Inspection on 29/05/07 for The Ridings

This inspection was carried out on 29th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Ridings 08/10/09

The Ridings 06/11/08

The Ridings 20/11/07

The Ridings 16/01/07

The Ridings 30/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Ridings Farnborough Road Castle Vale Birmingham B35 7JG Lead Inspector Sean Devine Key Unannounced Inspection 09:30 29 and 30th May 2007 th 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 The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ridings Address Farnborough Road Castle Vale Birmingham B35 7JG 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) 0121 748 8770 0121 747 0163 theridings@dukerieshealthcare.co.uk Dukeries Healthcare Vacant. Care Home 82 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (62) of places The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate up to 82 people in total within the following categories: A maximum of 20 people under the age of 65 years of age can be accommodated to include 11 people also receiving nursing care. In addition 5 of the 20 beds can be used for either care (maximum 25 care only) or care with nursing (maximum 16 nursing care). A maximum number of 62 people can be accommodated over the age of 65 years for reasons of dementia to include 34 persons also receiving nursing care. In addition 5 of the 62 beds can be used for either care (maximum of 23 care only) or care with nursing (maximum 39 nursing care) One named resident over the age of 65 years can be accommodated on the nursing unit for people under the age of 65. 16th January 2007 2. Date of last inspection Brief Description of the Service: The Ridings is a large care home in Castle Vale that has been built by the Dukeries organisation It is registered to provide a service for up to 20 younger adults with a dementia of whom 11 can receive nursing care and up to 62 older adults with a dementia of whom 34 can receive nursing care. There are two residential units called Aintree and Doncaster, two units which provide nursing care called Cheltenham and Ascot and two units for younger adults known as Champion Crescent. The service plans to provide a specialist service for residents who are of working age and have a dementia with a focus upon assessment, rehabilitation and where needed longer term care and support. The residents’ rooms all have single en-suite facilities and are spread across six independent units, at the time of writing the report the home had 67 residents and all of the six units were open. All units have their own dining room and lounge areas and bathing facilities. Each unit has a fully adapted bathroom and a shower room to meet a wide range of movement and mobility needs; nine toilets some being spacious for use by wheelchair users are available across the home close by residents’ rooms. All areas of the home including the first and second floors are accessible by a large passenger lift. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 5 There are enclosed gardens for residents on all units to experience, however at present much of the plant life needs to mature. There is a large car park at the front of the building. The home is close by many bus and rail routes in and out of the city and within close proximity of local shops and other community facilities such as a retail park. The pre inspection questionnaire completed by the manager of the home indicated the current scale of charges for this service ranges from £548.00 to £1034.00 each week. Additional charges are made for hairdressing, chiropody, daily papers and toiletries. This information is available in the homes Service Users Guide. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection there has been three additional visits to the home on the 20th February 2007 by two regulation inspectors to investigate a complaint and to look into recent concerns shared with us regarding the safety of some of the residents. There were then additional visits by pharmacy inspectors on the 16th January 2007 and on the 22nd February 2007 whose focus on the visit dated the 22nd February 2007 was to assess compliance with the previous requirements following the last pharmacist inspection on 16th January 2007 and found that improvements had been made. This key inspection was undertaken unannounced by three inspectors over a period of two full days. One of the key aspects to the visit was to assess if there had been improvements for residents especially with regard to their health and welfare. There has been some regular visits by the contracts team from Social Care and Health to monitor the homes performance It was evident that in certain areas there had been improvement, however their continues to be serious concerns and an immediate requirement letter was needed to make the home take actions following this key inspection, these included; 1. Improve risk assessing and observation of a resident. 2. Accurately weigh residents and take appropriate action if there was a concern. 3. Ensure that residents who have poor skin conditions including pressure sores have the correct equipment available in the home. 4. Take appropriate actions to improve medication administration to residents following the discovery of serious drug administration error. 5. Ensure that actions are taken to provide a resident with appropriate medication and is maintained pain free. 6. Ensuring that staff have adequately protected a resident from harm. Since the inspection the new manager has responded detailing what action he has already taken to improve the health and welfare of the residents and further actions he intends to take to manage these serious concerns. He has made adult protection referrals, contacted tissue viability nurses and is managing the performance of staff. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 7 Prior to the visit the previous manager completed a pre inspection questionnaire known as a PIQ and returned this to us with details about the establishment, policies and procedures at the home, information about the homes residents, personnel and information about other health professionals who support the residents at the home. Before the inspection twenty Relatives completed a survey form known as “have your say about…” telling us about their experiences of life at the home. During the inspection the inspectors followed the experiences of living at the home for eleven residents, including looking at their care records, conversations with them, viewing their rooms and meeting some of their relatives. This process is known as case tracking. The inspectors were able to meet with and talk with other residents, relatives and staff. Who told us in their opinion of what it is like to live in the home. A tour of the residents’ rooms and communal and service areas was completed and records about safety of equipment and the building were checked. The home informed us on the PIQ that they have received fourteen complaints in 12 months, one was substantiated and 5 were found to be partially substantiated. The PIQ did not record the outcome of the other complaints. What the service does well: Relatives told us and we observed that they could visit at anytime and that the staff were always friendly on these visits, residents were also able to have visits in private so that they are able to maintain personal relationships. The building is new and remains in a good condition including pleasant gardens for residents and their family and friends to use, providing a nice environment for people to live in. There are some staff who have a good knowledge of the needs of the residents and who recognised that good communication for residents with a dementia was very important to giving them personalised care. Many comments were made about the staff by the relatives, most of these wanted staff numbers and qualities to improve the service for residents but there were some positive comments including “they do very well, the staff are marvellous” and “they really have their hands full and it’s not a job I could do myself they are worth millions”. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Written care plans need to be improved so that the staff are given clear and concise information about how to care and support for the residents. How the home responds to the changing healthcare needs of residents must improve and they must provide the equipment that residents require, without this all residents are at risk of their health deteriorating. Adequate rehabilitation resources on the Champion Crescent must be provided so that the residents are able to maintain and learn new skills. The residents must be provided with nutritional meals that will meet their individual health needs and not put their health at risk. The management team must ensure that we are informed events that effect the well being and safety of residents. The environmental temperature throughout the home must be kept at a constant level for the comfort of the residents. The cleanliness of the home needs to improve to ensure it is a safe and pleasant place for people to live in. Recruitment practices of new staff must improve, which will ensure the protection of the residents. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 9 Staff must be provided with training so that they have the skills to safely provide care to residents. Records about the care of residents must be up to date and available at the home. There were nine comments from different relatives who had concerns about how residents needs are met, these included “I am seriously shocked at how involved I have to be in order to achieve an acceptable level of care” and “My wife does seem to wear the same clothes several days running”. To improve the health of residents they must be given their medication as prescribed by their doctor. Errors in their administration must be immediately reported to a doctor and actions must be taken to safeguard residents from poor practices. The management and administration of the home needs to improve to ensure they can effectively do their duty and meet the needs of residents. It is important that the new manager has the full support of senior managers and the necessary resources to make the required improvements. To enable the home to make plans we will be requesting that the home complete an Improvement plan detailing how they will make these improvements. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 10 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 The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4 and 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is failing to meet the needs of residents as not all areas of the residents’ life and needs are assessed prior to admission, which may result in care needs not being met. The staff team do not have suitable skills to provide the service that is needed by some residents. EVIDENCE: There was no evidence amongst the records of the eleven residents who were case tracked that they or their relatives/ representatives were involved in their assessment of need to ensure the residents choices and preferences were considered in the pre-admission assessment. The assessments completed before admission had a great emphasis on physical needs but there were no specific assessments for mental health, social or psychological needs. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 12 It was concerning to find that none of the staff apart from the unit manager of the Working Age Dementia (WAD) unit had received training in Korsakoff’s syndrome / alcohol related dementia. This is worrying because a large number of residents were diagnosed with this type of dementia. The home cannot therefore be sure that it is meeting the needs of this group of residents. There were concerns for one resident recently admitted to the WAD unit as the manager stated that they were at a loss as to how to meet her needs because they were still waiting for the assessment information and as yet had only received an Occupational Therapy assessment. There were no formal assessments on the residents file but there was a lot of information about the resident from other professionals involved in their care such as the psychiatrist and OT and there was enough information to plan care with the resident. We also case tracked a resident on the nursing unit Ascot who had been admitted into a Step down bed, the nurse in charge explained that they don’t always get the opportunity to see the resident before admission this means they are not given the opportunity to assess their needs and do not know what needs residents have when they arrive at the home. This is very poor practice and must change as it puts the health of residents at risk and is not in accordance with the homes policies. On Aintree unit two residents files contained assessments that were physically orientated, yet there was evidence that the home had started to re-write them to include their choices and preferences. Residents had some recorded details that a senior nurse had visited them to assess their needs prior to admission. The residents had additional information available gathered before admission including care plans from Social Care and Health and other documents such as a health report from a Community Psychiatric Nurse. It was evident in these residents assessments that certain areas of their lives had not been considered being mainly their mental health, social needs and spiritual needs, which means if the residents do need support the staff will not know. Information on one residents file indicated that she had needs that had not been adequately assessed and when staff were asked about diets they were unaware this resident required a diabetic meal. This clearly puts the health of this resident at risk. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is failing to meet the health and personal care needs of the residents; omissions of care and some poor practices are putting the wellbeing of residents at risk. EVIDENCE: At this inspection visit looking at residents care plans formed part of case tracking process, the findings that were of concern (and were found on all units) included; care plans were often inaccurate and confusing with additions made which were not dated and made it difficult to assess what were the most up to date care instructions for staff to follow. An example of this was one care plan identified that a resident had a poor appetite and it stated “give me the prescribed fortisips (a nutritional supplement that is prescribed by a Doctor)” but when the treatment sheet was checked no fortisips or other nutritional supplements were prescribed. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 14 The same resident had care instructions that he could walk unaided although two staff were observed to give him considerable assistance to walk holding him up by his trousers the lack of accurate instructions put both the resident and staff at risk of accident. Staff are not consistently planning care for short term medical conditions. For example, residents had developed rashes, dry skin conditions or become constipated, there were no new plans drawn up to include these new developments and to instruct staff on how to meet these new needs. Serious health concerns were identified relating to the care of one resident as staff had failed to take any action to alert the GP about the deteriorating physical and mental health, including weight loss until the resident had been transferred from the residential unit onto the nursing unit. The records of weight for this resident were clearly inaccurate and despite requesting the weight be measured this was not completed as staff advised they had been unable to locate which unit the weighing scales were on. This residents health needs were not adequately assessed and were not being met, he was not being adequately monitored and so an immediate requirement was made to improve health monitoring, review risk assessments, provide appropriate pressure relieving equipment, taking appropriate actions to meet the healthcare needs and taking actions to assure that the resident receives appropriate medication and is maintained pain free. All residents who had been case tracked had completed risks assessments for formation of pressure sores, poor nutrition, moving and handling and falls yet sadly and despite ongoing reviews risk assessments were not accurately completed and did not accurately reflect weight loss or the existence of pressure sores despite one resident having a large pressure sore for at least two months. The management of medication at the home was assessed at this inspection and the findings were as followed. On Cheltenham Unit medicines were generally seen to be administered appropriately although concerns were raised by relatives that the Unit Manager does not ensure that residents take their medicines. Medicine records are appropriately signed when given and the nurse in charge did not hurry residents to have their medication. No gaps were seen on the records and the unit manager has been auditing stocks of medicines to ensure safety. The nurse in charge did say that they do run out of medicines towards the end of the month. The unit does not have a drugs fridge and opened prescribed medicine was being stored in the general fridge that is accessible to residents and is unlocked – the unit needs to store all medicines safely and we recommend that a drugs fridge is available for this unit. There were serious concerns about the pain relief given to one resident. This resident had his pain relief reviewed, existing pain relief was discontinued and The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 15 stronger pain relief was prescribed. Detailed instructions in the daily records confirmed the changes to this residents’ pain relief, but despite this he received a further fentanyl patch and had also commenced his new and stronger medication whilst also being prescribed another analgesic. It is of further concern that within days he was admitted into hospital increasingly sleepy and with symptoms that are similar to over sedation. The controlled drug records however appear to have been changed and were not consistent with stock control records that were available. This was brought to the managers’ attention, as it is a serious concern. Several residents are prescribed creams and lotions, these are currently stored in their bathrooms which is a risk given the confusion and lack of understanding of the residents. The medication practices on the WAD unit was generally satisfactory with the trained nurses being responsible for the ordering, receipt and returns of all medicines. The trained nurses administer medication on the ground floor of champion crescent, carers have been trained to do this upstairs, the unit manager did say that not all of the staff have received the appropriate training yet, so when this happens, a nurse goes up to the first floor and administers the medication. There was also evidence of “when medication” protocols being in place on Ascot unit. One area of concern was that the fridge for medicines that require cold storage is not available on all units, Ascot has to share with Doncaster, this means that the nurse has to leave the unit to fetch the medication. One nurse said “it is a bit of a pain but what can we do”. On Aintree unit homely remedies are available, stocks of Paracetamol were found to be greatly inaccurate as 80 tablets were unaccounted for and the Homely Remedies guidance of what can be given, what for and how much had not been agreed with the GP and this can lead to unsafe practices. Both residents case tracked on Aintree unit had a medication profile, saying what the medication was called, what the common side effects are and what the resident needed it for; both residents also had medication administration records. For one resident this had not been completed when the last delivery of a month’s supply of medication was delivered to the home. For another resident on Aintree unit there were concerns as the daily report recorded administration of Paracetamol as a Homely Remedy yet there was no evidence of who administered it and when it was administered on the MAR. The same resident is prescribed a sedating drug called Zopliclone when required at night, there is no PRN protocol to guide staff about when it should be administered this is left to the ability of the staff to decide and this could lead to inconsistent administration. On Doncaster unit medicines were being managed more safely. The MAR had been fully completed for the receipt and administration of medicines for the two residents case tracked. For one resident medicine had recently been The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 16 reviewed and this had been managed safely. Again both residents had medication profiles written in first person. Both residents were prescribed medicine as required and both had a PRN procedure to guide staff only when, how much and how often the medicine could be administered. On Cheltenham there was little interaction between staff and residents. Three residents who were described as “noisy” and “upset” other residents were left alone for the majority of the morning with staff only coming into that lounge to lay the table and during which time there was no acknowledgment of the residents that were sitting in the room. One member of staff said “ I don’t think all staff know how to talk to residents and ignore them but I just love this client group and thoroughly enjoy my job”. Staff were also seen to consistently put meals in front of residents and left them without offering them any assistance which was also raised as a concern by relatives who were spoken to saying: “ They just leave the meal without cutting it up for the residents, I’ve seen residents left with a whole sausage and the resident can’t cut up the food and has no teeth so she just left it, I think the food is totally unsuitable for these old people”. The last wishes for most residents had not been adequately assessed, there were some reference on three files that funeral arrangements would be taken care of by a family member and for one resident regarding resuscitation. There were no assessed last wishes and there were no available care plans for the residents that were case tracked. This may mean that the residents’ choices about the care they want through the end of their life may not be given. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not meeting the daily life and social activity needs of the residents, the omissions of care and not promoting the choices of residents will negatively affect their health and welfare. EVIDENCE: All units have an activity plan. On Cheltenham unit during the two days of the inspection none of the activities identified were undertaken with the exception of the television that was on in one lounge throughout the inspection, visitors said, “there is a really good programme of activities identified but you can ask anyone it doesn’t happen.” Residents on the WAD unit said “we do get out to the shops sometimes, we can go to the cinema as well”. One resident said “I wish I could be encouraged to meet a friend outside of here but they don’t seem to get it”, “I’m scared of being here sometimes there’s a lot of aggression”. “I make my own food and cook it here, we go up to Sainsbury’s to get it”. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 18 On the WAD unit there was no structure to the day, there were toys and games for residents to take part in but staff admitted that this depended upon the staff numbers. One residents plan states he “likes to go for daily walks and listen to his music”, the unit manager said that they do try to do this wherever possible but don’t always have the time and it depends on the mood of the residents. Care plans do attempt to address the social aspect of care but there is no evidence to show that they are working or that the residents are happy with the plan. One “working and playing profile” clearly documented “I like to go shopping, sewing, cooking and reading magazines, I need help to carry on my hobbies, no more involvement anymore due to dementia” the care plan stated “develop a structured plan with me assist me to involve myself in the local community in order to meet others and document all the activities I take part in” none of the above could be evidenced. The resident said that “it’s like a prison in here some days”. Observations on Aintree unit on the 29th were made. It was observed that staff were spending much of their time engaged with residents, either talking or arranging more formal activity. A care assistant was seen singing with a group of residents who really enjoyed it. Some residents were seen to go with the hairdresser to the salon in the home. There was a well organised quiz which 8 residents joined and had a good time reminiscing about famous people. At 11am hot drinks were served, and some residents assisted making drinks, giving them out and washing up afterwards. Residents were seen regularly tidying the kitchenette area and talking amongst themselves. One resident said “we keep busy and the girls always find something to do”. After lunch a member of staff and a resident went around talking to residents about the next days menus, discussing the menu and choices and taking their orders. During the afternoon residents were seen in the garden, one was helping tidy and another was cleaning the outside of a window. It was good to see throughout the day on all units a steady stream of visitors, some of them were spoken to and they were very pleased with the care and attention their relative is receiving on the whole. And they said “its so relaxing to know that your loved one is in the care of properly training people who know what they’re doing”. “We can visit when we like”, “you can go into their rooms, sit in the lounges or they have a quiet lounge down the bottom of the unit”. Other relatives said that some days there is a good atmosphere, its warm and friendly and on other days it is not, they put this down to some residents not wishing or unable to join in activities on the unit. The daily life and social activity care plan for one resident indicated he preferred to spend time alone in the bedroom and preferred to see his visitors alone in the bedroom, there was no information such as a risk assessment about isolation and this resident stayed in bed until lunchtime, staff would occasionally verbally check he was okay, however it was clear that they were concerned about his behaviour if they were too persistent. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 19 The home could improve upon the choice that they give residents and the involvement in their care particularly on the WAD unit where there was no real emphasis and building upon existing skills and maintaining independence. For example, Assessments were clearly stating that residents have cooking skills and were able to make drinks and meals with prompting, we observed that some residents were making themselves sandwiches and drinks throughout the day, more encouragement should be given to those residents to help maintain their skills in the kitchen. This is important as Champion Crescent considers itself to be a rehabilitation unit, skills training should be included as part of this. On Aintree unit the care plans of residents did not always include their personal choices and where they were included there was often a lack of evidence in records that it had been achieved. For example one resident has been assessed as having a life long enjoyment of cooking and outdoor pursuits, yet the activity care plan did not include taking part in such activity and another resident with an assessment and a care plan that she enjoys going shopping had no records of this. At the additional visit on the 20th February 2007, concerns had been raised by a relative that the food menus had disappeared “once again”. The availability of food menus was checked, on two units including Aintree unit, they could not be found, which at this time may have meant residents did not have all the information to make a choice of meal. At this inspection the choices of meals were limited during the two days of the inspection. Day one there was boiled potatoes, with mixed vegetables and sausages in an onion gravy or bean goulash and sponge pudding and custard. Day two there was gammon and pineapple with carrots, cauliflower and boiled potatoes or tuna pasta bake with fruit trifle or jelly and cream. The soft diets were the above main meals that had been liquidised. The cook was asked what special diets were available and said diabetic and Caribbean but the only “special” diets that she was currently catering for were soft meals, this is despite the home currently accommodating diabetic residents and other residents who said they would like Caribbean foods and is recorded on assessment records about biography and culture. Staff said that there was a vegetarian option although staff informed the inspector that the “vegetarian option on day two of the inspection was the “fish pie”. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints procedures are not robust so residents or their representatives cannot be confident that their views are listened to or responded to. The home by not acting quickly and effectively in all cases have failed to fully protect the residents, this will mean that the residents health and welfare is at risk of deteriorating. EVIDENCE: The health care of residents were looked into at the additional visit to the home on the 20th February 2007, following a complaint and an adult protection meeting. The complaint issues included residents health needs not being reported to other health professionals and a resident being left in a chair for very long periods who had been incontinent of urine. There was not enough evidence to adequately investigate this and no evidence of lack of care. Other health issues were looked into, as there were some concerns in the following areas that residents’ needs were not being met; including a lack of good pressure area care to help prevent residents from developing pressure sores and the lack of monitoring residents after they had suffered a fall. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 21 The adult protection issues included staff sleeping and not turning residents during the night, the care of this resident included a Tissue Viability nurse and her recommendation included 24 hour turn chart, which had been comprehensively completed by all shifts. Other protection issues regarding health included concerns that a resident may have suffered broken arms because of a member of staff dragging the resident. Records seen did not refer to any concerns about moving and handling, accident forms were completed and recorded that the injuries sustained were from a cause unknown. There were concerns about the reliability of daily record entries for a resident with a pressure sore on Aintree unit. The district nurse visited on the 11/02/07 and records available advised that there was shearing damage to the skin, yet an entry in the daily records says “intact” and the entry on the 10/02/07 says “broken down”. Staff advised that slide sheets are used to assist moving in bed, however this residents’ handling assessment did not describe the use of slide sheets, or the type of sling and hoist to be used. The last concern looked into at the additional visit was that a resident had a fall during the night and was not discovered until the morning, that they had been injured and needed to go to hospital for stitches; and that this was due to staff not doing any checks at night. The evidence indicated that immediate healthcare needs of this resident were met. The home informed us prior to the inspection that they have received fourteen complaints in 12 months, one was substantiated and 5 were found to be partially substantiated. Three complaints have been received since the previous inspection. One complaint was the result of a vulnerable adults referral when concern had been raised about the rough handling of a resident but could not be substantiated. The provider stated that all complaints were appropriately managed, two other complaints have been made to the Director of Operations but there was no record made of any written feedback to the complainant on the findings of the complaints. Two other relatives returned comment cards and identified that they had made complaints in recent weeks to the home but had heard nothing about the outcome of their complaint and no records were available of these complaints. One relative was spoken to during the inspection who asked the inspector “ what shall I do, I have made complaints to the Director of Operations, I just get a letter that insinuates that I am mistaken and I feel they are telling me that I am lying about what I have seen and nothing changes”. There were a number of incidents that were brought to our attention that we had not been informed of and other required actions had not been taken to give assurance that residents will be protected. These include several relatives reporting that one resident constantly displays sexually disinhibited behaviour and one relative said that “my mother is terrified of any man coming into her room”. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 22 A resident who was found on the bathroom floor with unexplained injury and with similar unexplained injury some three days later, had no risk assessments highlighting the danger that this resident was in and no management plan instructed staff of what to do, leaving the resident as risk. The manager who had commenced his employment on the first day of the inspection had concerns that a resident was distressed on certain occasions and that staff had witnessed these. The manager urgently contacted the Emergency Duty Team for Social Care and Health sharing his concerns and making a POVA referral. The manager was persistent as he wanted clarity of how the multi agencies wished for the staff to manage the situation and was concerned that a lack of co-ordinated action would not help the resident or the staff. Since the inspection two POVA meetings have been completed and the staff at the home have clear strategies of what to do should they witness this distress again. In addition, since the inspection the new manager has said that staff who had witnessed abusive behaviour towards a resident did not always raise their concerns, he plans to revisit training and policies with the staff to ensure they are all aware of their roles and responsibilities. There are policies about the roles and responsibilities of staff, including a policy about adult protection and whistleblowing. These have been seen at previous inspections and are good policies for staff to follow. The pre inspection questionnaire recorded that they had not changed. The majority of staff have attended training to protect residents, there are some staff who have not attended the training and more training sessions have been arranged. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that the residents are provided with an environment that will meet their needs and is safely maintained. This will put the health and welfare of residents at risk. EVIDENCE: There have been some positive attempts to make the units more homely, with pictures of famous people to help residents with memory recall and recognition. There has been aesthetic improvements such as plastic flowers and drapes over some doorframes and windows. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 24 Signage remains inadequate and residents were constantly asking for help “its lunch time and I don’t know where to go” or residents who were wandering and when asked wanted to go to the toilet but didn’t know where it was. Photographs of residents have been put up outside most of their bedroom doors although the majority of photographs are their appearance today and it is doubtful that the majority of residents would recognise themselves in the photographs which was also highlighted by relatives. There have been photographs put up of old movie stars and other photographs, but generally the environment is uninteresting and provides only minimal stimulation for people with dementia. Residents’ bedrooms are bland with just magnolia walls and are uninteresting, which was a particular issue as some residents spend long periods of time in their bedrooms and had nothing of any interest to look. It was no surprise to see regular entries that identified that one resident “had trashed his room again” despite having just had a crash mat on the floor. In this room a wardrobe and two chest of drawers that had been turned round so this resident was unable to get into them. It was a concern that bed rails are not always fitted into the brackets on the bed and the brackets are left on the bed frame posing a risk of injury to residents. The home is generally in need of a good clean, the domestic staff said that “we could do with more of us, to do the things that get missed like the skirting and door frames, it’s starting to smell a bit but there’s not enough of us”, there are two staff for the entire home, someone suggested “two staff to each floor would be good, the home would sparkle then”. Cleanliness was inadequate in bathrooms and toilets, they had dirty floors and despite ongoing checks by us during the day it was obvious they were not cleaned. One resident had stains on the bedroom carpet and although it was cleaned by day two of the inspection it was noted there were other areas of staining on the carpet that had not been adequately cleaned. It was noticed that windows above the ground floor were dirty both inside and outside of the home and this was also an observation made by the Director of Operations during the April visit of the registered person. The reception area of the home is pleasant providing seating and machines to purchase drinks and snacks, but it does lacks adequate direction for visitors, we