Inspection on 18/11/09 for Victoria Lodge Care Home

This inspection was carried out on 18th November 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria Lodge Care Home 10/02/10

Victoria Lodge Care Home 07/12/09

Victoria Lodge Care Home 04/08/09

Victoria Lodge Care Home 25/06/08

Victoria Lodge Care Home 03/12/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB zero star poor service 05/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 1 8 1 1 2 0 0 9 Information about the care home Name of care home: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB 01384572567 0138479658 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Select Health Care Limited care home 61 Number of places (if applicable): Under 65 Over 65 0 61 dementia old age, not falling within any other category Conditions of registration: 61 0 The maximum number of service users to be accommodated is 61. The registered person may provide personal care (with nursing) and accommodation for service users of both sexse whose primary care needs on admission to the home are within the following categories: - Old age, not falling within any other category (OP 61) - Dementia (DE 61) Date of last inspection Brief description of the care home Victoria Lodge, a purpose built home was opened in the summer of 2007. It is registered to provide personal and nursing care to people who have dementia and people who have other care needs associated with old age. It can accommodate a maximum of 61 people at any one time. The home is located near to Brierley Hill High Street with easy access to main bus routes and a range of shops and other amenities. Care Homes for Older People Page 2 of 19 0 5 0 8 2 0 0 9 Brief description of the care home The premises consist of three separate floors, with dementia care provided on the first floor and nursing care provided on the second floor. Each floor has communal areas, a dining room and lounge, bathrooms and toilets. All bedrooms are single occupancy with en-suite facilities. There are hoists and pressure relieving equipment available. A passenger lift provides assisted access to all floors. There is a main kitchen and small kitchenettes on each floor. There are also laundry facilities. The small garden areas are accessible to people using wheelchairs. Care Homes for Older People Page 3 of 19 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit to monitor requirements issued at the key unannounced inspection in August 2009 relating to the safety and well being of people living at the home. This was because the service received a poor, zero star quality rating as a result of our key inspection. The home has also had a history of considerable management instability and a number of incidents reported as safeguarding referrals. The purpose built home, which opened in August 2007, had Statutory Regulation Notices served in 2008 for breaches of the Care Homes Regulations 2001. There have been five managers in the short time the home has been operating and although some improvements were made, these had not been consistently maintained. The current acting manager commenced employment in January 2009. This random inspection was unannounced, which meant the home was not given notice of our visit. Two inspectors spent nine hours at the home. We looked at some aspects of the medication systems, care records, the systems for dealing with complaints and safeguarding people, staff recruitment and the homes quality audits and improvement plan. We also looked at how people were supported and given assistance to meet their daily needs. We looked at some bedrooms and equipment, particularly bedrails. We talked with people living at the home, staff and visitors. We looked at the way medication was stored and how medication was being managed for a small sample of people. One person had an updated care plan for the administration of as and when PRN medication. However there were no care plans for another person for the administration of antipsychotic and pain relieving medications. There was confusion about the use of Lorazepam. The prescribing instructions for as and when needed were not consistent with the homes administration records, which showed that it had been administered routinely, initially without a medication review. There were no records to indicate why this medication was administered and what the outcomes were. This was poor practice as staff may administer PRN medication for different reasons that would not always be a benefit to the person. There were various codes used to record the nonadministration of Paracetamol prescribed as PRN; and without a care plan it was unclear why and how this should have been used. We noted that the persons daily notes daily notes referred to Chloramphenical given but there was no care plan relating to an eye infection or how and when the medication should be given. We looked at the medication record which showed that the Chloramphenical eye drops had been administered for an additional day to the doctors instructions. We looked at the temperature records for the storage of medication, which indicated that the temperature was in excess of 25 degrees C. on the ground floor. This was confirmed during the inspection visit. This meant that medication was not being stored in accordance with manufacturers guidelines which state medication must be stored below 25 degrees C. The records were insufficient to demonstrate that the medication fridges on each unit were being maintained within correct temperature limits. The staff spoken to, including a recently recruited nurse, told us they did not know how to use the minimum / maximum thermometers or what they should do if they recorded temperatures below 2 degrees or in excess of 8 degrees C. Care Homes for Older People Page 4 of 19 Although two medication audits had been undertaken, these were not comprehensive. Where discrepancies in storage temperatures or medication stocks had been identified the management had not taken any action. Medication, which was not stored at the recommended temperature may not be effective in treating the condition it is prescribed for or may pose risks of harm. For example we saw that quantities of unopened insulin stored in the