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Inspection on 26/04/05 for Swarthdale Nursing Home

Also see our care home review for Swarthdale Nursing Home for more information

This inspection was carried out on 26th April 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken with felt that the manager was "kind" and that she and most staff worked hard to improve things for them and provide the care they need. More than one resident said that staff did their best for them but were very busy. The manager responds positively to the inspection process and has identified problem areas needing urgent attention, taking steps to respond to them, such as stopping admissions until staff levels can be stabilised.

What has improved since the last inspection?

Re-decoration in resident`s rooms has been progressing well and residents were pleased with the work that had been done. Work on the outside of the home has improved its appearance. Infection control systems have been improved by the addition of a sluicing disinfector in the home. With the addition of 2 new chefs to the catering staff the standard of catering had improved, this would be improved even more when the new menus are available to residents. Efforts had been made to improve the provision of activities in the home and these are more varied and more regularly available to most residents.

What the care home could do better:

The standard of the pre admission assessments and detail in the care plans has deteriorated since the last inspection and needed to contain current and relevant information to avoid confusion. There were residents living in the home with varying levels of dementia and as a result particular individual needs. Training on dementia awareness is needed so that staff are able to respond to these needs. Adult Protection procedures were in place in the home but when a situation arose staff in charge had not responded quickly and appropriately. This had affected the safety of a resident and must be addressed. Complaints handling systems and the feedback of actions had been criticised and this must be improved so that anyone making a complaint has confidence in the investigation process, feedback and actions. The manager has a poorly defined job role and had to fulfil several roles. This results in poor management supervision of staff and support being stretched. This and the unsatisfactory staff levels at busy times of the day and a high staff turnover needs to be addressed quickly Consultation and communication within the home and with residents, relatives and other agencies was not always good and better communication systems would improve and inform services. The CSCI must be notified quickly of incidents and events that affect residents.

