Inspection on 20/10/06 for The Firs Residential Care Home

This inspection was carried out on 20th October 2006.

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

Other inspections for this house

The Firs Residential Care Home 07/08/07

The Firs Residential Care Home 29/12/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Firs Residential Care Home (The) 2 Lickhill Road Calne Wiltshire SN11 9DD Lead Inspector Alison Duffy Unannounced Inspection 20th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000067611.V316067.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000067611.V316067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Residential Care Home (The) Address 2 Lickhill Road Calne Wiltshire SN11 9DD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01249 812440 The Firs Care Home (Calne) Limited Heike Sampson Care Home 20 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (19) of places DS0000067611.V316067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection under the new ownership of the home. Brief Description of the Service: The Firs is a residential care home registered to care for twenty older people, one of whom may have a diagnosis of dementia or associated illness. The home has recently seen a change in ownership. Mrs Sehnaz Butt of the Firs Care Home (Calne) Limited, now owns the home. Mrs Butt owns another care home within the Bristol area and spends her time between the two services. Mrs Heike Sampson continues to be the Registered Manager. The home is situated within a residential area on the outskirts of Calne town centre. There is a fair walk into the town alhough residents would probably find a car journey more appropriate. Private accommodation consists of two twin and sixteen single rooms. All are on the ground floor and have access to a call bell system. Communal areas consist of a dining room and two adjoining lounges. These areas are comfortable, homely and have recently been refurbished. An enclosed garden has been created to the rear of the property. Staffing levels are maintained at two members of staff throughout the waking day with an additional member undertaking a 9am – 12noon shift. At night a member of staff undertakes a waking night and there is also sleeping in provision. Management on call support is available at all times. Nursing or intermediate care is not provided at the home. Any required nursing task would be referred to the Community Nursing Team. The fees for living at the home range between £380 and £425 a week. DS0000067611.V316067.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 20th October 2006 between the hours of 9.30am and 2.40pm. Further visits were undertaken on the 8th November, between 9.30am and 4.30pm and the 16th November between 9.30am and 1pm. Mrs Butt needed to leave on the first morning of the inspection. However at all other times, Mrs Butt and Mrs Sampson were available to assist and discuss matters as required. At the start of the inspection, discussion took place with Mrs Butt and Mrs Sampson regarding the new ownership of the home. This included the changes, which had been made so far. Mrs Butt expressed a clear indication of further developments, which she has planned. So far, there has been significant progress with the environment. This has included the refurbishment of communal areas and fire safety works. Mrs Butt is also working with staff to enable the service to be more resident focused. Mrs Butt confirmed that this would take time, as she was not wishing to condemn any practice that had taken place in the past. The inspector spoke with a number of residents in their own room and within communal lounges. The feedback was generally positive. Any reported negativity generally centred on insufficient occupation during the day. As part of the inspection, comment cards were also sent to all residents, their primary relative, their GP and social worker (if applicable.) A positive response was received although there was some negativity within the feedback. In general, this related to staffing and lack of activity. On a positive note, one relative stated ‘my XX has been very settled and content. I feel this in itself speaks for the quality and level of care she has received and the general atmosphere in The Firs. The home has been taken over by new management in the last few months and we are so far pleased with the changes that have been introduced. It is encouraging to learn that the new owners intend to undertake improvements to the accommodation and facilities provided. It is still ‘early days’ with the new management regime but indications so far are very positive and overall I am very satisfied with the quality of care and facilities provided for my XX.’ The inspector viewed care-planning information, daily records, staffing rosters, menus and the fire log book. Staffing information including training and recruitment were also addressed. A tour of the accommodation was made and the medication systems were examined. Prior to the inspection, Mrs Butt submitted an application to vary the home’s registration to accommodate five residents with dementia. Within the inspection, discussion took place at length regarding changes in service DS0000067611.V316067.R01.S.doc Version 5.2 Page 6 provision, which would be required in order to meet such specialist need. It was evident through discussion that Mrs Butt did not want to change the atmosphere of The Firs. The variation was intended to enable residents with low-level dementia care needs to maintain their lives within the existing structure of the home. Providing a specialised dementia care service was not the intention. It was therefore agreed that this matter should be addressed within the home’s Statement of Purpose. It was not necessary to have a separate category of registration. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Since the last inspection, there have been significant developments with the standard of the environment. Communal areas have been refurbished and there is a programme of redevelopment with residents’ bedrooms. Locks are in the process of being fitted to all residents’ doors. The garden has been DS0000067611.V316067.R01.S.doc Version 5.2 Page 7 enclosed so residents are able to use the area without the fear of going on to the road. Patio doors have also been installed to give easier access to the garden. The regularity and content of staff meetings have been improved and systems such as the development of a key-worker system will further benefit residents’ care. Additional training opportunities, such as a six-week dementia care course, has been undertaken. Other topics include adult protection and fire safety. The home now has its own transport, so enabling residents to attend external events will be made easier. Mrs Butt and Mrs Sampson have assessed the service and are clear on the developments they wish to make. Both are committed and motivated to build on existing good