Inspection on 27/06/07 for Tower Bridge Care Centre

This inspection was carried out on 27th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Tower Bridge Care Centre 27/11/09

Tower Bridge Care Centre 28/07/09

Tower Bridge Care Centre 19/08/08

Tower Bridge Care Centre 30/01/08

Tower Bridge Care Centre 22/01/07

Tower Bridge Care Centre 27/06/06

Tower Bridge Care Centre 22/11/05

Tower Bridge Care Centre 09/05/05

Tower Bridge Care Centre 06/10/04

Tower Bridge Care Centre 23/08/04

Tower Bridge Care Centre 21/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Tower Bridge Care Centre Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR Lead Inspector Pam Cohen Unannounced Inspection 27th June 2007 10:00 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 DS0000007047.V341943.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. DS0000007047.V341943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower Bridge Care Centre Address Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR 020 7394 6840 020 7394 7198 towerbridge@schealthcare.co.uk 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) Southern Cross Healthcare Services Limited Care Home 128 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0) DS0000007047.V341943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. on the first floor, 34 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male) to include one female resident aged 46 years and above on the ground floor, 29 residents aged 65 years and above with dementia on the second floor, 33 patients, elderly persons aged 60 years and above (female) and 65 years and above (male) with mental health disorders and/or dementia on the third floor, 31 residents with dementia, and/or persons with mental health disorders on the second floor, 1 patient, 54 years and above (female) with dementia As agreed on 19/06/2006 one Service user, 57 years and over, with a mental disorder can be accommodated on the second floor Two (2) service users under the age of 65, with dementia, can be accommodated. 22nd January 2007 Date of last inspection Brief Description of the Service: Tower Bridge Care Centre is a large purpose-built home, over four floors, with rooms for 128 older people, the majority of whom have single rooms with ensuite toilet and basin. The ground floor provides residential care, but is now changing over to provide care for people with dementia. The first floor is for people who need nursing care and the second for people with dementia who need care of a nursing level. The top floor is for people with dementia whose needs are of a residential level. There is ample communal space on each floor and a small garden. There is car parking space at the front of the building and a small garden to the side. On the day of inspection there were 12 vacancies. The fees for the home range from £330 to £709 a week. DS0000007047.V341943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection started with an evening visit on the 27th June. The next day was spent at the home and also the following afternoon. The inspector was helped in the inspection by the manager of the home and also had the opportunity to speak to the operations manager. She spoke to staff on all floors during the inspection. She spent time with residents and on the last day spent a short time of structured observation in the lounge on the ground floor. She was able to speak to many relatives and also to the nurse from the Care Homes Support team and two visiting care managers. She checked care plans and documentation on all floors. What the service does well: What has improved since the last inspection? A new manager has brought improvements that were commented on by relatives, staff and visiting professionals. Amongst these are: An improvement in health care, especially the prevention and treatment of pressure areas. An improvement in the administration of medication. An improvement in the conduct of meal times. An improvement in the recording and investigation of complaints and allegations of abuse. An improvement in the provision of staff supervision. DS0000007047.V341943.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000007047.V341943.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000007047.V341943.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents can move into the home knowing that their needs have been assessed. However those people suffering from dementia can still not be sure that their special needs will be met. EVIDENCE: The relative of a resident who had moved in the week before said that he had visited the home on behalf of his father and had been given all the necessary information about the home. The inspector saw files for people who had moved into the home since the inspection. These showed that the home had obtained a full social services multi-disciplinary assessment and had also sent a member of staff out to assess their needs. The home confirms in writing that they believe they can meet these needs. However, the inspection showed that the home still does not demonstrate the capacity to meet the specialist needs of people who have DS0000007047.V341943.R01.S.doc Version 5.2 Page 9 dementia. Requirements concerning this are made in appropriate sections of the report. The home does not offer intermediate care. DS0000007047.V341943.