CARE HOMES FOR OLDER PEOPLE Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ Lead Inspector Marian Whittam Unannounced 26th April 2004 08:45 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. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Swarthdale Nursing Home Address Rake Lane Ulverston Cumbria LA12 9NQ 01229 580149 01229 581333 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) Vishomil Limited Helen Janice Watson Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) The home is registered for a maximum of 43 service users to - up to 43 service users in the category of OP (old age not falling within any other category) 2) The home must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 3) The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults Date of last inspection Brief Description of the Service: Swarthedale Nursing Home is a large old house that has been adapted and extended and now cares for up to 43 older people, including up to 15 older people who receive personal care only. The home is in a residential area on the outskirts of the south Lakeland market town of Ulverston approximately a mile from the town centre with all the usual amenities. The home is on a bus route and the station is less than a mile away. There are shops, a post office and a public house on the nearby housing estate. The home is on two floors and there are two passenger lifts for residents. There is a small private garden to the rear of the building with seating. At the front of the building there is a large car park and garden areas and seating. There are two main communal areas on the ground floor, a lounge with a conservatory attached and a large dining room with a quiet area. There are 32 single rooms, 28 with en suite and 6 double rooms although only 3 are being used as double rooms. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th April 2005 from 08.45 to 17.00hrs. Time was spent with the manager and touring the home and speaking with the residents individually and in groups in their rooms and in the lounge and also speaking with visitors, relatives and staff. A visit to investigate a complaint was made since the last inspection. Letters sent to the registered person following this can be obtained from the CSCI office on request. Concerns and experiences about the service raised by letters or telephone calls to the inspector before this inspection have been addressed at this inspection. An inspection by the Pharmacy inspector took place on 29th April 2005. What the service does well: What has improved since the last inspection? Re-decoration in resident’s rooms has been progressing well and residents were pleased with the work that had been done. Work on the outside of the home has improved its appearance. Infection control systems have been improved by the addition of a sluicing disinfector in the home. With the addition of 2 new chefs to the catering staff the standard of catering had improved, this would be improved even more when the new menus are available to residents. Efforts had been made to improve the provision of activities in the home and these are more varied and more regularly available to most residents. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 6 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. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.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 Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.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) 2, 3 and 4 The standard of the pre admission assessments done by the home had fallen and were not always sufficiently detailed to ensure individual needs could be met on admission to the home. Without this there is no assurance that care needs can be met. EVIDENCE: The assessing nurse had not completed sections of the pre admission assessments. There were recent examples of two people having being admitted without a thorough assessment and the home could not meet all their healthcare needs and safeguard other service users. Copies of assessment by social services and any other agencies involved were held on file and the home provided residents with terms and condition of residency and information on trial periods. The inspectors spoke with residents, relatives and visitors during the visit and some expressed concerns that not all needs were being identified and met, especially those with specialised needs such as dementia. Specific needs for those with levels of dementia were not detailed in care plans. A relative described a particular concern about a lack of staff understanding of dementia that meant that a resident’s health and social care needs had not been fully met. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 9 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 and 10 The personal and healthcare needs of residents were documented and had been reviewed but not always updated with changing needs. As a result staff were not always certain what to do to meet residents changed needs. Medicines handling was in need of improvement in line with good practice guidelines. There had been satisfactory access to healthcare according to need to promote service users health. Personal support in the home was at times poor and was not offered in such a way as to promote individual dignity and to meet personal needs for every resident. EVIDENCE: All residents had an individual plan of care and clinical and personal risk assessments had been done following admission. However, psychological health was not monitored in detail so changing needs were not quickly identifiable for nursing staff to take action. Assessments were out of date or incomplete in some cases. Although care plans had been audited changes were not always updated in the plan or assessments. The daily progress sheet provided information to follow events but not the actions staff needed to follow because of changes. Residents spoken with were not aware of what was in Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 10 their care plans and could not recall seeing them and some spoke about needs that had not been recorded in their plans. The pharmacist inspector examined medicines handling on 29.4.05 and found the administration of medicines was in need of improvement in order to ensure the safety of residents. A more detailed report of medicines administration is available in an additional visit letter from the CSCI Penrith office. Satisfactory arrangements were in place for seeing medical staff in private and shared rooms had screening. Staff observed were polite and pleasant with residents and one resident said that “ the majority of staff are very good, not at all bossy” and another that she could “find no fault” in how she was looked after. Some newer less dependent residents described how they had settled in well and had developed friendships while in the home. However, from speaking to more dependent residents, visiting families and friends and from letters received prior to the inspection the inspector was told of occasions when the staff had not helped residents with their personal care in a way that met their personal needs or maintained their dignity. Residents were not always being helped to the toilet as they requested and this placed residents at risk of not having hygiene and personal needs met, did not meet with their personal wishes and did not ensure their personal dignity was respected. The practice of writing peoples names on the outside of their wardrobes in double rooms should stop, as it is institutional and impersonal. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 11 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 and 15 The home provides some activities but this is not adequate enough to meet individual social and recreational needs or promote social relationships especially for those with levels of dementia. Family and friends were able to visit the home and keep contact as the residents want. The home has made progress to improve the provision of a varied menu and caters for particular needs of residents to provide a varied diet. EVIDENCE: The home had begun to improve the variety of activities it provided and kept some record of hobbies and interests but these were not detailed and individualised. No one person took responsibility to made sure that activities went ahead or were what people wanted. Much of this work fell to staff in addition to their main job as carers. Residents said that some carers did come in to have a chat and “ do their nails” for them but that they were very busy. There had been no discussion with residents on the kind of things they wanted to do in groups or on their own with support and no particular consideration given to stimulation and recreational activities for people with levels of dementia or those being nursed in bed. Several less dependant residents commented on the need for another lounge so they could have somewhere quieter to meet and talk and do other activities as they found the main lounge Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 12 noisy and crowded. A number of the residents living in the home and their visitors were spoken with and residents said that they had been given the opportunity to take part in more activities recently but one still said they “were surprised that they did not do more on a regular basis”. Two new chefs had been employed and were in the process of developing new menus. Residents said that the chefs asked them what they wanted each day and many residents commented that the food had improved recently with the new chefs and said that they enjoyed their meals. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 13 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 and 18 Although complaints policies and procedures were in place some relatives and visitors were not confident that their concerns were listened to and acted upon to protect residents. Adult protection arrangements were not satisfactory and staff understanding was poor placing residents at possible risk of harm and abuse. EVIDENCE: Despite there being a complaints procedure on the notice board and in the service users guide, anecdotal evidence given to the inspectors indicated that some of their complaints were not being followed up and fully dealt with. Residents, relatives and other visitors must feel confident that their complaints will be listened to, taken seriously and acted upon. In November 2004 CSCI investigated a complaint about personal care, staffing and lack of stimulating activities, which was upheld. The home had a procedure for responding to allegations of abuse and multi agency guidance was available. There had been two incidents that had affected residents that occurred in March 2005 and placed a service user at risk. These incidents were not acted upon promptly and reported to the appropriate agencies including the CSCI or according to the home’s procedures. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 14 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, 21,22, 24, 25 and 26 Recent investment has improved the décor, furniture and fittings in the home and improved the appearance of the home. Continued refurbishment of the home and additional social areas would further improve the environment for residents and provide more social areas. Unsafe water temperatures were compromising the resident’s health and safety. EVIDENCE: The new owners had already invested in improving the inside and outside of the home and further improvements are planned. Routine maintenance was being done. A relative said they had asked for their family members room redecorated and this was done with new carpets and residents were pleased with the improvements in their rooms. Other visitors said they had noticed, “Improvements with the new owners, they seem to be spending money on improvements” and that “they showed an Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 15 interest”. Some carpets still needed replacing and posed potential risks of tripping for service users The new owners had put in a sluicing disinfector improving infection control within the home. There is a lack of communal space for residents to meet each other socially or to meet visitors in private, or as somewhere quiet for them to go. Some told the inspector they had to get together in each other’s rooms for a chat and had developed friendships that way. Residents who were more dependent sat in the lounge and were often not able to hold conversations and could be noisy. A resident said that, “we need another lounge, I go to my room each afternoon as I can’t stand it in here.” A visitor said that her family member also sat in her room most days too as other people in the lounge shouted out and were disruptive. If social, recreational and privacy needs of residents are to be fully met then the home must address this and consult with residents to review and improve the sitting and recreational space that it provides separate to peoples own bedrooms. Hot water temperatures in some areas of the home are not being regulated and water leaving the tap is very hot. This places vulnerable people at risk and an immediate requirement was issued to put this right within the next 7 days. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.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 and 30 Staff morale is low with high staff turnover, sickness and the use of agency staff. This does not offer consistent management or nursing care to the people living in the home so their health’ personal and safety needs may not always be met. EVIDENCE: There has been a significant turnover of staff in the last 6 months. Until the levels of sickness and absence drop, the home is not taking any new residents in order to avoid affecting the care of the other residents. This is a sensible measure in the short term but in the longer term adequate levels of competent staff must be on duty at all times. Anecdotal evidence given to the inspectors and letters received about the home before the inspection indicate that staff levels have been low at times and residents have had to wait for the help they need. Anecdotal evidence from more than one source was that staff were easily not available to residents in the lounge and other areas as break times. The inspectors observed that a member of staff does not always remain in the lounge to offer assistance, support and make sure residents are safe, as some residents could not use the call bells. NVQ training was making good progress towards the target of 50 . Training plans were recorded for the rest of the year for staff and dementia awareness training for all staff must be included in this plan. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.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) 31, 32, 33 and 38 The management systems in the home are not clearly defined with no clearb leadership resulting in poor practices which do not promote the safety and welfare of residents. Consultation systems with residents and relatives must be improved if residents are to affect the way their care and the way services are delivered. EVIDENCE: While residents, relatives and staff spoke of the kindness and hard work of the manager many people gave examples of the manager being too busy, working as a nurse on duty, and “ not being the manager” and “not dealing with concerns”. The manager’s role boundaries, scope of responsibility and duties are not clear and she is fulfilling several roles including working as a nurse on duty and secretarial/ administrative work. Staff are not receiving sufficient leadership, guidance and direction. As a result practices went on that did not best serve residents and promote their safety and welfare. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 18 Staff spoken with felt that morale was beginning to improve and felt the manager worked hard. The residents said they saw the manager most days and one visitor said, “she knows everybody, she has a personal touch”. The home had used surveys in the past to find out people’s views however there were no regular meetings or individual or group discussion for residents and families to allow them to affect the way in which the service is delivered. The CSCI had not been notified promptly of all accidents, incidents and injuries asked for by the regulations and this could put residents at risk. Ways of making sure that residents and their families are listened to, kept informed and included must be developed to ensure the home is run in the best interests of residents in an open and transparent A visitor commented on having had feelings of isolation and a lack of support and understanding from staff about her relative’s condition when they first arrived. Records indicated that appropriate fire training, testing of emergency lighting and equipment and servicing of equipment had been done. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 19 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 3 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 2 3 3 x 3 2 3 STAFFING Standard No Score 27 2 28 2 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 3 2 2 2 2 x x x x 2 Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 20 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 OP3 Regulation 14 (1) Requirement Accommodation must not be provided to people unless their needs have been assessed in sufficient detail to ensure staff can meet their needs Care plans must be updated to reflect changing needs and current objectives for health and personal care. Care plans, including residents social interests, must be drawn up with in consultation with the residents. Psychological health must be monitored and preventative and restorative care provided. The manager must address the issue of unlabelled and insecure sleeping tablets in the bedroom of one service user. Selfadministration of sleeping tablets must be risk assessed and if this continues the resident should have access to appropriately labelled tablets and security issues must be addressed. To implement a system for identification of residents for medicines administration. Medication review must be requested for residents identified Timescale for action 31.5.05 2. OP7 15 (2) 31.5.05 3. OP7 15 (1) 16 (2) 13 (1) 13 (2) 31.5.05 4. 5. OP8 OP9 31.5.05 5.5.05 6. 7. OP9 OP9 13(2) 13 (2) 16.6.05 14.6.05 Page 21 Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 during this inspection. 8. OP9 13 (2) The manager must ensure that administration of medicines are signed appropriately on the MAR at the time of administration and that the dose administered is documented where this is variable. Hand written MARs must be specific for dose and frequency. Medicines with limited expiry after opening must be marked with the date of opening. Arrangments for personal care must ensure residents personal dignity is upheld. Residents must be consulted about the programme of activities arranged by the home with attention to recreational activities for residents with levels of dementia and those nursed in bed. Complaints must be fully investigated and the outcomes and actions notified to the complainant. All nursing and care staff must be given training on how to respond to suspicion or evidence of abuse. The worn carpeting in the lounge must repaired or replaced. Review in consultation with residents the provision of communal space to meet their social, recreational and privacy needs. Water temperatures must be regulated and design solutions found to maintain safe temperatures. There must at all times be sufficient suitably qualified, competent and experienced staff on duty to meet the health, social and welfare needs of 5.5.05 9. 10. 11. OP9 OP10 OP12 13 (2) 12 (4) 16 (2) 12 (4) 5.5.05 5.5.05 31.5.05 12. OP16 22 (1) 31.5.05 13. OP18 13 (6) 30.6.05 14. 15. OP19 OP20 13 (4) 23 (2) 31.5.05 31.5.05 16. OP25 13 (4) 4.5.05 17. OP27 18 (1) 5.4.05 Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 22 residents. 18. 19. OP30 OP32 18 (1) 12 (1) (2) (3) and 21 (1) 37 Dementia awareness training must be included in the training plan for 2005. A review of the arrangements in place to enable residents, staff and families to communicate and affect the way services are provided must be undertaken. Notifications required under Regulation 37 must be made to the Commission without delay. 30.6.05 30.6.05 20. OP38 5.5.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Refer to Standard OP9 OP9 OP9 OP10 OP12 OP18 OP27 OP27 OP30 OP30 Good Practice Recommendations To review the policies for the administration of nonprescribed medication. Where an interaction is noted that advice be sought from a pharmacist or GP of action to take and documented. The contents of the medicines cupboard should be reviewed. Residents names should not be displayed on wardrobe doors in shared rooms. There should be one person to oversee the activities programme and make sure they happen as planned. All staff should be given training on dealing with verbal and physical agression by residents Staff should not take their breaks at the same time. There should be a staff presence in the lounge to provide assistance and support. The manager should have a clear job description making clear their role,duties and scope of responsibility. Lines of accountability and management processes within the home and external management should be clear. Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park, Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swarthdale Nursing Home F58-F10 s61688 Swarthdale NH v208787 270405 ui Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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