Inspection on 04/08/09 for Victoria Lodge Care Home

This inspection was carried out on 4th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 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 18/11/09

Victoria Lodge Care Home 25/06/08

Victoria Lodge Care Home 03/12/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report Care homes for older people Name: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Jean Edwards     Date: 0 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 46 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 46 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: Select Health Care Limited care home 61 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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. 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 Care Homes for Older People Page 4 of 46 61 0 Over 65 0 61 Brief description of the care home 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 5 of 46 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection was on 25 June 2008. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit over two days. This meant that the home had not been given prior notice of the inspection visit. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included discussions with the acting manager, and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the Commission. We looked at a number of records and documents. The acting manager submitted the homes Annual Quality Assurance Assessment (AQAA) as requested prior to the inspection visit. We looked around the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their Care Homes for Older People Page 6 of 46 permission, where possible. The home had published the range of fees in the service user guide, which range from £373.00 to £500. There are no third top up fees. People are advised to contact the home for up to date information about the fees charged. Care Homes for Older People Page 7 of 46 What the care home does well: What has improved since the last inspection? The acting manager had a proactive approach in that she had started to audit some aspects of the home and take action where necessary. She had also reported allegations of abuse to relevant agencies in a timely way. Information about the home had been updated and was provided in different formats so that it was easy to read and understand. Some improvements were being introduced to the way risks were assessed and how peoples care was planned, though this was at an early stage. Food safety had been improved and pictorial menus have been introduced to help people with dementia make realistic choices. There were also themed lunches such as Italian, French, and St Patricks day, St Georges day, which made meals more interesting. Redecoration was taking place to improve the environment using colour contrasts to make it easier for people with dementia and sensory disabilities to recognise their Care Homes for Older People Page 8 of 46 surroundings. A training programme had been introduced so that all staff can be provided with the knowledge and skills to meet the needs of people living at the home. There are now meetings involving people living at the home and their relatives so they can have their say about their home. What they could do better: 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 on page 4. Care Homes for Older People Page 9 of 46 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 46 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 46 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have up to date contracts terms and conditions of occupancy, and there is accurate, up to date information about the home and provider. This has the effect that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. Evidence: The information contained in the homes AQAA about what it did well stated, We have an up to date Statement of Purpose and Service Users Guide that sets out our aims, objectives and philosophy of care. The Service Users Guide is presented in normal type format and also in audio format. All residents are issued with a contract. All prospective residents are invited to visit Victoria Lodge and spend time here prior to their admission. All prospective residents are visited prior to assessment and initial care plans prepared. Their chosen room is made ready and all staff and department informed of their arrival date. Only in emergency circumstances are residents admitted to Victoria Lodge who have not been visited prior to that admission day. The Care Homes for Older People Page 12 of 46 Evidence: homes statement of purpose and service user guide had been updated in April 2009 to reflect the change of manager and change of regulator to Care Quality Commission. The documents could also be provided in alternative formats on request. The documents clearly set out the aims and objectives, admission criteria and provided clear information about the home. Information about the range of fees and payment arrangements were included, which gave people full information about the service to help them make decisions about the choice of home. The acting manager told us that they had created an enquiry pack, which was sent to people considering moving into the home. The pack contained information about the activities programme. We were also shown copies of monthly newsletters, which were introduced in January 2009. This had been well received by people at the home and their families. There were plans for further improvements such as expanding the range of formats to include pictorial and easy reads for other information Each new person was provided with a contract and statement of terms and conditions. This document had also been revised and updated and was easy to read and understand and set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. We were shown evidence that everyone living at the home was being issued with a new revised contract, though not everyones had been signed and returned. From the information provided at the home we noted that the majority of people were funded through the Local Authorities, whilst a small number of people were privately funded. There was evidence from examination of a sample of care records at the home and from discussions, which confirmed the good practices claimed in the homes