CARE HOMES FOR OLDER PEOPLE
The Hermitage 66 Holly Road Uttoxeter Staffordshire ST14 7DU Lead Inspector
Sue Jordan Announced Inspection 17th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 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. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Hermitage Address 66 Holly Road Uttoxeter Staffordshire ST14 7DU 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) 01889 562040 01889 565299 Doctor Charles Bamford Convalescent Home Trust Mrs Dawn Dorothy Thompson Care Home 15 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (15), of places Physical disability over 65 years of age (6) The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th November 2004 Brief Description of the Service: The Hermitage, a large detached Victorian house has been extended to provide accommodation for 15 older people, Six of whom may be physically disabled and three of whom may have dementia care needs. The home is provided by the trustees of the Charles Bamford Memorial Trust and managed by Care Manager, Louise Hurst. She is presently undergoing registration with the Commission for Social Care Inspection. The home is situated close to the centre of the market town of Uttoxeter and within easy walking distance of local shops and a public house. A bus route passes the end of the drive. Accommodation is provided in three double and nine single bedrooms, none of which have en-suite facilities. One double and six single bedrooms are situated on the ground floor. Access to the first floor is by staircase that has been fitted with a stair chair lift.Communal facilities consist of a large lounge and a dining room. The large square entrance hall leads into a small rear hall with seating. Externally there are small gardens accessible to service users, a large kitchen garden and a bowling green and outbuildings that are used by a local club. Some service users enjoy watching the matches in the summer months. The grounds are landscaped and well maintained. There are ample car parking facilities at the end of the drive.At the time of this inspection there were nine service users resident at The Hermitage. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Announced Inspection took place over 6 hours with two Regulation Inspectors. The methodologies used were discussions with all of the residents, two members of staff and three visitors. A tour of The Home was undertaken and care records, staff files and random Health and Safety documentation was checked. The medication systems were also observed. Five Additional Visits have been made to The Hermitage since the Unannounced Inspection on 20/04/05 and these included both a formal and informal meeting with the Trustees and management of The Home. A mutual decision was made on 18/05/05 that the Home refuses admissions until further work had been completed to meet the National Minimum Standards. Following this inspection the Commission for Social Care Inspection and the management agreed that admissions be resumed. The previous manager resigned in June 2005 and a new manager commenced employment at the beginning of September 2005. She is presently undergoing the registration process with the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection?
The new manager has developed care plans for all of the residents and risk assessments are being undertaken on an on-going basis. The staff have been involved in this process and speak positively of the changes. A staff supervision system has commenced and the staff recently attended a full team meeting. This has assisted them to feel more involved and consulted. Medication systems have been improved and strengthened and the staff are receiving appropriate training in the safe handling of medicines. The Home’s
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 6 pharmacist has undertaken an audit of the medication procedures. This will become a regular event. Staff recruitment has been improved to include the Criminal Records Bureau and Protection of Vulnerable Adults checks and the receipt of appropriate references. The files now contain the necessary information. The Home have completed a quality survey and held a residents’ meeting. However there were issues identified during this visit, which indicated that more resident and/or family consultation is required. The new manager works supernumerary to the staff rota, allowing her the time to complete her required managerial responsibilities. The Home now has two deputies. Training opportunities have greatly improved and this is confirmed in the training records and during discussions with the staff. The new manager is aware of the need for adequate pre-assessment of all potential residents, to ensure that The Home and its staff team are able to meet the individual’s needs. What they could do better:
Although assessment of resident need has vastly improved, it was noted that more information is required following manual handling and falls assessments. This information should include specific guidance for staff as to the handling techniques, including the use of any required equipment. The new manager has worked since the beginning of September to build the trust of the staff team and to include them in any changes. This now needs to be extended to include the residents and/or their families. There are some misunderstandings surrounding risk assessments previously made, which seem to restrict personal choice and this needs to be discussed and agreed with all relevant parties. Some new activities have been arranged, however this facility needs to be expanded to provide more regular stimulation. Work has started in this area, with the inclusion of activities in The Home’s quality survey. The Home needs to examine how individual personal choice and autonomy can be expanded on a day-to-day basis, within ‘normal’ routines. All staff should be aware of residents’ rights to make choices and take risks. However this needs to follow appropriate consultation and documentation. Visitors are made very welcome in the Home, however they and the residents would benefit from a private area to meet. The possibility of including such an