observed many visitors come through the front door and ask “where’s the reception”, they then headed off toward Champion Crescent. We noticed that some of the bathrooms are particularly uninviting; they are used as store areas for plastic bags, pads, and an old cushion in one case. The bathrooms and shower areas lack decor that would help residents to relax and enjoy bathing. We noticed on more than one occasion that the emergency pull cord was tied around the bath hoist, making it impossible to pull. This is unsafe in an emergency and could put residents and staff at risk should they need assistance. The base of the hoist was dirty with hair and a yellow The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 25 substance. There were some toilets that didn’t have paper towels in them for residents to dry their hands on after having used the toilet. It was discussed with the managers that there was such a variance of temperature on all units to the point of extreme. On one unit temperatures need reducing whilst on others windows had to be closed to keep heat in. Lounges on Doncaster unit were very cold, windows were open and a resident was seated in one lounge with a cardigan on, which had a large hole in it, he was clearly cold. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that the staff are available in adequate numbers, well trained and recruited to effectively meet the needs of the residents; this has had have a negative impact on their health and welfare. EVIDENCE: At the additional visit on the 20th February 2007 it was observed that the night staff commence their duty at 8pm. At this time on two of the units many residents were very active and some wished to go to bed. There was two staff on duty and some residents needed assistance from two staff, there were some residents who required assistance and some who were becoming angry and agitated, it was observed that there were no staff available to help them. This needs to improve to ensure residents’ needs are met. The previous manager completed the pre inspection questionnaire and included staff rotas for each shift on all units. Relatives comments on the surveys about the numbers of staff included “regular staff tend to have the same time off together which then involved agency staff who do not know the residents as well”, “they need more staff as sometimes they do not have the time to sit and talk to the residents” and “they are short staffed and need more male carers, The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 27 my brother needs a man to shower him he doesn’t like females to do this but he has no choice”. At this inspection that staff files of five people were examined, they were found to have some shortfalls, for example the most recent employee had a completed application form but a reference was not obtained from the last employer and there was no evidence that the manager had attempted to authenticate the references or seek the reason as to why this person left their last job, this is unsafe practice and poses a risk to residents. All the files had a Criminal Records Bureau disclosure. The residence permit for one staff member was only valid until September 2006, there was no evidence to suggest this had been extended or updated, there was no available evidence that the registration of a nurse had been checked before appointment, both these omissions may well pose a risk to the health and welfare of residents. On three staff files there was no copy of terms and conditions of employment, no job description and no letter of acceptance in the file. In addition to this on two staff files there was no evidence of an induction having ever taken place, these are concerns and do not reflect good recruitment and induction practices and may well effect the safety of the residents. The home has its own ongoing training plan for its workforce, they do not provide a training matrix but manage the process centrally via the manager’s office. The dementia training was discussed with the manager at the time of the inspection and he is going to arrange for staff to have training in specific alcohol related dementia. A staff training matrix was forwarded to the Commission after the inspection. It recorded that many staff have attended required mandatory training, yet there are training gaps. The matrix recorded additional training achieved or that was required by staff to meet the specific needs of residents depending upon their role. For example 36 out of 50 care staff have completed Manual Handling training, 32 out of 50 care staff have completed Fire Safety training, 27 out 50 have completed NVQ level 2 in Care or above and 18 out of 50 have completed Dementia training. It was confirmed by the new manager that a college had agreed a contract to provide training to staff including Dementia Care ASET at Level 2. The manager has confirmed that the programme is well under way. The gaps in mandatory training require improving quickly to ensure the majority of the workforce is competent and safe to deliver care to residents. Relatives comments about the staff and their skills, attitudes and competencies included; “they do very well, the staff are marvellous. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 28 They really have their hands full and its not a job I could do myself they are worth millions”, “I’m not sure who to talk to about the small things when I visit” and “staff are very welcoming and chatty and friendly they do try to involve me in his care”. However some relatives did raise concern about the staff and their comments included “A report from a main carer may be nice occasionally”, “They are not always careful with clothing it can take up to 8 weeks to locate things”, “I am seriously shocked at how involved I have to be in order to achieve an acceptable level of care and “My wife does seem to wear the same clothes several days running”. The relatives have a range of views and opinions about the staff and how good they are, it is most important to improve standards around staffing to ensure residents’ needs are individually and safely met. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that the management and administration of the home is effective to meet the needs of residents, there are omissions in care records, a lack of support to staff and limited consultation about quality with residents that have had a detrimental effect on their health and welfare. EVIDENCE: Due to the recent changes in how services are inspected some of the requirements issued in the last report have been removed, some have been made as recommendations and some remain unaddressed and this is The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 30 disappointing. The home needs to get better at meeting statutory requirements. The Director of Operations had informed us that the previous manager was to step down as the registered manager and to continue as the homes assistant manager, and that a new manager was due to commence duty on the 29th May 2007. At the inspection the previous manager had not taken up the role of assistant manager and had left. On day one of the inspection it was the first day he had worked. He gave all the inspectors a brief about his determination to make considerable improvements in the next 6 months. He gave a brief about his background and experience. He was made aware of an Adult Protection issue by a nurse and immediately acted to safeguard this resident. This was very positive considering he had limited experience of how such concerns are managed by the Birmingham Social Care and Health department of the local authority. Since