CARE HOMES FOR OLDER PEOPLE
The Laurels Nursing Home South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER Lead Inspector
Kathy Marshalsea Unannounced Inspection 09:30 4 & 5 December 2007
th 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 DS0000049317.V349388.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. DS0000049317.V349388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Laurels Nursing Home Address South Road Timsbury Nr Bath Bath & N E Somerset BA2 0ER 01761 470631 01761 471351 lreuropeancare@aol.com www.europeancare.co.uk European Care (SW) Ltd 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) Lesley Weir Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (4) of places DS0000049317.V349388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. May accommodate 36 persons aged 50 years and over requiring Nursing Care. May accommodate up to 4 persons aged 18-64 years with Physical Disabilities. Staffing Notice dated 22/08/2001 applies. Manager must be a RN on parts 1 or 12 of the NMC register. May continue to accommodate named persons who require dementia care. Any further admissions of service users with a definitive diagnosis of Dementia or Alzheimer’s disease is prohibited until an application to change The category of registration to DE(E) has been approved by the CSCI. From the 12th July 2005 until the 5th December 2005, European Care (SW) Ltd shall not admit any service user to the Home unless it has given a representative of the Avon Office of the Commission for Social Care Inspection prior notification of the proposed admission of that service user to the Home. 19th April 2007 7. Date of last inspection Brief Description of the Service: The Laurels is a care home operated by European Care, a limited company that operates numerous other care homes registered with the Commission for Social Care Inspection. The company has one other registered care home within Bath and North East Somerset. The home was first registered under The 1984 Registered Homes Act. European Care purchased and took over as the registered providers in May 2003. The Laurels is registered to accommodate up to 36 older people who require nursing care. Additional conditions of registration enable the home to offer accommodation to four younger adults with a physical disability. The home is an older detached property which has been considerably extended and adapted. It is situated in the village of Timsbury, which is approximately 9 miles from the city of Bath. Accommodation is offered on two floors and there is a passenger lift between floors. There are a total of twenty-eight single bedrooms and five shared rooms. Only one of the single bedrooms offers en-suite facilities. There is extensive parking available to the side of the property.
DS0000049317.V349388.R01.S.doc Version 5.2 Page 5 DS0000049317.V349388.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key (main) inspection and done unannounced. We spent two consecutive days at the home for which the manager was present. Before the visit took place survey forms had been sent to the home so that people living in the home, their relatives and visiting health care professionals could complete them. This helps us form judgements about the quality of life in the home and gives other people’s opinions about that apart from the inspector. There was a disappointing response to completing the survey forms and only one was received from a relative, none from the people living in the home and two from health professionals. The last key inspection was in April 2007.There has been maintenance of the standards in the home since then. There has been extended periods of the trained nurse team having been unstable where there was a change of personnel and the temporary absence of the Deputy manager. The home continues to try and employ sufficient staff to have sufficient staff to cover all vacancies. One Immediate Requirement notice was left at the end of the first day of this visit. These are served where we wish the home to take quick action to improve the safety of the people living in the home. In this case it was to make sure that any person who was identified as being at risk of being malnourished should have the amount of food offered to them that is in thier care plan and be weighed as often as is suggested in their care plan. Records of food given and offered but refused should also be accurate. What the service does well:
Positive comments on the survey forms included the following: “ I was very impressed with how my relative’s admission was handled. We were treated with the utmost care and professionalism, as it was a difficult time for them and the family”. Most care plans continue to have sufficient information in them about meeting people’s needs. There is a lot of detail recorded which tells the staff how to promote people’s abilities and care for them in the way they prefer. The plans are discussed with the person whom they are about and if that is not possible then their relatives. People living in the home are protected by the home sticking to medication policies and procedures.
