CARE HOMES FOR OLDER PEOPLE
Paddocks (The) Hilperton Road Trowbridge Wiltshire BA14 7JQ Lead Inspector
Ms Sally Walker Unannounced Inspection 09.05 26th April 2006 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 Paddocks (The) DS0000028296.V291811.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. Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Paddocks (The) Address Hilperton Road Trowbridge Wiltshire BA14 7JQ 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) 01225 752018 The Orders Of St John Care Trust Jessica Ann Young Care Home 30 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14), Old age, not falling within any other category (30), Physical disability (1) Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 30 No more than 14 service users over the age of 65 years with either a mental disorder or dementia may be accommodated at any one time Only the one named, male service user currently in residence under the age of 65 years with a physical disablement may be accommodated 22nd September 2005 Date of last inspection Brief Description of the Service: The home was originally built by the local authority as a home for people with a visual impairment in the 1970s. The home is situated on the outskirts of Trowbridge within a mile from the town centre. All the residents accommodation is to the ground floor and all single bedrooms. If any residents wish to share, the second bedroom would be set up as a sitting room. Small items of furniture may be accommodated if the bedroom allows. The home is divided into three units all leading off from a central area of sitting room, dining area, kitchen, bar, visitors room, administrative offices and laundry. Each of the units has its own small sitting area, bathroom and toilets. The home offers 1 respite bedroom and a 10-place day service. This day service operates from Monday to Friday and is separately staffed. Residents can join in with the activities and trips organised by the day service. There are plans to increase the accommodation and provide a separate day service facility. The care staffing rota provided a minimum of three care staff and a care leader during the mornings, 2 care staff and a care leader during the afternoons and evenings and 2 waking night staff with a member of staff sleeping in. In addition there are housekeepers, chefs, kitchen assistants, the handyman and the administrator. Miss Jessica Young was registered as manager in June 2005, having worked at the home for 5 and a half years, 3 years as a care leader. Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th April 2006 between 9.05am and 5.15pm. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection?
Significant efforts have been made to improve the environment for residents with redecoration of corridors. The organisation’s surveyor has identified other areas which need to be address in terms of maintenance and upgrading the building. Staff commenced a training programme in dementia care in association with the Alzheimers Society. An activities co-ordinator from one of
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 6 the organisation’s other homes was providing a day each month of different activities, although the home has not been provided with a separate coordinator as it some of its other homes. The home relies on the person providing day care and care staff for daily activities. Activities can take place in the home or in the locality and some residents have one to one time if they do not like groups. Relatives are also invited to special events. All of the vacant posts had been filled. 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. Paddocks (The) DS0000028296.V291811.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 Paddocks (The) DS0000028296.V291811.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 The home provides good information about what potential residents can expect from the home. However the Statement of Purpose gives little information about what is provided in terms of the complexities of a mental health provision. Without an ongoing training programme and consideration of staffing levels the home cannot prove its specialism in caring for people with a mental disorder. The home is very well able to provide a service for older people and older people with a dementia. The home ensures that the admission process is a positive one for residents and their families. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The requirement that the ongoing provision of a service for people with mental disorder must be considered together with staffing levels and a suitable ongoing programme of relevant training, has been actioned in part. No application to vary the category has been submitted but Miss Young is aware of difficulties of maintaining this service. She reported that the home was filling only 10 of those 14 mental disorder beds at the present time as she had been unable to secure ongoing training either through the mental health team, the organisation or other providers. There had also been 4 incidents between
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 9 residents which had been investigated and resolved through the Vulnerable Adults process. Staffing levels had not increased. The Statement of Purpose does not show how the individual categories of care are to be provided. The home is however, well able to provide a good service for older people and older people with dementia, with an ongoing programme of relevant training and evidence of staff skill and understanding in the care records. Residents and their families reported experiencing a good admission process. The home obtains care management assessments, occupational health assessments, social histories and carries out their own assessment of the potential resident either in hospital or their own home. Letters of diagnosis were also on file. The organisation’s current format for assessment does not support the home to carry out assessment of complex care needs and relies on the assessor’s ability to ask the right questions. Paddocks (The) DS0000028296.V291811.