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Inspection on 08/05/07 for The Malvern Nursing Home

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

This inspection was carried out on 8th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The Malvern provides a home to people with mental health needs, most of who would not fit into other services. Most of the residents have long-term mental illnesses and have spent long periods of time in mental health hospitals. The staff at the home work hard to encourage individuals to live their lives as they wish. This does present issues of risk to residents but these are very effectively considered, recorded and managed as part of the resident`s plan of care. The staff continue to have a good working relationship with other professionals, who comment on the home`s successes in working with clients that have been hard to place. The activities coordinator continues to develop appropriate services for the people who live at The Malvern. She has a person centred approach and a well developed understanding of researching and providing appropriate activities to the residents that offer to improve their quality of life. During the visit residents were preparing to enrol on a passport to leisure initiative that would provide them with access to swimming pools and leisure facilities in the Bradford area at reduced rates.

What has improved since the last inspection?

There has been a positive effort by staff to include residents in any decisions that affects their lives. Most of the residents have lived in mental health institutions for many years, and this has reduced their ability to deal with day to day decisions. Staff work with individual residents to reintroduce daily living skills in away that is sensitive, respectful, and encouraging with the aim to enable residents to understand and participate positively in community living. Residents have been involved in agreeing new menus to include food they enjoy eating. Standards of cleanliness in the kitchen have improved, food is prepared and served in a way that protects residents from ill health. The process of reviewing the homes policies and procedures is underway. This should ensure staff work safely and consistently within the home. It is recommended that priority be given to reviewing those procedures that may currently put residents and staff at risk of harm. For example safe use of chemicals.

What the care home could do better:

To care for the residents who present with challenging behaviours staff must be trained to understand and learn techniques to manage such behaviour, to minimise the risks to themselves, and people who live at The Malvern. The registered Manager must undertake a formal management qualification, to complement her existing skills, to manage a complex, diverse service. There should be an ongoing internal refurbishment programme, to create a more homely environment. The home is shabby and in a state of disrepair in places. This is often caused by a lack of respect by residents, for their surroundings.

