CARE HOMES FOR OLDER PEOPLE
Townsend House Court Farm Lane Mitcheldean Glos GL17 0BD Lead Inspector
Ruth Wilcox Announced 22 August 2005 09:00 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 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. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Townsend House Address Court Farm Lane Mitcheldean Glos GL17 0BD 01594 542611 01594 541449 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of St John Care Trust Mrs Dorothy Jayne Care Home with Nursing 40 Category(ies) of Old Age not falling within any other category registration, with number (40) of places Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: One bed in the rehabilitation unit can be used to provide respite care for service users over the age of 55 years. Date of last inspection 21 February 2005 Brief Description of the Service: Townsend House is situated in the centre of Mitcheldean, and is in close proximity to the local shops and amenities. The home is managed by The Orders of St John Care Trust. The home is purpose built, and is registered to provide both nursing and personal care for 40 older people over the age of 65 years. Four of the registered places are used to provide rehabilitation care, with one of these four places registered for the use of a rehabilitation resident under the age of 65 years if necessary. The home is able to provide respite care if there is a vacancy. A day centre, which serves the local community is also integral to the home. The home provides forty single rooms, six of which have en suite facilities. A passenger lift has been installed to provide easy access to the first floor. Communal areas consist of a main lounge and dining space incorporating a conservatory, a separate lounge and kitchen/dining area for rehabilitation care, and a further lounge and dining room for those service users with higher dependency needs. Adapted bathing facilities are provided. The home is surrounded by well-maintained gardens with inner courtyards of flowerbeds. A number of rooms overlook the gardens and courtyard. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this announced inspection over seven hours on one day in August. Care records were inspected in the rehabilitation unit as well as the main part of the home, as were the systems for the provision, recruitment and professional development of staff, their supervision and direction. The management of medications and complaints was inspected, as were the policies and procedures for protecting and upholding the rights of the residents. The standard and choice of meals was inspected. A tour of the premises took place, with particular attention to the standard of hygiene and environmental safety issues. The management of the home was also looked at. Staff were observed going about their duties whilst interacting with the residents. The Registered Manager was present throughout the inspection, providing assistance where needed. Six other members of staff were spoken to during this visit, who were cooperative with the inspection process. There was direct contact with ten residents and three visitors. The care of four residents in particular was closely looked at. What the service does well:
The home provides a safe environment for the residents, in that radiators are of a safe design that offers a low surface temperature for protection, and blended hot water to ensure safety in this regard also for the residents. The home offers a good rehabilitation service in four of its rooms, with specifically designated staff. The care in here is led with a joint working arrangement between the staff, an Occupational Therapist and Physiotherapist, so that the residents concerned are able to return to their own homes. Residents here were very satisfied with the care they received. There is a satisfactory standard and choice of food provided here, with only one or two residents saying that the food could be variable. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 6 There are suitably robust recruitment procedures employed at Townsend House, in order that full pre-employment checks are carried out on new staff as a safeguard for the residents. New staff undergo a structured induction training programme when they start at the home, and work in a supported capacity initially. There is also an evident commitment from The Orders of St John Care Trust towards the professional development of all its staff. The Orders of St John Care Trust have taken over the management responsibility of this home earlier this year, and good management systems were assessed during their registration process with the Commission for Social Care Inspection. There are effective arrangements for ensuring the health and safety of the residents and staff, with policies and procedures, appropriate servicing and maintenance contracts, and provision of equipment. What has improved since the last inspection? What they could do better:
Residents have an individual plan of care, which is based on an assessment of their health and personal needs, and in the main these are adequate. However, there are some elements of recording, which must be improved upon in order that plans demonstrate more clearly how certain needs are to be met. Staff must be sure that an assessment of risk is undertaken in all cases where the person may be at risk of falling; this has been required on a previous occasion, and has been done in some cases, but not all. Recording in the rehabilitation unit, though in many ways comprehensive and informative, must now be formulated into a recognisable plan of care, in cases where individual needs are identified. The systems for managing medications are generally good, with residents enabled to self-medicate if they wish. However, some nursing staff continue to be guilty in their periodic omission to sign for administration of a medication;
Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 7 this practice increases the potential for errors, and could pose a risk to the residents. Whilst residents and visitors said that many of the staff at Townsend House were very good, a number said that there were some who were ‘less than helpful’. There appear to be occasions when some residents do not receive timely assistance, even if they request it, and this is having a detrimental impact on their sense of wellbeing and dignity. Among a small number of the residents and their relatives there was very little confidence in the home to listen to concerns and complaints, take them seriously and deal with them. There was a sense among some that their views and opinions are disregarded by the home. The standards of cleanliness throughout most areas of the home were satisfactory, but two concerns regarding odour and hygiene were identified in the environment that require an increased focus from staff in order to address them. The numbers of staff on duty at certain times, and the manner in which the rota is managed has meant that there are occasions when there are insufficient numbers of staff to ensure the safety and supervision of the residents, and the timely delivery of their care. From inspecting the arrangements for the supervision of staff, it seems as though it has not always focused on working practices; this should now be fully incorporated into supervision, in order that staff and residents can benefit from good clear guidance and leadership. 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. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6. Residents receiving intermediate care in the designated unit at Townsend House are enabled to be rehabilitated back to their own homes. EVIDENCE: There are designated facilities for four residents to be accommodated on an intermediate care basis; this includes single rooms, a lounge, bathroom and kitchen/dining room. The care of these residents is provided in conjunction with the home’s designated staffing, and an Occupational Therapist and Physiotherapist. Individual programmes are put in place for each intermediate care resident, which will rehabilitate them in order to enable them to return to their own homes. Assessments of residents’ abilities and progress are carried out, including assessments within the resident’s own home prior to discharge. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. There is a care planning system in place, which in the main adequately provides staff with the information they need to satisfactorily meet residents’ health and personal needs; omissions in recording have not compromised residents’ health needs being met at this time, though improved recording in some cases would be more representative of how health needs are being met in practice. The systems for the administration of medications are good, however the failure by staff to follow them consistently could compromise the safety of residents. There are occasions when personal support is not consistently offered in such a way as to promote the dignity of all residents. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of all their needs; four were selected as part of the case tracking exercise. In the main care plans are well written, with clearly recorded health care interventions, regular reviews, and are devised in consultation with the resident or their representative.
Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 11 In two cases an assessment had identified the person as being at risk of developing a pressure sore; despite them not having done so, there was no associated documented plan of care, and no recorded rationale to support the decision not to introduce any support equipment. In one case the person had a history of falls, but there was no recorded risk assessment for this, and the risks they were at were not reflected in the plan of care. In another case where a falls risk assessment had been carried out, the control measures indicated as necessary in the assessment were not reflected in the associated plan of care. One person’s records showed a history of mental health needs, and the Community Psychiatric Nurse (CPN) had been involved. There was no accurate care plan for managing this, and the interventions of the CPN were not included in the action plan. This person also had a wound that was being attended by the District Nurse (DN); the DN’s involvement was not accurately reflected in the care plan. In the intermediate care unit care records are recorded differently, and focus largely on the assessment information and meticulously detailed daily records; there are no documented plans of care as such. The Occupational Therapist and Physiotherapist manage care overall here. Records showed that external health care support services are sourced very appropriately for the residents, with visiting health care professionals for assessments and treatments, and medical referrals as necessary. There are safe systems for the management of medications, with clearly printed medication administration records. However, there continues to be some staff that neglect to sign for administrations of a medication on isolated occasions. Residents are able to self-medicate, if they wish and are able to on the basis of a documented risk assessment. Residents in the rehabilitation unit manage their own medications in the main, and maintain their individual records, with the support of the staff where necessary. Medications are safely stored, though the home should remain mindful of the temperature in the storage area, given the sun-lit window close by. Staff were observed interacting with the residents, and on this day were very attentive, respectful and helpful to them. Comments from the residents and visitors were very varied. All said that there were some excellent staff at Townsend House, who did everything they could for them and were very respectful and kind. A small number of residents, and the visitors said that
Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 12 there were some staff who were ‘less than helpful’ and that they were sometimes ‘kept waiting for attention when they ring the bell’. This sometimes meant that they were kept waiting an unacceptably long time for the toilet, which was compromising their dignity. One relative commented on how her relative had been sent to the hospital for a medical appointment in a dishevelled and ‘not very clean state’; this also included her sitting in a very dirty wheelchair from the home. Another relative commented that staff spend little social time with the residents, and that her relative was under stimulated. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15. Dietary needs of the residents are well catered for, with a balanced and varied selection of food available that in the main meets residents’ tastes and preferences. EVIDENCE: Menus show a good range of varied and nutritious meals available for residents, with due regard for special diets. Observation of the lunchtime meal confirmed that residents are offered a very good degree of choice with their meals; a list of individual preferences is maintained in the kitchen. The lunch looked wholesome, nutritious and was well presented; a good number of residents confirmed their complete satisfaction and enjoyment of the meals; others indicated the standard of the food was variable, with one saying the lunch on this day was ‘tasteless’. Staff were assisting residents where necessary with their meals in a sensitive and discreet manner. However two visitors said that they had been concerned to see a member of care staff feeding more than one resident at a time on a previous occasion; this issue is reported on more fully later in the report, under the staffing section. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. The home has policies and procedures for dealing with complaints and for protecting the rights of vulnerable residents, however there was little confidence among residents or relatives that their concerns are listened to or appropriately acted upon. EVIDENCE: Some residents confirmed that staff were attentive to them, with some saying that staff will do what they can to help them. Other residents and two visitors said that their concerns had not been dealt with appropriately, and indicated that little is done to rectify any concerns. The home maintains a record of complaints and concerns received. The complaints procedure was not accessible to residents or their representatives, and was not contained in the Statement of Purpose that was sited in the entrance hall, as is required. The home has written policies and procedures for the protection of vulnerable adults, and has copies of other relevant documents and information available. Staff receive mandatory training in abuse at induction and during the NVQ programme; all staff spoken to confirmed their training, and were aware of the Whistleblowing procedures to follow if they had any concerns. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25 & 26. The environmental risk reducing measures within this home provide residents with a comfortable and safe place to live. Despite a mainly satisfactory standard of cleanliness, there are some areas requiring attention that are currently adversely impacting on the environment for some of the residents. EVIDENCE: Radiators throughout the home are of a low surface temperature design to ensure safety. Hot water is blended at outlets, to provide a safe temperature for residents. The Orders of St John Care Trust have made arrangements to employ an external contractor to perform monthly safety checks on the water system, and to check and maintain the hot water temperatures at outlets. Records confirm appropriate water storage temperature control measures for the prevention of Legionella, and safe temperatures at outlets.
Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 16 Windows on the upper floor have a restricted opening. Most areas of the home are cleaned to a good standard, however there were offensive odours detected in some areas. Three relatives expressed concerns about the odours, with one actually saying that they had sat in a communal armchair the previous week whilst visiting, and had become wet and soiled with urine that had previously soaked into the cushion from a resident earlier in the day. Recorded minutes of staff meetings certainly include references to a number of cleanliness and hygiene issues requiring increased attention from staff. The laundry room was clean and organised on the day of this visit. A new system has been introduced for handling and segregating items of laundry, according to circumstances. A clinical waste contract is in place. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. Staffing levels and deployment have had a detrimental impact on the standards for the residents on occasions, particularly in terms of meeting their needs in a timely and appropriate way. Recruitment and training procedures ensure that full and appropriate safeguards are in place to ensure the protection of residents. EVIDENCE: Some concerns have been identified about the ability of staff to always meet residents’ needs in a timely way. Information indicates that there is often insufficient staff to safely supervise the residents at meal times. Staff have been depleted at certain times, due to the way in which the rota has been organised; there is some recognition of this by the home now, and some changes have been affected to address this. However, two residents said that on the previous weekend there had only been two care staff plus a nurse on duty on one shift, and due to there being no catering support, the nurse was washing up in the kitchen. From discussion with the manager, it seemed that this shortfall in the kitchen was known about in advance, but that nothing had been done to address it; it should be reported that a carer’s sickness on the same day could not have been planned for in advance. Two residents said that there were insufficient staff on duty, and that they are kept waiting for attention sometimes; one of these spoke of staff being absent over breakfast due to ‘seeing to other residents in their rooms’.
Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 18 Three visitors spoke about poor levels of staffing, saying that they have seen one carer having to feed a number of residents at the same time due to the numbers of staff available, and that the zone 2 lounge can be left unattended, where higher dependency residents spend their time; on at least one occasion this has resulted in a resident falling from a wheelchair whilst alone. Other comments were more positive, and some residents said that the staff were most helpful and kind to them; this included the rehabilitation unit, where a resident said that the staff ‘couldn’t do enough for me’. There has been a significant use of agency and peripatetic staff, due to the shortfall in regular staff at the home, for some valid reasons. A random selection of staff files was chosen for inspection, some of which were on the basis of their recent recruitment to the home. Each record contained application forms, including a full employment history. Records of interviews were seen. Full and complete evidence of all the required pre-employment checks was seen. To date there have been good training opportunities for the staff, with access to a range of mandatory and optional training, plus the NVQ programme. However, the Orders of St John Care Trust have a designated training manager, and a review of staff training and development is underway; the company demonstrates a clear commitment to the training of its staff, with a clearly written policy. One member of the more recently recruited staff confirmed that she had received a formal induction training programme, and had been well supervised and supported by the staff group. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 36 & 38. Residents’ views are sought from time to time, but they do not perceive them as having much effect in changing how the home is run. The way in which staff are supervised is not sufficient to provide them with clear guidance regarding working practices. Management systems are in place to ensure that the health and safety of the residents is safeguarded. EVIDENCE: The manager has adopted some ways of ensuring that information is discussed and shared with residents and staff; meetings have been held with minutes recorded. These show evidence that residents are able to raise and discuss their views and ideas at the meetings. However, conversations with some of the residents and visitors indicated that when they raise certain issues they are disregarded, and that things do not get resolved. Three visitors indicated that
Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 20 the management approach in the home was not entirely conducive to an inclusive and reassuring atmosphere as far as they were concerned. The overall management of Townsend House is now provided by The Orders of St John Care Trust, and evidence of robust financial and business management systems was inspected as part of the recent registration process. The administrator is receiving additional training in order to manage some increased responsibilities regarding invoicing and financial issues in the home. A formally recorded staff supervision programme has been implemented; a recorded matrix shows that the majority of staff will not be likely to receive the recommended minimum number of six sessions during the current twelvemonth period. A random sample of supervision records showed that supervisions have not always focused on working practices, and in some cases the records were not indicative of the supervision content at all. One carer confirmed that she had received structured induction training, and had been adequately supported and supervised by staff. Concerns about the day-to-day supervision of staff have been identified, arising from certain working practices, which residents and relatives have found unacceptable. There was evidence that health and safety issues are addressed satisfactorily in this home, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. There are six staff who are currently qualified to provide First Aid. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x 3 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 3 x 2 x 3 x 2 x 3 Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(1) Requirement The Registered Manager must ensure that staff document fully and appropriately detailed plans of care for residents who are at risk of developing pressure sores, at risk of falling, and who have have identified mental health needs. The Registered Manager must ensure that a risk assessment for falls is documented in residents care plans. (previous timescale of 31/3/05 not met in full) Staff in the rehabilitation unit must prepare written care plans as to how rehabilitation residents needs in terms of their health and welfare are to be met. Staff must sign Medication Administration Records consistently for each administration, or make a clear entry in the Record to identify why an omission was made. (previous timescale of 31/3/05 not met in full) The Registered Person must ensure that staff conduct themselves in a manner which Timescale for action 30/9/05 2. 7 13(4.c) 30/9/05 3. 7 15(1) 31/10/05 4. 9 13(2) 30/9/05 5. 10 12(4.a) 30/9/05 Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 23 6. 16 4(1.c) 7. 16 22(3) 8. 9. 26 26 16(2.k) 16(2.j) 10. 27 18(1.a) 11. 32 12(5.a) 12. 32 24(3) 13. 36 18(2) consistently upholds the dignity of all the residents. The Registered Person must ensure that the arrangements for dealing with complaints is included in the homes Statement of Purpose. The Registered Person must ensure that any complaint received is fully and appropriately investigated. The Registered Person must ensure that the home is kept free of offensive odours. The Registered Person must ensure that satisfactory standards of hygiene are maintained in the home. The Registered Persons must review the provision and deployment of staff, to ensure that they are provided in such numbers as are appropriate for the health and welfare of the residents. The Registered Persons must maintain good personal and professional relationships with the residents. The systems for monitoring quality at the home must provide adequately for consultation with residents and their representatives. The Registered Manager must ensure that staff are appropriately supervised. 31/10/05 30/9/05 30/9/05 30/9/05 30/9/05 30/9/05 31/10/05 30/9/05 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 7 Good Practice Recommendations Staff should record the rationale behind decisions taken
d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 24 Townsend House 2. 3. 4. 5. 7 9 16 36 not to introduce high risk pressure relief equipment in cases where a high risk has been identified on assessment. In cases where there is District Nurse involvement in specific aspects of care, this should be included in the action plan in the associated plan of care. Staff should monitor the temperature in the medication storage area to ensure that it remains at an appropriate level. The home should display the complaints procedure to make it more available to residents and their representatives. Formal staff supervision should be given at least six times each year, and should include aspects of working practice, philosophy of care and career development needs. Townsend House d51_d03_s64611_Townsend House_v235827_220805_Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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