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Inspection on 06/04/06 for The Lodge Nursing Home

Also see our care home review for The Lodge Nursing Home for more information

This inspection was carried out on 6th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

What the care home does well

It was evident throughout the inspection that staff were dedicated and committed to the work. Residents spoke highly of the staff saying, "all the staff are very helpful and kind" and, "it is very nice here, the staff do their best". The laundry service was of a very good standard, and several positive comments were received concerning this service. The laundry staff took great pride in their work. The manager and administrator worked well together. It was evident from discussions with the manager and staff that the manager had been working hard to try to improve and develop the service. All residents spoken with praised the meals at the home. Comments included "the food is very good here" and "we usually get what we ask for". Visitors spoken with said that they felt well informed and supported by the staff and manager when necessary. The area manager visited the home frequently and undertakes monthly reports and audits of the home. A number of new specialist beds have been purchased, which will benefit residents and staff. The home was in the process of being re-decorated at the time of the inspection visit.

What has improved since the last inspection?

There were a number of requirements and recommendations made at the previous inspection visit. Most of the requirements had been met, or in the process of being met. This includes covering of radiators for safety, controlling the temperature of water from taps, safe wheelchair use and locks on bathroom and toilet doors for privacy.

What the care home could do better:

The key issue identified during this inspection was that staffing levels were not always meeting residents` needs. There was poor practice taking place due to staffing levels that included on occasions use of a hoist by one worker when it is only safe for two staff to assist. Records showed that bathing had been cancelled the previous week due to staff shortages. Some staff were working excessive hours in order to cover shifts. This practice may be unsafe for the staff as well as residents. An immediate requirement was issued concerning staffing levels at the time of the inspection, and improvements in this area will be monitored.

