Inspection on 02/12/08 for The Priory

This inspection was carried out on 2nd 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Priory 10/02/10

The Priory 02/02/10

The Priory 20/10/09

The Priory 30/06/09

The Priory 21/10/08

The Priory 08/07/08

The Priory 31/07/07

The Priory 02/03/07

The Priory 11/12/06

The Priory 06/10/06

The Priory 08/05/06

The Priory 14/11/05

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Bank House

Inspirations

Ashcroft Hollow Nursing Home

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 Priory Springhill Wellington Telford Shropshire TF1 3NA     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: Joy Hoelzel     Date: 0 9 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 27 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 27 Information about the care home Name of care home: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA 01952242535 01952641577 thepriory.home@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wellcare Management Ltd Name of registered manager (if applicable) Ms Kay Davies Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care Home with Nursing (Code N) 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) 37 Date of last inspection Brief description of the care home The Priory is a privately owned Care Home registered to provide accommodation, personal and nursing care for a maximum of thirty seven older people. Situated on the eastern edge of the Shropshire town of Wellington, with local amenities available a short walk away the home is set in its own grounds, with a car park to the front. The building comprises a large converted town house with a purpose built extension added in recent years. Single and twin bedrooms are available, some benefit from an en suite Care Homes for Older People Page 4 of 27 care home 37 Over 65 37 0 Brief description of the care home facility. The home has a selection of sitting and dining areas; some areas within the home have benefited from redecoration and refurbishment. Other areas still require attention. Information of the home and the provision of the service are available in a service user guide and statement of purpose and are available on request at the home. The service user guide specifies the weekly fees for the service, from £400:00 to £ 650:00 per week, and what is and what is not included in the fee. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Older People Page 5 of 27 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: The last key inspection was carried out on 8th July 2008 with a follow up random inspection in October 2008. This inspection was carried out on Tuesday 9th December 2008 over a period of five hours with the home not being informed of our visit. A registered nurse was in charge of the home supported by six care staff, catering and domestic staff. Twenty eight people are permanently resident and are living at the home. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and Care Homes for Older People Page 6 of 27 staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. The unannounced random inspection on 21st October 2008 was conducted to check compliance with the statutory requirement notices issued for breaches of the regulations following the previous key inspection on 8th July 2008. This was in relation to the recruitment of staff. Other areas of concern were the condition of the environment and the documentation used for ensuring that staff have the information needed to fully meet a persons assessed and identified care needs. This inspection has shown us that improvements are being made, systems have been introduced to ensure that suitable people are providing care to residents. Some areas around the home have received attention and the content and accuracy of the care plans are under review. Work to provide a wet room, which will provide better and improved bathing and showering facilities for residents, and a new laundry facility, needs to be completed as soon as possible. The service must now sustain and further develop these improvements to ensure the effectiveness and continuity of good outcomes for the people residing at the home. 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 27 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 27 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. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information of the service provision is detailed in the statement of purpose and service user guide. The Statement of purpose has not been reviewed, it is not possible to establish when it was last reviewed and revised. The service user guide has been revised this year and is available upon request at the home. The service user guide specifies the weekly fees for the service, from 400:00 to 650:00 pounds per week, and what is and what is not included in the fee. The service has not had any admissions since September 2008, the local authority have suspended the funding for new residents following concerns raised relating to certain areas of the service. It was not possible to establish, therefore, on this Care Homes for Older People Page 10 of 27 Evidence: occasion whether the admission processes and procedures continue to ensure that no one moves into the home without the assurance that their care needs can be fully met. The case files of people already living at the home were looked at and contained a pre admission assessment completed by a member of staff. Other assessments from previous placements and community and social worker reviews were also available in the file. The service user guide states service users who are interested in coming to the Priory are encouraged to visit the home to see for themselves the service provided and indeed to sample the atmosphere. Two visitors described the admission process and stated that they were satisfied with the care provided. The home does not provide an intermediate care service. Care Homes for Older People Page 11 of 27 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. Peoples