Inspection on 20/12/07 for WCC Mayfield

This inspection was carried out on 20th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

WCC Mayfield 19/12/08

WCC Mayfield 05/06/08

WCC Mayfield 12/10/06

WCC Mayfield 30/01/06

WCC Mayfield 02/08/05

WCC Mayfield 08/03/05

WCC Mayfield 01/06/04

WCC Mayfield 11/12/03

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE WCC Mayfield Mayfield Close Bedworth CV12 8ES Lead Inspector Lesley Beadsworth Key Unannounced Inspection 20th December 2007 11:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCC Mayfield Address Mayfield Close Bedworth CV12 8ES Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02476 313600 02476 315376 Warwickshire County Council, Social Services Department Raymond Durkin Care Home 35 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (35) WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 Brief Description of the Service: Mayfield is a Local Authority home for older people, with thirty-five beds. It provides permanent care, phased care (which means that people come in for regular, planned periods) short stay and day care. Four assessment beds are also available for rehabilitation. The home is situated on a housing estate, within easy walking distance of Bedworth town centre. The town is a small but busy community, with a variety of shops, a local market and a civic centre. These are all in a pedestrian zone. The home is close to local bus routes as well as being provided with services from Coventry and Nuneaton. It is also close to the M6 motorway. There is car parking to the front and rear of the home. Mayfield was refurbished in 1995 and provides accommodation on two floors. There are three lounges with kitchenettes as well as the main dining area. There is a day care area with its own lounge with kitchenette. All bedrooms have en-suite toilets and washbasin, and on each floor there are bathrooms and toilets suitable for people who need assistance. The main kitchen, laundry and staff offices are on the ground floor. As well as the two staircases, there is a passenger lift to the first floor. The home has a registered manager, three care officers, domestic staff and care staff, which cover the home over twenty-four hours. The home does not provide nursing care. Service users who require nursing attention receive this from the community nursing service as they would in their own homes. The home’s fees were not published in the Service User Guide although the items not covered by the fee were listed. These were hairdressing, chiropody, day trips, toiletries and entrance fees whilst on outings. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a visit to Mayfield, looking at notifications received from the home and any information received about the home since the previous inspection. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. The information contained within this has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The registered manager was not on duty at the time of the visit with the Assistant Manager in charge until the afternoon and a care officer in charge afterwards. The inspection visit took place between 11:45am and 10:00pm. What the service does well: All care files looked at included a plan of care for the resident. All care plans had been reviewed monthly. Records for falls, weight, bathing and nail checks were in place within the files looked at. Nutritional risk screening and a manual handling risk assessment were also in place. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 6 Two medication trolleys are used by the home and both were clean, well organised and kept securely. There was a safe procedure for the security of medication keys. All staff responsible for medication had undertaken relevant training in order to safeguard residents. Residents spoken with had no concerns about their clothing going missing and there were no signs of lost property in the laundry, indicating that clothing is returned appropriately. Residents were cared for in a respectful manner and residents spoken with confirmed this ensuring that their dignity and selfesteem were maintained. The assistant manager said that there had been a great deal of fund raising, including selling cards that she had hand made for this purpose and the funds had a good balance. The home has a licensed bar for residents’ use. There was a good supply of alcoholic and soft drinks in readiness for Christmas. Visitors spoken with said that they were always made welcome and that they were happy with the home. One visitor said that, “There is always a nice atmosphere.” Another visitor when asked for an opinion of the home said it was, “Very good.” Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities and church services or not and where to spend their time, including where they sat in the lounges. The dining room was attractive with appropriate and good standard furniture, floor covering and tableware provided, including display units which residents said they admired. Menus were displayed in the home for residents’ information and included a variety of nutritious meals to choose from. Lunch was taken with the residents. The meal was tasty and nutritious. Assistance was available from care staff and given in a sensitive manner. Residents spoken with said that they had enjoyed the food and made comments such as, “the food is always good.” The complaints procedure for the home was displayed on the home’s notice board. Residents and visitors spoken with said that they knew who to talk to if they had any concerns and would be able to do so. This indicated that complaints were taken seriously and that staff were approachable. The home had the appropriate policy of registered Protection of Vulnerable Adults.This safeguarded residents from abuse and helped staff to be able to identify if abuse was occurring. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 7 All bedrooms had en-suite toilets and washbasin. The bedrooms looked at were comfortable and of a good standard. Permanent residents had brought in personal possessions and therefore been able to make their rooms more homely. Many of the bedrooms viewed had a track hoist round the bed for transferring residents safely from and to their bed. The laundry was clean and well organised with appropriate action taken to maintain infection control. 65 of the care staff have achieved National Vocational Qualification Level 2 in Care. This qualification shows that the person has been assessed as being competent to do their job. The registered manager has the appropriate qualifications and has had considerable experience in managing a care home for older people. The home uses the Local Authority Quality Assurance Programme, which is extensive, covering all areas of the service. Feedback is also gathered from residents regarding the service and action taken to address issues. A third party carries out an unannounced visit each month to audit sections of the Quality Assurance and a report of the visit is forwarded to us and to the manager. These practices support standards being maintained and any necessary improvements to be implemented. What has improved since the last inspection? What they could do better: Current fees should be included in the Service User Guide to advise prospective residents to give this information to prospective and current residents. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 8 Pre-admission assessments should be recorded in order to demonstrate that the home has ensured it is able to meet the person’s needs before that person is admitted to the home. The person assessed must also be informed by the home, in writing, of the outcome of any pre-admission assessment. There continues to be a need for further training in subjects related to specialist needs and to needs in later life, including sensory and physical impairment and specific health issues related to older people. More effort needs to be made to meet the religious and cultural needs of residents from an ethnic minority background. Efforts to meet equality and diversity needs had been made by staff attending relevant training; social services leaflets giving information about care services were available in the home in several different languages; prospective residents were asked at their pre-admission assessment if they have concerns regarding the gender of the persons their personal care. However this has not always been put into practice so that religious and cultural needs are supported by the home. Care plans need to be made easier for staff to be able to retrieve information they require in order to provide the appropriate care to people staying at the home. Information should be in the appropriate sections, be detailed by showing all care to be provided, up to date by addressing any change in circumstances, and show that the residents and/or their representative have been involved and are in agreement with the plan. Assessments and care plans for people staying at the home short term must be updated when they return to the home for subsequent visits. This is in order that their current needs are identified and met. Advice should be sought from an infection control nurse with regard for the need to use facemasks and plastic glasses when emptying catheter drainage bags and facemasks when managing diarrhoea. The use of these protective items could be upsetting to the resident and affect their sense of dignity. All residents must have an assessment carried out regarding the risk of them developing pressure sores. This will ensure that those at risk are identified and that steps can be taken to prevent them occurring. There were several shortfalls related to medication – • The home does not have a homely remedy policy. This creates the risk of a GP being called on each occasion, minor ailments being left untreated or residents purchasing their own ‘over the counter’ tablets. • Although the medication trolley remained in sight of the person administering medication it was left open whilst going from person to person. To ensure that the contents of the trolley are safe if the member of staff was distracted or needed to attend to an emergency, it should be locked when WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 9 leaving it to go to each person or the trolley taken from table to table so that it is not left unattended. • There were some unexplained gaps in the Medication Administration Record Sheets where staff had not signed to show the medication had been given, nor an appropriate code to show why it had not. • Eye drops and Calogen liquid in the medication fridge were not labelled with the date of opening. As eye drops and medicines need to be discarded after a set time as they begin to be unstable it is necessary to always label them with the date of opening. • Six of the eleven packets of tablets checked had an in correct balance, indicating that medication had not been given correctly. This would put the residents’ health and well being at risk. • A resident was put at risk of being in unnecessary pain due to a pain killing patch not being changed at appropriate intervals. • A large quantity of cartons of prescribed supplement drinks in the easily accessible fridge in the kitchenette on the ground floor and a carton of thickening powder was left on the worktop. These need to be stored in a more secure place. Activities and stimulation were limited. Residents spoken with over lunch said that there was not enough to do during the day. Despite ample fund raising by the home, plans for Christmas were not known to people staying at the home and staff said only one event had been planned although the date and time of this was