fridges on each unit. This medication is especially vulnerable to low temperatures and crystals may be formed. Following discussions about the risks the management arranged for new stocks of insulin to be provided before we completed the inspection visit and arranged the disposal of existing stocks. The concern about the safe storage of medication had been raised previously and the management had failed to make suitable monitoring arrangements. We were told that some staff had used the E-Learning training but we were not shown evidence of completion. We were shown medication training Certificates of Attendance for eight staff, which stated Attended a talk on the Supply, Receipt and Administration of prescription medicines using a monitored a monitored dose medication system, as supplied by 8PM Chemists. The certificates were dated 01/10/09. We were not given any evidence that the unit manager on the nursing unit had received appropriate, updated medication training. At the previous inspection we issued a requirement to show that all staff involved in medication administration must be competent in their practice but the acting manager acknowledged no competency assessments had been undertaken. We discussed our findings in relation to medication with the management of the service and informed them that the evidence did not demonstrate compliance with requirements issued at the key inspection or with their improvement plan. We copied documentary evidence, which may be used in future enforcement action. We informed the management that a further random inspection will be undertaken for a fuller assessment of the homes medication systems. At the key inspection we issued a requirement that each person must have appropriate and accurate care plans, risk assessments and health care screening assessments to maintain their health and well being. The organisation provided us with an improvement plan, which told us compliance would be in place, within the timescale identified. The acting manager told us that the organisation had employed a consultant on a part time basis to re-write all of the care plans, with the involvement of each person, their relatives or representatives and staff. She explained that this was a slow and time consuming process, which also included mentoring the staff, so that they had a good understanding and could continue to develop care plans when the consultant had completed the work. We looked at some newly completed records, which were comprehensive and person centered. From our observations of people in the home, they generally looked well presented and dressed appropriately for the weather and to maintain their dignity. A relative told us, staff keep her clean and take trouble with her hair. However as already identified care plans for the use of PRN medication had not been put in place for everyone prescribed this type of medicine and one person did not have a short term care plan for an eye infection. We also saw entries in daily notes, which indicated that a person on the nursing unit, had developed two pressure ulcers. We were Care Homes for Older People Page 5 of 19 unable to find a care plan, wound charts, measurements or photographs on this persons care file. The tissue viability assessment was assessed as low risk and had been evaluated as unchanged, which was inaccurate. We were told there was no-one with pressure ulcers at the present time at the start of the inspection visit. The deputy manager stated the wounds had not been reported to her or the acting manager. She looked at the persons care records and confirmed there was no care plan or records of wound assessments or treatment records. We established the information had not been reported to the newly recruited nurse in charge at handover but she checked and confirmed that a dressing was in place, as described in the daily notes. There was no record or prescription for the Allevyn dressings being used for this person and the management could not explain how the dressings had been obtained. We saw in daily records that a persons urine was offensive and indicted a urine specimen was needed for testing, we were unable to determine if the urine sample was obtained or if the test had been carried out. We were also unable to determine whether any action had been taken regarding the report of offensive stools reported twice in a five day period. This persons weight record indicted a weight loss of more than five kg since admission in June 2009, with no action taken. At the beginning of this inspection the management told us there was no-one with unplanned weight loss. The deputy manager arranged for the person to be weighed again during the inspection visit and informed us that there was a weight gain to almost the persons original weight on admission. This weight gain had apparently taken place in the space of 13 days. This persons records described aggressive and challenging behaviour but no account had been taken of her deteriorating physical condition, which may have contributed to the escalating behaviours. We noted from another persons weight records that the recorded weights showed considerable fluctuations, which the deputy manager agreed did not appear to accurately reflect how the person presented. She also acknowledged that apparent weight losses or questionable fluctuations were not being either reported to management or acted upon. We observed the main mealtime and noted that a carer went to remove the plate from the person with recorded weight loss with the meal virtually untouched, she then proceeded to give her four or five spoonfuls of food, whilst standing in front of her. This was 40 minutes after we had found the food being served to be tepid. Another carer said, try her with a pudding as she has not had much. The carer returned with the rice pudding and fed this person, whilst standing and looking away from her. The trained nurse was also in the lounge giving out the medicines but did not challenge this poor practice. However despite the way the person was assisted, she ate all the rice pudding, which indicated she would eat acceptable food, if given assistance. We discussed our observations of the food temperature and the poor practice with