CARE HOMES FOR OLDER PEOPLE
The Manor N & R Home 78-80 Lutterworth Road Aylestone Leicester LE2 8PG Lead Inspector
Janet Browning Unannounced 10 May 2005 08:30
th 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Manor N & R Home Address 78-80 Lutterworth Road Aylestone Leicester LE2 8PG 0116 2990225 0116 2990257 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Bassir Jugon Mr Howard Michael Kelsall CRH 49 Category(ies) of Dementia (49), Dementia - over 65 years of age registration, with number (49), Learning disability (23), Learning disability of places over 65 years of age (23), Mental disorder, excluding learning disability or dementia (23), Mental Disorder, excluding learning disability or dementia - over 65 years of age (23), Old age, not falling within any other category (49), Physical disability (49), Physical disability over 65 years of age (49) The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No person may be admitted to the home who also falls within the category/combined categories MD, MD(E), LD, LD(E), when 23 persons who fall within any category/combined categories are already accommodated within the home. No person under the 55 years of age who falls within categories DE, MD, PD, or LD may be admitted to the home. Date of last inspection 17th November 2004 Brief Description of the Service: The Manor Nursing and Residential Home is a large purpose built establishment situated on the Lutterworth Road close to the centre of Leicester. It is within easy reach of Leicester by public transport or car. The home offers accommodation for up to forty-nine service users with nursing, residential, mental health, and learning disability needs. The accommodation is based between two buildings, which are conjoined, and are now an amalgamated unit. The home also offers respite care facilities and is set in extensive mature gardens. The grounds are mainly laid to lawn with shrub borders. There is a large conservatory and also a covered area, which is occasionally used for activities or as a quiet area for visitors. The home has a lounge diner on each floor and on one side of the premises a second large lounge is located. The home has a number of shared rooms and some bedrooms are en-suite. Both floors are accessible to service users by either a passenger lift or a stair lift. All rooms are fitted with smoke detectors and nurse call systems. There are ample parking spaces and a number of local hotels and public amenities are within close proximity of the home. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection with two inspectors and took place over 9 hours. In all, four residents were case tracked, with two staff records, and some of the home’s records being examined. A pre-inspection questionnaire, sent out to the home prior to the inspection, was not returned back to CSCI as requested, and no comment cards were received from residents or relatives. There was an opportunity to talk with three residents who were able, two relatives and three members of staff. The registered manager was on the premises throughout the inspection and the service provider was present throughout most of the inspection. The findings of the inspection were discussed with both the registered manager and service provider. What the service does well: What has improved since the last inspection?
Using the expertise from an external source, the home has worked hard to improve the admission process and this is on-going work. They recognise that there is improvement to be made in communication within the home and have organised an external training source to come into the home to improve communication both verbal and written. Care plans are now being evaluated monthly. They are utilising outside agencies for training programmes to meet requirements from previous inspections in moving and handling and infection control, with a plan to develop this in other areas of care. Again this is ongoing work and the home is striving to work with external agencies in improving care within the home. New carpets have been provided in areas of the home, which was a requirement from the previous inspection.
The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 6 What they could do better:
Although improvements have been made with the admission process, care planning is still a problem with plans being confusing or lacking detailed guidance especially in respect of dementia care. Some risk assessments are inaccurate or, again, lacking in sufficient detail in order to ensure that risks to residents are eliminated as much as possible. Monthly evaluations of the care plans do not give clear or accurate information as to the outcome of care for the resident. Robust care planning is essential for all residents but especially those who require complex care or who are unable to voice their needs, as care plans give clear direction to staff as to what care is required. Indications are that some staff require more training in dementia care and, without adequate detailed guidance, it can not be assured that all care needs are being met. Training in both written and verbal communication is being organised by the home. Poor moving and handling practices are being performed by some staff, which can put both residents and staff at risk of harm. The home states that staff are currently having in-depth moving and handling training from an outside source and they are putting in extra training immediately to address the current poor practice. There are issues surrounding administration of medication. There are indications that medication is not being administered when care notes suggest it should be. This is being addressed by the home immediately. The home is generally clean and tidy, but equipment is being stored blocking access for staff to all hand-washing facilities, especially in clinical areas. There are records to show that pressure relieving equipment is checked regularly, but some equipment was not working as it should with staff being unable to recognise the signs of faulty air mattresses and cushions. The home is addressing this issue immediately. The home states it is committed to improving care within the home but does not keep adequate records to demonstrate this. The complaints records book is insufficient and lacking in detail and there are no records kept of training received, including training for new starters on induction and no training development plan. The home does not have a formal system for monitoring the quality of the service it provides for residents, and therefore will be unable to measure the effectiveness of any new ways of working. Staff are being employed in the home without the proper checks required to ensure the safety of residents. The home is addressing this immediately. The registered manager was not sure of the procedure for checking prospective employees on the Protection of Vulnerable Adults register and staff are not fully aware of the correct procedure in reporting suspicions of abuse. On the whole, the indications are that the staff treat residents with respect but two residents raised issues surrounding staff using inappropriate language when talking with residents. This is being addressed formally both with the home and other agencies.
