although staff do an excellent job overall and we are very satisfied with the care given.’ ‘Staff are friendly and helpful.’ ‘Some residents spend half their time wandering along the corridor at ground level. More wandering space would be an improvement, such as an exercise room, or an activities room with books, games and things of interest.’ What the service does well: Residents look well dressed and groomed. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 7 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 Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 8 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) 1, 3 Standard 6 is not applicable to this home. The statement of purpose does not clearly describe the way in which standards set by the home are to be met. The statement of purpose does not meet the National Minimum Standards in setting out what is provided for residents. This restricts the choice residents and their families have when choosing a home. Residents are safely admitted to the home, by gathering information about their needs before they come to live at the home. This is not supported by policies and procedures. The service user guide is not in place, leaving residents and their families with a lack of information about the home. EVIDENCE: The new Statement of Purpose was sent to the CSCI with the pre inspection questionnaire. This raised some questions, which were discussed with the manager. The home has devised a set of standards, which is commendable. However, it is not clear how these standards are to be met. These standards do not relate to the National Minimum Standards for Older People and does not list the documents required in Schedule 1. One new resident was case tracked, looking at all of the records before being admitted to the home and the care plans and risk assessments in place since Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 9 being admitted. There are pre admission assessment forms completed by the manager and information from the resident’s previous placement. No admission policy and procedure could be found during the inspection. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Care plans put residents at serious risk of not having their needs met, especially when care needs change. Risk assessments are not clearly defined, setting out guidelines and methods of safe practice. This puts residents at risk. Not all medication admitted into the home is clearly recorded. This could result in errors when medication is given. Residents’ health needs are recorded showing what action has been taken. EVIDENCE: The care plans are very brief and do not clearly describe how care is to be met, when managing other aspects of care, such as challenging behaviour, or mental health issues. This has been raised at previous inspections and there are plans now the new manager is in place to change the format to be more comprehensive. Care plans are reviewed monthly, and notes are made about any changes that have been noted. However, the care plan is not adjusted as a result. In other care plans, serious care issues identified in daily notes had not been followed up and identified as a changing need. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 11 There are notes to show when doctors and community nurses have seen the resident if they are poorly, or injured. These records were seen for those residents who were case tracked. None of the residents self medicate. When the person who is usually responsible for receiving medication is off duty, staff are not recording medication received into the home accurately. A requirement from the previous inspection has not been met. This is when staff are receiving new medication, such as antibiotics. This is not being countersigned by two staff. The manager will assess staff competence in administering and recording medication. Residents are not able to say directly that they feel they are treated with dignity and respect. Observations of staff interacting with residents showed that some staff did spend time with residents talking to them and reassuring them. However, some residents who were sat quietly, did not receive any contact with staff at all, until it was time for lunch. Residents were then asked if they wanted to visit the toilet, or to sit at the table. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The lifestyle arrangements, which includes activities, do not meet all of the residents’ needs. Visitors are able to come to the home whenever they wish to see their relative/friend. Menus do not reflect the full range of choices available to residents. Resident’s needs are not always fully met at mealtimes, which can lead to frustration and an acceptance by staff of a low standard of care. EVIDENCE: Residents are not able to discuss their preferences or expectations clearly. The inspector used a book of pictures to help residents express their feelings about living at Stainsbridge. Not all of the comments can be directly interpreted. However, the discussions showed that residents valued being communicated with and some sought out the inspector to talk to. There is a rota showing activities in the home, which is displayed in the kitchen. This is not accessible to the residents or relatives, nor in a type large enough for them to read. It shows that there is an activity every day, but not for every resident. For example, hairdressing and religious services are down as activities. It is unusual to see such items on an activity rota. Residents are dependent on staff understanding their needs and interests and finding ways to meet them. If staff do not have a full understanding of the Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 13 residents’ behaviour, this can lead to residents feeling undervalued and not respected. Although no relatives were seen on this occasion, relatives have given their views via surveys. Records in the home also show that there are frequent visits to the home. It is difficult for residents to show that they have choice and control over their lives. Residents may not feel this is true, when they are hoping to go outside independently for example. However, staff were observed trying to support residents who made some difficult or potentially dangerous choices during the inspection. Staff were sensitive to their wishes and tried to fulfil them in the best way possible. A proportion