AQAA. Such as pre admission assessments, which were conducted professionally and sensitively and had usually involved the family or representative of the person. The pre-admission assessment documentation was well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. This meant that staff had good information about each persons needs and preferences about how they wished their care to be provided. We saw that as peoples needs changed referrals were made to appropriate Care Homes for Older People Page 13 of 46 Evidence: professionals for reassessments, for example one person with failing physical health in the residential unit had been reassessed for nursing care. This demonstrated peoples heath care needs were being monitored and reviewed appropriately. Care Homes for Older People Page 14 of 46 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and risk managements do not give sufficient guidance to staff to ensure each persons needs are fully understood and met. The arrangements for the administration of medication does not ensure that every person at the home receives their medicines as prescribed by their doctor. People are usually treated with respect and courtesy, with rights to privacy and dignity maintained. Evidence: We looked at a sample of care records for new people admitted to the home and people who had lived at the home for longer periods of time. We were told that everyone had risk assessments and care plans, though new care documentation was in the process of being introduced. This meant that some peoples care records were in old formats and other peoples had been transferred to the new formats. Some care records were disorganised and there were considerable variances in care records on each of the three separate units. Risks assessments and care plans did not give Care Homes for Older People Page 15 of 46 Evidence: sufficient guidance how meet each persons needs and manage risks. There was only very limited evidence of involvement of the person and their relatives or representatives in the development and review of their planned care. For example there were no signatures on the majority of care plans and many care records were undated had not been signed by the person completing them. We saw that the care plans were based on very comprehensive assessment information. However care plans were not person centred and did not give staff sufficient guidance to meet each persons needs. For example they did not show staff how to care for people with conditions such as behaviours, which challenged the service, dementia, diabetes and short term infections, when additional supervision, care and support would be needed. The quality of recording was variable and some of the information was inaccurate, for example one person had a risk assessment for dementia, which stated, unable to make informed choices and this care plan does restrict freedom to leave and re-enter the care home. this is in the best interests of XX safety. We discussed this with the acting manager because this person did not have a recorded diagnosis of dementia. The acting manager confirmed that this information was inaccurate. Care plans were shown as reviewed on a regular basis, but the review was a tick box format and did not provide detailed information about how the plan has been evaluated. We saw examples of monthly evaluations, which stated, care plan remains the same and no change to care plan, when there were daily progress records and behaviour charts showing episodes of agitated behaviour and poor appetite. Another noted weight stable when the persons weight chart showed refusals to be weighed and then a weight loss. The Malnutrition Universal Screening Tool (MUST) was not being used for appropriate weight monitoring for people unable to be weighed. There were no night care plans, though the acting manager told us she had plans to introduce them. Records of night care checks had been put in place as a result of investigations into allegations about poor and potentially abusive practice at night. These would have provided valuable information about the care provided at night but they were not diligently completed. There were no care plans or written protocols for the administration of when and as required (PRN) medication on any of the three units. We saw that people had been administered medication on various occasions; there were no records to indicate why this 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. The medication regimes in care plans had not been updated and Care Homes for Older People Page 16 of 46 Evidence: did not always contain the same information as the Medication Administration Records (MAR) sheets. The references to agitated and aggressive behaviour in daily progress records were not specific. The use of health screening tools and risk assessments was variable, and sometimes inconsistent with other information on care records. Low dependency scores did not always correspond with the high level of supervision, care and attention required from staff. Moving and handling assessments did not include the level of assistance and equipment required for each transfer, which meant that staff may not use appropriate techniques or equipment posing risks to the people they were caring for and themselves. We were concerned to note that records of blood glucose monitoring (BM) were inconsistent about required frequency, one persons records had gaps and another showed the procedure had been carried out at more that the frequency advised by the healthcare professionals. This meant that some people may not be properly monitored and another person was being subjected to unnecessary invasive body procedures, with the associated risks. There were no written protocols or procedures for BM monitoring for each person, agreed with their nurse or doctor, and the acting manager was not able to tell us whether staff had been trained to carry out the procedure. One member of staff told us she had received training about three years ago at another home. We saw that a pressure relieving mattress for one person on the dementia unit had been set to full, firm pressure. The acting manager and team leader could not tell us whether the setting was correct for this persons weight and they acknowledged that there were no manufacturers instructions