CARE HOMES FOR OLDER PEOPLE
Trowbridge Oaks Nursing Home West Ashton Road Trowbridge Wiltshire BA14 6DW Lead Inspector
Susie Stratton Unannounced 24th May 2005 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. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Trowbridge Oaks Nursing Home Address West Ashton Road Trowbridge Wiltshire BA14 6DW 01225 774492 01225 776965 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) BUPA Care Homes (CFC Homes) Limited Vacant Care Home with Nursing 60 Category(ies) of OP Old Age (60) registration, with number PD Physical Disability (8) of places TI Terminally ill (5) TI(E) Terminally ill - Over 65 (5) Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 60. 2. No more than 5 service users with a terminal illness may be accommodated at any one time. 3. No more than 8 service users under the age of 65 years with a physical disability may be accommodated at any one time. 4. The staffing levels set of in the Notice of Decision dated 16 June 2003 must be met at all times. Date of last inspection 2nd December 2004 Brief Description of the Service: Trowbridge Oaks is registered to provide nursing and personal care for 60 people. At the time of the inspection, there were 58 persons in the home and the two empty beds were booked. The home is owned by BUPA, a national provider of care homes. A new manager was appointed on 3rd May 2005, she is supported by a team of registered nurses, care assistants and ancillary staff. The home was purpose built, providing many single rooms with en-suite facilities and a variety of different sitting and dining areas, on two floors. The home benefits from pleasant surrounding grounds and a patio area, which is easily accessible for residents. Car parking is available on site. There is a bus stop close to the entrance. The centre of the Wiltshire market town of Trowbridge is a short ride away. Trowbridge has a railway station and the M4 can be reached in about 30 minutes. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between 10:00am and 4:00pm on Tuesday, 24th May 2005 in the presence of Mrs Tracey Williams, deputy home manager. During the inspection, the Inspectors also met with five registered nurses, four care assistants, a domestic, the deputy chef, a catering assistant, the administrator, the activities coordinator and the maintenance man as well as touring the building and reviewing documentation. The Inspectors met with eleven residents, three relatives and observed care for seven residents who were unable to communicate. The Inspectors observed a lunch-time meal and two activities groups. Records relating to five service users were examined in detail and four further records were examined about specific areas. Employment folders for four members of staff were reviewed. The medicines records, fire log book, complaints records, supervision and training records were inspected. What the service does well: What has improved since the last inspection?
The home has set up an auditing system for care plans and consistency in care planning has much improved since the previous inspection. All care plans are now evaluated regularly. All medicines administration records are completed
Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 6 in full on every occasion and up-to-date British National Formularies have been provided to inform staff on the actions of different drugs. All staff records include copies of all required documentation. All of the four requirements from the previous inspection have been addressed and four of the six recommendations have been addressed or are in progress. 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. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5. The home does not provide intermediate care, so this standard is not applicable. Trowbridge Oaks is able to meet the needs of residents, including those who have complex nursing and care needs. Pre-admission visits are encouraged and the home provides residents and/or relatives with a statement of terms and conditions operating within the home. Residents are not given ready access to the inspection reports on the home and so will not have full information how Trowbridge Oaks is meeting National Minimum Standards. EVIDENCE: All residents are provided with a copy of the service users’ guide in their own rooms. A copy is also available in the front entrance. Only the guide in the front hall includes copies of the most recent inspection report, so all residents do not have ready access to the most recent inspection report. Residents and/or relatives report that they have received a statement of terms and conditions operating within the home. Care plans reviewed by an Inspector provided evidence that care needs had been comprehensively assessed on the day of admission, and that a care plan addressing identified needs had been developed.
Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 9 Trowbridge Oaks cares for residents with a wide range of nursing and care needs. Service users spoken with reported that the home could meet their needs. Observations of care and discussions with staff showed that staff had the skills base and that relevant equipment and systems are in place to care for persons with complex nursing care needs. Residents and relatives of residents with whom an Inspector spoke indicated that they had had the opportunity to visit the home prior to admission in order to assess the quality and suitability of facilities. Trowbridge Oaks cares for persons admitted for respite care and one of these persons said that they came back to Trowbridge Oaks each time as they and their family knew it could meet their needs. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 Residents are generally protected by full nursing and care plans and their privacy and dignity are respected. Residents with risk of falls did not have care plans and this puts them at risk. Most systems for management of medicines were met, however service users are put at risk because handwritten instructions about medicines are not counterchecked to verify their accuracy. EVIDENCE: All residents have assessments and care plans in place, these detail their individual needs. Assessments and care plans are up-dated regularly and accurately describe need and direct care. Care plans were observed to be being followed by staff and staff spoken with showed a detailed knowledge of residents’ individual care needs. Where a service user has a history of falls, risk assessments are made, however where a risk is identified, while the number of falls is documented, an individualised care plan detailing how risk of falls is to be reduced for that resident has not been drawn up, to minimise risk of falls. The falls risk assessments did not include an assessment of footwear and as inadequate footwear can be a factor in falling, it is advised that this should be included in assessments. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 11 Residents who were assessed as being at risk of pressure damage had clear care plans in place, which detailed how risk is to be reduced. All residents with wounds had clear documentation stating how the wound was to be treated with regular assessments of how the wound was responding to treatment. Trowbridge Oaks cares for several residents with diabetes, all residents have care plans in place to direct staff on how each resident’s care needs are to be met. Care plans for management of diabetic residents should be more individualised, avoiding the use of such terminology as “normal levels”, they should state what the normal levels are for each individual resident. Some diabetic care plans needed more precision in how hypoglycaemic episodes are to be managed for the individual resident. Residents have assessments for continence. All residents with a urinary catheter in place have clear records of the management of the catheter. One such resident did not have the clinical indicator for use of a catheter documented, so that the reason for use of such equipment was not identified. Records showed that the home maintains close working links with residents’ GPs and that other professionals were asked for advice when needed, for example the diabetic specialist nurse was to visit the home shortly. Staff are aware of the needs of residents with acute care needs and the home had recently effectively managed the acute care of one resident and made their condition stable, prior to the ambulance arriving. Residents of the home spoken to by an Inspector, reported that their right to privacy is upheld by the home. In rooms for example accommodating two residents, Inspectors observed that screens were effectively used to ensure privacy. All care was provided behind closed doors and staff were observed to be careful to knock on bedroom doors, prior to entry. Residents were dressed as they liked, one resident who could no longer communicate or mobilise had several necklaces and smart shoes on when they were out of bed. Trowbridge Oaks has two clinical rooms where medicines are stored. The controlled drugs cupboards continue to be very small and there is likely to be inadequate space for the storage of such items if any more residents are prescribed controlled drugs. Where residents are assessed as able to selfmedicate, there is clear documentation relating to this. All medicines administration records had been completed. The home continues not to sign and counter sign some hand written medicines administration instructions. At this inspection, it was noted that two prescriptions for Controlled Drugs and one for Insulin had not been signed and counterchecked. Any inaccuracy in such prescriptions could have serious complications for a resident. To ensure that the resident is being administered what their GP prescribed, all handwritten records need to be signed by the person completing the record and verified by a second person. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Trowbridge Oaks meets residents’ recreational needs, both in and out of the home. The home strives to ensure that it facilitates choice, and in so doing meets the lifestyle expectations and preferences of its residents. Meals are attractively served and a wide range of choice is offered. EVIDENCE: The home’s activity co-ordinator provides a range of activities to residents in large and smaller groups. He also visits all residents each day and he maintains full records of activities provided. A number of events had been recently arranged for residents, including a V.E. party, a Burns’ Night celebration and an exhibition of ballroom dancing. One resident reported that the co-ordinator had arranged them her to visit a theatre, while another said that the home facilitates their continued involvement in a local club outside of the home. One resident said “I’ve made a nice lot of friends here”. Another resident described the activities coordinator as “great” and another said that staff are “always available to chat to”. Visits out of the home are organised in the summer months. Residents and their relatives said that they could come and go as they wished. Several of the residents said how much they enjoyed sitting in the patio area outside the home when the weather was warm. Residents said that it was up to them which activities they attended or if they stayed in their room most of the time. Residents also said that they chose when they got up in the morning and went to bed in the evening. The home
Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 13 continue to document residents or their representatives’ wishes in the event of sudden illness or collapse but full documentation has not yet been made for all residents. Some residents ate their lunch in the dining room, others preferred to eat on their own in their rooms. Lunch was unhurried and a pleasant occasion. Staff sat with residents who needed assistance, encouraging them and helping them to eat. Lunchtime is seen as a social occasion for residents who wish to eat in the dining room. Choice, including drinks are offered at every meal. One resident described the meals as “lovely” and another as “excellent”. One resident said about the meals “If I don’t like it, I don’t eat it and they bring me something else” and another said that the meals were so varied that there was “always something to suit”. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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, 17 & 18 A complaints procedure is in place, which works in practice, however improvements could be made in the monitoring of concerns, to ensure that all areas of concern are being consistently being met. Residents’ rights are met and where residents show complex care needs, systems are in place to protect them and make them feel safe. EVIDENCE: The home’s complaints procedure is displayed and is made available in the service users guide. The Responsible Individual regularly reviews complaints during their monthly visits. During the inspection, the Inspector became aware of three concerns which had been raised by residents, some of these had been documented in their daily records but not all, discussions with staff and the resident showed that action had been taken to address the concerns. It is advisable that all such concerns are documented and records maintained centrally in the home, so that managers can audit the types of concerns that are being raised and that staff are responding effectively. Residents spoken with knew who to take concerns to, one said that they told the nurse and another said “If I’ve a problem I go to the manageress” Residents who needed equipment to maintain their safety, such as lap belts and safety rails had care plans in place, which were regularly evaluated. Very few mood altering drugs are used and care plans for confused or restless behaviours are clear. None of the residents spoken with were able to remember what they did about the recent election. Mrs Williams reported that three prospective MPs had visited the home during the election campaign and that residents who had
Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 15 chosen to vote had had a postal vote. A training session for staff on advocacy was taking place during the afternoon of the inspection. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24 & 26 Trowbridge Oaks provides an environment which meets the needs of its residents. It is well-maintained, clean and provides comfortable furniture and equipment, to give residents a homely setting in which to live. EVIDENCE: Trowbridge Oaks gave the impression of being well maintained and staff reported that the maintenance man was quick to respond where matters were identified. Trowbridge Oaks was purpose-built as a care home, most bedrooms have en-suite facilities and a range of baths and showers are available. There are two sitting rooms on the first floor, a dining room and sitting room on the ground floor and a patio garden area. Some residents also like to sit in the front entrance hall. All communal areas are warm, comfortable and welcoming. Residents are able to bring their own furniture in if they wish. One resident said “I’ve a very nice room”. A range of equipment, including profiling beds, hoists and pressure relieving equipment is provided for residents with more complex needs. All residents had been left with access to their call bell and
Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 17 there is an electronic monitoring system for response times which the manager audits daily, to ensure that staff respond promptly when the call bell is used. One resident said that they could not use their bell but that staff popped in and out often to check that they were alright. All of the home was clean and the laundry area, although small of this size, was well-organised. The kitchen is also small but staff are used to working within the environment and manage the space available effectively. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 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, 29 & 30 A full range of staff with a skill mix to meet service users’ needs are in post. There are safe systems for the recruitment of staff to ensure that residents are protected. Training in a wide range of areas to meet residents’ needs is supported to ensure that staff are competent to perform their roles. EVIDENCE: Trowbridge Oaks is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. A registered nurse manages each floor of the home, these nurses are supervised by Mrs Williams, the deputy manager, who is supported by the home manager. A range of senior care and care staff are in post. A full team of ancillary staff are employed, including domestic, catering, laundry and maintenance staff. An activities coordinator and an administrator support the home. Staff at all levels showed a sound knowledge of the needs of the service users they were caring for. There is a low turnover in staff at all levels. Standard recruitment systems are in place for all staff and all files examined showed evidence that the recruitment systems are consistently applied. Training records showed that a range of opportunities are offered to staff at all levels. Mrs Williams is currently providing training for care staff to enable them to understand how residents who need assistance with personal care may feel when care is being provided. Two registered nurses have recently completed an English National Board, Care of the Dying course to support residents, and staff who are caring for residents who are dying. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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, 33, 36, 37 & 38 The owners of the home seek user and staff feedback, to ensure that the home is being run as they would wish. An induction programme and regular supervision supports staff in their roles. Polices and systems are in place to ensure the health and safety of residents and staff. EVIDENCE: Trowbridge Oaks does not currently have a registered manager in post. A new manager has been appointed by BUPA, an application has been received and it is being processed by the CSCI. The Deputy Manager reports that the home keeps an “open door” policy, providing residents with an easy opportunity to discuss areas of concern. Inspectors observed the minutes of the registered nurse meeting of 17.05.05 and that of the Kitchen Assistants meeting of 28.01.05, both of which were displayed on staff notice boards. BUPA regularly sends out questionnaires to residents on the quality of care provision and the results are published. The responsible individual visits the home regularly, to assess that the home is meeting BUPA’s standards, and a
Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 20 written report is completed. A standard induction programme is in place for all newly employed staff, to ensure that they are aware of their roles and responsibilities. All staff receive regular supervision, suited to their level in the organisation. Supervision for care staff is resident care need based, to ensure that staff are able to meet the needs of the people that they will be caring for. BUPA has a range of policies and procedure in place to support staff. The home does not have a procedure for taking residents out of the home and as this takes place, it is advisable that one should be drawn up, to direct staff and ensure residents’ safety. Records showed that regular maintenance takes place on equipment. All required checks on fire safety. Records show that staff are trained in areas relating to health and safety such as manual handling, fire prevention and first aid. The home has a copy of the most recent Health Protection Agency guidelines to direct staff on prevention of risk of infection. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 3 x x 3 3 3 Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 22 No 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 1 Regulation 5(1)(a)(2) Requirement A copy of the summary of the inspection report must be included in all service users guide. All service users with an assessed risk of falling must have a care plan in place to direct staff on how to manage the risk. Where medicines’ administration instructions need to be completed by hand, the record must be verified by a second person. Both persons must sign the record. (Parts of this requirement were identified as a recommendation at the previous inspection). Timescale for action 30 August 2005 30 June 2005 2. 7 13(4)(c), 15(1) 3. 9 13(2) 30 June 2005 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 7 8 Good Practice Recommendations Falls risk assessments should include an assessment of the service users footwear. Care plans for service users with diabetes should use
Version 1.30 Page 23 Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc 3. 4. 5. 8 9 14 6. 7. 16 37 precise terminology to describe how the service users diabetic care needs are to be met. Care plans for urethral catheters should include the clinical indicator for their use. Larger Controlled Drugs cupboards should be provided. (This is an outstanding recommendation from the previous inspection). Service users/representatives wishes in the event of sudden collapse or deterioration in their condition should continue to be documented in their records. (This recommendation was identified at the previous inspection, progressis being made but it has not yet been addressed in full). A system should be set up to monitor all concerns brought up by service users, to ensure that the manager can evidence that they are all managed effectively. A policy and procedure on and staff taking service users out of the home should be developed. Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 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 Trowbridge Oaks Nursing Home D51_D01_S15947_TROWBRIDGEOAKS_V224948_240505_Stage4.doc Version 1.30 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