the management. The management could not show us monitoring and management strategies for people described as having agitated, aggressive or other challenging behaviours. We discussed our findings in relation to health and personal care with the management of the service and informed them that the evidence did not demonstrate compliance with requirement issued at the key inspection or with their improvement plan. We highlighted that the improved care plans would not be effective unless there were actions taken as peoples needs changed. We copied documentary evidence, which may be used in future enforcement action. Care Homes for Older People Page 6 of 19 We looked at the homes systems to deal with complaints. We saw that there was an up to date complaints procedure displayed in the home and available in the Service Users Guide. The acting manager told us that there were now books on each unit for written records of verbal complaints, so that people could see that even minor complaints were taken seriously. We spoke to relatives who told us they had made complaints about the food being cold when it reached the second floor from the kitchen. They told us that the deputy manager had arranged for hot meals to be served from a heated food trolley but some food was still not hot when served. From our observations and tasting the lunch time meal options, the temperature was at best tepid. We asked for the temperature of food to be tested, the staff told us they did not have a food probe on the second floor unit; this meant food was not routinely tested to make sure it was safe and pleasant to eat. Furthermore it did not demonstrate a proactive and robust approach to the management of complaints to make sure that resolutions resulted in satisfactory outcomes for people. We saw evidence that an immediate requirement relating to the use of child safety gates, without appropriate risk assessments and multi-agency agreements had been actioned. The acting manager told us there were three complaints from families who were concerned that their relative could not be kept safe without the safety gates to keep other people from entering their bedrooms. We discussed the need for multi-agency reviews to make decisions in each persons best interests. However we highlighted that the home must consider the mix of people admitted to each part of the home, with staffing levels and skill mixes to meet each persons needs for safety. Equipment should not be used as a method to manage peoples behaviour. The organisations improvement plan gave us assurances of compliance with the requirement to ensure staff were trained and would diligently follow safeguarding procedures. The acting manager told us that the organisations policies and procedures to inform staff about safeguarding vulnerable people had not been fully implemented. She told us there were no staff signatures to demonstrate staff had been given time to read and have awareness of Safeguard and Protect the multi-agency Procedure to safeguard vulnerable people. We were told that not all staff had undertaken updated safeguarding training because the Local Authority training provider was not able to supply training until January 2010. The acting manager stated there were plans to use another external training provider but this had still to be arranged. She stated that staff were using ELearning, but we were not given evidence to show how many staff had completed this programme. We looked at accident records, and although the acting manager had audited the accidents since September 2009, she acknowledged she had not noted the incident of abusive behaviour between the two people living at the home. She stated that the unit manager on the nursing unit had not reported the incident to her. She acknowledged that no Regulation 37 notification had been submitted to us and no referral had been made to the Local Authority to be considered under the safeguarding remit. Information looked at in relation to safeguarding told us that the management of this service had failed to effectively report issues relating to safeguard vulnerable persons. This meant that they were unable to assure us that they had taken action and made improvements to Care Homes for Older People Page 7 of 19 safeguard people living at the home. We took copies of documents, which may be used in future enforcement action. We noted that the maintenance and redecoration programme was continuing. A family commented on the improvements but wanted a noticeboard to display daily menus so that people could be reminded about choices available. We looked at bedrails in use and noted that new full length bumpers had been provided to protect people from potential injury. There were risk assessments in place, however these should contain fuller details of the risks and checks. There were 58 people accommodated on three units with varied and diverse needs. The first floor was the designated unit for people with dementia and the second floor was the designated nursing unit. The nursing unit had a mix of people who were frail and needed nursing care and people with dementia, some of whom were mobile and presented with challenging and aggressive behaviours. Comments from relatives described staff as ,having to think on their feet, records and our observations showed that agitated and aggressive behaviours were not well managed and as already highlighted poor practice was monitored and challenged. Relatives comments also included, The mix of people with dementia and others with nursing needs does not help the situation; and there are always staff changes and recently staff have changed again. We looked at the personnel file of the nurse, who we were told was the only new member of staff since the key inspection in August 2009. The file was organised with a recruitment checklist. However the recruitment process was not robust and did not provide safeguards for people living at the home. The nurse had been employed on a POVA First basis, prior to a full satisfactory CRB (Criminal Records Bureau) disclosure; and though there was a risk assessment, there was no named supervisor. We saw that the nurse had worked two long 13 hour day shifts as the nurse in charge of the