CARE HOME ADULTS 18-65 The Malvern Nursing Home 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN Lead Inspector Chris Levi Key Unannounced Inspection 8th May 2007 09:00 The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 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 Malvern Nursing Home DS0000019899.V331472.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 Adults 18-65. 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 Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Malvern Nursing Home Address 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN 01274 492643 01274 499557 rachel@malvernuk.com 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) Mrs Rachel Halsall Mrs Rachel Halsall Care Home 28 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (28), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (28) The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: The Malvern is a 28-bedded care home with nursing, specialising in the care of adults with mental illness. The home takes both male and female service users and was established 20 years ago. The house is a late 19th century detached residential building situated on a main road approximately 3 miles from the centre of Bradford, served by a good bus route. Many of the buildings original period features have been preserved and the home includes an extension built in 1993. There is a parking area to the side of the building and a small patio area situated on the other side of the building. Access to the home is gained through the conservatory at the front and a ramp is provided for people with mobility difficulties. There are 16 single bedrooms and 6 double rooms on two floors, accessible for those with mobility difficulties by stair lift to the first floor. The home is owned and managed by Mrs Rachel Halsall, RMN. The current care fees are from £444 per week. Additional charges are made for newspapers, hairdressing and toiletries The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A review of information about the home held by the Commission for Social Care Inspection. This included looking at the number of reported accidents, complaints and compliments from residents and relatives and the written and verbal opinions of residents and relatives who live and visit The Malvern. This information was used to plan the inspection visit. The providers were not notified of this inspection in advance. This enabled the inspector to observe how the home is run on a day-to-day basis, without any changes being made to the usual routines of residents and staff. The visit started at 9.00 am and finished at 5pm. The person in charge of the home was the Manager Ms R Halsall, who, with the senior management team, was made aware of the findings at the end of the inspection. Most of the day was spent talking to residents, relatives, management and staff, to find out what it is like to live, work and visit The Malvern. Six residents survey forms were completed during the visit. Most provided little information but one said, she was happy living there. What the service does well: The Malvern provides a home to people with mental health needs, most of who would not fit into other services. Most of the residents have long-term mental illnesses and have spent long periods of time in mental health hospitals. The staff at the home work hard to encourage individuals to live their lives as they wish. This does present issues of risk to residents but these are very effectively considered, recorded and managed as part of the resident’s plan of care. The staff continue to have a good working relationship with other professionals, who comment on the home’s successes in working with clients that have been hard to place. The activities coordinator continues to develop appropriate services for the people who live at The Malvern. She has a person centred approach and a well developed understanding of researching and providing appropriate activities to the residents that offer to improve their quality of life. During the visit residents were preparing to enrol on a passport to leisure initiative that would provide them with access to swimming pools and leisure facilities in the Bradford area at reduced rates. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. Prospective residents have access to suitable written information regarding the facilities and services provided by the home, which would assist them to make a choice about living there. Prospective residents undergo a comprehensive process of assessment, to ensure that their care and support needs can be met. EVIDENCE: The home has produced written information about services provided at The Malvern. It is clear and easy to read and should help people decide if they wish to live at the home. Senior managers, at the home, spend time with prospective residents assessing their needs. Because most of the residents who move to home have complex mental health needs, the views of external health professionals are also considered. The success of a placement requires not only the expertise of staff at the home, but also support from external agencies who provide additional services to people with a mental health illness. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 9 A very comprehensive pre- admission assessment was seen. There was detail necessary to ensure the resident’s needs with associated risks could be met. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. Plans are in place to enable individuals to live their lives as they would wish, and risks are assessed and well managed. EVIDENCE: Each person living at The Malvern has a written plan of care to provide staff with information about how the person wishes to live their life and what support is needed from staff to achieve that goal. One plan was looked at in detail. It contained all the information about the needs of the person. It was comprehensive, clear for staff to understand and regularly reviewed. Risks taken by the person were identified, discussed, and a plan of action agreed with staff. One risk, relating to smoking cigarettes in the home, was regularly updated and reviewed with the resident, to minimise the risk of a fire in the home. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. People who live at The Malvern are encouraged to take part in the usual everyday activities involved in living in the community, with opportunities for personal development. There are some constraints that can impact on the effectiveness, such as staff shortages, lack of personal monies, and lack of interest by some residents. Staff work hard to help residents understand the balance between their rights and their responsibilities when living in a communal situation. EVIDENCE: The staff team led by the social activities coordinator is well motivated to research and offer appropriate activities for the people living at The Malvern. Because a large number of the residents have lived for long periods of time in mental heath establishments, staff spend time motivating residents to The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 12 reintroduce lost skills of daily living. This is not always well received by some residents, who want staff to undertake tasks they are capable of achieving. The activities coordinator appears to have a great understanding of the residents and demonstrated skills to engage residents throughout the day. She had contacted a Bradford agency that was visiting the home to prepare paperwork for residents to participate in a “passport to leisure” plan. This initiative will enable residents to visit various establishments in the area at a reduced cost, including access to swimming baths, which had been identified during residents meeting. Most residents now go shopping for their own cigarettes and personal items, something the staff have been encouraging for some time. There has been a change to the menus and residents have had their say in what they would like to see included. Most said they enjoyed the food served. Meals are served in a dining area which is very basic and doubles as a smoking area. Improvements to this area such as table cloths and serviettes may encourage residents to become more socially interactive at mealtime. The Environmental Health report for May 2007 was seen. It acknowledges that improvements in the storage, and cooking of food has improved and is now rated as good. An agency cook has been employed for a two-month period as permanent staff are on long-term leave. He said he found the kitchen equipment in working order, and was in the process of making steak and kidney pie for lunch. The home has a small number of residents from minority ethnic backgrounds. Their cultural catering needs are varied and well met by the home. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. People who use the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. Generally, the health of residents is met, in a way that maintains their dignity and independence. EVIDENCE: The policy and procedure for the safe administration of medication has been reviewed and updated. It now provides information on staff responsibility when a resident wishes to administer their own medication. Evidence was seen in one care plan of a resident who successfully self-administers insulin with support from staff. Medicines are stored safely, and checked to ensure they are correct when they arrive from the pharmacist. The procedure for the management of controlled drugs was checked and is safe. A member of staff was observed administering medicine to a resident. It was done in a sensitive way, but it is advised that the medicine’s The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 14 administration record is taken to the resident with the medicines, and signed as administered immediately, to avoid errors in recording. Staff within the home, and a team of external health professionals meet the health needs of the residents. There was evidence that external professionals recognise and value the complex and diverse support provided by staff to residents. The residents visit local health centres for any physical illnesses they may develop. A number of residents are aging and developing age related illnesses, which as yet the home has not addressed as part of its staff-training plan. This may impact on the well being of those aging residents. The mental health needs of the residents are well provided for. All the nurses are registered mental health specialists, who are trained to recognise resident’s deteriorating mental health and are able to call in specialist support when required. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. Residents are able to complain, and all staff are trained to ensure they understand adult abuse, to protect residents at the home. EVIDENCE: The home has a copy of the complaints procedure in the hallway. When asked, residents said they would talk to the staff if they had a complaint. Any complaints are recorded in a complaints file. It was suggested this could be improved by including the complainants satisfaction with any investigation and outcome to their complaint. Staff have a good level of awareness of the risk of potential abuse that some service users subject themselves to when outside the home; care plans showed how the staff try to support those at risk, through assessments and risk management plans. All staff have attended a training course in Adult Protection. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. Accommodation is safe but basic, with some areas of the home looking shabby. EVIDENCE: A fire safety officer has recently visited the home and assessed the home has systems in place to minimise the risk of fire in the building. An external fire safety consultant has developed a comprehensive fire building risk assessment that should be used by staff when undertaking safety checks within the building. The owner continues to invest in the fabric and structure of the building to increase the homely environment. However, the residents’ lifestyles, behaviours and lack of respect for their surroundings result in the environment looking shabby. This is especially noticeable in the sitting/ dining area, where most residents sit because it is also a smoking area. The type of chairs and flooring minimise the risk of fire should a lighted cigarette be dropped, but it The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 17 does little to increase the homeliness of the area. There is a well-decorated furnished lounge that is little used because it is a non -smoking lounge. The issue of smoking within the house will have to be addressed in July 07, when new legislation regarding smoking comes into place. The house was generally clean. The laundry area in the basement has two washers and dryers. Staff are aware how to safely deal with infected laundry, so as not to cause infection to spread. The lino floor covering, on the downstairs corridor, is badly damaged and is a trip hazard that could cause injury to residents or staff. This flooring must be repaired or replaced as a matter of urgency to avoid accidents. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. The procedures for the recruitment, training, and deployment of staff are not thorough enough to protect people living in the home. EVIDENCE: The number of staff on duty was appropriate to meet the current needs of the residents. The recruitment files of two members of staff were looked at. Relevant information relating to references was missing. A criminal records check was not completed before a member of staff commenced work at the home. This is unsafe recruitment practice which could put residents at risk from staff unsuitable to work with vulnerable people. There was no evidence that new staff take part in an induction programme to ensure they understand and carry out their roles in the way that is best for the resident. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 19 The home is to be commended for the numbers of staff with a formal care qualification. 75 of staff have achieved an NVQ level 2 in care. This should help staff perform their role competently and to a high standard and benefit the residents they care for. Four staff hold a first aid certificate, to deal with minor injuries that occur within the home. Internal training needs to be developed and delivered, especially understanding and dealing with challenging behaviour, caring for people with dementia and other age related training as it has been identified that a number of residents who live at the Malvern are aging and presenting with age related illnesses. The home has a vacancy for a qualified nurse. It would provide an improved skills mix if the home were to appoint a general nurse, whos expertise would complement those of the mental health trained nurses The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 and 42. People who use the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service. Improvement in the management of the home continues. Senior members of staff are working to continuously improve standards, for the benefit of the people who live at the home. EVIDENCE: The home has a friendly atmosphere. Staff are welcoming to visitors and the senior team are continuing to develop an open and transparent service. The majority of staff are from minority ethnic backgrounds and in discussion with one staff member it was identified that some residents subject them to racial abuse. The manager and staff team must consistently challenge this behaviour from residents. Training may help staff deal with inappropriate comments from residents. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 21 Work continues on the up- dating and review of the home’s policies and procedures to ensure staff understand how they are expected to work whilst in the home. A new target date has been set for the completion of this task. The owner /registered manager is a registered mental health nurse, with vast experience of caring for people with enduring mental health illness. However, as yet she has not commenced a formal management course This was identified in the last report and needs to be prioritised. During the first quarter of 2007 questionnaires were sent out to health and social care professionals, residents, relatives and staff asking for their views on standards of service at The Malvern. The majority have been returned. The senior team are proposing to analyse the information; look at areas identified for improvement and put together an improvement plan. The results will be sent to all those who received a questionnaire. This process of quality monitoring should assist the manager to develop a continuous improvement plan for the benefit of residents and staff. Information sent to the inspector indicated that all relevant health and safety maintenance work is up to date. The 5 year electrical hard wiring certificate was not available, as work had just been completed. The contractor confirmed by telephone this work had been completed. The gas landlords certificate was up to date. The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 x 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 2 2 2 2 x 2 x The Malvern Nursing Home DS0000019899.V331472.R01.S.doc Version 5.2 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 Requirement The process for recruiting staff must be more robust, to ensure staff are safe to work with the vulnerable residents. Staff must be trained to ensure they are capable of providing support for the residents in their care. Specifically, as a priority, training in understanding challenging behaviour and dementia. Also a detailed staff induction training programme must be introduced for new staff, using the Skills for Care Council guidance. The registered manager must undertake a formal management qualification to complement her existing skills when managing a complex and diverse service. (From previous report, agreed timescale not yet reached) The updating of all Policies and procedures in the home continues, to ensure all staff are working in a consistent safe manner. (previous timescale not met.) DS0000019899.V331472.R01.S.doc Timescale for action 30/07/07 2 YA21 12 30/07/07 2 YA21 12 30/09/07 3 YA37 10 30/10/07 4 YA40 17 30/09/07 The Malvern Nursing Home Version 5.2 Page 24 5 YA20 13 6 YA24 13 7 YA38 13 To minimise the risk of errors when administering medication nurses must take the medication recording record (MAR sheet)with them and sign as given immediately. The floor covering in the main downstairs corridor must be repaired or replaced, as it is currently a health & safety hazard and could cause a resident to fall. The manager and staff team must consistently challenge verbal racial abuse by residents on staff. Training may help staff deal with inappropriate comments from residents. 30/06/07 30/08/07 30/08/07 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 1. Refer to Standard YA6 YA24 Good Practice Recommendations The recording of social events should be more detailed to accurately reflect the amount of work and achievement made for the benefit of the residents. Ways must be sought in making areas in home identified within the main body of the report, more homely looking. 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