for this type of mattress. We were told that the District Nurse had set the pressure. This was contradicted by the nurse who stated that the mattress had not been supplied by the PCT and it belonged to the home. This meant that the mattress had not been prescribed for the person and the staff were not using it to be effective and may have posed risks of discomfort and tissue damage. Some progress was being made with the introduction of personal preference information and life stories so that care could be delivered with a person centred approach. Staff spoken to could generally tell us about peoples needs, which was reassuring but care records must be robust and accurate. Reliance on systems of verbal communications may result in people not receiving the right care to meet their needs. We saw that people living at the home had generally good access to health care services to meet their assessed needs. Some people were able to choose their own GP within the limits of geographical borders, though most people were transferred to a GP Care Homes for Older People Page 17 of 46 Evidence: practice contracted with the home. We were told that the GP generally attended the home for a weekly surgery. However we saw evidence that a person with deteriorating needs was not been seen by the GP the day requested by staff, which meant this person was not receiving medical attention in a timely way. There were some records to show that people had access to dentists, opticians, and other community services. Though these records were insufficient to demonstrate people with diabetes received all appropriate screening and healthcare checks. We looked at the homes systems to manage the medication for people accommodated. Each unit had secure storage for peoples medicines. Staff had received medication training and some were knowledgeable about medication people were receiving. However others could not tell us the correct time to administer specialist medication such as Allendronic Acid. We were told this was administered with other medicines at breakfast time, which exposed people to avoidable risks of adverse effects. In addition we saw that one person had not received their weekly dose of this medication, which had not been noticed or reported as a medication error to their doctor or notified in compliance with Regulation 37. There was no evidence that competency assessments had been carried out to make sure staff were administering medication safely. We also found that the specimen signature lists for staff administering medication was not up to date. We looked at a sample of MAR (Medication Administration Record) charts, which documented each persons current medicine requirements and regime. Records of receipt of medication received into the home and carried forward balances of medication stocks on the MAR (Medication Administration Records) sheets were not consistent and as a consequence the home did not know whether this medication was being used appropriately. In addition variable dosages such as one or two tablets, 5mls or 10mls were not consistently recorded. This meant that the accurate auditing of medication dispensed in original containers could not be easily carried out. We undertook some random audits of MAR charts and medication stocks, the majority of which were accurate. There were some we were not able to audit and there some discrepancies. This meant that there were not always assurances that people were consistently receiving their medicines as prescribed by their doctor. There were also handwritten entries on MAR sheets, which were not signed and witnessed by two trained competent staff, which would reduce risks of errors. The home had an air conditioning unit on one floor where medication was stored, which meant that medication was stored appropriately. However the rooms on two Care Homes for Older People Page 18 of 46 Evidence: other floors where the medication was stored were too hot. This meant that peoples medication might not always be stored at the correct temperature to maintain its integrity and effectiveness. We saw records monitoring the maximum and minimum temperatures of the medication fridges on a daily basis but these did not show that temperatures were being maintained between 2 degrees C and 8 degrees C. This was likely to have a detrimental effect on medication, especially, insulin. We discussed the recorded temperatures with the acting manager who agreed to investigate and take remedial action. There were also two medicines on the nursing unit, which were not refrigerated but were stored inappropriately and one was past its use by date. This was destroyed during the inspection visit. The acting manager acknowledged that there was considerable development work to do, including staff training, auditing and monitoring. We saw that staff on duty were aware of how to treat each person with respect and to consider their dignity when they were providing personal care. From our observations of people in the home, they looked well presented and dressed appropriately for the weather. Care Homes for Older People Page 19 of 46 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be assured that there will be appropriate activities for them to participate in. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person can be catered for with a balanced and varied selection of foods that meet their preferences and nutritional needs. Evidence: The homes AQAA cited the following evidence of what was done well, Our preassessment and continuing assessment ensures that the needs for individual residents are met. Leisure and social activities are designed to meet both the current need and also to stimulate conversation, questioning and debate. Outside links with the local community are actively encouraged. The Home operates an open door policy with regard to visiting (within acceptable times) those are times that do not compromise the safety of other residents, such as late night visiting. The were two activities coordinators employed, these people were enthusiastic and showed us examples of what people living at the home had been doing. This told us that there was improved stimulation and there were some activities available for Care Homes for Older People Page 20 of 46 Evidence: people who required one to one attention. There