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, 9 & 10 Care plans make sure that residents general care needs are met with clear detail and regular review. The home cannot evidence that it is providing the same good standards of care to those residents with more complex care needs, particularly in mental health. Residents have good access to healthcare professionals. The medication administration system is generally robust, but the current system for collection of new medication puts residents at risk of not having that medication when it is prescribed. Residents can know that staff will respect them and their privacy. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Care plans were very detailed with regard to the personal, social, healthcare and physical care provided to residents. Good evidence of monitoring and reviewing residents needs with immediate care charts for food and fluids. The inspector advised that the few blank spaces should indicated whether items were offered and refused or not given. Residents in their rooms and in the sitting areas had jugs of juice nearby and these were refreshed during the morning. All residents were weighed on admission. The organisation’s blue form for recording residents’ assessment of developing pressure sores was only recording weights. A format for non nursing staff to be alerted to
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 11 indicators of residents risk of developing pressure sores is being piloted by the Tissue Viability Specialist Nurse and it is expected to be introduced to care homes with some training very soon. The Paddocks has in the past had tissue viability training from the Specialist Nurse, and this is evident from the statements in some of the risk assessments. Although a member of staff reported that a resident would be referred to the district nurse when any red marks appeared, clearly too late. Miss Young was due to give 2 training sessions in May on tissue viability. None of the residents had any pressure damage and pressure-relieving equipment was in place for some residents. The recording for wounds was limited and although body maps were available they were not always filled out. The home should not rely on district nursing notes, but must record their own record of healing of wounds and phrases such as “sore on left buttock” and “got a red bottom” must be avoided as they are not clear. Miss Young said they were taking photographs of wounds with residents’ permission as a record of healing. It is expected that once the form has been launched and the training provided, that the home will carry out tissue viability assessments for all residents but a requirement has not been made at this inspection. Risk assessments were in place for all aspects of residents’ safety. One assessment showed good advice on risk of suicide and another had good guidance to staff on dealing with verbal and physical aggression. Care plans did not necessarily show evidence of how the residents overall complex mental health needs were being planned for and met. Residents and relatives made very positive comments about the care provided, both on the day and through comment cards. Generally the systems in place for the administration and control of medication were robust with good recording systems and staff competency training. The inspector advised that the pharmacist should be requested to remove those medications from the medication administration record that are not longer prescribed to avoid confusion. One resident had been prescribed an antibiotic the day before which had not been given, 4 possible doses had been missed. One of the care leaders immediately dealt with the problem. They said that normally the GP would take the prescription to the adjacent pharmacy which would then deliver it to the home. Clearly this system is not working and putting the residents at risk. Residents were able to administer their own medication following a risk assessment and secure storage was available in their rooms. A recent maladministration had been addressed with re-training and staff giving medication now wearing tabards to make sure they were not disturbed. Paddocks (The) DS0000028296.V291811.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 Residents spend their day as they wish. A good range of activities is provided both at the home and in the locality. Residents retain contact with families and friends. Residents retained a degree of choice if they were able, other residents with more complex needs relied on staff to support them. Residents enjoyed the quality and variety of meals provided. Information about best practice in proving a good diet to older people and people with dementia was discussed with staff. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Although a 35-hour post for activities co-ordinator has been appointed, this person has the responsibility for day services. The home does not have additional hours post as other homes in the organisation. A good range of activities is provided each day both at the home and in the locality. Residents can also have one to one time if they do not wish to join in with the group activities. Activity co-ordinators from other homes in the organisation were spending a day a month at the home to provide different activities. Staff were observed to invite residents to activities. Residents and relatives made positive comments about the activities both on the day and in comment cards. Two relatives said they had been invited to a 1940’s evening the following weekend. Visitors were encouraged and made welcome. Residents who were able to decide could spend their day as they wished. Other residents with