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that all their personal and social care needs are included in their plan of care, and they cannot be sure that all areas of risk are minimised as far as possible. Their health care and medication are dealt with well and they feel they are treated with respect and dignity. EVIDENCE: Care plans were checked on all floors. Some plans showed some good person centred care planning. However, most still did not cover all areas of need such as social and emotional needs and did not detail the individualised care needed. Most did not have the life histories, which would enable staff to know what the resident had been like for the majority of their life. One resident who had been in the home for six weeks only had a minimal care plan. Risk assessments and care plans for dealing with challenging behaviour were not always in place when they should have been. When they were in place they did not adequately analyse the behaviour and give strategies to minimise risk; one that was in place gave a strategy based on a medication, which had not been DS0000007047.V341943.R01.S.doc Version 5.2 Page 11 prescribed. However, the inspector did see one extremely good risk assessment and care plan for dealing with challenging behaviour and it was clear that it had helped the resident to deal with his behaviour and he was grateful for this. Risk assessments for other areas such as nutrition or falling sometimes showed a considerable risk but did not then have a care plan to minimise the risk. Several people with moving and handling needs did not have care plans to show how to safely help them. File notes showed appropriate monitoring of health care and referral to the GP and to other health specialisms such as old age psychiatry when needed. The Care Home Support Team nurse confirmed that in her opinion the home was handling the health care needs of residents well and referring on and communicating information where needed. She agreed with the manager’s assessment of pressure care area as good. Medication was checked on two of the four floors and was seen to be in order with robust procedures for recording and monitoring. Instructions from the GP are now recorded on the charts. However, staff who administer medication need to know what all medication is for, together with its possible side effects. There was evidence that on admission the possibility of self-medication is assessed. On the ground floor it was seen that one resident retains responsibility for her own medication and a risk assessment was seen to show that all areas of risk had been considered. All the residents and their relatives spoken to said that they were looked after well in the home and that their privacy and dignity was respected. Two care managers said that they felt the home was looking after their clients well and one said that she had confidence in the staff. DS0000007047.V341943.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is striving to generate community contact for residents and continues to welcome residents’ friends and relatives into the home. The activities programme is still not demonstrating a full and varied programme of activities for most residents but the management believes they are compensating for that with small group and individual activities. EVIDENCE: The manager said that the staff are trying to take residents out and about more, on an individual basis, to such places as local markets and pubs. Links are also being made with community groups such as the local Turkish association, as well as with local churches. The home is hoping that volunteers from these local churches will enable residents to go out to services as well as attending the services in the home. On the day of inspection local church visitors were in the home. A relative told the inspector about entertainments that happen in the home on a regular basis and are good. DS0000007047.V341943.R01.S.doc Version 5.2 Page 13 The inspector did not believe that the activities programme yet had sufficient varied activities, especially for people with dementia. The relative of a resident who has dementia and who visits three times weekly said she never sees her relative engaged in activities. The home again has only one activities organiser and this is not enough for a home of this size and there is no programme of activities at weekends. Most care plans seen still did not state the activities which people used to like, or still like and are able to do. Also no real record is being kept of if people take part in activities which means it is very hard to be clear if most people are taking part in activities they like or not. However the manager was clear that many activities are happening on a small group and individual basis which are not on the programme. The inspector was impressed, during a short observation she did in a lounge, at the way the staff there interacted with the residents, meaning that although there was no activity as such, the residents were engaged and positive all the time. She did also see some good activities happening whilst she was in the home. Because of the conflicting evidence and the fact that clear recording is not being made of how people spend their time the requirements from the last inspection will be extended to allow the home time to find ways of showing that what they say is happening, is indeed happening. As before residents are able to welcome visitors at all times and there were, on the day of inspection, many visitors in the home. Residents are able to follow different life-styles, to stay in their rooms, sit in the variety of lounges, and go out as they wish and are able. They are able to personalise their rooms and are supported to make choices. Residents and their relatives who spoke to the inspector said they enjoyed their food. There was more evidence on care plans of peoples food likes and dislikes being noted and people are able to eat in their rooms if they wish. Smoothies have been added to the menu to provide more fruit in the menu and finger foods were evident at suppertime to enable people who are no longer able to manage a knife and fork to feed themselves. DS0000007047.V341943.