was a monthly activities programme, including games, crafts, one to one activities, exercises, quizzes, music and cookery. The choices were made available to each person, and information was displayed at various locations throughout the home and was included in the colourful monthly newsletter. There were newspapers available at the home or people could choose to have their own individual paper to follow events of interest. We observed people living on the ground floor enjoying a movement to music session. During the inspection visit we did not observe activities particularly geared to people with dementia, though the activities coordinators spent some time on the dementia unit and the nursing unit on the second day. There was only limited information in care records about some peoples activity opportunities, and what they had actually done. A yoga therapist, entertainer and a hairdresser visited once a week, which people told us they enjoyed. There were regular church services where people could receive Holy Communion if they chose. We were told that arrangements were made for people of other faiths as they wished. We were told that a small service is held by the staff and people living on the ground floor to commemorate and toast the life of people who have passed away. This was appreciated as a sensitive remembrance. The home had an open visiting policy, which meant that people were able to maintain important relationships. Relatives confirmed that they could visit at anytime. We saw that people were encouraged to bring in their personal possessions to make their room more homely. There were some inventories of personal possessions on the sample of files examined, but they were incomplete and were not signed and dated by the person or their representative and witnessed by the member of staff. There was a four week menu in place and offering an option of a full breakfast or cereals, soup and two hot choices at lunchtime and a buffet tea at teatime. Fruit platters were made available and there were plentiful cold drinks and hot drinks offered frequently. The manager showed us pictures of meals and snacks, which had been put together. These were very colourful and displayed meals, which looked appetising. We were shown samples of large print daily menus; these were good initiatives to assist people make real choices for their meals. We were shown information in newsletters advertising themed meals, such as Irish, French and Italian. Care Homes for Older People Page 21 of 46 Evidence: Dining tables were attractively presented with napkins, tablecloths, condiments and flowers. At some meal times some staff were observed to sit down and help people with their meals and assist with feeding where required. On the dementia and nursing units a number of people had their meals on small tables and there were times when staff appeared not to have sufficient time to spend assisting these people. Most people told us that the food was good but some people were not able to remember or comment. A relative told us, Food is not too bad, staff to try to tempt XX with different things. At the previous inspection in June 2008 one person required Caribbean meals, which were being provided by an external company. The acting manager told us this was no longer available, due to potential Environmental Health and health and safety issues. We were told that the person been content to opt for main menu choices, despite being offered culturally appropriate alternatives. However the person told us that they missed the Caribbean food, especially rye bread but enjoyed traditional Caribbean fare at their relatives house every Sunday. Care Homes for Older People Page 22 of 46 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available to people assist them to raise concerns and complaints. The arrangements to safeguard people living at the home do not always protect them from risks of harm. Evidence: The home had an up to date complaints procedure, which was displayed in the reception area and contained in the service user guide. Information supplied as part of the Homes AQAA indicated that the home had received three complaints, over 12 months, which had been investigated and upheld by the provider within 28 days, with satisfactory resolutions implemented. There were complaint forms to record formal complaints, which provided detailed information. The majority of people knew they could tell the staff or manager about concerns or complaints but two people felt they were not listened to and that no action was taken when they made verbal complaints. We saw the acting manager respond to one relative and look into the concerns, offering an immediate resolution. This was an area the management needs to look into and ensure proactive responses to peoples experiences and perceptions of the service. There were three situations which were being considered under the Safeguard and Protect multi agency procedures at the time of this inspection. The registered Care Homes for Older People Page 23 of 46 Evidence: manager had co-operated fully with outside agencies investigating one incident, and remedial measures were introduced to improve night care provided at the home. However the night check records introduced were not completed diligently and the lack of clear information meant further action was needed. We also saw child gates being used on the nursing floor, which we were told were to keep one person from wandering and interfering with other people and their belongings. We were told this persons family had agreed to the arrangement. Other child gates were used to prevent entry into bedrooms so that people or their possessions would be protected. We looked at risk assessments, which were not consistent with the explanations given by the nurse and staff. We discussed the risks of potential harm posed by the child gates, including accidents and ineffective fire safety. The nurse and acting manager acknowledged that no referrals had been made for Deprivation of Liberty safeguards (DOLs), though staff had received some training relating to these regulations. We issued an immediate requirement for the home to cease using restrictions to control behaviours and to make referrals to appropriate agencies to review these arrangements for each of the people affected. The