DS0000049317.V349388.R01.S.doc Version 5.2 Page 7 Most people living in the home benefit from varied activities organised by the home’s activities organiser. They have worked very hard to cater for everyone’s preferences and studied to improve their knowledge. People’s complaints are taken seriously and efforts made to remedy the dissatisfaction. Staff are trained to be aware of the possibility of abusive practice and any allegations of abuse are directed to the appropriate agencies so that full investigation can take place. The home has continued to improve the standard of the accommodation and over the past year purchased new equipment and furniture. What has improved since the last inspection? What they could do better:
An Immediate requirement notice was left. This is done to make the home take quick actions to make sure that people are cared for in the best way to promote their health and welfare. In this case instructions in care plans about food intake and being weighed regularly were not being done as they should have been. To show that any restrictions of liberty are being done in the person’s best interest this decision needs to be agreed and recorded. People living in the home would benefit from staff being informed about any new condition they have been diagnosed with. This should be written in the
DS0000049317.V349388.R01.S.doc Version 5.2 Page 8 care plan and discussed with the staff. If the condition is unfamiliar information about the effects it could have should also be shared with the staff. Any mental health problems should also be clearly described with its effects upon the person, and staff given strategies to deal with those problems. Anyone coming into the home to live even for a short time needs to have a full assessment of their needs completed and a full care plan to direct staff in what their needs are and how to meet those needs. The activities organiser must make sure that the materials used for crafts and art are age appropriate. Those people who are poorly so no longer able to join in organised group activities should receive the sensory stimulation suggested in their care plan, eg.hand massages. People living in the home would benefit from having newspapers and magazines provided. Supervision sessions for all staff should happen 6 times a year to provide the opportunity for discussion about their practice and career development. The newly purchased radiator covers need to be fitted as soon as possible. In order to make sure that medicines are being administered at thier optimum time the time taken to complete the morning medicines round needs to be reviewed. The home would benefit from having more storage space in the kitchen for cold and dry foods. A deep cleaning schedule should be completed periodically to ensure hygiene standards are maintained. One relative pointed out their relative’s dirty wheelchair and we saw others in a similar state. These should be kept clean by the staff. The Manager and staff group should continue to try and involve people living in the home and their relatives about the decisions made about the running of the home, so that it is run in their best interests. 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.
DS0000049317.V349388.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 DS0000049317.V349388.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A comprehensive pre-admission assessment was not done for someone moving into the home for respite care. This may not have been a suitable placement. EVIDENCE: The records of a person who had moved into the home for respite (short term) care were checked. Although they needed some help for physical problems the main reason for the admission was for rehabilitation for an addiction. The home is not a specialist centre for this type of problem. There was no information in the pre-admission assessment about how staff should monitor this problem. After talking with this person it was evident that they were not being provided with the sort of social stimulation they wanted. They told us that they would have liked to have gone out but had not been able to. They also said that they were only able to have a couple of cigarettes a day and
DS0000049317.V349388.R01.S.doc Version 5.2 Page 11 staff had their lighter. None of these restrictions were recorded in their care plan. A senior member of staff told us that the community team involved with this person had imposed the restriction of cigarettes. This was checked by the manager who discovered that was not the case. In summary their care plan and admission details were quite basic and did not cover the main reason for the admission and any social care needs. DS0000049317.V349388.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While most care plans are quite detailed new physical and mental health problems had not been recorded. A respite care plan was not adequate. Some instructions in care plans for food intake and frequency of being weighed were not being done. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: We checked the records for three other people living in the home. One plan did not cover two new health problems, one of which was a recent diagnosis of a mental health problem causing the person significant difficulties and distress.