practise, in order to make the service more resident focused. What they could do better: As feedback from comment cards identified some negativity with staff, staff should consider how residents and their visitors perceive their actions or attitude. Within the first day of the inspection, staff engagement with residents was also poor. Residents have access to health care services yet some responses from staff appear insufficient in addressing poor health. Greater monitoring is therefore required. While some residents are content to relax and watch television, others would benefit from greater occupation. This involves more individual activity within the home and more external activity. Staffing levels are currently being maintained at a minimum. In particular, having only two care staff on duty between the hours of 8am and 9am with 20 residents is insufficient and does not enable personal care needs to be met in a relaxed manner. Mrs Butt reported that she has identified additional staffing as a need and is in the process of addressing this area. Although there is a high level of care planning information in place, the organisation of documentation makes evidencing care provision a challenge. Proposed changes to the care planning system will improve the standard significantly. While the home encourages an open culture, consideration should be given to building confidences of those residents not wanting to complain. DS0000067611.V316067.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000067611.V316067.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000067611.V316067.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable, as intermediate care is not provided within the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient information is given to prospective residents so an informed choice can be made about moving into the home. Assessments form an integral part of the admission process. However, all forms of documentation should correspond, in order to fully meet individual need. The Statement of Purpose must evidence the level of need, which can be accommodated in the home. EVIDENCE: Since the last inspection there have been a number of new residents to the home. The assessment material of two of these residents was viewed. It was noted that one contained an assessment from their social worker. The other contained discharge information from hospital. All documentation was detailed and enabled an informed decision to be made regarding the suitability of the placement. Mrs Sampson confirmed that prospective residents are also encouraged to view the home. Sometimes however, family members make the decision on their relative’s behalf. Mrs Sampson reported that a visit to the DS0000067611.V316067.R01.S.doc Version 5.2 Page 11 prospective resident’s own surroundings to undertake a pre-admission assessment is made. Letters were available to demonstrate that Mrs Sampson had written to the prospective resident confirming that the home could meet their needs. Although a range of information was available, some aspects had not been transferred to the care plan. This included the need for regular pain relief, individual hobbies and potential risks. Another assessment stated that the resident needed close supervision due to a risk of falls. They also needed medication to aid sleep. The care plan however, contradicted this, stating mobility was good and XX slept well. Mrs Sampson reported that the resident had portrayed differently on admission and therefore the care plan had been developed to reflect this. It was agreed that any change should be documented accordingly. Contracts were not assessed during this inspection. However within comment cards, nine residents confirmed that they had a contract. Three were not sure and one said ‘no.’ Two residents confirmed their contract was made with the previous owner. Mrs Butt confirmed that she was in the process of reviewing all contracts and these would be issued in due course. Eight residents confirmed that they received sufficient information about the home before their admission. Three said they did not. Specific comments included ‘I was brought here by somebody, but I like it here’ and ‘this was the only available room in the area, in the only available home.’ A relative confirmed ‘the home was chosen because it was small. Heike [the registered manager] visited XX in hospital. XX didn’t visit The Firs although was able to do so.’ As stated within the summary of this report, Mrs Butt has recently applied to vary the home’s registration to accommodate five residents with dementia. Through discussion and observation during this inspection, the home is currently not ‘set up’ to manage specialist needs such as challenging behaviour, severe agitation or disorientation. Mrs Butt agreed that she did not wish to provide such a service. It was agreed therefore, that Mrs Butt would clearly document her criteria for admission, within the Statement of Purpose. Further feedback from relatives, stated that in addition to the weekly payment of living in the home, relatives have to supply bed sheets, waterproof sheeting, towels, flannels and incontinence pads. Mrs Butt confirmed that in the past residents were expected to bring in their own towels and flannels. Also, before an assessment can be undertaken to qualify for free incontinence aids, residents are expected to pay for their needs. Mrs Butt confirmed that fees for incontinence aids are addressed within contracts. Other provision would benefit from clarification. DS0000067611.V316067.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current documentation does not fully reflect individual need and required care provision. However, planned developments with care plans will significantly improve the standard of information available to staff. Residents have access to health care intervention yet there is some evidence that staff may not be responding to ill health, as they should. Medication systems are generally well managed yet adjusting some practises would minimise the risk of potential error. Systems are in place to promote residents’ privacy and dignity yet some staff practises, compromise this. EVIDENCE: The home uses the ‘standex’ system for recording residents’ information. Within this there is a summarised account of individual need within a long and short-term care plan. In addition Mrs Sampson is currently developing a life history format. Residents are involved with completing this document. All residents also have a separate file, which contains assessment material, health care appointments, contracts and any other correspondence. There are further files that contain pressure area care, manual handling, falls, nutritional and DS0000067611.V316067.R01.S.doc Version 5.2 Page 13 risk assessments. Within all files, a large amount of information is maintained. However, being stored in various places makes consistency of evidencing care, a challenge. Mrs Sampson confirmed that recently, she has noted that the current system no longer meets the needs of the home. Mrs Butt also confirmed that the existing system did not demonstrate the person centred approach, which she wishes to apply. By the second day of the inspection, a draft care plan had been developed. This was much improved and if completed in detail, would be a valuable tool to meet residents’ needs. Mrs Sampson has generally signed and dated all care plans yet there were some omissions. Some residents have also signed their plan. There were some entries within the short-term plan, which had not been reviewed. Within some existing information, there were instances when greater detail would be of benefit. For example, ‘on bad days needs the assistance of two carers.’ Terms such as ‘is confused’ also require greater clarity. Within a risk assessment dated 22.8.06, it was identified that one resident does not drink enough. A fluid chart had been set up yet further intervention or conclusion was not evident. Another resident had been identified with a risk of weight loss. Although regularly weighed, preventative measures were not identified within the care plan. It was also noted within daily records that one resident did not receive an aspect of their personal care due to unpredictable behaviour. This was not identified within the care plan and guidelines for the management of such were not evident. Health conditions such, as Diabetes and Parkinson’s disease were addressed yet due to the various locations of information, an overall management plan could not be evidenced. Mrs Butt explained that shortfalls in record keeping appeared to be linked to the current system of care planning. The framework did not enable staff to record information, other than that covered by specific headings. Once in place, Mrs Butt believed the new care plans would enable identified shortfalls to be successfully addressed. The information would also be kept together in one file, which would be clear and more comprehensive. Daily records generally contained information about the provision of personal care and sleep patterns. Within one record there was an entry whereby a resident got up at 12.30am and asked for tea and toast. The report stated that XX was assisted back to bed. The resident continued to have an unsettled night yet documentation stated that tea and toast were given in the morning. Through discussion, Mrs Butt confirmed that she would address this with the staff team. However, she did not believe that staff would intentionally deny a resident’s wish of food. Mrs Butt suspected that the problem might lie with a recording issue. Within comment cards received from residents, nine confirmed that they always receive the care and support they require, Two said usually’ and one said sometimes. One resident confirmed ‘the staff are always available for me DS0000067611.V316067.R01.S.doc Version 5.2 Page 14 to talk to’ and another stated ‘I am quite happy here.’ Another said ‘I always try to thank the carers for what they do for me. I hope our report is satisfactory.’ Within comment cards received from relatives there were a number of comments regarding care provision. On a positive note, it was reported ‘staff help XX wash and dress and XX is kept clean.’ Negatively, one relative stated ‘staff are never able to answer questions such as ‘what medication is XX on. One member of staff said ‘I think she is on…’ Relatives generally felt they were kept informed of events. Mrs Sampson confirmed that this is the intention and informal discussions are welcomed. Daily records and care planning information highlighted access to various health care services. However, further detail in some areas would be of benefit. This includes matters such as ‘has chiropody.’ There was little evidence of optician’s appointments or dentistry although Mrs Sampson confirmed these are arranged as required. It was identified that one resident, is regularly escorted to health care appointments with a family member. Mrs Sampson should ensure that a written account of any intervention or the reason for the appointment is made. It was evident within one daily record that a resident was ‘quite unresponsive and sleepy.’ This appeared an isolated incident yet there was no evidence of any intervention or a GP visit. Another entry highlighted a fall, whereby a resident had redness to their head. There was no evidence of medical input or of any further monitoring. Mrs Butt reported that she would investigate these areas, as she believed staff were generally, very good at calling the GP as required. There have been occasions when a resident has left the building unattended. This has been identified within a risk assessment. There are now alarms on all exit doors and the rear garden has been enclosed. Mrs Sampson must however monitor the situation and apply additional control measures such as additional staff as required. CSCI must also be informed of all such incidents under regulation 37. As stated earlier, all residents have a pressure sore risk assessment. In some instances, preventative measures were identified. However, some assessments were concluded with a term such as ‘low’ or ‘high risk.’ There were no guidelines for further action. This was discussed with Mrs Sampson. On the second day of the inspection, criteria for further intervention, was in place. Within comment cards, eight residents reported that they always receive the medical care they require. Six said ‘usually’ and one said ‘it could be improved upon.’ Medication is currently administered through a system of dosette boxes, which the local pharmacy provides. Changes are currently being investigated, as the system was reported not to be totally successful. Mrs Sampson confirmed that only a number of staff administer medication. These are the more experienced members who have had training and also undertake competency checks. The DS0000067611.V316067.R01.S.doc Version 5.2 Page 15 medication was orderly stored and each medication had been receipted appropriately. Photographs are located before each medication record, in order to minimise the risk of error. Information regarding each medication had been taken from the Internet for staff reference. There was one gap in the medication administration record related to a prescribed tablet. Some creams however had not been signed for. A number of creams stated ‘as prescribed’ or ‘as directed’ on the label. Mrs Sampson confirmed that this has been addressed with the pharmacy and the GP, yet changes have not been made. There was inconsistency with countersigning hand written instructions and also with documenting the dates of opening eye drops. Staff had recorded the number of tablets given in the event of a variable dose. It was noted that one resident had been prescribed ‘as required’ medication yet this had been given consistently each night. Mrs Sampson stated the resident appeared to need the medication and it appeared to help. Mrs Sampson was advised to discuss the medication’s usage with the resident’s GP. The practise of assisting one resident who did not want to take their medication was observed. After some exchange, involving the reason for the medication, the resident walked away. The liquid medication was then left on the table, unaccompanied. This practise must be addressed with the staff team. Staff were observed to knock on doors and wait to be invited in, before entering. However there were some practices, which have been identified within areas of this report that do not promote residents’ dignity. These include poor engagement from staff and some inappropriate and inadequate staff responses. DS0000067611.V316067.