Inspection on 18/12/08 for The Perry Tree Centre

This inspection was carried out on 18th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Perry Tree Centre 11/02/09

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Perry Tree Centre Dovedale Road Kingstanding Birmingham B23 5BX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Perry Tree Centre Dovedale Road Kingstanding Birmingham B23 5BX 01216755571 01216755573 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Social Care and Health Name of registered manager (if applicable) Andrew Leslie Orlando Marsh Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: The maximum number of service users to be accommodated is 32. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 32 Dementia (DE) 32 Mental Disorder (MD) 32 Sensory Impairment (SI) 32 Learning Disability (LD) 32 Physical Disability (PD) 32 Date of last inspection Care Homes for Older People Page 4 of 30 care home 32 Over 65 0 0 0 32 0 0 32 32 32 0 32 32 Brief description of the care home The Perry Tree Centre is a new two-storey building of Brick and tile construction. The centre has been designed and built to a high standard with input from the Sterling University regarding dementia design. The residential unit is accessed through a security door to which passes can be set to varying access levels, to exit a push button system is in operation. The accommodation consists of thirty-two single occupancy bedrooms all with en-suite facilities, on the ground floor, which include a walk in shower and an adjustable sink for wheelchair users. The accommodation is divided into units of eight with their own lounge/dinning areas, staff work stations for the location of files and medication. All bedrooms have communication systems, which, include pull cords and voice communication, which can only be cancelled at the point of call. The system can be extended to included other assistive technologies. All bedrooms exceed current NMS about personal space. All rooms have access for wheelchair users. Bedrooms have TV and telephone points; the site has Wi-Fi for computer access. The centre has two gardens, which have been equipped to a high standard with sensory facilities. There is kitchen that caters for the whole building and a laundry sited outside of the unit. There is some parking in a designated car park at the front of the building. Fees charged at the home are assessed by placing social workers. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first inspection undertaken of the Perry Tree Care Centre since its registration. It was carried out by two inspectors during a day in December 2008. Before the inspection we had received an Annual Quality Assurance Assessment (AQAA) which provided us with some information about how the home was operating. We sent out 10 questionnaires to the people living in the home and 5 to staff working there to get their views on the running of the home. At the time of writing this report we had received one completed survey from someone living in the home. During the day we had a look around the home, spoke to the manager of the home, the team leader and one of the direct care workers. We were able to observe breakfast Care Homes for Older People Page 6 of 30 time and looked at the files of two people living in the home and the management of medicines in the home. We spoke to four of the people living in the home. Since the home has been registered we have received information about the accidents occuring in the home. There have been no complaints about the home. There has been one adult protection issue raised at the home and the matter has been addressed to ensure that the individuals are safeguarded as far as possible. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who had moved into the home had had a comprehensive assessment before they moved in so that the staff were aware of their needs. People were offered a visit to the home before they decided to move in to help them decide if the home was suitable for them. People were given a residential care agreement but the manager needed to be more proactive to ensure they were issued at the point of admission. Evidence: The Perry Trees Care Centre was registered as a care home in July 2008. At the time of registration the statement of purpose was sampled and found to be accurate. During a tour of the building it was seen that a file containing the service user guide was in place in each of the bedrooms occupied by the people living in the home. The people who had moved into the home had all been transferred from other Local Authority homes that were due to be closed. As part of the resettlement process Care Homes for Older People Page 10 of 30 Evidence: individuals were assessed by social workers and it was determined that the home would be able to meet their needs. We were told that people were offered a pre admission visit however on some occasions this was not suitable for the individuals and relatives had a look around the home on their behalf. The files of two people who had moved into the home were looked at during this inspection. Both files contained very comprehensive assessments carried out by the placing social workers ensuring that the staff in the home had access to information making them aware of the needs of the people moving into the home. For the two people whose admission was looked at during this inspection it was evident that a twenty eight day review had been carried out with the social workers and the individuals representatives which concluded that the home was able to meet their needs and they were happy there. In one case an independant advocate had been used to make sure their views were known. One of the files looked at had a residential care agreement in place however it had not been fully completed to show that either the individual or their representative was aware of the terms and conditions of living in the home. The manager told us that he was aware of this situation and was waiting for a relative to come and sign it. The other one had been completed. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people were being met. The care planning documentation needed some improvements to ensure that people living in the home were having their needs met in a way they wanted and were kept safe. Improvements needed to be made to the management of medicines to ensure that people living in the home got their medicines as prescribed. Evidence: The files of two people living in the home were sampled to check that the staff were aware of their needs and how they were to be met. The AQAA sent to us before the inspection told us that each person in the home had an Individual Service Statement (ISS) alongside the assessment and care plan. Both of the files sampled included these documents. The documentation with the ISS in the files stated that the ISS would be person centred and not task orientated. The ISSs we looked at lacked detail in describing the needs of the individuals and how the staff were to meet these needs. This issue was Care Homes for Older People Page 12 of 30 Evidence: discussed with the manager who felt that the ISS was a statement of what the individual said they wanted to be done and the assessment would provide the detail for the staff to follow in meeting their needs. The assessment identified the needs of the individuals but not the way in which they were to be met. Also the assessments were a very long document and it would take new or agency staff a long time to read and acquaint themselves with the individuals needs. For this reason the ISSs should be rewritten to ensure that it is a document that informs the staff what the needs of the individuals are, how much they can do for themselves, what support they need and how that support is to be provided. A member of staff that was spoken with was well aware of what one of the people living in the home was able to do and what support was needed. This member of staff had transferred from the same home as the individual and had a lot of knowledge of her needs however, other staff may not. Although the member of staff had a lot of knowledge about the individuals needs they did not know that the person suffered from epilepsy. This was clearly documented in the assessment but not mentioned in the ISS. There was no risk assessment or management plan for this issue. There were no indicators of how the individual might present if they were to have a seizure. For one person the assessment indicated that when the individual became upset or agitated boiled sweets could be offered which usually helped to calm the situation. The management plan for this individual stated only that they should be left alone by staff who would come back some time later. This accumulated information had not been utilised to help manage the behaviour of this individual. For another of the individuals the ISS stated that there was no problem with their skin, however, the daily records indicated a breakdown of a skin area requiring dressings by the district nurses. The ISS had not been updated and there was no risk assessment or management plan in place. It was important that this was addressed so that preventative steps coud be put in place to prevent further breakdown of skin integrity. One of the issues that could affect the breakdown of skin is weight loss. The weight records for the two individuals whose care was being tracked had not been recorded since October so that it could not be determined if they were at increased risk of developing pressure ulcers. This is particularly important for people who have dementia who may not be able to tell staff verbally that they are in pain. We were shown records that documented visits made by GPs, district nurses, opticians and so on. However, these records did not state the reason or outcome of the visit and Care Homes for Older People Page 13 of 30 Evidence: on occasions there were entries in the daily records that did not clarify why an action had been taken. For example, one daily entry stated that the GP had visited and recommeded a check at the hospital but it could not be determined what the reason for this was. Daily records made by the care staff needed to be clear about what was being described. On occasions people living in the home had were described as being moody or aggressive but with no additional information about how this presented. For example, was the individual being physically or verbally aggressive and what were they actually saying or doing. Daily records also evidenced that occupational therapists had been involved in individuals care. The home used a monthly blister pack system for the management of medicines. Medicines were appropriately stored in metal trolleys that were secured to the wall in the medication room when not in use. Prior to this inspection we had been informed by the home that one of the people living in the home had been given another persons medicines. The person undertaking the medication round had asked another staff member to give the medicine to the individual. The individual was checked at the hospital for any adverse effects and we were told that the staff concerned were being re trained. As part of this inspection we looked at the management of medicines in the home. When trying to carry out an audit of the medicines in was difficult to determine whether some of the entries were signatures or codes. The manager needed to ensure that there was a specimen signature sheet in place to assist in auditing the medicines. The medicines administration records (MAR) showed that medicines were being booked in when they were being received into the home. Whilst doing an audit of some of the medicines it was noted that there were some gaps on the MAR charts. As these records are a record of whether people have been given their medicines it could not be determined that people were always given their medicines as prescribed. During an audit of some of the boxed medicines the amounts received, the amounts signed as having been administered and what was left in the box did not tally. On occasions this meant that people may not have been given medicines that had been signed as given. During examination of the files it was noted that a record had been made that the GP had agreed for the individual to be given their liquid medicines in a drink as they were unable to make the decision as to whether they needed to take the medicine due to Care Homes for Older People Page 14 of 30 Evidence: their dementia. There was no record that had actually been made by the GP, and the MAR charts did not indicate which liquid medicines were being given covertly. One medicine had not been given to the individual as the prescribing instructions were not correct. It was commendable that this had been identified however, if the issue had been addressed earlier, as well as the fact that insufficient supplies for the month had been provided this could have been avoided. Privacy in the home was being maintained. All the bedrooms were singly occupied and had en suite facilities that further promoted privacy and dignity for the people living in the home. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were able to make some choices in their day to day lives and there were some activities available daily. People living in the home said they were happy with the food served to them. Evidence: People living in the home were able to make choices about when to retire to bed and when to get up in the morning. They could make choices at mealtimes and were helped to make choices about the clothes that they wore. As part of the assessment process the hobbies and likes and dislikes of the people moving into the home were recorded. This information was not always used to ensure that indivdual activity plans were drawn up. For example, for one person the assessment stated they attended church on a weekly basis. At The Perry Trees Care Centre they could attend a service on a monthly basis. There was no evidence to indicate what other efforts were made to meet this individuals needs. There was evidence on the files seen of some activities such as attendance at coffee mornings, Christmas concert, hairdressers visits, helping with Christmas decorations, Care Homes for Older People Page 16 of 30 Evidence: nail care and watching television, playing some games and chatting to staff. The file of one person stated that the General Practitioner had told the staff that they could mix the individuals liquid medicines in a cold drink to ensure that the individual took the medication. There was no evidence that this decision had been recorded by the GP or that the decision had been made under the remit of the Mental Capacity Act. A record needed to be made of why and who had made this decision and that the person had had a capability assessment. There was evidence that relatives and friends could visit people living in the home. There was also contact with the local community with people attending the elders group and local pubs. We were told by people living in the home that they were happy with the food provided and that they were asked what they wanted to eat. On the day of the inspection breakfast was observed and we were told that some people had been waiting a long time for breakfast. Some people had cereal and toast and others also had a cooked breakfast consisting of egg and bacon. The bacon was seen to be rather dry and one person was unable to cut it. We were told that it had taken longer than usual for people to get up and this had delayed the collection of the hot food trolley from the kitchen. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a system in place for the recording of complaints made for the centre as a whole but not for the care home separately. There had been some incidents in the home that meant that the people living in the home had not been fully safeguarded. Evidence: Since the home was registered in July 2008 one adult protection issue had been raised at the home. The issue was raised by the home with the appropriate social workers and plans have been put in place to monitor the individuals involved. It was identified however, that there had been an incident recorded in the daily records that had not been passed onto the management team. This would indicate that some staff did not fully understand adult protection and their roles in protecting vulnerable adults. The manager had put a system in place to ensure that the daily records were checked by a senior member of staff and any actions needed taken. There had been one instance where the wrong medicine had been given to the wrong person by staff. The complaints procedure was not looked at during this inspection however, it was Care Homes for Older People Page 18 of 30 Evidence: noted that a booklet was available in the bedrooms of the people living in the home. The manager needed to ensure that the procedure was in a format that was suited to the needs of the people living in the home. We were told that any complaints made were recorded by Business Services onto the computer system. Three reports were printed off for us and we could see that one of them was in respect of the care home, one was about the reception service and one was a compliment regarding the care centre. The manager needed to ensure there was a system in place that identified the complaints received specifically in respect of the care home so that he could monitor and follow them up within the appropriate timescales. There had been a large number of accidents that had been happening in the home. We were told that some actions such as referring people for assistive technology and to the falls clinic had been taken. This needed to happen on a more regular basis and there needed to be a system whereby the manager was monitoring falls. We had looked at the falls that had been occuring and found that a large proportion of them had been occurring between Fridays and Mondays. The manager needed to look into the possible reasons for this. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building was a purpose built care centre encompassing several purposes including a care home. The building was clean and airy and provided a good standard of accommodation. Further improvements were to be made to the home including appropriate sign posting of facilities within the units. The home needed to be made more homely. The home was accessible throughout to people using wheelchairs and other mobility aids. Evidence: The home was registered in July 2008 and built to meet the requirements of new build care homes. This means that the bedrooms are big enough to accommodate all the furniture required by individuals. People moving into the home are provided with a single bed, wardrobe having see through panels, dressing table with drawers and a bedside cabinet. Each bedroom has an en suite facility consisting of a wash hand basin, toilet and walk in shower. Bedrooms are carpeted and curtains and bedding are provided. There is a call system in each bedroom. In one of the bedrooms seen the call system would not have been accessible to the individual when in bed. Unfortunately there was Care Homes for Older People Page 20 of 30 Evidence: no extension cord available with it and the system was fixed system so could not be moved. This situation had arisen as the position of the bed had been moved to prevent the individual from falling out of bed. Having a static call system means that even though the rooms are large enough to rearrange the furniture within them the call system determines the placement of the bed. The call system had been causing some difficulties in the home. There had been a problem with some calls stacking and taking some time before they came through on the handset. Also staff had to go to the staff base to pick up the handset to find out where the call was made cancel the call and then cancel the call from the point of call. Pagers had been acquired however, this was still causing some problems. Problems were particularly pertinent at night when there were fewer numbers of staff on duty. The system also did not have a separate emergency call that would alert other staff that additional assistance was needed or that there was an emergency situation rather than just a call for assistance. The residential accommodation was located on the ground floor of the building and there were wide corridors ensuring adequate space for people using wheelchairs and there were support rails in the corridors. There were other adaptations such as assisted bathing facilities and hoists. There was access out into a sensory garden with a water feature included in it. As stated above there were assisted bathing facilities available however, the bathroom was not homely in feel due to the equipment and decor of the room. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the people living in the home are met by sufficient numbers of staff with the relevant training. The training matrix had not yet been drawn up. Evidence: There were five care staff and a senior member of staff on duty at all times during the day. During the night there were three members of staff on duty including a senior member of staff. The managers hours were in addition to these hours. There were also domestic and catering staff. There were sufficient numbers of staff on duty to meet the needs of the people living in the home. All the staff had been transferred from other homes provided by the Local Authority. We were told that there had been no new staff employed but that references were taken for each member of staff. The staff had undergone immersion training before the home opened and this meant that they all had had the necessary training including dementia awareness, first aid, food hygiene and manual handling. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was being well managed in a professional manner that put the needs of the people living in the home uppermost when decisions were being made. Evidence: The manager of the home has been registered with us for six months and has the appropriate skills and knowledge to meet the needs of the people living in the home. He was receptive to issues raised at the inspection and had already raised several issues that he had identified as needing some attention, including the difficulties with the emergency call system. The home still lacked items that would make it homely, for example pictures. However, the manager told us that he was waiting until the people living in the home had been consulted so that their wishes were taken into account. This was to be commended and showed that the views of the people living in the home were important to him. Care Homes for Older People Page 23 of 30 Evidence: Due to the home having been open for such a short time and needing to settle into a routine the quality assurance system was not assessed at this inspection. We were told that the manager of another care centre had visited the home once since it had opened however the minutes were not available at the time of the inspection. It was important that the providers representative visited regularly, especially during the early months when problems were likely to arise. The home was new and health and safety management was good. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be a written plan 31/03/2009 that describes how the needs of the people living in the home are to met. This will ensure that the staff know the needs of the people living in the home and they can be met in a person centred way. 2 7 15 Care plans (ISS) must be updated as changes in need oocur. Ths will ensure that the staff will know what the current needs of the people living in the home are. 01/02/2009 3 8 13 A tissue viability assessment 01/02/2009 and management plan must in place for people at risk of developing pressure ulcers. This will ensure that a plan is in place that will minise the risks of individuals developing pressure ulcers. Care Homes for Older People Page 26 of 30 4 8 13 There must be a risk assessment and management plan in place for all identified risks. This will ensure that the staff know how any risks can be safely managed and the people living in the home is safeguarded. 28/02/2009 5 9 13 The medication 31/01/2009 administration system must ensure that the people living in the home get their medicines as prescribed. This will ensure that the people living in the home can be assured that their health needs are being met. 6 12 12 Any decisions made to 28/02/2009 override an individuals decision must be recorded with details of why the decision has been made, by whom and whether it is in line with the mental capacity act. This will enable the people living in the home toremain in control of decisions affecting their lives unless it has been determined that it is in their best interest. 7 22 23 The emergency call system 31/01/2009 must meet the requirements of the home. This will ensure that the people living in the home get help when they need it. Care Homes for Older People Page 27 of 30 8 32 26 The providers representative must visit on a monthly basis and provide a report of the visit. This will ensure that any problems arising can be addressed and the provider can be assured that the home is being run in the manner required. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 Terms and conditions should be completed at the point of admission to the home to ensure that the people moving into the home or their representatives know their rights and responsiblities. Staff needed to be careful about the words used in recordings and be explicit about what they mean, eg moody and aggressive. The records should clearly show the reason for a visit by a health professional and the outcome of the visit. Weights should be recorded on a monthly basis so that any changes in health can be monitored. Staff needed to ensure that enough medicines were being received at the beginning of the medication cycle or identified in sufficient time that the matter could be addressed before individuals had to go without their medicines. A specimen signature sheet must be in place for staff giving out medication to ensure that audits can be undertaken and any problems rectified. Activities should be linked into individuals likes and dislikes to make them more person centred. Accidents happening in the home need to be scrutinised more for patterns and referrals for people who are falling regularly be made more quickly. 2 7 3 4 5 8 8 9 6 9 7 8 12 18 Care Homes for Older People Page 28 of 30 9 29 Consideration should be given to having additional hours for the night staff as the current staffing hours do not allow for leave and sickness. A copy of the training matrix should be forwarded to the CSCI when it has been drawn up. 10 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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