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 7 area if the Home is extended was discussed. In the interim period, the manager should look at the usage of space in The Home. The Home needs to ensure that the temperature in individual bedrooms is such that residents can comfortably spend time in them if they wish. Recruitment has improved greatly, however the manager was asked to ensure that potential staff provide a full employment history. Random Health and Safety checks indicated that this is generally another area of improvement, however the manager must ensure that COSHH data sheets are available for all of the products used to the staff using them and the use of latex gloves needs to be assessed. It must be noted that the new manager only started at The Hermitage at the beginning of September 2005 and during the Commission for Social Care Inspection feedback she was able to demonstrate that she had already considered many of the issues highlighted and had appropriate ideas of how to address them. 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 Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 The manager is aware of the need to obtain or complete comprehensive assessments for potential residents, ensuring that The Hermitage is able to meet their needs. EVIDENCE: The administrator reported that The Statement of Purpose has been updated to reflect the recent change of manager in The Home. The Home are reminded that this report must be available to residents, staff and significant others. Difficulties in The Home over the last twelve months initiated a joint decision between Commission for Social Care Inspection and the management of The Hermitage not to admit any new residents. The Commission for Social Care Inspection has visited the Home seven times during the inspection year 2005/06 and a mutual decision was made during this visit to re-commence admissions. Major improvements in care delivery and the action taken to address the National Minimum Standards prompted this decision. The new
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 10 manager, Louise Hurst is aware of the need to obtain Local Authority Community Care Assessments and care plans for Social Services’ referrals and that she must assess self-funding potential residents. The information required for all potential residents is detailed in National Minimum Standard 3.3. The Home’s Statement of Purpose states that emergency referrals and admissions will not be accepted. The manager has completed vital assessments for the existing residents, including those for manual handling needs and pressure sore care. She was reminded that these should also contain the required management of any identified risks. She did report that physiotherapy assistance and training is being accessed for one of the residents and that a Local Authority reassessment has been requested to ensure that The Home has the equipment etc required to continue to meet this person’s needs. The Home does not provide intermediate care. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Care planning has now been implemented and there is evidence that staff have been involved in the changes. This now needs to be extended to include consultation with the residents and/or their families to ensure that the delivery of care is agreed and understood by all involved. EVIDENCE: The new manager, Louise Hurst commenced employment at the Home at the beginning of September 2005 and has since completed care plans for all of the nine residents. These have also been reviewed. Scrutiny of the records and discussions with a resident and her family indicated that there has been a lack of consultation. It is noted that the manager has had to prioritorise during her first month at The Hermitage, however it is important that she now involves the residents and/or their families in the developing of care plans and risk assessments. This will help the Home to take residents’ personal choice into account and avoid misunderstandings. The manager reported that she intends to hold three monthly review meetings and this was agreed to be a very good idea. The manager has however involved the staff in care planning and discussions with two members indicated positive reactions to the changes. The staff said that the manager had explained the changes and that they felt
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 12 comfortable approaching her for assistance. They are involved in updating the care plans as and when necessary. One said that they now know things that they’re supposed to. Health care needs are included in the care plans and these records should allow for better monitoring. This will continue to be at future inspections. One family reported not having been notified of their mother’s illness and this was reported to the manager. Physiotherapy assistance and training is being accessed for one of the residents. This will include the provision of equipment. The medication systems are greatly improved. The staff have undertaken the ‘safe handling of medicines’ course and the storage and receipt and disposal of medication is appropriate. There is a separate fridge for medication requiring refrigeration. The manager was reminded that this medication must be dated on opening and was advised that the same practice should be implemented for all liquid preparations. The administrator is to introduce a policy for the use of homely remedies. The practice of providing paracetomol for staff should be discouraged. Some of the residents stated that staff knock on bedroom doors and that their privacy is respected. However personal choice issues are identified in National Minimum Standard 14. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Generally the residents are happy within The Hermitage, however more evidence is required that personal choice and autonomy is enabled, encouraged and upheld. EVIDENCE: Discussions were had with most of the residents during this visit. Although all state that they are generally happy in The Home, a number said that they get bored. The manager has started to plan activities. The residents were recently given a questionnaire and asked to identify some chosen activities and the manager intends to plan accordingly. She has also organised a future trip to see the Walsall Illuminations, which residents said they were looking forward to and an entertainer has been booked. Some of the residents are able to knit or read and another regularly goes out of The Home. The hairdresser attends The Home weekly and communion is held monthly. The manager is aware of the need to expand activity provision. Three sets of visitors were spoken to during this inspection, of which two reported their satisfaction with The Home. One said that they wished to be more involved in care planning and risk assessment and particularly felt that they should have been contacted in the event of their family member being ill. The Commission for Social Care Inspection received four relatives’ comments cards prior to the inspection; all stated that they were welcomed in the Home