unknown. Senior staff said that the lack of Christmas entertainment or events was because the home had celebrated their 35th anniversary in November. There was no evidence that this had been the residents’ choice. Whilst two visitors spoken with said that they were always made welcome, the inspector was not acknowledged or any identification requested when arriving at the home. This was of concern as it created a risk to residents’ and property security and a failure to make visitors/strangers to the home welcome. The outside surfaces of the fridges and freezers were dirty despite the cleaning schedule showing that they had been cleaned that day. There was spilt sugar on worktops in the room housing fridges and freezers, which could encourage insects and vermin and thus cause contamination. There were areas of the home that were in need of redecoration, looking gloomy and out of date, particularly the ground floor areas. There were plans to redecorate these areas after the Christmas season. Curtains in the bedrooms seen were unlined and therefore would let in the early morning light or summer evening light that could disturb the sleep of occupants. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 10 Two toilets on the ground floor had stained floors and an offensive odour, which was unpleasant for residents and could be a source of cross infection. Some lighting in communal areas of the home was not of sufficient brightness, mainly due to the Tiffany-type shades and low energy bulbs used, although wall lights assisted this when turned on. The shades were attractive and domestic in character but may benefit from the use of brighter bulbs. The call bell of a resident in bed was found not to be working, causing the person distress as they were unable to summon assistance. Care needs to be taken when leaving someone in their room to ensure that this is prevented. The assistant manager advised that there were currently twelve members of staff on sick leave – one care officer, six care staff and five domestic staff. At least three of these were long-term sickness. Management were attempting to minimise the impact of this by not admitting any new permanent residents and by assisting with care tasks and forsaking their own management tasks. However one visitor said that the home always seemed short staffed. Rotas were not clear and were without any information regarding the capacity in which staff were working. Any absences and subsequent cover were recorded on a separate sheet. Although the assistant manager said that this worked very well the home must have a rota that shows what staff are meant to be working, in what capacity and whether they actually worked the shift or not. Correction fluid had been used on one of the references for one member of staff and had been written over. There was no evidence that this, or any of the other references, had been validated. This creates the risk of inappropriate people being employed. There continues to be a need for staff to undertake training related to specialist needs such as sensory and physical impairment and other age related needs. Supervision was not up to date due to staff absences. This needs to be carried out six times a year to give members of staff and management to meet on a one to one basis to discuss issues that affect the delivery of the service. A post office cash card was held for one resident. It had originally been kept in a sealed/signed and envelope but the seal had since been broken. There was no receipt and no documentation to show that it was being held for safekeeping. This does not safeguard the interests of the owner. In-house fire prevention and safety checks were not up to date and had not always been carried out at appropriate intervals, putting residents and staff at risk in the event of a fire. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 11 There was no record of hot water temperature checks since January 2007, creating the risk of residents sustaining accidental scalding if the temperatures rose above 43°C. There was no record of call bells being checked, to ensure they were working satisfactorily so residents could summon assistance when required. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 12 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 Quality in this outcome area is adequate. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met but not always recorded. Some effort was made to meet specialist, cultural and religious needs through training and policy but there are shortfalls in practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the Statement of Purpose and Service User Guide were displayed in the reception area of the home. Fees for accommodation at the home were not included in the documents. Three residents were case tracked, one person who was at Mayfield for phased care and two people who lived at the home permanently. Assessments carried out by Social Services prior to the admission of these people into the home were included in their care files. Only the person visiting for phased care had a WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 14 pre-admission assessment record completed by anyone from the home, relying on the assessments and care plans from the social work team to be the record of this information and from which to devise the care plan. The care officer in charge of the home in the evening was able to describe the pre-admission process in detail, explaining that a senior person visits the prospective resident in their own home or in their current location, to assess if their needs could be met at the home. The person is then invited to view the home. All residents spoken with during the visit to the home said that their family had done this on their behalf but could recall being visited by a member of staff from the home. Once a person is