The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 7 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 Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Progress has been made to improve the assessment procedure but staff are not fully trained in meeting the care needs identified and therefore there is no assurance that all needs can be met. EVIDENCE: The residents’ care plans examined contained a full assessment of needs. The assessment documentation has only just been introduced after consultation without an external health professional. Different nurses completed two assessments examined, both varied in content. One contained very detailed information, but both were sufficient to develop a plan of care for assessed needs. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 10 The registered manager could not give details of any specialist training in dementia care although some of the nurses are registered as mental health nurses. For care assistants there was no evidence of specialised training in challenging behaviour or dementia care. One resident identified in his assessment as having challenging behaviour was heard shouting out continuously whilst being assisted by two care assistants in the toilet. The registered manager explained that the resident does not like having his space invaded but guidance on handling this situation was not detailed in the care plan and by talking to staff and with no training record, there was no evidence that the carers had received the appropriate training. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Care needs identified during the assessment process are not always reflected in sufficient detail in the residents’ care plans and there are some inconsistencies in medication administration, all of which has the potential of placing residents’ health and welfare at risk. The respect of residents, though generally good, can be such as to cause concern. EVIDENCE: The care plans examined were inconsistent and some did not contain enough detail to sufficiently guide staff to provide care for residents. The care plans were also confusing in that either the care plan did not clearly identify what the need was or the evaluation did not correspond to the care need identified. One resident had a care plan for taking night sedation as a care need and the last evaluation stated, “uses wheelchair and hoist for transportation”. This was confusing, as the care plan did not give details as to why night sedation was required or an explanation as to what the evaluation related to. Due to being unable to communicate with the residents case tracked, it was difficult to know if needs were being met from the residents’ perspective. This was not assisted by the fact that comment cards sent out to the home for distribution to residents and relatives were not received by CSCI. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 12 Pre-written or “core” care plans are used which do not reflect the individual aspects of some care such as dementia. For example, one resident had complex needs surrounding his mental health problems and he was unable to understand instructions. The care plan for his anxiety stated for him to be encouraged to with relaxation techniques and to have stress management classes. There were no review dates for some assessments, but there was evidence that they had been looked at recently. However changes in the resident’s care needs had not been reflected in assessment reviews, with the assessments still detailing the residents’ needs as they were on admission. Risk assessments for pressure sore development and moving and handling were updated regularly, but in two sets of notes examined they were inaccurate, as they did not reflect the resident’s current situation or identify equipment required. The corresponding care plans were not evident in two sets of notes. Without clear assessments and guidance in care plans, incorrect equipment and techniques could be used in moving and handling causing risk of harm to both residents and staff. This was evident when staff were observed struggling to place a sling behind a resident to be hoisted, causing them to perform an unsafe technique. The care assistant stated that no-one had told her which sling to use, and that she decided that herself. There was no guidance in the resident’s care plans. An air mattress and air cushion for the aid of pressure relief were observed as being faulty with the alarm light evident. Three members of staff on duty had not recognised this fault. Medication was not always being given as prescribed or there was confusion or lack of clarification from a doctor. For example, one resident required medication to be given as required for constipation. He was unable to request his own medication, relying on the clinical judgement of the staff. His care notes indicated that he required this medication two or three days ago, but it had not been given and there was no explanation from staff why it had not been given. The registered manager had organised for a pharmacist to give a lecture on drug administration including handling stock, but there was no record of who attended. It was also noted that non-nursing staff in one side of the home was administering medication for residents in receipt of nursing care. During the inspection, one carer was observed chatting and talking sensitively to residents whilst she was working and one care assistant spoken to stated that she had received training on dignity. Some residents stated • “These two girls in here are lovely.” • “Staff are nice to me” However, discussions with two residents indicated that staff attitudes can be disrespectful, with shouting at residents and staff occurring at times. This issue is being reviewed formally both with the home and other agencies. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 13 Residents had access to other health professionals with evidence in the notes of visits from dieticians and doctors, with a dietician praising staff in the notes for keeping good records of a resident’s food intake. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 14 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 standard(s) 12 The detailed and varied activities offered by the home enable residents to be stimulated and meet their recreational needs. EVIDENCE: The activities organiser employed by the home works Monday to Friday 8:30am to 2pm, but she varies this to suit activities going on within the home. She keeps a journal of all the activities undertaken which details which resident has joined in, how they responded and conversations that have taken place. She was observed in the lounge in one side of the home, encouraging residents to sing along to taped music, she prompted residents to talk about their lives and encouraged residents to finish phrases and sayings. Residents, including residents with dementia, were observed at the beginning of the session as being very quiet, but were actively taking part after a few minutes. The organiser demonstrated an in depth knowledge of the residents’ lives and interests which she used to encouraged the residents to chat. The organiser spreads her time throughout the home and activities take place in different parts of the home at different times. Residents are offered to be taken to other parts of the home for different activities.