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. While some activity is organised, this is insufficient for some and more opportunities are required. Greater monitoring of staff members engagement with residents is needed to ensure individual needs are met and well being is assured. Visitors are welcomed yet are encouraged to avoid mealtimes. Some residents expressed an element of control over their life but some appear restricted through routine. Residents benefit from a choice of meal and appear satisfied with current meal provision. EVIDENCE: Within the morning of the first day of the inspection, activity within the home was minimal. At 10am eight residents were asleep in the lounge and many needed to be woken up for their morning drink. Interactions between staff and residents were minimal. Some staff were supporting residents with their mobility but there was no communication of any form. In one instance, the member of staff was walking behind the resident rather than at the side. One resident asked for a cup of tea. They were told the kettle was on but the tea did not arrive. The resident then asked for their frame but they were given a cushion. The member of staff was clearly not engaging with the resident. It was apparent that this resident was restricted in their movement without their DS0000067611.V316067.R01.S.doc Version 5.2 Page 17 frame. Mrs Sampson reported that risks had been identified, if the resident was unsupported by staff. It was agreed that the risks needed to be addressed within the risk assessment process and be agreed with the resident’s care manager and their family. On the second day of the inspection Mrs Sampson confirmed the risk assessment had been completed. Poor engagement with residents continued throughout the morning and at 12noon four residents were asleep at the dining room table. The member of staff continued to lay the table without interaction. A relative also confirmed within their comment card, ‘interactions between staff and residents are minimal. Basic care is provided which includes getting up, sitting at the dining room table for lunch then back to the armchair etc, etc. There is no discussion or no extra attention/care.’ The lack of engagement was discussed as an area of concern with Mrs Butt and Mrs Sampson. Both agreed that this practice was not the norm, yet would address the matter with the staff team. The inspector was pleased to note that on the second day of the inspection, interactions were much improved. Interactions and communication were also evident when staff were not aware that they were being observed. Mrs Butt confirmed that she was aiming to develop social activity both in house and externally. The home now has its own transport so that external events will be easier to organise. A number of residents reported a successful trip out to a garden centre, which was much appreciated. Other residents confirmed that they recently enjoyed a singer who had visited the home. One resident stated ‘there isn’t much to do, I wish there was more’ and another said ‘the days are long. I wish I could do more.’ Within comment cards three residents confirmed that there are always activities in which they can join in with. Four said ‘usually’ and seven said ‘sometimes.’ Within comment cards received from relatives there were a number of negative comments regarding social activity. These included ‘activity is minimal. Although I visit regularly, I have only ever seen a game of snakes and ladders and throwing a ball at each other. XX has not been out since being in the home’ and ‘XX is very inactive. There are not enough staff so XX is never taken out and therefore never gets any fresh air. The first trip to Whitehall (a garden centre) took place last week as the home has a minibus now.’ Another comment card confirmed ‘activity within the home is limited.’ Two residents confirmed that the home enables you to do what you like. This includes staying up late, staying in your room and watching television when you want to. One resident however, did not want to complain or cause trouble but stated that she was woken up early so that the staff could get everyone ready for breakfast in time. The resident confirmed that they didn’t really mind as ‘you could doze in the daytime.’ One relative reported that ‘XX is not very social but is expected to stay in the lounge all day.’ A resident also gave this impression. Another relative also confirmed that ‘one resident, XX is allowed to stay in bed and walk around in pyjamas. (Others are not allowed to do this.) Often in the afternoon XX is still in bed and hasn’t had lunch.’ Mrs Butt DS0000067611.V316067.R01.S.doc Version 5.2 Page 18 reported that it is intended that The Firs is the residents’ home and therefore preferred routines must be respected. Mrs Butt reported that individual choice of how residents want to lead their life is paramount. Mrs Butt confirmed that she would revisit these areas with residents and staff. It was agreed that as some residents feel they are able to do as they please, others may need the knowledge or confidence, to ensure they could do the same. A number of residents reported that they are able to have visitors when they wish. Mrs Sampson confirmed this, although stated that visits are discouraged at mealtimes if possible. If a visitor happens to arrive at lunchtime, for example, they are asked to wait in the lounge until the resident has finished their meal. Within a comment card, one relative confirmed that the owners and staff welcome them into the home. They are also able to visit their relative in private. Mrs Sampson reported that there have been no changes to the meal arrangements other than care staff are currently undertaking meal provision. The cook’s vacancy is being advertised. Meals are generally served in the dining room. In addition to conventional food, vegetarian and diabetic diets are currently being catered for. On the morning of the inspection, a member of staff asked residents individually, what they wanted for lunch. A choice is available for each meal. Within discussions with residents, general feedback included ‘the food is very good’ and ‘we can’t complain.’ Within comment cards, four residents said the food is ‘always’ very good. Ten said ‘usually.’ Specific comments included ‘the food is very good and there is always a choice,’ ‘the food is very nice’ and ‘could do with more variety and not have sauces i.e. cheese or white sauce.’ Two relatives commented that the food is very good. Within a comment card, it was reported that a family member takes items of food, such as biscuits into their relative. The relative continued however to report that ‘nothing stays in the room. Items such as biscuits and drinks always get taken away and are not seen again.’ Mrs Sampson confirmed that items are only ever taken from a room if there is a concern with overeating or complications with a health condition. This is however very rare. It was agreed that this restriction should be discussed and agreed with all concerned. DS0000067611.V316067.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home encourages an open culture yet consideration to build confidences of those residents not wanting to complain, would be of benefit to some. Residents are assured greater protection through adult protection training. However, further consideration regarding local reporting procedures would give greater strength to the system of protecting vulnerable adults. EVIDENCE: The home has a detailed, well-written complaints procedure, which includes the required information. The procedure is clearly displayed on the wall in the entrance area. Within discussion, a number of residents stated that they would ‘tell Heike’ if they weren’t happy. There were also comments however, implying that some residents did not want to cause any trouble. As a result of this, they didn’t want to raise any issue. Within comment cards, eight residents confirmed that they knew who to speak to if they were unhappy. Five said ‘usually’ and one said ‘sometimes.’ Specific comments included ‘I speak to Heike and the staff on duty at the time’ and ‘if I’m not happy, which is rare, I would go to Heike.’ One resident stated ‘I could do with sitting down with someone one-to-one, so I could speak frankly instead of everyone butting in.’ Within feedback, Mrs Butt reported that she hopes the introduction of the key worker system would assist in this area. Another resident said they didn’t know how to make a complaint, as they had never had to. All relatives except one stated that they were aware of the home’s complaint procedure. Mrs Butt confirmed that she encourages residents to share their views as a way to DS0000067611.V316067.R01.S.doc Version 5.2 Page 20 encourage the development of the service. She continued to report that sharing concerns would be revisited with both residents and staff in order to enable an open culture. The home has a copy of the Wiltshire and Swindon Vulnerable Adults procedures. Copies of the summarised ‘No Secrets’ documentation are also available. All staff have completed adult protection training. This did not however include local reporting procedures. Mrs Butt is therefore advised to contact the Vulnerable Adults Unit for possible training opportunities. As stated later in this report, Mrs Sampson confirmed that abuse refresher courses have been arranged for some identified members of staff. DS0000067611.V316067.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of a clean, well-maintained environment, which provides all facilities on one level. Since Mrs Butt has taken ownership of the home, the standard of the accommodation has improved significantly. The refurbishment of residents’ bedrooms will further enhance the quality of each resident’s personal space. Although the area is now secure, consideration is needed to minimise potential risks to residents, who may be unaccompanied in the garden. EVIDENCE: Since Mrs Butt has taken over the management of the home, there has been significant consideration regarding how the environment can be improved upon. New furniture has been placed in the entrance hall making the area more homely and welcoming. The lounges have been re-carpeted and all armchairs have been replaced. A door has been added to the lounge to divide the area. This enables the opportunity to have an additional quiet room when DS0000067611.V316067.R01.S.doc Version 5.2 Page 22 the television is on. Patio doors have also been created where a window was in situ. This enables easier access to the garden. The garden has been enclosed to promote residents’ safety. However, residents would require assistance to use the garden due to uneven paving, varying steps and some uneven ground. Mrs Butt confirmed that these areas would be addressed. A number of residents commented on the new television, which is much bigger and clearer than the old one. Mrs Butt confirmed that a programme to redecorate all bedrooms has commenced. This includes new fittings, carpeting and furniture if required. Additional items such as new towels and bedding have been purchased. Mrs Butt is aiming to replace all draw-sheets (a sheet used on the bed to contain incontinence) with more appropriate and modern ‘kylies.’ Within the professional feedback from comment cards, it was raised that a black bin liner had been used instead of a waterproof pillowcase. Mrs Butt confirmed this was an error, which should not have occurred. A difficulty with the heating was also raised. Mrs Butt confirmed that radiators in a number of rooms had been turned off. This has now been addressed. Residents’ bedrooms are located on the ground floor. All rooms viewed, contained a high level of personal possessions demonstrating individuality. Call bells were readily accessible. Residents confirmed satisfaction with their environment. Two relatives confirmed ‘XX has a lovely room.’ One resident said that additional lighting had been provided to assist with reading. Within a tour of the accommodation it was noted that there were various types of locks on bedroom doors. Some of these did not appear easily accessible in an emergency. One relative reported ‘the rooms are open to the wandering of the less mentally capable residents, as are the toilets, which are limited in number.’ Mrs Butt confirmed that she had intended to assess the locks, as she had noted that they were unsatisfactory. Within the second day of the inspection, new locks were in the process of being fitted. The environment was cleaned to a good standard throughout and there were no unpleasant odours. Liquid soap was available in all toilets. Within residents’ surveys, eleven stated that the home is always fresh and clean. Two said usually and one confirmed ‘my room is freshly decorated and we now have a new cleaner.’ A relative stated ‘my XX is very happy and very well cared for. Everything is kept very clean and it’s a very friendly place when I visit. I am very pleased with the home.’ On a negative note, two relatives reported that they were continually asked to bring more of their relatives’ clothes into the home. This was because the home had been without a tumble drier for approximately 2 months. The relatives continued to report ‘the tumble drier was finally purchased yet took forever to be installed’ and ‘during this time, limited amounts of clothing were available to residents. Some needed to wear other peoples’ clothes.’ Mrs Sampson confirmed that there were many problems with the tumble drier and DS0000067611.V316067.R01.S.doc Version 5.2 Page 23 its installation. However, many trips were made to the local launderette to ensure residents’ clothes were returned to individuals quickly. Mrs Sampson strongly denied that residents needed to wear other people’s clothes. There is now an industrial washing machine and tumble drier in situ. On the day of the inspection the laundry was ordered and well managed. Further comments from relatives included ‘residents clothing does not get ironed. The draw-sheets the home uses are terrible and not good enough to be used as cleaning clothes. Towels are hard like boards.’ Mrs Butt confirmed that it is the responsibility of the night staff to undertake all ironing. To date a problem has not been identified yet Mrs Butt agreed to monitor the situation. As stated earlier in this report, Mrs Butt is in the process of purchasing new draw-sheets and new towels are in situ. Mrs Sampson reported that residents generally have their own towels, as in the past, towels were not provided. DS0000067611.V316067.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels, although maintained in line with the previous registration authority, are not sufficient to enable relaxed routines. More robust monitoring of some staff is required so that residents are not put at risk of poor practice. Recruitment is generally well managed yet further attention to detail would ensure residents’ greater protection. Additional training is planned to enable further development of skills and service provision. EVIDENCE: The staffing roster demonstrated that there are two members of care staff on duty at 8am. This increases to three at 9am. After approximately 12noon, the levels reduce back down to two. There is sometimes an overlap of staff due to shift patterns. Discussion took place regarding staffing levels, as it was apparent that for 20 residents, having only two staff on duty at key times is insufficient. Mrs Butt confirmed this had been identified and she was planning to deploy an additional member of staff at this time. Mrs Sampson also reported that discussions had been held with staff in order to increase the length of their shifts. This would ensure residents’ greater consistency. In response to the morning routine, one resident confirmed that they are woken up, so that the night staff can get everyone ready before they go off duty. The resident stated however, that they were not complaining, as they could doze later in the day. Mrs Butt confirmed that this should never happen DS0000067611.V316067.R01.S.doc Version 5.2 Page 25 and reported that individual wishes and routines would be revisited with staff. In relation to staffing levels, one relative confirmed, that they believed there are insufficient staff on duty. Another stated ‘there are never any staff around. Residents shout for the toilet but do not get heard.’ Five residents within their comment cards stated, staff were always available. Nine said staff were ‘usually’ available. One relative reported that ‘staff are currently cooking as the cook has left. They are also doing most of the cleaning.’ Mrs Butt agreed that care staff who wish to do so, are currently cooking. This is however, in addition to their care hours and is not interfering with care provision. A new domestic has recently been employed. The hours of deployment involve mornings during the week. At weekends care staff undertake minimal cleaning duties as required. Mrs Butt was informed therefore to address the absence of domestic staff when devising the complement of staff required for each shift. Within feedback there were a number of negative comments about staff members. One comment included ‘one staff member, XX, makes totally inappropriate comments. This has included ‘you wet the bed like a baby’ and ‘you’re a moaner, we’ll call you the Mona Lisa. XX has also made faces when a resident has asked for something.’ Another comment from a different source, involved the same member of staff. It was reported ‘one member of staff, XX is very abrupt and shouts for example ‘sit down.’ There is one resident, who often calls ‘Nurse, Nurse I want to go home.’ This member of staff has said ‘shut up, you’ve not got a home.’ In addition to this staff member, there was another specific comment about another member of staff. This stated ‘XX is aggressive and short when dealing with residents.’ A further comment included ‘XX often says staff are rough when helping XX with a bath.’ This was clarified as staff being insensitive to frailty, rather than inappropriate ‘manhandling.’ The seriousness of these comments was discussed with Mrs Butt and Mrs Sampson. Both confirmed that the issues would be dealt with immediately. On the second day of the inspection, Mrs Butt confirmed that the staff members had been spoken with formally. Mrs Butt expressed to the staff that such behaviour would not be tolerated. Further training has been arranged and the situation is being monitored through formal supervision and observation of practice. Mrs Butt confirmed that if any further evidence were apparent, CSCI would be contacted immediately. Mrs Butt reported that legal advice was also being sought regarding the staff members’ deployment. It was agreed, in the event of any further evidence, a referral would need to be made to the Vulnerable Adults forum. Additional comments from relatives included ‘staff are friendly and always offer a cup of tea.’ Also, ‘during a recent visit, staff handled a challenging incident very well yet there appeared to be no senior staff on duty.’ Mrs Butt confirmed DS0000067611.V316067.R01.S.doc Version 5.2 Page 26 that there might not always be a designated senior member of staff on duty. However, in such instances, all staff are competent to take charge of the home. Within discussion, it was agreed that it would be good practice to have a nominated person to take control in the event of an emergency. Mrs Butt confirmed this would be allocated according to skill and would be identified within the staffing roster. There were two comments involving the language barriers of some staff. One included ‘many staff are foreign and the language barrier is a real problem’ and ‘the hearing of many of the residents is not good. This is not helped when English is not the first language of the carer, also English should be used whenever residents are present.’ Mrs Butt confirmed that the home does have staff who do not have English as their first language. She was not aware of any difficulties but would investigate the matter. Within comment cards received from residents, thirteen confirmed that staff always listen and one said ‘sometimes.’ To clarify their answer of ‘yes,’ one resident had stated ‘maybe at the time of their own choice.’ Documentation demonstrating the recruitment procedure of the two most recent members of staff was viewed. It was noted that the application form had been revised and now contains greater detail. A health care questionnaire and a declaration of criminal offences are both in place. Mrs Sampson has also developed a standard written reference request letter. Both files contained two written references. In one instance however, the relationship of the referees was not evident. It did not appear that one reference was from a previous employer. With the second member of staff, one reference stated ‘XX’s work was satisfactory’ and there was no further detail. It was recommended that further information should be sought in such instances. Within documentation sent to CSCI before the inspection Mrs Sampson confirmed that one member of staff has NVQ 2 and three staff have NVQ 3. Mrs Butt confirmed that she would be looking to encourage more staff to undertake this training. At present however, staff views of this had not been determined. Within the home, Mrs Sampson had devised a training matrix. This identified the subjects that had been undertaken but there were no dates. The matrix was also in need of updating as some subjects such as manual handling had been undertaken but had not been recorded. Other topics included medication, food hygiene, challenging behaviour, dementia care and POVA. Many staff had a certificate, which demonstrated competence within fire safety. Mrs Sampson confirmed that the course had been completed in house and the certificate had been devised on completion of the course. As Mrs Sampson had facilitated the fire training, it was recommended that the certificate demonstrated attendance rather than competence. Mrs Butt confirmed that she wanted to give training priority and is currently arranging additional topics such as communication and the key worker role. DS0000067611.V316067.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mrs Butt and Mrs Sampson are motivated to develop the home further and have already made progress. Mrs Butt is aiming to further develop a resident focused service, which reflects residents’ individuality. While consideration has not been given to a formal quality assurance system, improvements are being made to service provision. Residents’ personal monies are well managed, which minimises the risk of error. Health and safety is given priority yet greater attention should be given to monitoring the actions of others, in order to ensure a safe environment. EVIDENCE: As stated earlier in this report, Mrs Butt took over ownership of the home in June of this year. Mrs Butt currently owns another registered care home in the Bristol area. Through discussion it was evident that Mrs Butt has a clear DS0000067611.V316067.R01.S.doc Version 5.2 Page 28 resident focus. Mrs Butt confirmed that she has observed current care provision and has spent time building relationships with residents, their families, staff and other professionals. Various changes have been made and Mrs Butt has a plan for further changes, she would like to implement. Mrs Butt confirmed that these would not be applied over night as many included a shift in attitude or practice. Mrs Butt felt strongly that she wanted to empower staff and build on existing good practice so as not to condemn previous provision. Mrs Butt confirmed that she visits the home on alternate days. She also provides some management cover during the weekend when Mrs Sampson is off duty. Mrs Sampson commenced her role as the registered manager in August 2003. She has since completed the Registered Manager’s Award. Mrs Sampson has continued in her role following the change in the home’s ownership. Mrs Sampson confirmed that she is well supported. It was evident that Mrs Butt and Mrs Sampson have worked closely in all areas of development. Both have a clear aim of future provision and are enthusiastic about the future of the home. As stated earlier in this report, consideration must be given to strategies for allowing staff to consider their practice. Within discussion with residents, a number reported on the new management. One resident said ‘Mrs Butt is very nice. She talks to me a lot and says I should always remember it’s my home so I can ask for things that might make my life better.’ When asked about any recent changes two residents commented about the large television that has recently been purchased. Within comment cards received from relatives, there were a number of negative comments. These included ‘the new provider is very new and she hasn’t been in the home for long. She is very nice but is far removed from the home’ and ‘Mrs Butt is never around. The Manager doesn’t get involved in any care work and doesn’t know what is going on. Staff are unhappy and many are trying to get other jobs. (The Indian girls are very good.)’ An additional comment stated ‘the manager doesn’t have a lot to say. In fact, since Mrs Butt has taken over the home, Heike is in the office. Anytime you might see her and ask how’s XX, she just says ‘fine.’’ These comments were discussed with Mrs Butt and Mrs Sampson. Both were alarmed and did not realise that this was the way some relatives felt. Both felt that they were visual within the home and always welcome open discussion. Mrs Butt confirmed that she would consider ways in which to address the areas. On a positive note one relative reported that ‘Heike keeps me up to date and checks that I have XX’s appointments in my diary.’ When Mrs Butt took over ownership of the home, a social evening with residents and their families was held to ensure introductions. Within this, Mrs Butt commented upon planned developments. These include enhancing the environment, providing more activities for residents and further staff training. Mrs Butt requested further ideas and reported that any views would be welcomed. At present, Mrs Butt is progressing with the list of immediate improvements that as owner, she would like to see in place. The emphasis is DS0000067611.V316067.R01.S.doc Version 5.2 Page 29 therefore very much on getting things done. Following this Mrs Butt reported that there would be more reflection and attention would be given to a formal quality auditing system. Mrs Butt confirmed that a formal system would be developed although it is not a priority at this time. This was acknowledged, as within the short time that Mrs Butt has been at the home, many improvements are evident. Residents continue to be encouraged to manage their financial affairs although some have given this responsibility to their family or representative. A small amount of personal money is stored for safekeeping. Receipts demonstrate expenditures and staff have signed to authorise transactions. Mrs Sampson regularly audits the records. A number of cash amounts were checked