DS0000049317.V349388.R01.S.doc Version 5.2 Page 13 The rest of the plan was detailed and contained health care and risk assessments where necessary. The file showed the referral of these new problems and there were letters for health care professionals showing that the staff passed on their concerns. It was also clear that there had been an efficient monitoring of the medication regime and changes made when these were not effective. The plan had also been discussed with the person’s relative who had signed to show that they were in agreement with the plan. The second plan was very detailed which was very important, as this person was unable to tell staff about their preferences and needs. The plan included how staff should consider the fact that they may be socially isolated in their room and what should happen to reduce the risk of that happening. Staff were given clear and personalised descriptions of how to meet all needs and make the person as comfortable as possible. The third plan was fairly detailed but for the area of mental health was a bit vague and did not give clear tactics for staff to follow. For example there was an inaccurate evaluation of a type of behaviour, which had the action of “divert me” without saying what that could be and if any diversion had been needed, and which had been successful. Instructions such as weigh weekly and do a monthly check of the blood pressure had not been done as often as instructed. There were also some concerns expressed about their relationship with one of the relatives so that staff had to supervise their visits. This was not in the care plan. They had been admitted to the home under a section of the Mental health Act which should have been have been recorded in their plan and what implications that may have had. Health problems are monitored and risk assessments done to try and reduce the possibility of a problem occurring or deteriorating. In three instances the food intake recorded on sheets in people’s bedrooms did not match the requirements in their care plan. On some days there were very few entries so it was unclear if the person had eaten or been offered an appropriate diet. These same people had also not been weighed often enough (as instructed in their care plan) to help to monitor their health. An Immediate requirement notice was left which means that the home has to remedy that very quickly. We checked the medication systems to make sure that they were safe and followed good practice guidelines. It was noted that on both days of the visit the morning medication round took a considerable amount of time, despite the fact that there were two trained nurses giving out medicines on each floor. On one floor the round took till late morning and almost ran into the lunchtime round. This needs to be reviewed. DS0000049317.V349388.R01.S.doc Version 5.2 Page 14 There are systems in use to make sure that the medicines are given safely, for example “do not give if the pulse is below” and protocols for when to give insulin for diabetes. The Deputy manager showed a detailed knowledge of medication for the people we discussed. It was seen that there was minimal use of anti-psychotic type medicines and sleeping tablets. There were no gaps in the signatures of medicines being given and courses of treatment such as antibiotics signed as being fully completed. The home uses homely remedies as instructed by the GP’s and this allows staff to give one off medicines such as paracetamol, even if it hasn’t been prescribed for them. We observed whether people were being treated with respect and their dignity upheld. Most of the time staff were kind and responsive. We saw one person being quite distressed for a considerable period of time; staff did not stay long enough or respond to them to reassure the person. At our intervention this was done. On the second day people were taken up to the dining room 45 minutes before they were served their meal with nothing to do. We spoke with them and they complained of being bored and uncomfortable. This information was passed onto the manager. DS0000049317.V349388.R01.S.doc Version 5.2 Page 15 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): 12,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a varied activities programme and thought is given to meeting each person’s interests. This does not happen quite so well for some people unable to join in group sessions. EVIDENCE: We spent time talking with the activities organiser. Since the last visit they have completed a co-ordinators course with the Open University. They said that this has given them lots of ideas for improving the quality of activities. The course helped them to organise their time better and learn about dementia. They have developed a varied and interesting weekly programme. They have also assessed each person for their preferences. They have arranged for local clergy from different churches to come to the home and conduct services. A television and radio survey was done to make sure that
DS0000049317.V349388.R01.S.doc Version 5.2 Page 16 staff are aware of people’s preferences. One person I met had classical music playing in their room both days of our visit in accordance with their written preferences. Various people come to the home such as musical entertainers and dogs for pet therapy. There is fund raising for the Residents fund, which helps to pay for entertainment. We discussed the fact that I had noticed a lack of newspapers and magazines. The manager agreed that money could be found to provide some. Seasonal events had been planned for Christmas including carol services and a Christmas party. A photo album has been developed of everyone living in the home which has been done very thoughtfully. The organiser hopes to improve the amount of outings and is aware that this doesn’t happen often enough yet. Both cooks are doing their National Training Vocational qualification in catering. One of the assessors was present during our visit. The cook said that in the main the set menus are adhered to but this can depend on their suppliers. It was evident that the communication to the cooks about people’s special needs was not effective. The diet sheets held in the kitchen were old and for those at risk of being malnourished no new sheets had been completed. There is limited storage in the kitchen including the fridge space and dry store. Packets of food seen on shelves were open and need to be put into airtight containers. Safety checks are done to make sure the fridges and freezers are at the correct temperature. There is a daily cleaning schedule but not one for deep cleaning. Cooked breakfasts are offered for 6 days a week. Lunch choices are quite varied. The teatime meal offers a cold and hot choice. Puddings are served at both main meals. DS0000049317.V349388.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and acted upon. Staff have been trained in the awareness of adult abuse. EVIDENCE: We checked the two formal complaints which the home had received since our last visit. One had come in from someone living in the home about an incident. This was resolved and no further complaints had been received from that person. We met them and they confirmed this. The second complaint was also from someone living in the home about a lost possession. This had been replaced by the home. The manager stated that she attempts to deal with complaints as they come along before they turn into formal ones. For example someone who is not happy with some of the meals has had different foods provided. The home does receive compliments and we saw a card from the relative of someone who had lived at the home. They praised the staff for their kindness. An allegation of abuse dealt with before our visit concerned a staff member not following the correct procedures for safe moving and handling. The manager referred this matter to the Protection of Vulnerable adult’s team. Steps were taken to fully investigate this matter.