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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 standard(s) 16 and 18 The recording of complaints and awareness of adult protection procedures is insufficient to ensure that residents and relatives are confident that concerns will be listened to and that residents are protected from risk of harm. EVIDENCE: The complaints procedure was seen on the wall in the reception area and a relative spoken to stated • “I haven’t had to make a complaint but if I did I would report to the manager.” The complaints record was unable to be found on the day of inspection, but produced a few days later. It was a notebook with one complaint recorded in 2003 when evidence provided by the home suggested that they had received four complaints in the past twelve months and a relative stated that she had made an informal complaint last year, which was not recorded in the book. The registered manager agreed that the book used needed to be more formal with details of investigations, actions taken and outcomes. A relative spoken to stated that she would report any concerns to the registered manager. The home stated that a more formal complaints record is to be used. A new member of staff spoken to understood about the adult protection procedures as outlined in the Department of Health “No Secrets” guidance. She had received training during her induction. However, another carer did not fully understand about adult protection and had not heard of whistle blowing or the “No Secrets” guidance. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 Improvements had been made within the home to present a clean environment, but are insufficient to ensure that residents are protected from the risk of infection. EVIDENCE: New carpets were evident in the home and the rooms of the residents case tracked and the bathrooms inspected were clean and hygienic at the time of inspection with liquid soap and paper towels evident which was a requirement from a previous complaints inspection. The laundry room was tidy and clean, with labelled containers for residents’. Clothes. Linen trolleys were placed throughout the home with stocks of gloves and aprons. The sluice room upstairs was untidy, with bags on top of the sluice inhibiting its use. Access to the washbasin was completely blocked by equipment. On talking with a carer, she explained that she washed hands in the bathroom next door to the sluice and used disinfectant hand wash outside the sluice. This procedure involved handling door handles with potentially infected hands.
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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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Adequate staffing levels are provided by the home, but the recruitment procedure and recording of staff training needs to be more robust to reduce the risk of harm to residents. EVIDENCE: Two staff members’ recruitment records were examined and found to be incomplete. For example, one record did not have any written references and another new member of staff was employed without the relevant checks made. The registered manager was not aware of the correct procedure for checking the Protection of Vulnerable Adults register before employing someone and did not have a copy of the Department of Health Protection of Vulnerable Adults guidance. This gives guidance for referring staff who may be unsuitable to work with vulnerable adults and of checks to be made prior to employing staff in care positions. A requirement was made for the home to act upon this immediately and to review their recruitment procedure. This was a requirement at the last inspection. It was not evident due to the lack of training records or development programme that the staff were competent to meet all the needs of the residents. A new starter had an induction book but the first day induction had not been completed or signed even though the staff member demonstrated that she had received some induction. Another member of staff who had worked at home for one year had not received any training on infection control, but had been showed correct hand washing procedure.