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that their complaints are listened to and acted upon and there are policies and procedures in place to safeguard vulnerable adults. However it was found that practise on one of the dementia floors amounted to a form of restraint. EVIDENCE: The home has an up-to-date complaints procedure. Since the last inspection the commission has received one anonymous complaint about the home, and one other complaint. The inspector has also received a concern from a former resident. On checking the complaints file it was seen that the manager was aware of this concern and it had been properly handled. There was also a good recording of all complaints, whether verbal or written and all had been properly dealt with and acted upon. There is a vulnerable adult’s policy and an ongoing training programme for staff on safeguarding adults, and it was noted that new staff have this training. There have been two allegation of abuse since the last inspection and the home had handled these properly liaising with the commission and working with the relevant social services staff. However, when the inspector started the inspection in the evening she found that two residents on the dementia unit, who are mobile, were being kept in wheelchairs with a safety belt in, DS0000007047.V341943.R01.S.doc Version 5.2 Page 15 whilst sitting in the lounge. This is a form of restraint and should not happen. When the inspector returned to finish the inspection the organisation’s senior consultant in dementia care was visiting to deal with this issue, and the promptness is to be commended. It is also recommended that when the home uses bed rails they record on file the reason they are needed. DS0000007047.V341943.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well equipped, spacious and safe throughout. Work is being done on replacing furniture but residents do not yet have the benefit of a proper standard of furnishings and fittings. The environment has not yet been adapted to be suitable for residents suffering from dementia. EVIDENCE: The home is a purpose built four-storey building close to public transport, shops, cafés and pubs. The home and grounds are fully accessible. There is a large car park with a small front garden and a side garden adjoining it. The floors are large with over 30 rooms. Each floor has two lounges and a dining room. The communal areas are generally clean, bright and pleasant but not always well furnished; all areas are seen to be safe. The three units DS0000007047.V341943.R01.S.doc Version 5.2 Page 17 providing dementia care are still not providing a proper level of environmental adaptations required to orientate and stimulate residents with dementia. One relative commented how easy it was for him and his relative to get lost. The home has not yet obtained the specialist advice needed to make the units into a good environment for people with dementia. Maintenance continues to be a problem. There has been some decorating and purchase of carpets and furnishings. The carpet in the second floor hall is in a very bad state but the inspector was told that a new carpet had been ordered. Residents’ rooms are of a good size and many are personalised. Residents and their relatives generally said that they were happy with their rooms. They have en suite toilets and there are also bathrooms with assisted baths on each floor as well as walk in showers. However many of the rooms that the inspector saw had one or more items of broken furniture. She also still saw many bedclothes of a poor quality. There is a programme of putting bathroom cabinets in and this should continue. There are systems in place to prevent infection. A relative who spoke to the inspector said that she often found the home smelly. However during the inspection the home was clean and free of odour. DS0000007047.V341943.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is deploying adequate numbers of staff at all times and the manager has shown a commitment to protecting residents and is implementing a safe recruitment system. There is a good level of NVQ qualification. However residents cannot be sure that staff have the training to meet their needs in the areas of health and safety and dementia care. EVIDENCE: The numbers and mix of staff on duty continues to be of an appropriate level. Staff files showed that new staff are given an introductory induction into the running of the home and then embark on an induction and foundation programme designed to give them an overview of caring and in line with standards. The home also reports that it has met the target of 50 of care staff having, or having completed, a national vocational training qualification. All staff also now have individual training files. Therefore a record of training already done, together with information from supervision and appraisal, enables managers to know what training is needed. However there is still not sufficient level of training in the two important areas of Health and Safety and knowledge of the needs of people suffering from dementia. The home estimates that 97 out of 116, or nearly 85 of residents suffer from dementia, with people on the two dementia units having a high degree of confusion and distress. However only 10 of staff have a basic level of dementia training. DS0000007047.V341943.R01.S.doc Version 5.2 Page 19 Recruitment files were checked for newly recruited staff. There has been a high turnover of staff since the last inspection as the manager found, through auditing staff files, that not all staff had, or were willing to supply, the necessary documentation to allow them to work in the home. The files that were checked showed a good recruitment process. DS0000007047.V341943.