nursing unit, without appropriate supervision. The evidence highlighted throughout this report shows that the management was not demonstrating compliance with the previous requirement: that the number of care staff on duty are skilled and trained and in sufficient numbers to meet the needs of people living at the home. At the key inspection we reported that this home had been registered and operating for two years and in that time there had been five managers, which meant inconsistent management arrangements. The current acting manager had been in the post since January 2009. She holds a registered nurse qualification, had 14 years managerial experience and was previously registered as a manager with the Commission for Social Care Inspection. We were told that the acting manager would be applying for registration for this home but the application had not been received at the date of this inspection. The acting manager told us that her hours were supernumerary. We were told that the deputy manager would usually spend supernumerary shifts on each unit but has been based on the dementia unit because the unit manager was working as a carer at her request for personal reasons. The acting unit manager on the nursing unit had been confirmed into the substantive role but continued to cover clinical nursing shifts. There was additional administration support and the services of an external consultant were being used to re-write care plans and mentor staff in relation to a more person centred Care Homes for Older People Page 8 of 19 approach. We spoke to relatives who told us, there are relatives meetings and good camaraderie between relatives which helps. They also commented, there have been improvements with decor and painting activities and how some staff deal with some people with behaviours. There could be further improvements such as the small lounge could be made more homely. This manager has improved things, but there have been a number of managers some good some not so good, but not really continuity of management. The acting manager told us that she had started to devised an annual development plan for the home and there were some audits but these had not identified areas of concern as highlighted in this report such as failures to implement important aspects of care planning and medication improvements. There were records of unannounced visits by the responsible individual on behalf of the organisation in compliance of Regulation 26, to monitor the management and running of the home. The reports highlighted some good practice improvements and some areas, which needed to be improved but had not identified the lack of compliance with previous requirements and the homes improvement plan. The Responsible Individual told us that there had been lots of hard work to implement improvements and she was very disappointed in the lack of action, where we had identified breaches of Regulations. We have informed the management of the organisation that we will consider what further enforcement action we need to take to secure improvements for the health, well being and safety of people living at this home. We will continue to undertake inspections to monitor the service. What the care home does well: What they could do better: Care plans must be accurate, up to date and give clear guidance about how to meet the needs of each person in the home. Care Homes for Older People Page 9 of 19 Some medication practices were potentially unsafe. Storage, administration practices and records must be improved. Improvements must be made to the policies to safeguard people. All staff must be provided with suitable training so that they understand how to protect vulnerable people and diligently report concerns to appropriate agencies without delay. The management must be able to demonstrate that there are skilled staff in suitable numbers to meet all the needs of the people living at the home. Thorough employment checks and supervision arrangements must be put in place to make sure the people are suitable to work with vulnerable people living at the home. Action must be taken to demonstrate that all staff are competent in their work practice. The quality assurance audits must be more robust so that failings are recognised with appropriate actions taken to improve the service. Any adverse event affecting people living at the home must be notified to us without delay to show that people are safeguarded. Records must be more rigorously monitored and improved so that risks are recognised and controlled. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 19 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 To ensure that there are 01/10/2009 health care assessments, risk assessments and care plans, which include all of each persons assessed needs, and are updated to accurately reflect all changes to health and care needs. This is to ensure care for each persons health and well being is properly provided at all times. 2 8 13 To devise and implement 01/09/2009 written protocols agreed with health professionals and obtain appropriate training for staff who undertake blood glucose monitoring, which is an invasive body procedure. This is to safeguard peoples health and well being from risks of harm. 3 9 13 The records of the receipt, 01/10/2009 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. This is to maintain the health Care Homes for Older People Page 11 of 19 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and well being of people living at the home. 4 9 13 To ensure prescribed 01/09/2009 Allendronic Acid 70mgs weekly is administered in accordance with special instructions, to be taken at least half an hour before first food or drink and the person advised to sit or stand for half an hour following administration. This is to safeguard people from avoidable side effects which may harm their health and wellbeing. 5 9 13 To ensure that variable 01/09/2009 dosages, such as 1 or 2 tablets, 5mls or 10mls are recorded as administered on MAR sheets. This is to ensure that peoples health and well being is safeguarded. 6 9 13 Medication must be stored 01/10/2009 within the temperature range recommended by the manufacturer to ensure that medication does not lose potency or become contaminated. This is to safeguard peoples health and well being. 