management took immediate action to remove all child safety gates and make appropriate referrals for reviews and assessments. There was a copy of Dudley DACHS (Directorate of Adult Community and Housing Services) multi-agency procedures relating to safeguarding vulnerable persons living at the home. The organisations policies and procedures to safeguard vulnerable people were not satisfactory and had not been reviewed and updated to be in line with regulations and other external guidance. For example there was no safeguarding policy available, and there was a policy, which referred to physical restraint for younger adults, not appropriate to the frail older people in this home. We looked at recruitment checks as part of this inspection visit and they did not demonstrate people were effectively safeguarded from risks. One bank carer employed on a POVA (Protection of Vulnerable Adults) first basis, but without full Criminal Records Bureau (CRB) clearance, had been allowed to work on night duty without a written risk assessment or named, trained, competent supervisor. The other bank carer on night duty was covering the long term absence of a senior night carer and did not have an NVQ qualification or safeguarding training. The acting manager told us that the majority of staff had not been provided with safeguarding training. Additionally there was no evidence to show that they had been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. The staff we spoke to told us they would make a Care Homes for Older People Page 24 of 46 Evidence: report to the manager should an incident occur but they were unaware of reporting procedures to outside agencies. The acting manager told us about an interactive oneto-one computerised training programme the organisation intended to use for aspects of staff training. We were told this programme did not incorporate essential procedures such as the local multi agency Safeguard and Protect, which staff must follow diligently to protect vulnerable people. Care Homes for Older People Page 25 of 46 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live a pleasant environment for people living there. The systems in place for maintaining infection control are not sufficiently robust. Evidence: Victoria Lodge was purpose built and opened in 2007. Each of the three storeys provided care for people with different needs. There were frail older people on the ground floor, people with dementia on the first floor and people with nursing needs on the second floor. There was a passenger lift to all floors and each floor had communal lounges, dining areas, kitchenettes, and communal bathing and toilet facilities. There were some additional smaller lounges for people to see their visitors, for meetings or for activities. The communal areas were comfortable and attractive and there was an activity room and a themed pub, which was well used by people at the home and their relatives. There were separate hairdressing rooms on each floor, which had magazines and pictures and these promoted a social occasion for people to enjoy. The homes AQAA cited the following improvements to the environment, The home is purpose built and is suitable for the resident group. The Home has good access, is well maintained and is homely. It meets all building regulations and meets current standards. We have a programme of maintenance and redecoration. We have a full Care Homes for Older People Page 26 of 46 Evidence: time maintenance operative and part of his remit is to maintain the grounds. We have key pads on all outside access doors, where applicable risk assessment and care plans have been created to safeguard the residents from abuse (DOLs). We do not have any CCTV cameras. We have a full time housekeeper who is supernumerary 8 hours per week; she is supported 5 full time staff and 2 staff who are dedicated to laundry services. She ensures that the domestic staff are working efficiently and are meeting the requirements as per their domestic cleaning schedule. We have washing machines that are equipped with sluice cycles and we use red bags for soiled linen. A full range of protective clothing is available for use. We have lifts that are dedicated for laundry use; this reduces the risk of cross infection. The cleaning of these lifts is undertaken by the laundry staff. Anti-bacterial hand washing units are in all bedrooms, toilets, en suites, kitchen, laundry and anti-bacterial hand gel is available in reception. We saw that attempts were being made to make toilets and bathrooms more distinguishable, in addition to existing signage, with schemes of colour contrasts. However we were not able to verify the accuracy of all of the claims made in the homes AQAA. We had reported at previous inspection visits that the home was difficult for people to find their way around as everywhere was painted in the same colour. Some murals of local places of interest had been painted on the walls and work was continuing to differentiate some areas of the environment on the day of this inspection visit. The acting manager told us about her plans to make further improvements to the environment with appropriate signage and orientation aids especially for people with dementia and sensory disabilities. We noted that though the dementia unit had two vacancies, the communal area was cramped and at times chaotic, with nowhere for people to move about as they wished, causing frustration and noise at times. There would be insufficient seating in the communal rooms on this unit if it was full and everyone chose to be in these rooms. The acting manager acknowledged the current situation was not acceptable and told us she had held discussions with senior management in the organisation about the possible changes she had in mind to try to resolve the situation. The home had a parking area and small landscaped gardens and garden furniture but this was not suitable for many of the people at the home because of lack of security and proximity to busy main roads. Care Homes for Older People Page 27 of 46 Evidence: We looked at a sample of bedrooms with peoples permission where possible. They were all spacious and had en suite facilities. Some were attractively decorated and personalised according to individual preferences, such as family photographs, ornaments and