CARE HOMES FOR OLDER PEOPLE
Tuxford Manor Care Home 143 Lincoln Road Tuxford, Newark Nottinghamshire NG22 0JQ Lead Inspector
Mary OLoughlin Unannounced 13 June 2005, 10:00 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. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Tuxford Manor Care Home Address 143 Lincoln Road Tuxford Newark Nottinghamshire NG22 0JG 01777 872555 01777 872666 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) Hallmark Healthcare (Tuxford) Ltd Vacant Care Home, Private 45 Category(ies) of OP Old age, male and female, x 45 registration, with number of places Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users shall be within category OP Date of last inspection NA Brief Description of the Service: Tuxford Manor Care Home provides 45 places for Older People that require Personal Care. The Home is situated on the outskirts of the town, close to a local public house but transport would be required to access the shopping areas. The accommodation is provided on two floors with a passenger lift to enable access for people with disabilities. All ground floor and garden areas have level access. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted unannounced over 6hrs by two inspectors. The main method of inspection used was case tracking, this is sampling the records of three residents ensuring that their needs are assessed and the home is providing the support required to maintain the health and wellbeing of the residents. Eight residents spoke with the inspectors and gave an account of how their needs where met by the home, all of these residents confirmed that they were happy with the care provided. The acting manager was spoken with and the Managing Director of the company also attended during the inspection. The home was recently acquired by Hallmark Healthcare who are now registered with the Commission for Social Care Inspection in May 2005. The home was warm and clean with no malodour. There is sufficient staff on duty to meet the needs of the residents. Health care support is provided by the local district nursing team. Care staff at the home monitored the conditions of the residents promptly referring any changes to the G.P. or District Nurse. What the service does well:
The home was clean and well maintained. Able residents were active and busy doing their chosen pastimes. Health care was well managed with early referral to the district nurse or Doctor and good access to equipment for supporting those with disabilities. The new provider is providing all new documentation that is much clearer for staff to understand and enables good continuity of care planning. There are sufficient staff in place to meet the residents needs.
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 6 Three residents spoke of how kind and caring the staff were, how they always knock on their doors before entering and how their relatives were made welcome when they visited. One resident felt able to live in the home independently and could choose to spend her time as desired with no restrictions on her movements, able to leave the home and visit local shops or relatives. What has improved since the last inspection? What they could do better:
There needs to be better recruitment practice and staff records must be in good order to ensure that all appropriate checks are undertaken prior to employment and that residents are protected from staff unsuitable to work with vulnerable adults.
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 7 The process of admission needs to be improved ensuring that all prospective residents receive a full assessment of their needs and that through written confirmation from the care home, are assured that the home are able to meet their needs. The care plans must be drawn up at the point of admission and in consultation with the resident or their relative to ensure that all parties are agreed on the type of care to be provided. There must be a signed contract in place for those people purchasing their care privately to ensure that all parties are informed of the terms and conditions of residency. The outcomes for residents could be improved if staff were to receive training in the areas of need specific to the homes registration category and methods of care planning. Planning for the long -term needs of the resident would include how people are supported to maintain or improve their level of independence in activities of daily living including their mobility which would ensure that residents remained as active as possible for as long as possible. The environment could be made safer for those people who may be unable to assess personal safety, if staff ensured that all chemicals were safely stored and that hot water temperatures were regulated. Better provision of grab rails in en-suite rooms would provide residents with improved support to be self -caring wherever possible. There must be a permanent manager to provide the leadership and continuity of care practice to ensure that the home meets its objectives, statement of purpose and registration requirements under the Care Standards Act 2000. Participation in activities could be improved by the employment of an activities person who could plan activities and provide the necessary support for people to undertake them. Improving consultation with residents would ensure that their wishes in regard to privacy would be recorded and carried out. Regular consultation with the residents on the type of meals and choice of meals would ensure that people were satisfied with the diet provided and had opportunities to inform the menu planning. Please contact the provider for advice of actions taken in response to this inspection.