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new manager has instigated changes in the running of the home that should result in benefits for residents. Regular surveys mean that residents’ views on the home can be heard and regular supervision of staff will support them in delivering care. Residents’ monies are handled safely and appropriate actions have been taken to protect the health and safety of residents and staff. EVIDENCE: The new manager has been in post since January. She has a nursing background and has the Operational Manager’s Award. She has worked in, and managed, services for older people since 1982. She is keeping her skills upto-date through the internet, professional publications and attendance at local DS0000007047.V341943.R01.S.doc Version 5.2 Page 21 providers forums run by the Care Homes Support Team. It is clear from the evidence seen during the inspection, that she is an effective manager. Work has started on surveys for residents and relatives. The responsibility for these is being held by a volunteer, instead of a member of staff, which is a good way of trying to get more people to feel comfortable filling in surveys. The manager is waiting for a format for surveys for visiting professionals, which the organisation is putting in place, and will then be able to complete the task of quality monitoring. The inspector saw robust procedures for enabling most residents to have access to their personal allowances, whilst ensuring that their monies are kept safe. She understands that her previous requirement in this area was wrong and based on misunderstandings, and so the requirement has been withdrawn. The manager has instigated a formal supervision process and staff files showed that supervision, of a good level, is happening two monthly. There are good procedures for Health and safety in the home. A specialist firm has been consulted about new legislation to do with fire safety and their requirements have been put into place. DS0000007047.V341943.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 2 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 DS0000007047.V341943.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 31/08/07 2. OP7 13(4)(b,c) 3. OP7 13(4)(b,c) The registered person must ensure that management input is provided to ensure that care plans adequately reflect the range of residents’ needs and adequately document how they will be met. Target dates of 01/02/05, 31/7/05, 31/03/06,31/10/06 and 31/03/07 not met. It has been noted on inspection reports that continued failure to comply may result in consideration being given to enforcement action and a warning letter was sent to Southern Cross to this effect after the last inspection. The registered person must 30/09/07 ensure that risk assessments cover the area of challenging behaviour. Target date of 31/03/07 not met. The registered person must 30/09/07 ensure that all residents with moving and handling needs have care plans to cover this area. DS0000007047.V341943.R01.S.doc Version 5.2 Page 24 4. OP7 13(4)(b.c) 5. OP12 12(4)(b) 6. OP12 16(2) (m,n) 7. OP18 13(7) 8. OP22 23(2)(a) 10. OP24 16(2)(c) The registered person must ensure that all areas of assessed risk then have a care plan with actions needed to minimise risk The registered person must ensure that there are a sufficient number of activities specially designed for service users who suffer from dementia. Target date of 30/06/06 and 30/11/06 not met. Target date of 30/04/07 extended to 30/09/07 The registered person must ensure that a programme of activities is arranged and delivered to give all service users adequate recreational activities. Target date of 30/11/06 not met. Target date of 30/04/07 extended to 30/09/07 The registered person must ensure that methods other than restraint are used to safeguard residents. The registered person must ensure that professional advice is taken about suitable environmental adaptations needed to orientate and stimulate service users with dementia. This advice must be sent to the Commission. Target dates of 30/04/06, 31/10/06 and 30/06/07 not met. Continued failure to comply may result in consideration being given to enforcement action and a warning letter was sent to Southern Cross to this effect after the last inspection. The registered person must ensure that residents’ rooms suitable bed linen and a bathroom cabinet. Target dates of 31/03/06, 30/09/06 and 31/03/07 not DS0000007047.V341943.R01.S.doc 30/09/07 30/09/07 30/09/07 12/07/07 31/08/07 30/09/07 Version 5.2 Page 25 11. OP30 18(1)(a) 12 OP33 24(1)(a) (b)(2)(3) 13. OP30 18(1)(c) met. The registered person must ensure that staff have training to enable them to meet the specialist needs of service users suffering from dementia. As only a percentage of staff have received this training the requirement will stand. Target dates of 30/06/06, 31/12/06 and 30/06/07 not met Continued failure to comply may result in consideration being given to enforcement action and a warning letter was sent to Southern Cross to this effect after the last inspection The registered person must ensure that an annual report of quality monitoring undertaken is produced. Target date of 31/12/06 not met. As work is well underway to meet this requirement the target date of 30/06/07 has been extended. The registered person must ensure that there are individual training plans, and a plan for the home, to ensure that all training needed for health and safety and to meet the needs of service users, is provided. Although there is now a system for training needs to be highlighted this has not yet led to health and safety training being provided to staff as needed and therefore this requirement still stands. Target date of 30/04/07 not met. 31/08/07 31/12/07 30/09/07 DS0000007047.V341943.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP18 Good Practice Recommendations It is recommended that the manager ensures that staff administering medication know what the medication is for and what possible side effects may be, It is recommended that the reason for using bed rails be recorded on file. DS0000007047.V341943.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 DS0000007047.V341943.R01.S.doc Version 5.2 Page 28 - 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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