health care needs are being met. There are some gaps in the care plans but staff are able to think of the person in an individual way and are able to give a verbal update of the care they need. Evidence: All people have a plan of care that is initially generated from the assessments obtained prior to the person moving into the home. Three plans were selected for inspection with people being at the home for varying lengths of time. Each case file contained a variety of risk and care assessments with the plan of care recorded on either core or individually written documents. Currently work is ongoing for all care plans to have a complete review and revision. This will ensure that the care needs identified and recorded gives an accurate reflection of the care being provided. The acting manager and a registered nurse confirmed that the care plans for 16 people have been completed. They were unable to determine a date of completion when all care plans will have been reviewed. People living in and visiting the home expressed a general satisfaction with the care provided and stated that the staff were very good. People Care Homes for Older People Page 12 of 27 Evidence: who were unable to offer an opinion appeared and looked well cared for and comfortable. Staff spoken with provided a verbal account of the care and described the individual and diverse care needs of the people at the home. Medication is administered to people by registered nurses and the senior care staff, using a monitored dose system with additional boxes and bottles of medicines. Amendments are required to the procedures for administration as some tablets are being left with the person to take at a later time. There is no guarantee with this practice that the medications are being taken as prescribed or by the person they are prescribed for. This was discussed with the acting manager who offered an assurance that the procedures will be reviewed. During the tour of the premises some external preparations were in use but had not been prescribed for the person in whose room they were seen. It was not possible to establish for how long the preparations had been in use as there was no date of opening on the item. Care Homes for Older People Page 13 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally staff are aware of the need to support residents with daily living and recreational activities. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. Evidence: A person has recently been recruited to assist with organising and arranging social, leisure and recreational activities. The acting manager stated that a variety of organised activity is available each afternoon for two hours. People in the lounge areas discussed the sessions that are available with most people saying that generally they enjoy what is arranged. Other people spoken with stated that they very rarely go out of their bedrooms and do not wish or are unable to participate. One person commented that they have tried to take part but it was not to their liking. They went on to express that they found life frustrating and very tedious. They were unable to think of anything that would help alleviate their situation. The acting manager was aware of how this person is experiencing life. Visitors to the home expressed a general satisfaction with the service and the visiting arrangements No concerns they look after mum very well, I am able to visit most Care Homes for Older People Page 14 of 27 Evidence: days, the staff are very good. The service user guide includes details of maintaining contact with family and friends and states visitors are welcomed at all times. The main front door is kept locked for security reasons, entry to the home is gained by staff answering the door or releasing the door lock remotely. No other doors were locked with the exception of storage cupboards; people have unrestricted access to areas around the home. The dining areas are prepared in advance of meals with people being encouraged to sit at the table, but people are able to have their meals in their preferred place. People spoken with stated that they enjoyed the meals provided, had plenty to eat and had a good choice. Care Homes for Older People Page 15 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and others involved with the service say that they are satisfied with the service provided and know what action to take if they have concerns Evidence: The complaints procedure is included in the service user guide and a copy is displayed in areas around the home. People living at the home said they would speak with a member of the senior staff if they had any concerns or complaints. Visitors to the home stated they would speak with the acting or deputy manager and they were confident that the problem would be sorted out. Currently they said they had no concerns or complaints about the service. Staff spoken with described the procedures and action they take when they have any concerns. A referral has been made to the Safeguarding adults multi agency team following some concerns raised about the service. The investigation is ongoing and has yet to reach a satisfactory conclusion. Staff are currently all receiving training in the protection of vulnerable adults with sessions arranged from two sources. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Care Homes for Older People Page 16 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that generally meets the specific needs of the people who live there. The home has a programme to improve the decoration, fixtures and fittings. Frequently there is slippage of timescales and maintenance tends to be reactive rather than proactive. Evidence: During the tour of the premises it was noted that some areas around the home have benefited from redecoration and the replacement of the fabric and furnishings. Some bedrooms in the older part of the property have had been decorated and the carpets replaced. The dining room in the residential area has been refurbished. The lounge in the residential area has been redecorated; the chairs and occasional tables are in variable condition, some of which require replacing. Some corridor carpets have been replaced. Radiator covers are being fitted to ensure that people are not at risk from direct contact with hot surface areas. However, not all of the older type of covers in the private bedrooms have been replaced and remain rusty and not fit for the purpose. Work in ongoing to provide suitable bathing facilities in all areas of the home to ensure that there are a selection of baths and showers to meet the needs and preferences of all people. The proposed installation of a wet room would be of benefit for many people but is currently unavailable. The shower and tray have been installed in a Care Homes for Older People Page 17 of 27 Evidence: previous bathroom and the room has been tiled. An electric heater remains fixed to the wall, the handyman was unsure whether this had been disconnected. The acting manager was unable to say what other work and equipment is required for completion of the area. Work has begun on re-siting the laundry. An area has been cleared in preparation and an electrical supply has been fitted. A gas supply is required. The staff were unable to confirm an expected completion date. Work to both the wet room and the laundry have been planned and discussed for a considerable period of time with the expenditure and grant for the work being obtained. It is now imperative that both areas are completed expediently, to a high standard and fully fit for purpose. The emergency call bells in two communal toilets were not in working order. The acting manager offered an assurance that they would be repaired expediently. Not all communal toilets and bathrooms have been provided with a privacy indicator and a toilet on the ground floor has no extractor fan. People living at the home generally expressed a satisfaction with their accommodation and stated that on the whole they were comfortable. A copy of the homes maintenance programme for 2008/09 was previously given to us for reference. On discussing the plan with staff and observations during the tour of the premises it seems that that plan is not being adhered to and there is a slippage in the proposed programme. It appears that any work at the premises happens when a problem has arisen or in an attempt to satisfy the regulators and local authority. The acting manager stated that the local fire safety officer has visited; the report of the visit was unavailable. A fire risk assessment for the premises has been completed. A copy is not on the premises but is held at the head office of the company and as such is unavailable for reference in the event of an emergency. The home has been awarded a score of 3 out of a possible 5 for food safety awareness by the local agency. The ancillary staff work hard to maintain the home at an acceptable level of cleanliness. The handyman confirms the recent purchase of a carpet cleaner to further assist in this area. The effective control of infection is being compromised by working practices and the lack of suitable hand wash facilities in some areas. This was discussed with the acting manager at the time of the inspection. Care Homes for Older People Page 18 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally satisfied that the care and support they receive from staff. The acting manager is aware that there are some gaps in the training programme and plans to deal with this. The acting manager is aware that additional training is needed, but is not always in a position to provide this training. Evidence: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the registered nurse was in charge of the home supported by six care staff and ancillary personnel. Twentyeight people are currently permanently resident. The service user guide gives information on the staffing levels based on the resident population. The acting manager stating that agency staff are being used to cover any shortfalls to the required staffing levels. General observations and discussion with people living in and visiting the home suggest that the current care staff arrangements are satisfactory. People stated the staff are very good, look after my relative very well, satisfied with the care provided. The acting manager discussed the proposal with the owner of the home for an additional registered nurse to be on duty during the morning at the peak time of activity. It was not possible on this occasion to determine how many of the permanent care Care Homes for Older People Page 19 of 27 Evidence: staff have an accredited National Vocational Qualification (NVQ) in care. The training matrix does not offer this information. However, the service user guide states that at least 60 of the care staff are trained to NVQ level 2 at all times. Staff personnel files were selected for inspection and evidenced that the checks required by regulation have been carried out. All people now working at the home have a criminal record bureau disclosure on file. The acting manager discussed the recent recruitment drive for first level nurses and is waiting for the return of the criminal record bureau disclosures before offering employment. These essential checks are required to ensure that people living at the home are supported and cared for by suitable people. A training matrix has been developed to indicate the training and development needs of staff. The matrix includes the core topic areas such as moving and handling and fire safety. The acting manager discussed the additional opportunities for staff to attend training sessions in protection of vulnerable adults, dementia awareness, food hygiene and end of life care. The introduction of the in-depth induction programme for new starters is planned for the end of December 2008. This will ensure that new staff have the basic knowledge to meet the needs of people living at the home. Care Homes for Older People Page 20 of 27 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 