admitted to the home a more thorough assessment takes place over a series of days by gathering information from the resident to ascertain the needs of and how staff will meet them.. There was no evidence that the service user is informed of the outcome of the home’s pre-admission assessment. It is necessary for the home to demonstrate they have assessed that they are able to meet each individual person’s needs prior to any agreement for admission and to directly inform the service user whether this is the case or not. Training records provided viewed in staff files showed that the majority of staff have undertaken training in dementia and continence management and six staff have attended training related to mental health, in order to meet these specific needs. Consideration should also be given to training in subjects related to other specialist needs and to needs in later life, including sensory and physical impairment. The majority of staff had attended recent training related to equality and diversity to assist in identifying and meeting these needs in others. However two residents of an ethnic minority background had little evidence in their assessments or care plans to show that any consideration had been given to address their cultural or religious needs by the home, and in one case relying on the family to do so. Social Services leaflets about care services were available in different languages in the reception. The care officer said that the prospective resident is asked if they have any concerns regarding the gender of the persons providing their care, at the time of the pre-admission assessment. Any concerns are then included in the care plan to ensure that residents wishes are established. Seven staff have also undertaken training related to sexuality in older life which would give insight to these needs. A multi faith church service is held at the home each month and residents are invited to attend. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 15 WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 16 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Further shortfalls in medication create risk to the residents’ health and well-being. Residents have access to health care professionals and are cared for in a respectful manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of the three residents case tracked were inspected and all included a care plan. Other care plans were also looked at. Care plans had been devised from the assessments and care plans written by the allocated social worker prior to admission and from further assessments carried out by staff at the home after admission. Assessment information was incorporated in the care plan format which was provided by the Local Authority and which covered all areas of need. The home’s care plans were cumbersome and difficult to extract information from, which would be particularly the case for temporary or new staff. The plans consisted of columns with the headings, WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 17 ‘Care Plan’; ‘date’; ‘Strengths, Needs and Causes of Problems’; ‘Aims and Objectives’; ‘Care staff instructions and Guidance to achieve Aims and Objectives’ and also columns for review dates. Some information that would have been more appropriate in the ‘Care staff instructions and Guidance to achieve Aims and Objectives’ had been written in alternative columns. This could cause this information to be missed by staff looking for what care needed to be provided. There was no evidence to show that the resident or/and their representative had been involved in devising the care plan or that they were in agreement with it. Some of the details in the care plans were vague, for example a resident with specific religious needs had a care plan that instructed staff to “Ensure religious needs are met” and the only advice as to how to do this was “Remind re monthly church services being held”. These services are multi faith and there did not appear, either in the care plan or in discussion with staff, to be any consideration made that it might not be appropriate or permissible for the resident to attend church services outside of the specific faith followed by them. Other instructions were merely, “monitor”; “give assistance needed” and the ‘care instructions’ for short term memory loss for a resident were “monitor and document any concerns”; “Inform family of any changes”, which do not advise staff how to mange the person’s short term memory. These care plans create the very real risk of individual needs not being fully met. Changes in circumstances were recorded on the review sheets in a different section of the file and this information was not transferred to the care plan, as the format does not lend itself to be added to without the whole plan being rewritten. For example the presence of sutures following surgery affected the assistance a resident needed and this was included in the care plan. However when the review showed that the assistance was no longer required the plan was not revised. Anyone needing up to date information therefore needed to look at these reviews as well as the care plans, which is time consuming and could result in needs not being met because information had been missed. Whilst on their initial admission an assessment and a care plan are devised for all short-term residents it was noted in those seen that they had not been updated on subsequent visits. For example one person had previously had a plaster cast in place and care instructions were given to enable their care needs to be met in several areas – eating, mobility, continence and personal care. However this care plan remained unchanged on subsequent visits when the plaster had been removed. An assessment of need should take place on each visit and the care plan updated as necessary. Some information