of time was spent in the dining room/ lounge. Some residents were sat at the table ready for lunch at least half an hour before it was served. The inspector has raised concerns over this practice before. It promotes confusion and frustration for residents, one of whom was heard to say that if her father had to wait for his lunch like this, then he’d be cross. Indirect comments like this can show how difficult it is for residents to wait and understand the reason why. The meals are served to the table one plate at a time and this practice still continues, despite previous comments from the inspector. One resident who was being fed did not have appropriate crockery to keep the food hot and another resident could not manage the utensils she was given. Solutions to these problems had not been sought, rather the situation was just accepted by staff, until the inspector offered advice on alternatives. Cooked breakfasts had just been introduced, although this was not recorded on the menu. Some residents were offered an alternative after refusing a meal. Situations such as these must be properly recorded, to show what was offered and what was eaten. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The way in which relatives are informed of the complaints procedure supports residents who are not able to use the complaints procedure independently. Residents are not fully protected from abuse as staff have not received up to date training on this. EVIDENCE: There have been two internal complaints dealt with by the home in May 2005. There is a record of internal action taken. The inspector asked how residents or their families were made aware of the complaints procedure as many of the responses to the survey suggested that relatives were not aware of the process. The manager states that since she has been in post, new residents’ families have been given copies of the complaint procedure on admission. Evidence of this should be kept. The manager has been trying to find a suitable course on adult protection for staff to attend. Only two places are available. In house training must be provided until an appropriate course can be found. This training must include the Swindon and Wiltshire ‘No Secrets’ procedure as well as an awareness of signs and symptoms of abuse. The manager became aware of issues relating to adult protection and has reported these using the procedure and has also involved the CSCI inspector for the home. Records show that staff have not responded appropriately to situations where residents may assault each other. This is an extremely low standard of care and must be rectified. This was raised at the last inspection and little seems to have changed since then. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25, 26 The layout and decoration of the home is not ideal for residents with dementia, as this can lead to feelings of disorientation and more confusion. EVIDENCE: The dining room and lounge are being re – decorated. Part of the lounge has been screened off, so that there is minimal disruption for residents. The smoking room has been re –decorated. The sluice room and the laundry have been thoroughly cleaned and re – organised. The kitchen is due to be refurbished several weeks after the inspection. Not all parts of the environment are suitable for residents who have dementia. The owner and manager were advised to look at specialist dementia guidance and advice when considering decorating, refurbishment and the new extension. Not all of the radiators have been covered. The rooms and areas that do not have them did not have up to date risk assessments in place. The manager does not know of any plan to the improvements to the premises, although she is very aware of what is to be actioned. This seems to have been discussed rather than planned formally. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 16 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 The staff numbers and skills mix do not always meet the needs of the residents. Residents are protected as far as possible by the recruitment practices in the home. EVIDENCE: The rota was of some concern at the last visit to the home. Hours had been reduced and altered. The guideline was that the staff hours should not fall below 42 hours per day. The pre inspection questionnaire with copies of the rota showed that there were shortfalls at least twice a week. This is not acceptable. The manager explained that there are to be three staff on duty during the morning and afternoon/ evening shift. On occasion this is falling to two staff. This is not sufficient for 24 residents, many of whom are highly dependent on staff to manage their personal care and challenging behaviour, as well as provide interesting activities and meet residents relatives. There are two waking night staff on duty. The manager is addressing these issues with the owner. Staff training sessions have started, with dementia awareness, continence promotion, first aid and basic food hygiene. Staff were unclear about how these training sessions had affected or would affect their practice. Records for staff who have been recently appointed were looked at. These were all in order. The CRB checks come through an umbrella body, who only provides the home with a copy of the result and not the actual disclosure itself. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 17 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) 33, 35 In the best interest of residents, the home does not handle personal finances. The home has not assessed it’s own quality yet, the impact on residents may be that they are not receiving a quality based service. EVIDENCE: None of the residents have their finances managed by the home. In future, the manager stated the details of power of attorney or court of protection will be identified pre – admission. A discussion took place about quality assurance, there are plans to implement a system. An extension to this deadline has been given so that this must be completed by December 2005. This must be based on Standard 33 and include the views of the residents, families and stakeholders. Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 18 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 1 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 2 x x x x x 2 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 x x 2 x x x x x Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 19 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. 