CARE HOMES FOR OLDER PEOPLE Lodge, The Nursing Home Hayfield Road Chapel-en-le-frith Derbyshire SK23 0QH Lead Inspector The Jill Wells Unannounced Inspection 6th April 2006 09:00 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 Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 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. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lodge, The Nursing Home Address Hayfield Road Chapel-en-le-frith Derbyshire SK23 0QH 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) 01298 814032 Union Healthcare Midlands Carole Anne Dennehy Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: The Lodge Nursing Home is located on the outskirts of Chapel en le Frith. The Victorian building has been extended and sits in its own grounds and can accommodate 36 older persons on three floors. A large dining room and conservatory plus a separate lounge are provided on the ground floor. A further smaller lounge is also provided on the first floor. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a six hour period. During this time 7 residents were spoken with, and five of their files were inspected as part of the case tracking methodology used. Three staff members were also spoken with in private, as well as the manager and administrator. Records were inspected including complaint records, staff files, activities records and staff rotas. What the service does well: What has improved since the last inspection? There were a number of requirements and recommendations made at the previous inspection visit. Most of the requirements had been met, or in the process of being met. This includes covering of radiators for safety, controlling the temperature of water from taps, safe wheelchair use and locks on bathroom and toilet doors for privacy. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users and relatives are provided with the information they need to help them make decisions about the home. The needs of new residents were assessed and it was assured that their needs could be met. EVIDENCE: There was a statement of purpose and service user guide available at the home. The statement of purpose had been revised as required at the previous inspection. The previous inspection report was available in the entrance hall. Visitors spoken with who had chosen the home for their relative said that they had received a service user guide and were given a tour around the whole of the home before they made a decision. A new resident spoken with confirmed that they had received a service user guide and had passed this to their relative. Information provided including the above documents as well as the complaints procedure were not in alternative formats. Therefore residents with sight impairment or other difficulties would not be able to access the information. One residents file showed that the resident was unable to read Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 9 and write. There was no record of how documents had been made accessible to this resident. New service users received an assessment of their needs at the time of being admitted to the home. This was evidenced within residents files. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10, 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ healthcare needs were met, and the care was provided with respect and sensitivity. EVIDENCE: Five residents’ files were seen as part of the case tracking methodology used. Each file had a care plan in place that provided the basis for the care to be delivered. The plan set out the action that needed to be taken by care staff to ensure that residents’ health and personal care needs were met. Several files had inadequate social care needs recorded. One file had a blank social needs assessment, another stated previous jobs and interests but did not include how care staff could now meet their social needs. The plans were reviewed and updated to reflect changing needs. There was not evidence that residents had been involved in care plans, and care plans were not signed by residents that were able to do this. Residents were assessed to identify their risk of developing pressure sores and appropriate action was taken including obtaining relevant equipment where Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 11 necessary. The service obtained professional advice about the promotion of continence and aids and equipment were provided. A nutritional assessment was undertaken on admission and regularly reviewed. Weight gain or loss was monitored. Records showed that residents had access to GPs, dentists, chiropodists and other community health services. Medication was not inspected on this occasion. During an additional visit that took place in February, medication was found to be in good order. The home had recently had an audit of medication from their pharmacist. Residents spoken with said that staff respected their privacy and dignity. They said that staff knocked before entering their rooms and personal care giving was undertaken sensitively. Residents could see their visitors in private. Staff were observed treating residents with kindness. There was only only one file examined that had residents’ wishes concerning terminal care and arrangements after death recorded. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some activities were arranged for residents, although this could be improved. The quality of food at the home was good. Contact with family and friends was supported and encouraged. EVIDENCE: Residents spoken with said that there were few activities taking place at the home. One resident said that, everybody is bored, a trip would be nice. Record showed that some activities had been planned including bingo, music, a quiz, and quoits. A band had recently visited the home to entertain residents. The activities records were incomplete however this was partly due to the activities coordinator being unable to work the full hours allocated. This area will be more fully inspected during the next inspection visit. Residents confirmed that they were able to have visitors at any reasonable time. Three visitors were spoken with and all said that they were welcomed at the home, offered drinks and made comfortable by the staff. There was little community contact. Staff spoke of times when they use to take residents to the local supermarket, but this no longer occurred. Staffing levels may be a contributing factors to this. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 13 Residents were encouraged to bring personal possessions with them, and many had chosen to do so. There was some evidence of consultation and opportunities to exercise choice. This included being asked at the time of being admitted to the home whether they wanted a key to their room, a lockable storage and a table lamp. The area of consultation could however be further improved and developed. An increase in staffing levels could support staff to help residents to exercise more choice and control over their lives. (See standards concerning staffing levels). Residents received a wholesome and appealing diet. The cook made most things herself including cakes and pastries, which was appreciated by residents. There were several compliments about the standard of food provided. Comments included, the food is excellent here, and we usually get what we ask for. One resident described the breakfast porridge as very creamy and wholesome. The days menu was now being displayed in the lounge/dining room area. The second choice was not displayed on the day of the inspection visit. The cook explained that although the choice was available, it was not encouraged on this day as it was a busy food delivery day. Therefore the cook chose a menu that was liked by most residents. Alternatives were however provided for individuals that did not like the main meal. At the previous inspection meal times were observed to be rushed, hectic and in an atmosphere that was not conducive to a relaxing meal. There had been some improvements in this area, although the dining room was still very cluttered at mealtimes with many residents having to eat their meals away from the main dining area due to space issues. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and visitors have the opportunity to complain if they wish to do so. Staff were aware of their responsibility concerning protection of residents from abuse. EVIDENCE: There was a written complaints procedure displayed in the entrance hall. This was also available in the literature provided for residents and relatives. Complaint record shows that there had been no formal complaints made at the home since the last inspection visit. CSCI had received two telephone calls identifying concerns around staffing levels (see standard concerning staffing levels) The manager had arranged adult protection training for staff in order to ensure that all staff had received training in this area. Staff spoken with were clear about different kinds of abuse and what they should do if an allegation was made to them. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service was well maintained and decorated with comfortable communal and bedroom areas. EVIDENCE: The location and layout of the home was suitable for its stated purpose. All areas were accessible and maintained. Residents said that seating was comfortable. Grounds were kept tidy and attractive. There was a large lounge/dining room area with a pleasant conservatory area off this lounge. There was also a smaller lounge on the ground floor as well as a third lounge on the first floor. The third lounge was also used as the nurses station and was therefore used very little by residents. However residents could take their visitors in this room if they wish to have a quiet area other than their bedroom. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 16 At the time of the inspection visit decorating was taking place in the hallway landing and stairs. Lighting in communal areas was domestic and sufficiently bright for residents. There were toilet facilities near to the communal areas. Privacy locks had been placed on these doors after a requirement made at the previous inspection visit. One bathroom area that was used very little was due to be converted into a storage room. This had been agreed by CSCI. Residents spoken with were very pleased with the converted shower room. There were appropriate adaptations and equipment in place to assist residents with poor mobility to access all areas around the home. This included the provision of ramps and a passenger lift. Grab rails had now been placed around all corridors after a requirement made during the last inspection visit. Various hoists were available for residents with mobility needs. There were a high number of residents that used a wheelchair, and the home was suitably adapted for this. Bedrooms were of various designs and were generally well decorated and maintained. Carpets that had been badly laid and could be a tripping hazard were highlighted at a previous inspection visit. The manager stated that a carpet fitter was due to re-lay these carpets. Not all furnishings were provided for residents. For example not all residents had bedside lighting, two double electric sockets or lockable storage space. There were records of residents being consulted about whether they wished to be provided with these when they were admitted to the home. However three out of five residents spoken with about this said that they would like lockable storage space. The premises were clean and free from offensive odours. Laundry facilities were sited away from food and residents. There was a washing machine with the specified programming ability to meet disinfection standards. The laundry staff were following the correct procedures concerning foul laundry. The laundry services were of a very good standard. Residents spoken with were very satisfied with this service. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 17 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels were not always meeting residents’ needs. This could potentially put residents at risk. Training for staff had improved. Safe recruiting practices were being followed. EVIDENCE: Staff rotas were checked. They showed that during the previous 14 shifts there were 8 shifts with only 4 or 5 care staff on duty and 1 or 2 nurses. One worker in the afternoon worked in the kitchen for 4 hours instead of working with residents, thus further reducing staff time with residents. The kitchen hours showed that there was only someone on duty between 7 a.m.-2 p.m., which left no cook or kitchen assistant, available at teatime. Several residents spoken with said that they had to wait a very long time when they called for assistance with toileting. One resident said that this was the worst thing about the home. One resident spoken with said that they often could not go to bed at the time they wished to as staff were too busy to assist them. One resident was observed at the dining table after lunch for a considerable length of time, waiting for assistance to go to her room. The comment heard Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 18 from the resident was, why do I always have to wait so long to leave the table? All residents spoken with however felt that staff were, doing their best and were not blaming staff for the shortfalls in care. Staff spoke of insufficient time for basic care at times. Staff said that there was insufficient time to wash and dress all residents before breakfast. One worker described how staff take residents from the middle floor and a few residents that can walk for breakfast, other people were not asked as they did not have time to get them ready. Care staff spoke of occasionally using the hoist with one carer instead of two due to other staff being too busy to assist. One care assistant spoken with had worked 63.5 hours the previous week, in order to try to assist to cover shifts. This level of working was likely to be unsafe for the worker as well as for residents. A bathing record for all residents was seen in the bathroom. It was scored across with the words ‘no bathing this week due to short staffing’. The manager stated that she was not aware of this decision. Although there has been approval for additional staff hours in the morning, and an advert has been placed, this additional shift has not yet commenced. There is a high level of dependency at the home with 25 residents requiring a hoist or two staff to transfer, 14 residents with dementia, 11 residents requiring assistance with feeding, 24 residents incontinent of urine and 15 residents that are doubly incontinent. This had not been fully taken into account when staffing levels had been considered. As the home is on three floors this causes additional difficulties and work for staff. CSCI received two independent concerns on the 30th and 31st March by telephone. Both callers stated that they were concerned about the staffing levels at the home, the level of stress that staff were under, and the additional hours that they worked. The inspection visit supported these concerns. These issues were discussed with the manager at the time of the inspection visit. The manager stated that she agreed that staffing was not adequate, and had raised the issue with senior managers. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 19 Three staff files were checked and found to be in good order. There was recorded evidence that the area manager checked recruiting practices on a regular basis and found them to be satisfactory. Training has significantly improved since the last inspection visit. Training had been provided for staff around health and safety, moving and handling, adult protection and dementia awareness. Training was booked for first aid, food hygiene, fire safety, and infection control. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 20 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, 35, 36, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager was competent to manage the service. The health, safety and welfare of residents and staff were generally promoted and protected, although some areas needed improvement. EVIDENCE: The manager had recently applied to CSCI to become the registered manager and this had been approved. The manager was experienced, and had started the registered managers award. There were clear lines of accountability within the home and with the external management. The area manager visited regularly and undertook monthly reports and audits. The most recent reports show that the area manager had talked to staff and service users, checked residents’ finances, staff files and walked around the home. A residents’ meeting was planned. Residents and visitors had the opportunity to complete Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 21 surveys and CSCI comment card were available in the entrance hall. The CSCI inspection report was on display. Good progress had been made to implement requirements identified in the recent inspection reports. Systems’ concerning protection of service users money was not checked on this occasion, however there was evidence that the area manager was regularly checking this and found that safe procedures were being followed. At the previous inspection it was highlighted that care staff were not receiving formal supervision at least six times a year. The manager stated that this was now taking place, although records were not inspected on this occasion. Individual records and home records were secure and up to date. The manager generally ensured safe working practices. This included mandatory training covering moving and handling, fire safety, first aid, food hygiene and infection control. At the time of the inspection visit the plumber was at the home fixing thermostatic control valves on all taps to ensure that water did not run from taps at an unsafe temperature. The environmental health department recently visited the home to look at food safety practices. The report was not available however it was stated that the only issue raised was the need to redecorate the pantry area. At the previous inspection a requirement was made concerning water storage and the risk of legionella. The manager had attempted to resolve this issue however further advice was required from the Health and Safety Executive. Lack of storage continued to be an issue at the home. The agreement for a bathroom to be converted to a storage area had not yet commenced. Records of accidents were not inspected on this occasion. Although hazardous substances were generally stored safely, a tube of steradent was found in a communal bathroom, and disinfectant was found in an unlocked sluicing area. A large amount of toiletries as well as several hair brushes were found in communal bathroom areas. It was explained at the time of the inspection visit that this practice encouraged communal use of personal items and was not safe practice. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 22 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 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 2 3 STAFFING Standard No Score 27 2 28 X 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 x 2 Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement Staffing levels must be revised. Immediate requirement issued at the time of the inspection visit. Formal supervision for care staff must take place at least six times a year. Supervision should be recorded. (Not inspected) Water must be stored at a temperature of at least 60°C and distributed at 50°C minimum to prevent risks from legionella. The registered manager must ensure that all hazardous substances are stored securely at all times. There must be adequate storage areas at the home. Timescale for action 08/04/06 2. OP36 18 (2) 30/04/06 3. OP25 13(3) 30/06/06 4. OP38 13(4)(a) 07/04/06 5. OP38 23(2) (l) 30/08/06 Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP24 Good Practice Recommendations Any residents that have stated within the consultation document that they wish to have lockable storage space should be provided with this. It should be checked with residents and relatives during resident reviews whether they still do not wish to have a lock on their bedroom door and a lockable storage space. A record should be made of this consultation. The service should provide a sluicing disinfector. The bathroom areas where towels and linen are stored on shelves should be kept tidy. Consideration should be given to a more suitable cupboard storage area within these bathrooms. Staff should undertake training in dealing with aggressive behaviour. The care plans should include more detail concerning residents social needs and interests including action which needs to be taken by care staff to ensure that individuals social care needs are met. Where possible each residents file should include residents wishes concerning terminal care and arrangements after death Residents should be involved with the drawing up of their care plan. Care plans should be signed by the resident where possible. Community contact should be encouraged and supported for residents that would want this. This includes visits to DS0000002087.V288583.R01.S.doc Version 5.1 Page 25 2 3 OP26 OP22 4 OP30 5 OP12 6 7 8. OP11 OP7 OP13 Lodge, The Nursing Home 9. OP1 the local supermarket and pub. Documents provided for residents should be in alternative formats to ensure that they are as accessible as possible. This includes access for residents with sight impairment, and residents unable to read. Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Derby Area Office South Point Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lodge, The Nursing Home DS0000002087.V288583.R01.S.doc Version 5.1 Page 27 - 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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