the inspection he has also raised similar concerns for two more residents and has been professional and knowledgeable at subsequent adult protection meetings, always acting in the best interests of the residents. The home has no formal quality assurance system and at present has not produced any method of gaining information from residents about the quality of the service they provide. A report from the company’s head of clinical governance confirmed some of our findings, including health and safety issues, not using footplates on wheelchairs, staff meetings not being held regularly, care planning being poor but this may be due to confusing paperwork and staff needing training. Comments included “general sloppiness and lack of attention to detail”, “staff just do not seem to grasp the importance of good planning”. This information clearly demonstrates the importance to fully implement a comprehensive quality assurance system to ensure the service is run in the best interests of the residents. The home does provide a safekeeping service for residents to place their money and valuables. How this was managed for six residents was assessed. Accounts were seen to be well maintained and reflected their current balance, where money had been spent on behalf of the resident by the home receipts were all available. There are regular internal audits of the residents account to ensure it is safely maintained. For residents who live on the WAD unit there are two records available, the amount of money available was accurate yet there were times when the records did not tally due to not being updated immediately following any transactions. It was also seen that since the previous manager had left, which is a short while many of the residents financial records had not been countersigned following transactions, two signatures should be made preferable a resident or representative if not a second member of staff should sign the transaction record to safeguard the residents finances. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 31 On the staff files there were very few records to indicate that supervision or other regular meetings are used to monitor the staff performance. This clearly indicates that staff do not receive the level of support they need to perform their work. At the additional visit on the 20th February 2007 there were concerns that daily and night records are completed, that do not always run consecutively and do not have a time of entry. It was a concern that on one night two different entries were made about a resident describing quite different events. At this visit there were more concerns regarding records kept about the care of residents, these included records not being made available despite requests to both unit staff and the new manager. This was particularly important for one resident, as it was the only possible evidence to determine the care provided by the home prior to developing a pressure sore. It was also seen that for another resident there were many gaps when entries over many days about the care given were not made and again there was no evidence that this resident had received the healthcare she needed. Prior to the inspection visit the previous manager completed the pre inspection questionnaire (PIQ) and recorded that the following had been subject to inspection / visit / service and that requirements or recommendations given had been implemented. Fire Officers’ report of Aug 2006, fire equipment check April 2007, Regular fire drills, fire safety training of staff, regular tests of the fire system, the environmental health officers visit of March 2006. The PIQ also recorded that gas installation, central heating, water bacteriological and temperatures, electrical wiring, lifts and hoists, nurse call system and COSHH products and their data sheets have either been tested, serviced or were available in the home. The management systems to promote the health and safety of all people in the home in respect of equipment and the building are in place. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 32 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 X X 2 1 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X 2 2 X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 1 2 The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 33 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 OP3 Regulation 14(1)(a)( b)(c)(d) Requirement You must ensure that the pre admission assessment of residents is comprehensive covering all the needs of the resident and enabling clear and concise care planning. It must involve the resident and or their relatives. You must ensure that all residents have care plans written that are clear and concise and which enable staff to meet the assessed needs of residents. Previous timescale of 31/10/06 was not met, this requirement is carried forward. You must ensure that care plans are written to meet the shortterm healthcare needs of residents this will provide staff with information about how to meet these needs. You must ensure that the residents who require pressure relieving equipment, due to prevention or treatment of pressure sores are fully DS0000067308.V333981.R01.S.doc Timescale for action 31/07/07 2 OP7 15(1) 31/07/07 3 OP7 15(1) 06/07/07 4 OP8 12(1)13(4 )(c) 06/07/07 The Ridings Version 5.2 Page 34 5 OP8 12(1)(a) 13(4)(c) 6 OP8 12(1)(2)( 3)(5) supported to use them. Previous timescale of 28/02/07 was not met, this requirement is carried forward. You must ensure weight records are accurate and that staff undertake appropriate actions to address any concerns. Risk assessments must reflect the true risks. This will ensure the residents’ health is appropriately monitored. The registered person must ensure that they act quickly and responsible to promote and make proper provision for the health, welfare and treatment of residents. 06/07/07 06/07/07 7 OP9 13(2) Previous timescale of 28/02/07 not met, this requirement is carried forward. You must take actions to address 30/06/07 the changes that have been made to the Controlled Drugs register book and the apparent over medication of a resident in relation to the administration of fentanyl despite it being discontinued and the commencement of MST and cocodamol. The right medicine must be administered to the right resident at the right dose at the right time as prescribed by the doctor. You must ensure that the missing stock of medication (Paracetamol used for homely remedies) is fully investigated and appropriate actions are taken. This will ensure the medicine when taken by residents is all accounted for and DS0000067308.V333981.R01.S.doc 8 OP9 13(2) 06/07/07 The Ridings Version 5.2 Page 35 9 OP9 13(2) 10 OP10 12(3)(4)( 5) 11 OP12 16(2)(m)( n) there are records of when it has been administered. You must ensure that when you 06/07/07 receive medicine at the home for a resident that you record how much was received, when it was received and who received it. This will help ensure you can account for all the residents medication. The registered person must 06/07/07 ensure that staff approach and treat residents with care and respect ensuring they always promote the dignity of residents and do not take actions, which are rude and undignified. You must ensure that all 31/07/07 residents have their daily life and social activity abilities and needs assessed and that either a care plan or programme of activity are individually implemented that are clear, concise and informative for staff. You must ensure that there are adequate resources including numbers of skilled staff available to support residents with their daily life