small items of personal furniture. People were able to have keys to their rooms to promote their privacy and dignity. There were sufficient numbers of communal bathing and toilet facilities on each floor, which should promote choices for people living at the home. Each floor also had sluice facilities, though these were not locked for safety to limit access to people living at the home. As reported at the Complaints and Protection section of this report there were child safety gates in use to restrict peoples movement on the nursing unit, which compromised safety. These were removed after we issued an immediate requirement. There were a number of additional areas, which required attention such as extractor fans, which were not working in some en suites, also highlighted at the previous inspection. One sluice machine was showing a fault warning, but no one was aware of what this indicated and the bottom of sink in the sluice room was covered in sludge. There were other concerns about the standard of cleaning and infection control, examples were an assisted bathroom not cleaned properly, personal toiletries left in a communal shower room and an en suite toilet seat not clean and insecure. The large laundry was well equipped with commercial washers, tumble dryers and ironing facilities. The laundry service was generally well organised and the staff demonstrated good standards of infection control. However we saw that there were unlabelled tights and stockings in a large container, the staff told us relatives sometimes sort through to find missing items. The acting manager assured us that the contents would be checked and unclaimed items would be disposed of. She gave us assurances that this matter would be raised as an issue of concern with the staff to promote better compliance with health and safety to protect people living at the home from risks. There was a laundry procedure and infection control guideline and supplies of disposable gloves and aprons readily available. The kitchen was maintained in good order, and it was clean and tidy and well organised. We noted that appropriate food hygiene and safety measures were in place, with records, which were monitored by the Environmental Health Officer at the same time as our inspection visit. He told us that this was a follow up visit to monitor legal requirements for improvements. The Environmental Health Officer told us he was satisfied with the improvements and level of compliance. The home had achieved the Dudley MBCs Environmental Health Three Star Food Award for healthy eating and food hygiene. Care Homes for Older People Page 28 of 46 Evidence: The atmosphere in the home was friendly, and though hectic on the first and second floors, it was calm and relaxed on the ground floor. People there were engaging in conversations with each other and with staff, or taking part in activities of their choice. Care Homes for Older People Page 29 of 46 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number and skill mix of staff may compromise the way the needs of each person living at the home can be met. The recruitment processes do not provide sufficient safeguards for people living at the home. There is a training programme in place to equip staff with skills to meet peoples needs. Evidence: The homes AQAA cited the following as evidence of what they do well, We have a full staff compliment that meets the needs of the residents. We have staff members who are used as bank staff. We only use agency staff when necessary. Domestic staff are employed and the only domestic duties done by care staff are to clean the residents chairs during the night hours. This is impossible to complete during day time hours. Currently we have 70 per cent of staff who have obtained NVQ level 2 and above. The staffing ratio is increased during early morning to meet the needs of breakfast. Staff members are recruited for their ability and aptitude for the job. 2 written references are obtained, CRB checks completed and a POVA first done before any staff member commences their employment. All staff members have a contract of employment and also have completed an induction programme that meets the common induction standard. The Home has a staff training development programme and in mandatory subjects are completed in house. Staff training for mandatory subjects is paid and equates to 3 paid days per year. From observations, discussions and examination of samples of records during this visit we were unable to verify all of the good practices Care Homes for Older People Page 30 of 46 Evidence: claimed. There were 58 people on three separate floors with a wide range of dependency levels and different, often complex needs. There was insufficient evidence to show that staffing levels on each unit were reviewed and adjusted on a regular basis, taking account of the occupancy and dependency levels of the people accommodated. The AQAA claimed that the staffing levels were sufficient to meet the needs of each person at the home. Relatives and some professionals told us that there were not always enough staff to attend to peoples needs in a timely way. We observed that there were high numbers of people with dementia requiring supervision, assistance and support, and a high number of people needing the assistance of two staff for their physical needs, and the majority of people required assistance with feeding on the dementia and nursing units. We were concerned to see the child safety gates used as a means to control peoples behaviour on the nursing unit. A relative also told us that a person living in the home frequently intruded into another persons bedroom. We were also told that staff had to leave when attending to a person cared for in bed to attend to other people on the unit. This indicated that the staffing arrangements were not providing adequate supervision to ensure each persons safety. Other relatives told us staff were always extremely busy and did not always have sufficient time to spend with each person and maintain good standards of cleanliness. The management must be able to demonstrate that there are trained and competent care staff on duty with sufficient allocated care hours to meet the needs of people living at the home. The Home had not had a stable staff team since it opened in 2007. The