DS0000049317.V349388.R01.S.doc Version 5.2 Page 18 The home uses the BANES abuse policy but should also have their own. All but one of the trained nurses attended the local alerters course following a requirement at the last inspection. Part of the induction course the home uses for new staff includes questions posed about different possible abusive scenarios. There is minimal use of restraint in the home. For example bed rails are used after an assessment is done of the risk of a person falling out of bed. As mentioned previously any restriction of liberty such as holding a person’s lighter and restricting their use of cigarettes must be recorded and reassessed, according to best practice guidelines. DS0000049317.V349388.R01.S.doc Version 5.2 Page 19 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): 19,21,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There continues to be improvements made to the home to make it more comfortable. EVIDENCE: Since the last visit there have been changes: the downstairs bathroom has been complexly refurbished and redecorated. It is now an attractive bathroom with many homely fixtures and fittings. The downstairs corridor carpet has been replaced, the upstairs corridor decorated, 2 bedroom carpets replaced with more needing to be replaced, more storage cupboards have been organised, windows have been replaced, the roof fixed and radiator covers purchased. The home’s maintenance man was putting these together as they arrived flat packed.
DS0000049317.V349388.R01.S.doc Version 5.2 Page 20 15 sets of new bedroom furniture and the remaining 10 electric beds are now in place. DS0000049317.V349388.R01.S.doc Version 5.2 Page 21 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): 27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to struggle to have enough permanent staff employed so still uses agency staff. Safe recruitment practices are used and there is now a better induction package for new staff. Training is better planned so that when staff need to be updated it is easy to see when this should happen. EVIDENCE: There were 32 people living in the home at the time of our visit. There were the following staff on duty: 2 trained nurses plus 6 care assistants (c/a’s) for the morning and after 5pm 1 trained nurse plus 5 c/a’s. At night there was 1 trained nurse and 3 c/a’s. There is still the use of agency staff but this is less than at our last visit. The home had just employed 3 c/a’s from overseas and were waiting for them to arrive. In the meantime staff are doing overtime to compensate for the shortages. We talked with staff about how they work as a team and it was evident that this still has some difficulties. Some of the trained nurses work out on the floor with staff but not all do.