2. Standard OP1 OP1 Regulation 4 Schedule 1 5 Requirement The statement of purpose must describe the details as laid out in Schedule 1 There must be a service user guide, which is accessible to service users, or where evidence can show that a copy has been given to relatives or advocates on admission. Care plans must accurately desribe the way in which care is to be given. This must include guidelines for managing challenging behaviour, or management of any mental health issues. Risk assessments must accurately reflect the risks that may affect other residents, especially where there is challenging behaviour or mental health issues. The guidelines must be clear and staff must be aware of them at all times. The registered person must ensure that the policy for handling medication in the home accurately reflects current procedures and promoted good practice. (Carried forward from the last inspection) Failure to Timescale for action 1st October 2005 1st October 2005 3. OP7 15(1) (2) 1st August 2005 4. OP7 13(4) (c ) 1st August 2005 5. OP9 13(2) 1st August 2005 Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 20 6. OP9 13(2) 7. OP12 12(5) (a) (b) 8. OP15 17 Schedule 4.13 17 Schedule 4.13 13(6) 9. OP15 10. OP18 11. OP18 13(6) 12. OP18 37 (1) (c )(e) (g) meet this requirement will result in enforcment action being taken. The registered person must ensure that there is a record kept of all drugs entering the home. (Carried forward from last inspection) Failure to meet requirement will result in enforcement action being taken. Staff must develop positive relationships with residents that reflect current best practice, including understanding the needs of residents with dementia and challenging behaviour Where alternatives to meals have been provided and when meals have been refused, accurate records must be kept. The menu must show what meals have been provided for residents and this must include breakfast. Staff must receive training and awareness in adult abuse and protection. This must include the Wiltshire and Swindon No Secrets guidance. (Carried forward from the last inspection, when an extension was granted to be completed by 31st March 2005. This was a requirement as a result of a complaint investigation in January 2005.) Failure to meet this requirement will result in enforcement action. Whenever a staff member or a resident is assaulted, this must be reported in the accident book.( Carried forward from the last inspection) Failure to meet this requirement will result in enforcement action. When the assault is serious enough to equate to actual bodily harm, the Wiltshire Vulnerable Adult Procedure must 1st August 2005 1st August 2005 1st August 2005 1ST August 2005 1st August 2005 1st August 2005 1st August 2005 Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 21 13. OP25 (13(4) (a) (c) 14. OP27 18(1) (a) 15. OP27 18(1) (a) 16. OP33 24 (1) (2) (3) be used to report the incident. These incidents must also be reported using Regulation 37 notifications to the CSC. (Carried forward from the last inspection.) Failure to meet this requirement will result in enforcement action. Residents who do not have radiator covers in their bedroom must have a risk assessment completed. If assessment shows that a cover is required, an action plan showing when it is to be fitted is to be produced.(This has been carried forward for third time.) Failure to meet this requirement by the specified time will result in enforcement action. The rota must clearly show hours to be worked as care, especially when there is a shorter number of hours. Staff must not be on the rota providing care hours when they are also providing cooking or cleaning duties ( Carried forward from the last inspection.) Staffing hours must not fall below 42 hours per day. (Carried forward the last inspection) Failure to meet this requirement will result in enforcement action A quality assurance system must be introduced in the home and a report sent to the CSCI on conclusion of first audit. (Carried forward from the last inspection.) This is due to be concluded by 31st July 2005 Failure to meet this requirement may result in enforcement action. 1st August 2005 1st August 2005 1st August 2005 1st December 2005 Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 22 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 OP3 Good Practice Recommendations The admission policy and procedure should be amended to show a process, where an assessment is made by health and social care professionals and manager or deputy managers of home. Information about assessed needs must be gathered before admission. ( Carried forward from the last inspection) All hand written additions to medication administration sheet should be signed and checked by two members of staff. The activities co ordinator should produce a plan of activities over the week, ensuring that the range of activities are suitable for all service users. There should be consulation with organisations who have specialist knowledge in this area. (Carried forward from the last inspection.) The homes activities programme should be displayed in a public area.( Carried forward from the last inspection.) The menu plan is discussed with a dietician or nutritionist to see that it offers a balanced and nutritious diet to the residents. ( Carried forward from the last inspection) The cook should receive further training in meeting the nutritional needs of older people. ( This has been carried forward for the fourth time) Evidence should be kept to show that residents relatives have been given a copy of the complaints procedure. The registered person or responsible individual should make an action plan describing the refurbishment of the home with timescales.( Carried forward from the last inspection) That an assessment of the facilities and premises as a whole is carried out by a suitably qualified person (Occupational Therapist and Specialist Dementia advisor) and the recommended environmental adaptations are made to meet the needs of the residents.( Carried forward from the last inspection.) 2. 3. OP9 OP12 4. 5. 6. 7. 8. OP12 OP15 OP15 OP16 OP19 9. OP22 Stainsbridge House D51_S28415_STAINSBRIDGEHOUSE_v221672_020605stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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