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 13 complex care needs relied on staff to set a routine which they were seen to do with explaining to those residents what was happening, at different times of the day or when unable to make sense of situations. All of the residents spoken with said they enjoyed the range and quality of the food. Residents could have meals in their rooms, in the dining area in each unit or in the central dining room. A cooked breakfast was available and a choice of main meal at lunchtime. Large print menus for breakfast and lunch were displayed on each table. Residents said they had talked to the chef about what they liked. One resident said it was the sort of food they had at home. Nutrition was being monitored if indicated. Residents had access to fresh drinks at any time throughout the building. Miss Young had discussed the Commission’s publication “Highlight of the day? – improving meals for older people in care homes” with the cooks and staff, together with the advice on food from the Alzheimers Society. Paddocks (The) DS0000028296.V291811.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 Systems were in place so that residents, relatives or staff could raise concerns about any matter concerning the home. Residents and their relatives had been made aware of the processes and were confident that their issues would be dealt with. All staff were clear that they would report any allegations of abuse of residents. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A complaints procedure was in place and displayed around the home. Residents and relatives were aware of the process and seemed confident in using it and had been given a copy. The Manager kept a log of all complaints showing outcomes, actions taken and response to complainants. Staff had received training in the local Vulnerable Adults procedure. When asked about reporting allegations of abuse their immediate response showed confidence in using the procedure and in reporting concerns via the home’s whistle blowing procedure. The administrator was clear that the home would not tolerate any financial abuse of residents and was confident in using the process if needed. Recent notifications to the Commission showed that staff were confident in using the process. Miss Young said she had the authority to suspend staff if needed pending an investigation of allegations. She was not familiar with the process of referral to the Protection of Vulnerable Adults list and was advised to consult the Commission’s website for details. The organisation had not provided the home with a policy on the use of restraint and Miss Young was advised to take this up with her manager, given the recent incidents between residents and vulnerable residents having gone from the building unsupervised. Staff need to know that they are acting appropriately in
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 15 attempting to prevent violent incidents or preventing residents who may be at risk from going from the building. Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home provides a safe, comfortable and clean environment for residents. The organisation’s surveyor was visiting regularly to assess outstanding works. Much work had been done to improve the physical environment for residents with recent redecoration of Blue wing. Residents said they liked their bedrooms. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents bedrooms were clean, airy and comfortable. Each has a good view of the gardens and all of the bedrooms are to the ground floor. Most are within easy reach of bathrooms and toilets. Some of the bedrooms are small so do not allow much additional furniture. Residents could personalise their bedrooms with their own possessions. The respite room was well presented. Residents said they liked their bedrooms and many had their own keys. All of those residents who were in their bedrooms had their call bells within reach and the jack plugs were now regularly checked following a failure noted at a previous inspection.
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 17 The Commission has been provided with the organisation’s surveyor’s report following visits to the home to assess the outstanding works to be carried out. This included non-slip bathroom and toilet flooring which was aged and difficult to keep clean. The batteries in the exit alarms were now being regularly checked by the handyman following a failure when a vulnerable resident was able to go from the building undetected recently. The home was cleaned to a good standard and no unpleasant odours were detected at any time. Comments cards agreed that the home was always fresh smelling. Miss Young agreed that she would dispose of the plastic patio chairs in the bathrooms as they were difficult to keep clean and replace them with something more suitable so that residents could sit comfortably as they got out of the bath. Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents are supported by a cohesive team of well-motivated staff. Staff are well trained in the provision of care to older people and people with dementia. However expertise and training in all aspects of caring for older people with mental disorder is poor. Current staffing levels do not support residents with complex care needs. Staff have good access to basic training and there was good evidence of proper induction. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The rota showed 3 care staff and a care leader on duty during the morning and 2 care staff and a care leader on duty for the afternoon and evening. There were 3 waking night staff. All of the vacancies had now been filled. There had been no increase in staffing levels as per the organisation’s proposal of May 2005. Many of the residents have complex care needs, most care staff have additional administrative duties and the care leaders were responsible for running the shift and giving medication. The layout of the building is three units linked to a central sitting room and dining area with residents choosing to be in all areas. Current staffing levels do not support the home to care for those people with complex care needs, particularly at busy times of the day, in all areas of the home, as evidenced by the reduction in numbers of people with mental health, a recent medication error, staff not being available to fill a prescription for an antibiotic and supervision of vulnerable residents who were at risk of going from the building. However, staff were highly motivated to provide a good service to residents. Residents and relatives both on the day of the inspection and in comment cards, reported very positive comments about