DS0000049317.V349388.R01.S.doc Version 5.2 Page 22 Recruitment records were checked and found mostly to be in order for the two staff that had been employed since August 2007. Expected checks to make sure that the person is suitable to work with vulnerable people were done as they should be. This included proof of their identity. Confirmation of the trained nurses fitness to practice as a nurse had been done. Other records showed a commitment to adhering to equal opportunities and employment law. New staff have a more comprehensive induction than had been used at our previous visits. It now includes 12-week Skills for Care course. We saw evidence of this being used and completed periodically during the first 12 weeks. We spoke with a new care assistant who had not worked in care before. They had found the induction and various training courses they had done very useful and helpful. We checked some of the training records of staff we had met during our visit. One nurse had done courses updating her clinical skills. Other staff have been updated in courses they have done before in topics relating to health & safety such as moving & handling and fire safety. There is now a training plan enabling easy reference to know when staff need to attend each course (training matrix). DS0000049317.V349388.R01.S.doc Version 5.2 Page 23 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): 31,33,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager continues to keep herself up to date with courses related to care practices so should be able to discharge her responsibilities fully. There has been no progress in the attendance for service users and relatives meetings making it difficult for them to be properly consulted about the running of the home. Fire safety training and fire safety checks protect the health and welfare of everyone in the home. EVIDENCE: DS0000049317.V349388.R01.S.doc Version 5.2 Page 24 Since the last visit Mrs Weir has become the registered manager of the home. She has now been managing the home since August 2006.We checked her training records to see that she is keeping herself up to date and found that she had done the following courses: supervision skills, dementia, the mental capacity act, protection of vulnerable adults alerters course and some compulsory courses for health & safety updates Mrs Weir is supported by the company’s Programme manager who visits the home regularly and is responsible for doing her supervision. It was evident that in between these visits there is a lot of phone contact with this person and other representatives from the company’s head office. We received a mixed response to people we met about Mrs Weir’s management style. While it was accepted that she is able to be clear about the standards she expects the delivery of this is not always appreciated. We noticed a different response to the inspection process at this visit. There also seems to be an “us and them “ culture between the trained nurses and care assistants as opposed to a team approach. These matters were discussed with the company’s Programme manager after the inspection. There are still regular staff meetings and we saw the minutes of some of the more recent ones. An agenda is put up before the meeting for staff to add to if they wish. We spoke with staff who had mixed views about these meetings and not all staff felt confident to speak up about matters which may concern them. Unfortunately there has been no progress in the success of the relatives/residents meetings. These have a very poor attendance from the relatives so have stopped. Mrs Weir was not sure why there had such a poor response. As we received only one survey from a relative and met one during our visit it was difficult to try and work out why the meetings are not well attended or survey forms sent to us. We looked at the supervision records for some staff. The content of the sessions has improved as now strengths and weaknesses are identified and requested or necessary training recorded. These sessions should be held 6 times a year but this did not happen for 2007. Some health & safety records were checked. The fire log showed that there is regular testing of the alarms and fire fighting equipment plus the emergency lighting. There were also invoices for external contractors who had serviced the systems and equipment. Night staff are receiving more frequent fire safety training than the day staff in a recognition that this is considered a higher risk time, partly due to the fact that there are less staff around. DS0000049317.V349388.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X X 2 X 3 DS0000049317.V349388.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP8 Regulation 12(1)(a) Requirement The Registered person shall ensure that the people at risk of being malnourished are offered the amount of food described in their care plan. Food charts must be completed accurately. The Registered person shall ensure that new health problems are recorded in the care plans. All mental health problems and any restrictions of liberty must be recorded and reviewed regularly. Instructions in the care plans for the frequency of interventions must be followed or changed. The Registered person shall ensure that no one moves into the home without having a full assessment of his or her needs. The Registered person shall ensure that all service users are treated with respect at all times. This relates to service users being left for too long at the dining room table waiting for their meal and a service user being distressed and staff not responding as they should have.
DS0000049317.V349388.R01.S.doc Timescale for action 04/12/07 2. OP7 15(2)(b) (c) 31/12/07 3. OP3 14(1)(a) 31/12/07 4. OP10 12(4)(a) 31/12/07 Version 5.2 Page 27 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. Refer to Standard OP36 OP38 OP12 Good Practice Recommendations Supervision sessions should be held at least 6 times a year. Radiator covers need to be fitted as soon as possible, covering the high risk ones first. Age appropriate materials should be used for craftwork. The organiser should ensure that activities suggested in the care plan happen for those who may be unable to join in the group activities. The manager should review how long the medicines rounds take. The home should review the kitchen storage and fridge space. A deep cleaning schedule should be implemented. The home should ensure that the wheelchairs are kept clean. The home should continue to strive to consult relatives and service users about life in the home so it is run in their best interests. Any opened packets in the food store must be kept in airtight containers. 4. 5. 6. 7. 8. OP9 OP15 OP26 OP33 OP15 DS0000049317.V349388.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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