and social activity needs. Previous timescale of 31/10/06 was not met, this requirement is carried forward. You must ensure that residents receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, including an appropriate diabetic meals. Previous timescale of 28/02/07 not met this requirement is carried forward. DS0000067308.V333981.R01.S.doc 12 OP15 16(2)(i) 06/07/07 The Ridings Version 5.2 Page 36 13 OP18 OP38 13(4), 37 14 OP25 23(2)(p) 15 OP26 13(3) 16 OP29 19(1)(c) para 5 Schedule 2. You must ensure that all untoward incidents regarding the health, safety and welfare are reported to the Commission, And Notify Social Care and Health when the nature of such an incident is reportable under adult protection policy. Previous timescale of 28/02/07 not met this requirement is carried forward. You must ensure that all residents and visitors live in a comfortable environment including having the facilities to effectively alter the temperature of the home. Previous timescale of 28/02/07 not met this requirement is carried forward. The registered person must ensure that the cleaning and infection control issues identified in the main body of the report are completed and undertake its own regular audit of infection control practices and make necessary improvement to keep the home clean. Previous timescale of 31/03/07 not met this requirement is carried forward. You must ensure that relevant checks are made for all potential new employees including a reference from the most recent employer and confirmation from the NMC that a nurses registration is effective. This will help to safeguard the residents. Previous timescale of 28/02/07 not met this requirement is carried forward. DS0000067308.V333981.R01.S.doc 06/07/07 06/07/07 13/06/07 13/07/07 The Ridings Version 5.2 Page 37 17 OP30 18(1)(c) (i) You must ensure that all staff receive appropriate training for the work they are to perform. This must include all safe working practices such as Fire safety, manual handling, basic food hygiene and infection control. Previous timescale of 31/12/06 was not met, this requirement is carried forward. You must ensure that the management and administration of the home is conducted by skilled and competent individuals who and able to effectively discharge their responsibilities in the best interests of the residents. You must ensure that all records required by regulation including individual care records are secure up to date and in good order. Missing daily reports must be located and safely securely stored. Previous timescale of 28/02/07 was not met, this requirement is carried forward. 31/08/07 18 OP31 9(1)(2) 12(1) 13(4) 31/08/07 19 OP37 17(1)(a) schedule 3. 13/07/07 The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 38 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 Refer to Standard OP3 Good Practice Recommendations You should your confirm in writing to the resident that having regard to the pre admission assessment that the care home is suitable to meet their needs in respect of their health and welfare. You should ensure that all your staff have the skills to deliver the care needed by the residents, this should include training on Korsakoff’s syndrome / alcohol related dementia for the staff work on the WAD unit. You should ensure that if you do not have the pre admission assessments or you do not have the capacity to meet a residents needs that you immediately inform the Commissioners. You ensure that care plans are drawn up with the involvement of residents or where needed their representatives to ensure their choices and preferences are included. You should ensure that each unit has its own lockable medication fridge to provide safe storage. You should ensure that all medication including creams and ointments are safely stored to protect residents. You should ensure any medicine prescribed to be administered on a when required basis has a supporting protocol detailing how it to be used. You should ensure that all residents are treated with dignity and where they do have needs that are challenging that they are not isolated and you should ensure staff do engage and communicate with them as they do with all other residents. You should ensure that the last wishes of all residents are assessed and that where needed care plans are written to meet their needs. You should ensure that for the residents on the WAD unit there is a well-planned and practical approach to building upon existing skills and maintaining their independence. You should ensure that the activity programme on the DS0000067308.V333981.R01.S.doc Version 5.2 Page 39 2 OP4 OP30 OP4 3 4 OP7 5 OP9 6 7 OP9 OP10 8 9 10 OP11 OP14 OP14 The Ridings 11 OP15 older adult units include the choices of residents that have been gathered through an assessment process and that there is recorded evidence that it has been achieved by each resident. You should ensure that the registered person consider how residents currently choose their meals and make appropriate improvements. You should ensure that daily menus are well advertised that the display is large and text bold or in another format that the residents will understand. You should ensure that a complainant does receive a response about the findings of the complaint investigation as detailed in the complaints policy. You should ensure that all bath and shower areas are not used as storage areas as this may present a risk to the residents. You should ensure that there are improvements made to the communal areas of the home to provide residents with signs and other triggers to aid communication and recognition. You should ensure that all pull cords used to operate the call system are at a height that can be used by residents and staff to call for assistance; and not tied up. You should ensure that the residents bedrooms are decorated and furnished in such away that provides comfort as well as reflects their lifestyle and interests, this will support their emotional and intellectual needs. You should ensure that domestic hours be extended and that all staff who see a spillage take responsibility for ensuring it is quickly cleared. You should ensure that all the staff have a statement of terms and conditions of employment on their staff file. You should ensure that all staff who are involved with directly supporting the residents complete an appropriate course in Dementia Care. You should ensure that an application to register the new manager is made to the CSCI Central Registration Team. You should ensure that a suitable, experienced and competent deputy manager be employed to provide support to the managerial, residential and clinical nursing team. You should ensure that a quality assurance system is implemented which will monitor your performance in meeting you aims and objectives, this system must include the views and opinions of the service users and DS0000067308.V333981.R01.S.doc Version 5.2 Page 40 12 13 14 OP16 OP21 OP22 15 16 OP22 OP24 17 18 19 20 OP26 OP27 OP29 OP30 OP31 21 OP33 The Ridings 22 23 OP35 OP36 their representatives. You should ensure that the financial records of residents are signed by two people, one preferable the resident or their representative if not a second member if staff. You should ensure that care staff are well supported and do receive regular formal supervision. The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 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 © 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 The Ridings DS0000067308.V333981.R01.S.doc Version 5.2 Page 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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