acting manager acknowledged that staff morale had been very low but she felt it was improving. There were 7 registered nurses, to staff the nursing unit, and 33 care staff, 19 ancillary staff, including domestic, catering, administration and maintenance deployed throughout the home. The AQAA told us that 22 care staff had left the homes employ since in the past 12 months. We were told that there were also staff absent through long term ill health and suspension from duty. The acting manager told us that there was active recruitment, especially for bank staff so that the home would not be reliant on agencies workers who may not know the home or the people living there. We looked at a sample of staff personnel files, which were well organised with a recruitment checklist. However the recruitment processes did not provide sufficient safeguards for people living at the home. There was an application form where employment gaps had not been explored; and there was a member of staff employed Care Homes for Older People Page 31 of 46 Evidence: on a POVA (Protection of Vulnerable Adults) First basis, without a risk assessment, working on night duty, without adequate supervision. This was important to ensure that the people were suitable and capable of working with vulnerable people in this environment. There was evidence of an in house induction on the staff files, some supervision records and evidence of the Skills for Care Common Induction Standards, which were in the process of being completed. There were 27 of 33 care staff with an NVQ level 2 (National Vocational Qualification) care award and other staff were enrolled on the training. There was a training matrix, which showed that the acting manager was proactively arranging training in all essential areas. However she acknowledged that the majority of staff had not received safeguarding training. We were told that the organisation intended to use computer based training for each member of staff to do at their own pace. Whilst this had merits, the management should also provide recognised training and also have systems in place to assess staff knowledge and competence in meeting peoples needs. Care Homes for Older People Page 32 of 46 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not always provide sufficient safeguards for people living at this home. There are systems for consultation with people living at the home. Evidence: This home had been registered and operating for two years and in that time there have been five managers, which meant there had been a lack of consistent management arrangements. The current acting manager had been in the post since the end of January 2009 and she would be applying for registration with the CQC. She was a registered nurse, had 14 years care management experience, had achieved the Registered Managers Award (RMA) and was previously registered as a manager with the Commission for Social Care Inspection. The acting manager told us that she had not yet devised an annual development plan for the home or a structured quality assurance system. There were some audits but these had not identified areas of concern highlighted in previous sections of this report such as care planning, risk assessments and medication. There were also areas of the Care Homes for Older People Page 33 of 46 Evidence: environment needing attention identified during this inspection visit, which were not recorded on the maintenance programme. There were records of recent staff meetings and there were monthly residents meetings, with topics such as food and activities, events and outings with recorded comments from people living at the home about their preferences. There were also some very positive results of surveys circulated by the home. Supervision records told us that staff had been receiving regular supervision since January 2009. This meant that there were systems to support and develop staff to improve their skills for the benefit of people living at the home. There were records of unannounced visits by the responsible individual on behalf of the organisation (Regulation 26), to check the management and running of the home. The reports highlighted some good practices and some areas, which needed to be improved. The acting manager had also visited the home during the night to carry out random checks, which was positive and gave some reassurance following allegations and incidents occurring during night shifts. The acting manager and some staff had attended training relating to the Deprivation of Liberty Safeguarding, which ensured that peoples rights were met, we were told there were plans to make training available for all staff so that they have awareness and understand their role. However as reported at the Complaints and Protect section we were seriously concerned to see child safety gates being used on the nursing unit to control peoples behaviour and restrict their freedom of movement. Though the management responded to the immediate requirement and ceased the use of these pieces of equipment and made referrals to appropriate lead agencies, the actions did not show an understanding of the responsibilities to safeguard people from all risks. The acting manager acknowledged that improvements were required, including a change in the culture of the home. She told us that the deputy manager would be spending some supernumerary shifts on each unit to monitor how people were being cared for and supported. We were told that people were offered the opportunity to manage their own money if they wished, and there were facilities to help keep it safe. We looked at a random sample of balances and records of monies held in temporary safekeeping on behalf of people living at the home, which were accurate, with records of all transactions. Records relating to people health care needed to be improved, such as care planning, Care Homes for Older People Page 34 of 46 Evidence: risk assessments and medication records. Regulations had not been followed diligently for example there were no notifications relating to medication errors when people had not received medication as prescribed. Policies and procedures were not accurate, especially relating to keeping people safe. We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and well organised. However the gas service