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 14 at any time. The Home has plans to extend and they were asked to consider the provision of a private visitors’ room, separate from the residents’ bedrooms. In the interim period the manager should consider the usage of space in The Home and whether these facilities could be better provided. One of the residents likes to access the local community. There have been some misunderstandings as to what she can and cannot do. Risk assessments have been completed previously, which have proved to be disabling and contradictory. This includes access and egress to The Home. The new manager was informed of the resident and her family’s concerns and she stated that she would initiate a meeting in which the care plans and risk assessments could be agreed by all parties. Most of the residents share the communal facilities in the lounge, however one resident likes to watch television in her own room. The temperature in the room is not conducive to being comfortable and arrangements need to be made and agreed that bedrooms are heated appropriately as and when necessary, see National Minimum Standard 25. It was also evident during discussions that residents’ choices are upheld dependent on the staff on duty and the manager needs to ensure a consistent approach. For example, some staff will provide a drink between the allocated times and others refuse. Some of the residents said that meal alternatives had ceased. The manager denied this but stated that she would give the cook the responsibility of ascertaining meal choices at the beginning of the day. She also intends to develop new menus. The residents’ views of the food were gained within The Home’s quality survey, the results were positive, although there were complaints regarding the quality and quantity of the meals during this visit. The residents did not know what was for lunch on the day of the visit. The manager has held a residents’ meeting and minutes were taken. However the residents did not verbally confirm this. During this period of change the residents seemed uncertain and anxious and the manager must now build positive and open relationships with them. The manager is required to examine the issue of choice; how they can be ascertained and upheld. A new cook has been employed at The Hermitage and there is a vacancy for an evening and weekend cook. The new cook is suitably qualified and the staff are now undertaking food and hygiene training. The provision of regular drinks and the danger of dehydration to the elderly were discussed during this visit and it was suggested that jugs of cold drinks be available and offered by the staff. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The Home’s procedures have improved, increasing resident protection. The residents require reassurance during this time of change, in order that an atmosphere of trust be established, which gives them the confidence to express their concerns. EVIDENCE: The Commission for Social Care Inspection received four relatives’ comments cards prior to the inspection; two stated that they were not aware of The Home’s complaints procedure. All of the residents completed a comment card for the Commission for Social Care Inspection; eight said that they knew who to talk to if unhappy, one said they did not. It is hoped that as the manager develops relationships with the residents and their families; continues with the residents meetings and initiates care plan consultation and review, all of the residents and their families will feel able to express their concerns. The Hermitage is now undertaking Protection of Vulnerable Adults and Criminal Records Bureau checks for potential staff. They are also obtaining two references, although they were reminded to obtain full employment histories. The training matrix and pre-inspection questionnaire completed by the manager for the Commission for Social Care Inspection indicate that Adult Protection training has not yet been organised. However discussions with staff demonstrate awareness of their role and the importance of reporting Protection of Vulnerable Adults issues to the manager. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26 There have been a number of improvements to the environment of The Home in the last twelve months. The residents live in pleasant, clean and comfortable surroundings. EVIDENCE: There are proposals to extend The Hermitage. The management are reminded to consult with the Commission for Social Care Inspection to ensure that the environmental National Minimum Standards are met. The Hermitage has a comfortable, clean environment and many improvements have been made over the last twelve months, including a refurbished bathroom on the first floor, the provision of a sluice area, re-organisation and decoration of the laundry. The Fire Safety officer and Environmental Health department visited The Home in 2004. Health and Safety issues identified in previous inspections have been addressed, including six monthly maintenance of mobility equipment and the covering of all radiators. Infection control measures have been introduced and The Home was seen to be clean and tidy on the day of this visit. One visitor remarked that there are no unpleasant odours in The Home and this is confirmed by the Commission for Social Care Inspection.