The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 18 The registered manager had initiated training with an external source for moving and handling, which involves in depth theory and practical sessions. Staff spoken to stated how useful they found the sessions, which are still ongoing. The plan is to follow this with infection control training. These are basic competencies for providing care and there was no evidence that staff, in particular care assistants, were competent in meeting the needs of residents with dementia. Six members of staff have completed the NVQ 2 qualification, and others are interested in signing up for the course. Staff rosters examined showed that care hours exceeded the required number as indicated in the Department of Health guidelines. Nursing staff were mainly on one side of the home, but went across to the other side of the home to provide care to those residents assessed as requiring nursing care. It is recommended that staff rosters have first and surnames to easily identify staff who are working. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35, 37 and 38. The management have introduced new systems to improve the quality of care for residents but lack of systems to monitor quality results in no assurance that any changes in care are successful, consistent or maintained. Some current practices in the home do not promote or safeguard the health, safety and welfare of the people using the service. EVIDENCE: The manager demonstrated innovative ideas and commitment to improve the home with external sources already being used for training, which will enable the home to meet the needs of residents. These commitments were not reflected in a training development programme. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 20 Staff spoken to found the registered manager to be approachable and supportive and one staff member found that he gave clear direction. Staff reported that they get a handover at each shift, and the assistant manager was observed giving a handover to the registered manager following a period of absence. However, comments received from staff indicated that, although some direction is given, this was not always clear with junior staff making their own decisions on care practices. • “There is poor communication and not much support from the management when the manager is away.” • “Could do with more teamwork.” • “I am not told which sling to use, I decide from the training I’ve received.” • “I get clear direction.” The home recognises that communication in the home requires improvement and have arranged for another outside source for training in both verbal and written communication. Discussions with the registered manager regarding auditing quality in the home demonstrated that the home did not have an auditing system in place. Some informal auditing took place in the form of the registered manager examining accident records. An example was given of a resident who had fallen frequently within a short space of time and from this a doctor’s visit was initiated. However with inadequate care planning being a problem previously in the home, an audit system had not been developed to monitor the new care plans and assessments introduced. The residents are encouraged to control their own money, but each resident would be assessed individually regarding their ability to control their own finances. The home had developed an individual system for one resident which fits into her choices whilst safeguarding her financial interests keeping detailed records and receipts. The registered manager was unable to locate records in the office following a short period of absence. For example, records of any previous or current training and complaints record. It is also noted that the pre-inspection questionnaire sent to the home by CSCI, was not completed or provided prior to the inspection. It was also noted on examining the home service history that a fall in the accident records had not been reported to CSCI as required. Although staff had received moving and handling on induction and were also currently on a course for moving and handling, two incidents of unsafe practice were observed in the moving and handling of immobile residents. A requirement was made to address this immediately. The home has provided additional training to the outside source training currently being received by the home.
The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 21 Records indicated that fire drills and instruction had taken place, but night staff had not received any fire drills, which was confirmed by the manager. Residents using bed rails did have consent forms for restraint in the care notes, but did not have risk assessments for their use, which is good practice. The registered manager stated that he would obtain information on risk assessments for bed rails. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x 3 1 x 3 x 2 1 The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 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 4 Regulation 18 Requirement All care staff employed in the home must be sufficiently trained in dementia care to meet the needs of residents. Further improvements must be made to ensure resident care plans are in sufficient detail to provide guidance to staff on the actions to be taken to meet all their health and welfare needs including dementia care. The care plans must also be accurate when being evaluated. (Previous timescale of 17/11/04) Resident risk assessments must be accurate and in sufficient detail to eliminate risk to residents when receiving care. Equipment used in the prevention of presure sores must be in good working order and staff aware of the indication of when equipment is faulty. Staff must be trained in knowledge of how medicines are used and how to recognise and deal with problems in use. Staff must be aware of administering as required medication as precribed by a medical practitioner.
C51 S1919 The Manor N R Home V215135 100505.doc Timescale for action 02/07/05 2. 7 15 02/07/05 3. 8 12 02/07/05 4. 8 23 Immediate 5. 9 13 Immediate The Manor N & R Home Version 1.30 Page 24 6. 16 17 Schedule 4 82 7. 18 8. 18 13 9. 26 13 10. 29 19 11. 30 18 12. 33 24 A record of all complaints made, including of investigations and any action taken must kept in the home. The registered manager must ensure he has in depth knowledge of the procedure for referring people under Protection of Vulnerable Adults. All staff must receive training in the procedures for responding to suspicion or allegations of abuse. (Previous timescale 17/11/04) Suitable arrangements must be made to ensure that access is available at all times to hand washing in areas where infected or clinical material may be handled. There must be a robust recruitment process and that it; a) all new staff are confirmed in post only following completion of a staisfactory check of the Protection of Vulnerable Adults registers and satisfactory police checks in line with POVA guidance. b) Two written references must be obtained before employemnt is confirmed. (Previous timescale 17/11/04) Staff must receive training appropriate to the work they perform and that training records are kept accurately. Systems must be established for reviewing and improving and maintaining the quality of care, including nursing care, within the home. Records must be kept in the home as per Care Home Regulations and be accurate and up-to-date. 02/07/05 02/07/05 02/07/05 02/07/05 Immediate 02/07/05 02/07/05 13. 37 17 02/07/05 The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 25 14. 38 13 15. 38 23 Suitable arrangements must be Immediate made to ensure the safe moving and handling of residents residing in the home. All staff must receive fire drills 02/07/05 and practice at suitable intervals, including night staff. 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 9 27 Good Practice Recommendations It is recommended that residents in receipt of nursing care are administered their medication by a registered nurse. It is recommended that full names are used on staffing rosters. The Manor N & R Home C51 S1919 The Manor N R Home V215135 100505.doc Version 1.30 Page 26 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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