certificate stated, not to be used as a Gas Safety Certificate so the management should obtain documentary evidence of a Landlords Gas Safety Certificate to show that people are safe. The Environmental Health officer who was revisiting the home to check compliance on legal requirements issued at a routine visit told us he was satisfied with the improvements to ensure food safety. We saw that there were a number of bedrails in use on the nursing unit. The risk assessments were insufficient and there were no regular recorded safety checks or staff training for the use of bedrails to maintain peoples safety. There was evidence that staff received mandatory training appropriate to their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training and there was evidence that training had been booked where there were gaps. We also looked at accident records and Regulation 37 notifications. There were 43 recorded accidents since May 2009. There was no accident analysis and evaluation. This meant that there was no system to identify trends and risks, which could be controlled or minimised to maintain each persons health and safety. Care Homes for Older People Page 35 of 46 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 36 of 46 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 1 18 13 To remove child safety 31/08/2009 gates and cease the use of restrictive methods to control behaviours. To review risk assessments and make referrals to the lead agencies relating to the use of restraint and Deprivation Of Liberty. To notify the CQC of actions taken in writing by 1700 hours on Friday August 2009. This is to safeguard all persons living at the home from risks of harm. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 15 To ensure that there are 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. 01/10/2009 Care Homes for Older People Page 37 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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 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 and well being of people living at the home. 4 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 01/09/2009 Care Homes for Older People Page 38 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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. 5 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. 6 9 13 To ensure prescribed 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. 7 9 13 To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to 01/09/2009 01/09/2009 Care Homes for Older People Page 39 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 monitor and inform the relevant healthcare professionals as needed. This is to safeguard the health and well being of people living at the home. 8 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. 9 9 13 Staff who administer 01/09/2009 medication must be competent and their practice must ensure that people receive their medication safely and correctly. This is to safeguard the health and wellbeing of people living at the home. 10 9 13 Medication must be stored 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. 01/10/2009 Care Homes for Older People Page 40 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 11 18 13 To provide appropriate, up to 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. 01/11/2009 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. 01/10/2009 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). Care Homes for Older People Page 41 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 This is to safeguard people living at the home from risks of harm. 14 31 9 To ensure that an application 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 01/09/2009 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. 01/11/2009 Care Homes for Older People Page 42 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 17 38 13 To implement management systems to ensure the safe use of bedrails, which includes correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. 01/09/2009 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 7 Statements indicating people lack capacity should be removed from care records where this does not apply or is inaccurate. 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. Page 43 of 46 2 8 3 8 4 8 5 8 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 6 9 That care plans, monitoring and management strategies should 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. 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 for the administration of medication and that staff should sign and date the homes medication policy to demonstrate their awareness and compliance. 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. It is recommended that food options and choices for people from other nationalities and cultures should be frequently reviewed with them and their supporters to make sure they are able to have their preferred meals. It is recommended that all staff should be made aware of the homes safeguarding policies and Dudley MBC multiagency Safeguard and Protect procedures for vulnerable adults, and that that staff signatures should be obtained to demonstrate they have read these documents. The telephone numbers of social service departments who support the people living at the home should be available to staff, relatives and each person so that they can report any suspected or witnessed abuse directly if needed. 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 Page 44 of 46 7 9 8 9 9 9 10 11 9 12 12 15 13 18 14 18 15 18 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 challenges, such as agitation, aggression and wandering. 16 19 The plans to ensure the environment meets the needs of everyone living at the home should be implemented in a prioritised timescale. Assessment of how the cleaning schedules and minor repairs are carried out to maintain the environment to an acceptable level should be undertaken. That regular documented accident analysis be resumed to ensure that accident records are fully completed, with the unit clearly identified and risk assessments are reviewed and revised in accordance with any changed needs. 17 26 18 38 Care Homes for Older People Page 45 of 46 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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