acting manager has the necessary experience to manage the home on a day-today basis and has highlighted areas where they need to make improvements. Efforts have been made to develop and improve the service but these are limited by the providers resource constraints. Evidence: Mrs Lyn Honey continues in the role of acting manager. She is a first level nurse and has had previous experience for managing a social care home. Mrs Honey has tended her resignation and is working her notice period, planning to leave when a replacement can be found. Recruitment for a registered care home manager is continuing but currently has not been successful in finding a suitable person. In the time that Mrs Honey has been at the service, she has identified areas for improving the service and improving the outcomes for people living at the home. Mrs Honey discussed the improvements made but also commented on the barriers and difficulties encountered with ensuring the continuity of improving the service. People visiting, living and Care Homes for Older People Page 21 of 27 Evidence: working at the home all offered positive comments about her management style and leadership. Limited quality assurance and monitoring of the service is ongoing with satisfaction surveys being distributed to people living and visiting the home. The acting manager has introduced areas for monthly auditing for example medication, bedrails and rooms. Reports of the monthly visits by the provider or a representative from the company (Regulation 26 of the Care Homes Regulations 2001) were unavailable for inspection. Independent auditors have recently been employed to offer advice and support for improving the service. Following the key inspection in July 2008 a Statutory Requirement Notice was issued for the provider to provide us with a copy of the companies latest accounts. A full set of accounts was not forwarded but a profit and loss account for the period ending 31st March 2008 was received. The provider has offered an assurance of the financial viability of the service. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Records, documents and certificates are available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. During the tour of the premises it was observed that infection control is being compromised through staff working practice. A medical device had been placed directly on the floor of a communal toilet. The potential risk of people developing infections was discussed with the acting manager at the time. Some risk assessments have been carried out for safe working practice topics. However a copy of the fire risk assessment for the service is not on the premises, the information is not available for use in the case of an emergency. Induction and foundation training to the skills for care specifications is currently not available. The acting manager is anticipating an implementation date for induction training at the end of December 2008. Care Homes for Older People Page 22 of 27 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 23 of 27 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 9 13 The procedures for the 16/01/2009 administration of medication must be reviewed To ensure that people receive the medication for which they have been prescribed. 2 19 23 The planned maintenance programme for 2008/09 must continue to be carried out. To ensure that people are provided with a good standard of living in a clean, comfortable and safe environment. 30/01/2009 3 38 18 All staff must receive induction training This will ensure that people living at the home are being cared for by staff who are trained and competent to do their job. 01/02/2009 Care Homes for Older People Page 24 of 27 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 1 The service should have a statement of purpose to ensure that people have the information they need to make an informed choice about where to live. The care plan should set out in detail the action which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the person are fully met. The service should make proper provision for the health and welfare of people who live at the home. Health care needs should be assessed and action taken to ensure the needs are met. The external medicinal products in use are not being dated upon opening. It is recommended to discard tubs after one month of opening and tubes after 3 months of opening. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. Work practices for the effective control of the spread of infections should be reviewed and revised. This will ensure that the health and safety of people is upheld. Staffing levels should continue to be determined by the care and dependency needs of the people living at the home. Additional staff should be available during peak activity times. The home should by now have achieved a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times The home should continue to operate a robust recruitment procedure to ensure that suitable people work with vulnerable adults. Staff should be trained in the core and specialist topic areas relating to the service. The service should have a registered manager to ensure the home is managed in an effective way and that outcomes for people living at the home are satisfactory. The home should develop an effective quality and 2 7 3 8 4 9 5 12 6 26 7 27 8 28 9 29 10 11 30 31 12 33 Care Homes for Older People Page 25 of 27 assurance monitoring system to ensure that it is providing the service that it states it does. 13 38 Staff working practices for the effective control of the spread of infections should be reviewed to ensure that people are not at risk of developing infections. All risk assessments relating to the health, safety and welfare of people living, working and visiting the home should be available for reference and in the event of an emergency. 14 38 Care Homes for Older People Page 26 of 27 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. 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