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 19 the staff. Most of the residents knew who their keyworker was. Staff were seen to engage with residents and were respectful of residents privacy when entering rooms and in giving personal care. Staff ensured that all the residents were well groomed. The designated activities staff was providing care as the co-ordinator from another home was running the programme that day. Robust recruitment procedures were in place with all the required information and documents in place. None of the staff commenced work without a Criminal Records Bureau certificate being applied for and a POVAfirst check. All new staff were induction as evidence by the records and in talking to three new staff. All of these new staff said that they had been welcomed into the staff group and that every one worked as a team. They said they had regular supervision and staff meetings. All of these new staff had also attended some training courses since coming to post, for example, moving and handling and vulnerable adults procedure. The organisation’s training matrix showed a good range of basic care and health and safety training provided by the organisation and all staff had the opportunity to complete NVQs. Whilst dementia care was listed as core training, mental health was not. The only mental health training had been a session on depression by one of the community psychiatric nurses last November for 15 staff. Miss Young reported difficulties in obtaining further training. The majority of the care staff were undertaking a training package on dementia care in association with the Alzheimers Society. Staff had also watched a dementia video last October. Staff said they were benefiting from this training. Miss Young was providing training on prevention of pressure sores and nutrition in May. Courses were also advertised for health and safety, first aid, policies and procedures and quality dementia care. There was no evidence that staff had had any training in dealing with behaviours or aggression, save one care leader who had worked with people with learning disabilities. Paddocks (The) DS0000028296.V291811.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, 33, 35 & 38 The home is run in the best interests of the residents. Miss Young has shown her ability to manage some difficult situation during the past year. She is well known to the residents. Residents and their representatives are encouraged to make comments about the service. Systems are in place to safeguard residents finances. Residents health and safety was promoted with staff training and regular risk assessment. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Miss Young was registered as manager in June 2005. She is well motivated and clear about how she wants the home to develop. She has successfully managed some difficult situations during that time; succeeded in filling all the vacant posts and demanding support with challenging residents from healthcare professionals. Miss Young said she had had difficulties in completing the Registered Managers Award due to the assessor’s long-term sickness, but had now found a new provider and was completing the award.
Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 21 She had undertaken recent training in computing, health and safety, risk management, business skills and first aid appointed person. Currently she was completing a course entitled quality dementia care. Robust procedures were in place to ensure all cash held on residents behalf was properly accounted for. Staff were trained in safe working practices and health and safety. The environment was regularly risk assessed. Questionnaires had been sent to residents and their relatives asking for comments about the service. Miss Young held regular residents meetings and individual unit [cluster group] meetings with residents and staff. Paddocks (The) DS0000028296.V291811.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 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 4 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 18(1)(c)(i ) Requirement The registered person must ensure that there is an ongoing programme of specialist training for all staff in mental health and dementia care. (Actioned in part with a programme of dementia care in place and dementia listed as essential core training on the organisation’s matrix. Only 1 session on depression in November 2005). The person registered must review the allocation of staffing hours to ensure that care needs are met. Management and administrative duties must be clarified. ( Remains outstanding). The person registered must consider the ongoing provision of a service for people with mental disorder. If the service is to continue then staffing levels should reflect this and there must be a suitable ongoing programme of training. Alternatively the home may
DS0000028296.V291811.R01.S.doc Timescale for action 30/06/06 2. OP27 18(1)(a) 26/04/06 3 OP3 14 26/04/06 Paddocks (The) Version 5.1 Page 24 4 OP1 4 5 OP3 14 6 OP37 17 7 OP9 13(1)(b)& (2) apply to remove the Category from their registration The Commission must be informed of any decision. The person registered must amend the Statement of Purpose to show what kind of service is available to older residents with a mental disorder. The registered provider must provide the home with a format for carrying out a full and thorough assessment of prospective residents care needs. The draft format being used by some of the organisation’s other homes is more useful that that used at The Paddocks. The person registered must ensure that a full and detailed record is kept of any marks, redness or wounds. This must include size, exact location and quality. The person registered must ensure that if a medicine is prescribed the prescription is filled immediately and the medication given to the resident, particularly in the case of antibiotics. 30/06/06 30/06/06 26/04/06 26/04/06 Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 25 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 Refer to Standard OP8 OP37 Good Practice Recommendations The person registered should ensure that fluid and food intake charts include whether meals and drinks were offered or refused rather than leave blank spaces. The person registered should ensure that the district nursing notes are not relied on as evidence of healing of wounds or other treatments. The home must keep its own records. Paddocks (The) DS0000028296.V291811.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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