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 9 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 Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 10 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) 2-3-4-5-6 The arrangements around admission do not provide the resident with the appropriate safeguards to ensure that the home is able to meet their needs. EVIDENCE: The records of the most recent admission were completed using the new Hallmark Healthcare pre-admission assessment document. The format of the document is comprehensive and covers all the required areas on which to make an assessment to determine if the home is able to meet the person’s needs. However from the records inspected, the assessment was not fully completed and no plan of care had been drawn up . The manager felt she did not have the skills to complete the new care plan format but was being visited this week by the regional manager and was to discuss her training needs. The resident was offered the opportunity but was unable to visit the home prior to being admitted, the acting manager confirmed that the relative had
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 11 attended and provided some of the required information whilst viewing the home and its facilities. The relative had signed the admission document confirming that they had been involved in the assessment which is good practice. The resident was self- funding but no record was seen of the financial agreement or terms and conditions of residence. The newly admitted resident was happy with the arrangements around the care being provided at the home. Intermediate care is not provided by the home. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 12 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) 7-8-9-10-11 The methods used to plan care are in a period of transition due to the change of ownership of the home. There is a good system of risk assessment in place but the care plans are not updated to reflect the current needs of the resident which may not ensure that the person receives the appropriate level of care. Staff are not trained in care planning and as a result have been unable to complete good person centred plans that ensure people are treated as individuals. There is poor consultation with residents and this has resulted in a loss of privacy and dignity for residents. EVIDENCE: Of the three care plans examined, one was completed using the new Hallmark Healthcare documents, risk assessments had been undertaken but no plan of care developed to address the identified risks to the resident or set out how the care needs of the individual were to be met. Two care plans completed on the previous care planning documentation provided evidence that risk assessments had been undertaken appropriately and care plans reviewed monthly, however changes identified at each review
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 13 had not been used to inform the original care plan, as a result the care plans themselves did not reflect the current needs of the resident. Where changes in the residents condition had been identified the care provided in practice was appropriate to meet the current needs of those people case tracked. Residents at risk of developing pressure sores had been referred to the District Nurse and pressure -relieving equipment was provided. Pressure relieving equipment was seen in use both on beds and in armchairs. Residents requiring wound care were receiving the support of the district nurse to ensure that their dressings were changed and the wound regularly reviewed. Nutritional assessment is undertaken monthly and residents are weighed monthly, however a significant weight loss of one resident had not been acknowledged at the care plan reviews and no action had been taken to address the risks identified. There was good recording of visits from the chiropodist and optician that ensured regular intervention as required and access to NHS services where necessary. Residents are registered with a GP locally. One resident spoke of not being able to see the Doctor in private as staff were always in attendance and had never asked her what her wishes were in this regard. Records of the medicine management for the three residents case tracked show that all medicines received into the home, medicines administered and medicines returned to the pharmacy are signed for which provides an appropriate audit trail. One resident, receiving insulin, had a discrepency with the medicine administration record and the instructions on the medicine label. The District Nurse had changed the dosage of the insulin but the administration record sheet had not been returned to the pharmacy for re-labelling, this is poor practice and may present a significant risk to the resident. It was clear however that the resident was receiving the appropriate dosage of insulin. Insulin was stored appropriately in a medicine fridge and the drug was predrawn up by the district nurse for the resident to administer. Records of fridge temperature checks were in place, which ensured that medicines are stored at the appropriate temperature.
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 14 There was no record of the assessment of the ability of the resident to selfadminister the medicine. Care staff administering medicines are trained to do so and all staff are to attend an extended twelve week course on medicine administration from June 2005. The acting manager has produced a revised policy on dealing with the death of a resident and how their spiritual needs will be met. A key-worker system is in operation but there was little evidence to support what the key-worker did for the resident, the acting manager completed the care plan reviews. Only the first name of the key-worker is recorded in the resident’s file, this does not provide sufficient clarity of who is responsible. The previous inspection had identified that staff required training in catheter care, this has not yet been accessed although the acting manager confirmed that she has made enquiries and is awaiting a response on the provision of this type of training. The district nurses are responsible for the catheter management and cascade information on the general management of the people with this type of device. Following the previous inspection the acting manager has provided a protocol on the use of sharps in the home to ensure that all needles are disposed of appropriately. Residents were seen during the inspection to have been provided with a range of equipment to maintain their mobility, many were seen up and about taking walks around the home or using motorised scooters to access the garden. Care plans need to be further developed to recognise how the resident’s mobility is going to be maintained or improved upon in the long term. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 15 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 Social activities and meals do not provide sufficient variation and interest to people living at the home. EVIDENCE: During the inspection residents were seen undertaking a variety of Activities, many were reading books, doing crosswords or walking in the garden. Previous inspections have required the home to develop an appropriate activities programme that residents can participate in. The acting manager confirmed that there had been little progress in the provision of this type, there are no specific hours that staff are employed to undertake activities with the residents. A programme is available but most residents do not participate. Of the eight residents spoken with there were no complaints that there was a lack of provision of activities. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 16 One resident spoke of visits to the local public house and others had relatives who came to take them out. There was little opportunity for staff to escort those without relatives to local community facilities. Residents were able to visit the local paper shop if risk assessment determined their safety to go unattended. The previous inspection required that staff were more informed of the role of advocacy services, there is an information notice displayed on the notice board for residents, showing them how to contact social services and arrange advocacy, however the acting manager was not aware of the notice and this type of service is not accessed, which would be good practice and provide appropriate support for those people without relatives or people acting in their interest’s. The meal of the day was wholesome and appetising, the dining area was clean and the tables well presented. The meals served are traditional English with fresh vegetables daily. The menu of the day was displayed on a notice board in the dining room. Residents commented that there was no choice at lunchtime and that meals had little variety. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 17 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) EVIDENCE: These standards were not assessed at this inspection. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 18 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) 19-20-21-2223-24-25-26 There is outstanding work on the health ands safety arrangements within the home to ensure that a safe environment is maintained for the residents. The work on the upgrade of the fabric and decoration of the building is under review by the newly registered provider. EVIDENCE: Evidence was seen that a resident had received an assessment by the community occupational therapist and a special adapted armchair had been provided which met the person’s needs, following previous inspection requirements. Temperature records were seen of all total immersion sites and did not indicate that temperatures exceeded the minimum safe levels. However the acting manager could not confirm the use of thermostatic control valves to regulate the safe temperature and none were seen. There was no bath thermometer to test the water temperature prior to bathing and bathroom doors were left
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 19 unlocked when not in use, these are insufficient safeguards and do not ensure the safety of the residents. Care plans did not identify hot water as an environmental risk to be considered for those that lacked capacity. This is outstanding from the last inspection of the home. Hallmark healthcare, the new registered provider have instructed a consultancy service who have undertaken an audit of the health and safety requirements at the home and an action plan was provided to the inspector during the inspection. The home was clean and warm. Resident’s bedrooms were clean and tidy with a range of suitable furnishings along with their personal belongings making them homely and comfortable. Bedroom doors are fitted with locks but there was no evidence that residents are issued with a key to their door. All bedrooms have a lockable space provided for personal safekeeping. The laundry room was not locked at the time of the inspection and chemicals were not stored safely in the room, this is unsafe practice and poses a risk to the residents. Industrial washing machines and drying equipment meet disinfection standards. There was a clinical waste disposal system in operation and staff are provided with protective equipment to prevent cross infection. The hot water storage temperatures are recorded and the manager confirmed that water sampling had been undertaken to ensure control of Legionella bacteria forming in the water storage systems. The new registered providers are undertaking an audit of the general upgrade of the fabric and decoration of the building, which whilst needing attention in some areas was fairly well maintained. The gardens were overgrown in some areas and provided a poor view onto overgrown weeds from some bedroom windows. A parker bath provides a suitable assisted bathing room. There are two hydraulic hoists in operation to assist people that are unable to walk. Toilets provide good access and are conveniently located. Ensuite rooms are not fitted with grab rails, which would provide safety and assistance to self care. Radiators are low surface temperature to prevent accidental burns. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 20 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 The numbers of staff employed is sufficient to meet the care needs of the residents. There are insufficient safeguards in place at the home to ensure that all staff employed are suitable to work with vulnerable adults. EVIDENCE: There were 18 people accommodated at the time of this inspection. The staffing levels meet the minimum number required. The acting manager’s hours are not included within the total care staff numbers. Two waking night staff are on duty throughout the night. The duty records did not contain the full name and designation of the staff on duty and must be rectified to meet the minimum standard and provide an appropriate audit. The records of three members of staff were chosen to reflect the recruitment practice of the home. Two members of staff employed from another home within the group owned by the previous registered provider, had no documents at the home to reflect what checks had been done prior to working at the home. An immediate requirement was made for the newly registered provider to obtain the documents and ensure that these staff were suitable to work with vulnerable adults.