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 17 The manager reported plans to refurbish the ground floor bathroom, providing a more modern assisted bath and making the shower area more usable. It was agreed that this would greatly improve bathing facilities for the residents. The manager was asked to consider the provision of a private visitors’ room, separate from the residents’ bedrooms. In the interim period the manager should consider the usage of space in The Home and whether these facilities could be better provided. Most of the residents share the communal facilities in the lounge, however one resident likes to watch television in her own room. The temperature in the room is not conducive to being comfortable and arrangements need to be made and agreed that bedrooms are heated appropriately as and when necessary. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Recruitment and training has improved in The Hermitage, further protecting the residents. EVIDENCE: On the day of this visit there were two care workers on duty, one domestic, one cook, the manager and the administrator. The domestic assists with breakfast before commencing her cleaning duties. Staff recruitment procedures have greatly improved. The Hermitage is now undertaking Protection of Vulnerable Adults and Criminal Records Bureau checks for potential staff. They are also obtaining two references, although they were reminded to obtain full employment histories. Training provision has also dramatically improved and this was confirmed during discussions with the staff on duty. This will continue to be monitored at future inspections. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 38 The new manager is in the early stages of developing new and improving existing management systems in The Hermitage. Staff and residents are being included in this process, although the residents seem to require more reassurance and consultation. EVIDENCE: The new manager, Louise Hurst commenced work at The Hermitage at the beginning of September 2005. As required she has applied to the Commission for Social Care Inspection to be registered and this is proceeding. Two deputies are employed at The Home. Staff spoken to during this visit were positive about the changes instigated by the new manager and reported feeling involved and informed. She has started a staff supervision system and at the time of this visit had supervised three members of staff. The staff also said that a very positive staff meeting was
The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 20 held the week before the inspection. The new manager has in particular spent time developing new care plans for all of the residents and undertakes risk assessment on an on-going basis. She encourages staff to be involved in this process and monthly reviews have been allocated to The Home’s two deputies. The manager has held a residents’ meeting and a Quality Survey has been undertaken. She is aware however that additional time is now needed to build trusting relationships with the residents and their families and is proposing to arrange three monthly care reviews. For example, the residents’ views of the food were gained within the survey and the questionnaires’ results were positive, although there were complaints regarding the quality and quantity of the meals during this visit. A random selection of the maintenance and Health and Safety records were checked. All of those checked confirmed the information given by the manager in the pre-inspection questionnaire received by the Commission for Social Care Inspection. The Home must ensure that COSHH data sheets are in place for all products and readily available to the staff using them. It was also noted that The Home provides latex gloves and it is well known that a number of people are allergic to them. The home must either complete individual risk assessments for service users and staff or provide non-latex gloves. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 2 3 3 X X 2 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP3 OP7 Regulation Requirement 3 4 5 OP9 OP12 OP14 6 OP14 7 OP20 13 (4c) 13 Manual handling and falls risk (5) assessments require expansion. 12 (2) Evidence of consultation with residents and/or their families is required with regard to care planning, risk assessment, which takes account personal choice. 13 (2) The manager must ensure that refrigerated medication is dated on opening. 16 (2n) Day to day activities need to be expanded. 12 (3) In order to promote personal autonomy and choice, service users must be enabled to take risks following suitable consultation and documentation. 12 (3, 4) The Home must examine the issue of personal autonomy and choice and how this can be further expanded and evidenced. 23 (2i) Should the home expand suitable facilities must be provided for service users to meet privately with their visitors, which is separate from their own bedrooms. In the meantime consideration should be given to the most appropriate usage of
DS0000005013.V257789.R01.S.doc Timescale for action 01/12/05 01/12/05 01/12/05 01/12/05 01/12/05 01/12/05 01/12/05 The Hermitage Version 5.0 Page 23 8 9 OP25 OP29 23 (2p) 19 (1b) 10 11 OP38 OP38 12 (1a) 12 (1a) space. Individual appropriate heating must be available in all of the bedrooms as and when required. The Home must obtain a full employment history for all potential staff members via application or CV. COSHH data sheets must be available for all cleaning products. The home must either complete individual risk assessments for service users and staff re: latex gloves, or provide non-latex or nitryl gloves. 01/12/05 01/12/05 01/12/05 01/12/05 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 Refer to Standard OP7 OP8 OP9 OP15 OP30 OP38 Good Practice Recommendations Old care plan information should be archived. The management of waterlow assessment results should be recorded. The Home should consider dating lactulose and similar preparations on opening. The Home should re-introduce meal/menu alternatives. The induction booklets should be ‘signed off’ by the staff member and mentor. COSHH data sheets should be kept with the actual products and staff trained how to follow the instructions within. The Hermitage DS0000005013.V257789.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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