7 9 13 Staff who administer 01/09/2009 medication must be competent and their practice must ensure that people Page 12 of 19 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action receive their medication safely and correctly. This is to safeguard the health and wellbeing of people living at the home. 8 9 13 To ensure that all persons 01/09/2009 living at the home receive their medication as prescribed by their doctor and the Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to maintain the health and well being of people living at the home. 9 9 13 Risk assessments must be 01/09/2009 put in place for any medication which is self administered, including creams, sprays and inhalers. This is to safeguard the health and well being of people living at the home. 10 9 13 To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to monitor and inform the relevant healthcare professionals as needed. This is to safeguard the Care Homes for Older People Page 13 of 19 01/09/2009 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action health and well being of people living at the home. 11 18 13 To provide appropriate, up to 01/11/2009 date policies and procedures, and safeguarding training for all staff, with monitoring arrangements to ensure the homes and Safeguard and Protect procedures to protect vulnerable people are implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. 12 27 12 To demonstrate that the number of staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 13 29 19 To ensure that all staff 01/09/2009 employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living at the home from risks of harm. 01/10/2009 Care Homes for Older People Page 14 of 19 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 14 31 9 To ensure that an application 01/11/2009 is submitted to register the manager. This is to ensure that the home is managed to safeguard everyone at the home. 15 33 24 To implement effective 01/10/2009 quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. 16 37 37 To ensure notifications are submitted to the Care Quality Commission and Inspection of any incident that has affected the health, safety or wellbeing of the people at the care home, without delay. This includes medication errors. This is to safeguard the health, well being and safety of people living at the home. 01/09/2009 Care Homes for Older People Page 15 of 19 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans, monitoring and 31/12/2009 management strategies must be put in place for people described as having agitated, aggressive or other challenging behaviours with ways to evaluate the effectiveness of strategies and use of PRN medication. This will ensure that staff take required actions to promote peoples health and well being. 2 8 12 To ensure that staff make timely referrals to health care professionals for specialist assessment, support and advice, with action taken to diligently follow instructions for each persons care needs. This will ensure that staff take required actions to promote peoples health and well being. 31/12/2009 3 8 12 To ensure that people with changes to their condition 31/12/2009 Care Homes for Older People Page 16 of 19 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action such as poor nutritional intake, weight fluctuations are monitored using recognised screening tools as frequently as required by their risk assessments and care plans. This will ensure that staff take required actions to promote peoples health and well being. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Advice from community dieticians should be sought for all persons assessed to be nutritionally at risk, with records of support and advice offered and that a record be maintained of staff training in relation to nutrition. The correct pressure setting for pressure relieving mattresses should be recorded in each persons care records with regular documented checks. Advice from Diabetic specialist nursing service should be sought for any person with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. Moving and handling risk assessments should include instructions for the level of assistance and equipment required for all transfers. That carried forward stocks of medication are recorded on each persons MAR sheet and random audits of medication stocks should be carried out, with recorded remedial action for any discrepancies. There should be an up to date specimen staff signature list Page 17 of 19 2 8 3 8 4 8 5 9 6 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations for the administration of medication and that staff should sign and date the homes medication policy to demonstrate their awareness and compliance. 7 9 All handwritten entries on MAR sheets should be dated, signed and witnessed by staff who are trained and competent. Internal and external medicine should be stored separately to avoid contamination. It is recommend that care plan goals in this area should be made clear, and that key workers evaluate actual opportunities offered, taken up or declined each month. This should then provide a sound basis for future planning and goal-setting. Food should be served at safe temperatures, which ensure people can enjoy their meals, with appropriate levels of assistance given to people unable to eat independently. All staff should be made aware of the homes safeguarding policies and Dudley MBC multi-agency Safeguard and Protect procedures for vulnerable adults, and that that staff signatures should be obtained to demonstrate they have read these documents. That behaviour care plans should be diligently completed with fuller and more specific information which can be used to evaluate, understand and improve the management of behaviour triggers for individual people with behaviour that challenges, such as agitation, aggression and wandering. The plans to ensure the environment meets the needs of everyone living at the home should be implemented in a prioritised timescale. 8 9 9 12 10 15 11 18 12 18 13 19 Care Homes for Older People Page 18 of 19 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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