against the balance sheets. All were found to correspond. The environment is well maintained and various control measures, to reduce potential risks to residents, are in place. These include radiator covers and hot water temperature regulators. Staff have watched a health and safety video and further training is planned. Portable appliances have been tested and equipment, such as the hoist has been serviced as required. The fire log book demonstrated satisfactory testing of the fire alarm systems. On the first day of the inspection, workmen were in the home. In one room however, there were a number of tools on the floor. A stepladder was also propped up in the corridor. Mrs Butt confirmed that she had addressed this with the workmen as soon as she was aware of the potential risks. At the time of Mrs Butt gaining ownership of the home, the Fire and Rescue Authority required various changes. This included creating a new fire escape though a resident’s bedroom. The work has been completed although Mrs Butt was advised to identify this within the Statement of Purpose. DS0000067611.V316067.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X 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 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 DS0000067611.V316067.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Timescale for action Unless it is impracticable to carry 31/03/07 out such consultation, the registered person shall after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. (Care plans must demonstrate the management of health care conditions and how individual needs will be met. All plans must be kept up to date.) The registered person shall 16/11/06 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (Staff practice must be monitored so that all residents receive the required intervention in relation to their health and general wellbeing.) The registered person shall make 16/11/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Medication must not in DS0000067611.V316067.R01.S.doc Version 5.2 Page 32 Requirement 2 OP8 12(1)(a) 3 OP9 13(2) 4 OP9 13(2) 5 OP9 13(2) 6 OP10 12(1)(a) 7 OP12 16(2)(n) 8 OP12 18(1)(a) any instance be left unattended.) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (All medication and prescribed topical creams must be evidenced within the medication administration record when administered.) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Any ‘as required’ medication given on a regular basis must be discussed with the resident’s GP.) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (Investigation is needed in relation to the identified incidents of inadequate staff responses. Further monitoring and observation are required in order to identify and address possible practices.) The registered person shall consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. (Residents need to have greater opportunities for activity both in house and on an external basis. Such opportunities must be based on individual wishes.) The registered person shall ensure that the care home is DS0000067611.V316067.R01.S.doc 16/11/06 31/12/06 31/12/06 28/02/07 31/12/06 Page 33 Version 5.2 9 OP27 18(1)(a) 10 OP27 18(1)(a) 11 OP30 18(1)(a) 12 OP30 12(1)(a) conducted so as to promote and make proper provision for the health and welfare of service users. (Discussion must be held with all staff to ensure that the routines of the home do not negatively impact on residents’ wishes.) The registered person shall ensure that at all times suitably, qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (There must be sufficient staff on duty at all times to meet residents’ individual needs.) The registered person shall ensure that at all times suitably, qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (Investigation is needed regarding the communication difficulties that some residents may have with staff who do not have English as their first language.) The registered person shall ensure that at all times suitably, qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (The identified members of staff must be monitored robustly so that any poor practice is identified and addressed immediately.) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service DS0000067611.V316067.R01.S.doc 16/11/06 31/12/06 16/11/06 31/12/06 Version 5.2 Page 34 users. (Investigation is needed regarding the comment from a resident alleging that staff are rough when assisting with a bath.) 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 6 5 7 8 Refer to Standard OP3 OP9 OP9 OP12 OP15 OP16 OP18 OP27 Good Practice Recommendations The Registered Person should ensure that information which conflicts with the resident’s initial assessment is clearly identified. The registered person should ensure that another member of staff countersigns all hand written instructions in the medication administration record. The registered person should ensure that all medications are labelled with clear guidelines for their use rather than ‘as directed.’ The registered person should monitor care practice to ensure that there is full engagement between staff and residents. The registered person should ensure that if there is a need for any restriction, such as taking food from a resident’s room, this is fully discussed, agreed and documented. The registered person should ensure that consideration is given to ways in which all residents are given the confidence to raise their views. The registered person should ensure that additional adult protection training that is facilitated by the local Vulnerable Adults Unit is undertaken. The registered person should ensure that a member of staff is designated as a shift leader in the absence of management. This should be identified within the staffing roster. The registered person should ensure that references contain sufficient detail, to assist successfully with the decision of employing a prospective member of staff. The registered person should ensure that when recruiting staff, one reference is gained from the candidate’s present or most recent employer. DS0000067611.V316067.R01.S.doc Version 5.2 Page 35 9 10 OP29 OP29 11 12 13 14 OP30 OP30 OP38 OP38 The registered person should ensure that the training matrix contains dates of all training undertaken so that it can be used as a tool for future provision. The registered person should ensure that all certificates devised as a result of in house training, evidence attendance rather than competence. The registered person should ensure that all workmen are aware of their responsibilities for maintaining the health and safety of residents. The registered person should ensure that the fire escape within the resident’s room is stated within the Statement of Purpose. DS0000067611.V316067.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000067611.V316067.R01.S.doc Version 5.2 Page 37 - 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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