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 21 The third staff file demonstrated that Police disclosure was obtained and appropriate references prior to employment, the file was not in good order and did not provide a clear indication of the employment process. However the new documentation being employed by the registered provider is comprehensive and organised providing a good audit of the documents required. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 22 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) 31-35-37 There is no registered manager at the home. The acting manager is continuing to provide leadership and continuity of care at the home. The new registered provider is undertaking all the necessary audits to ensure that safe working practices are in place. EVIDENCE: The acting manager is in a temporary position until a new manager is appointed by the registered provider. The home has been provided with a policy file from the new provider. A full health and safety audit has been undertaken and an action plan is in place to achieve compliance with all areas of health and safety.
Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 23 The fire system and fire equipment were serviced in November 2004 and staff test the fire alarm on a weekly basis to ensure it is in working order and that staff are aware of the procedure in the event of the alarm sounding. An Environmental Health inspection was undertaken by the local authority in 2005 and no concerns have been made available to the Commission for Social Care Inspection. All portable electrical appliances are tested annually to ensure they are safe. Staff receive training in moving and handling to ensure safe working practices. The home does not manage the personal finances of the residents. Cash floats can be left with the acting manager if relatives wish to do this and receipts are provided for all purchases made. The records of all incoming and outgoing payments for one resident were checked and in order. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 24 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 1 1 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1
COMPLAINTS AND PROTECTION 1 3 3 3 3 3 1 1 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 x x x 3 x 3 x Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 25 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 2 Regulation Schedule 4 Requirement The registered person must ensure that residents receive a contract if purchasing their care privately and a record is held in the home. The registered person must ensure that residents receive an appropriate full assessment of their needs by a person suitably qualified or trained. The registered person must inform prospective residents in writing that the home is able to meet their needs. The registered person must ensure that a care plan is drawn up for all new admissions that provides the basis for care to be delivered. The registered person must ensure that care plan reviews inform the actual plan of care in place and reflect current needs. The registered person must ensure that residents are consulted on their care and that they are offerred the choice of seeing external specialists in private. The registered person must ensure that residents are Timescale for action August 31st 2005 2. 3 14 Immediate 3. 4 14 Immediate 4. 7 14 Immediate 5. 7 14 August 31st 2005 Immediate 6. 10 12 7. 8 12 Immediate
Page 26 Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 8. 9 12 9. 9 12 10. 12 16 11. 15 16 12. 19 23 13. 19 26 14. 25 13 15. 16. 26 29 13 18 referred to the GP or district nurse for appropriate assessment if they are nutritionally at risk or show significant weight gain or loss. The registered person must ensure that where medicine dosages are changed that the supplying pharmacist is notified and a change in the medicine administration record is made with immediate effect. The regsiered person must ensure that service users have a current risk assessment completed that is reviewed monthly or as conditions change for those people self medicating. The registered person must provide a varied social and recreational programme to suit the needs and capacities of the residents. The registered person must consult with the residents on the provision of a varied menu and suitable meal choice at lunchtime. The registered person must provide to the Commission evidence of the renewal of the fabric and decoration of the building following audit. The registered person must provide monthly visits to the home and prepare a written report on the conduct of the care home to the Commission. The registered person must ensure that there are no unecessary riisks to the residents from hot water outlets. The registered person must ensure that chemicals are stored safely within a lockable facility. The registered person must ensure that staff employed at the home have undergone
C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Immediate Immediate September 30th 2005 September 30th 2005 September 30th 2005 Immediate Immediate Immediate Immediate Tuxford Manor Care Home Version 1.30 Page 27 17. 31 8 appropriate pre-employment checks and that records are held of all the requirements under Schedule 2 of the Care Standards Act. The registered person must appoint a manager for the home.A written notice of the management arrangements must be forwarded to the within 28days. August 31st 2005 18. 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. 3. 4. 5. 6. 7. Refer to Standard 8 8 8 14 19 22 27 Good Practice Recommendations The registered person should provide clear protocols for staff undertaking the key-worker role. Their full name should appear on the care plan. The registered person must continue to try to access training in catheter care for all care staff. The registered person should include more information within the mobility plans on what is in place to improve or maintain the residents mobility. The registered person should provide staff with information on the role of advocacy to ensure that the homes practice in supporting people to access these facilities is up to date. The registered person should ensure that all areas of the garden are appropriately maintained. The registered person should provide suitable grab rails in the ensuite facilities. The registered person should ensure that all duty sheets include the full name and position of the person on duty. Tuxford Manor Care Home C53 C03 S63842 Tuxford Manor V231961 130605 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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