not in a care plan was detailed in a risk assessment, for example for the emptying of a catheter drainage bag. This could be misleading and time consuming to any care staff looking for information for what care WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 18 they should be providing. The risk assessment for emptying a catheter drainage bag said that plastic glasses and a facemask must be used during the procedure in addition to protective gloves. As this seems to be excessive protection, and which could impact on the emotional well-being and dignity of any resident with a catheter, it is suggested that the necessity for the glasses and mask is confirmed with an infection control nurse. Boxes of facemasks were also seen in several of the bathrooms/toilets and a senior member of staff said that these were used for protection when dealing with diarrhoea, as well as previously discussed, but this is also possibly unnecessary for infection control purposes and should be checked out with the infection control nurse because of the affect on residents. Evidence of assessments carried out for the risk of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) was found in only one of the care files examined, for a resident who had a ‘minor’ pressure sore. The lack of this risk assessment in other care files creates the potential for the omission of any appropriate safeguards to prevent pressure sores occurring. However some preventative measures such as pressure relieving mattresses and cushions were in use for some residents. Records for falls, weight, bathing and nail checks were in place within the files looked at. Nutritional risk screening and a manual handling risk assessment were also in place. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for although one resident was seen to need nail care. The home had a medication policy provided by the Local Authority, which was in the process of being revised. A senior member of staff advised that the home does not have a Homely Remedy policy, which would enable ‘over the counter’ medication to be given for minor ailments, such as a headache or indigestion, on a short term basis. This creates the risk of a GP being called on each occasion, minor ailments being left untreated or residents purchasing their own ‘over the counter’ tablets. There was a safe procedure for the security of medication keys. All staff responsible for medication had undertaken relevant training in order to safeguard residents. The home had two medication trolleys, one for the permanent residents and one for those in the home short term. Both of these were clean and well organised and stored the blister packs of the multi dose system (MDS) used for WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 19 permanent residents or the original packages used for short-term residents and for tablets or liquids that cannot be dispensed in an MDS. The trolleys are locked to the wall in a locked cupboard, which also housed the medication fridge, and other medication cupboards. The administration procedure was observed. A trolley was taken into the dining room and the member of staff responsible followed a safe procedure apart from leaving the trolley open between going taking medication to each resident in the same room. Although the trolley remained in sight to ensure that the contents of the trolley are safe if the member of staff was distracted or needed to attend to an emergency, it should be locked when leaving it to go to each person or take the trolley from table to table thereby making the contents more secure. Medication Administration Record Sheets were examined. There were some unexplained gaps where staff had not signed to show the medication had been given, nor an appropriate code to show why it had not. Eye drops in the medication fridge were not labelled with the date of opening. This is necessary as they need to be disposed of after 28 days of opening after which they can become unstable. Calogen liquid was also in the fridge. The instructions on the bottle stated that it should be discarded after 14 days but the date of opening had not been recorded on the bottle and the date of dispensing was two months previously. A random audit was carried out on medication. Six of the eleven packets of tablets checked had an incorrect balance, three had too many tablets remaining, indicating that some may have been signed for and not given; three had less than the correct amount indicating that incorrect doses may have been given, tablets may have been lost or tablets may have been taken from the wrong container. All of these shortfalls put residents’ health and well being at risk. Controlled drugs and records were checked. The balances were correct but records showed that one person prescribed pain-killing patches that were to be changed every 72 hours had not had a new one applied for seven days. Oramorph medicine had been dispensed by the pharmacist five days before being entered into the control drug register, which could mean that it had not been delivered/collected until then or had been in the home for several days before being entered into the register. There was no record of the resident having been given any of the medicine during this time although it was not out of stock. In both of these cases there is a risk of the residents being in unnecessary pain and/or errors being made. A large quantity of cartons of prescribed supplement drinks in the easily accessible fridge in the kitchenette on the ground floor and a carton of thickening powder was left on the worktop. These need to be stored in a more secure place. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 20 Time was spent in residents’ lounges and staff and residents were observed. Preferred names were on the residents care plan and heard to be used by staff. Residents were cared for in a respectful manner and residents spoken with confirmed this ensuring that their dignity and self-esteem were maintained. However, as previously mentioned, the use of facemasks and plastic glasses if found to be used unnecessarily could be considered as lacking in dignity for the people receiving the care. Residents spoken with had no concerns about their clothing going missing and there were no signs of lost property in the laundry, indicating that clothing is returned appropriately. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 21 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 Quality in this outcome area is adequate. Residents had limited occupation and stimulation. Visitors were not always made welcome or their needs considered. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A notice board in the corridor displayed activities that were available between 10.30am and 11.30am and 3pm and 4pm. these activities included games, dominoes, puzzles, reading, manicures and twice a week there was exercises. There was also an advert for a pantomime that was showing in the locality although there was no evidence to support that residents had been involved in this programme or invited t attend the pantomime. There was little organised activity seen during the day of the visit although staff were interacting and chatting with residents. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 22 There were no notices regarding any events or of any special menus for over Christmas and residents spoken with were not aware of any arrangements. Both senior staff spoken with said that a decision had been made, including consultation with residents, to have entertainment at the November 35th anniversary of the home rather than Christmas. However the minutes of the latest residents’ meeting mentioned the anniversary but not the entertainment arrangements. The care officer said that there was to be an organist attending during lunch for a sing-a-long sometime over the weekend but that it was not advertised as there was no certainty as to when he would attend. This entertainer had been to play at the home before and the care officer said that she felt residents enjoyed it as they lingered in the dining room after their meal when he performed. There were no arrangements to involve the local community in, for example carol singing by local groups or schools. The home had been nicely decorated for Christmas however. The assistant manager said that there had been a great deal of fund raising, including selling cards that she had hand made for this purpose and the funds had a good balance. However some of the funds were being spent on having the first floor lounge decorated and this was taking place at the time of the visit. Residents had been transferred to the adjacent smaller lounge. The care officer expressed her regret that they had needed to be disrupted so near to Christmas but that they would be back in the main lounge before then. The registered persons need to consider if this is an appropriate way to use fund raising collections rather than by the Local Authority. The home has a licensed bar for use by residents, although there were boxes of drinks and other items stored there at the time of the visit. There was a good supply of alcoholic and soft drinks in readiness for Christmas. The home also has a large hairdressing salon for the use of residents. Residents spoken with over lunch said that there was not enough to do during the day. One resident spoken with later said that their time was spent watching television, reading, walking up and down and doing puzzles. Visitors spoken with said that they were always made welcome and that they were happy with the home. One visitor said that, “There is always a nice atmosphere.” Another visitor when asked for an opinion of the home said it was, “Very good.” However on the inspector’s arrival at the home the person answering the door, although polite, failed to ask for identification but indicated where to sign in, which was by the office door. The three members of staff in the office did not show that they had noticed that a visitor was in the building and continued chatting together and wrapping residents’ Christmas presents whilst the inspector waited at the door to be acknowledged. This was of concern as it created a risk to residents’ and property security and a failure to make visitors/strangers to the home feel welcome. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 23 Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities and church services or not and where to spend their time, including where they sat in the lounges. Menus were displayed in the home for residents’ information and included a variety of nutritious meals to choose from. Permanent, short stay and day care service users took meals in a communal dining room. The assistant manager said that smaller dining areas throughout the home had been tried in the past but that residents had not realised how many other people were in the home until they had all eaten together one Christmas time and therefore the decision had been made to revert to one dining room. The room was attractive with appropriate and good standard furniture, floor covering and tableware was provided, including display units which residents said they admired. Food was served from a heated trolley by the catering and care staff and desserts were served from a trolley taken from table to table. There was choice of pork slices, mashed potatoes and mixed vegetables or scrambled eggs for the main course and a choice of trifle or apricot crumble for dessert. Gravy, condiments and sauces were available on the table for residents to help themselves. A choice of squash or water was offered during lunch and appropriate drinking vessels were in use. ‘Seconds’ of the meal were offered to everyone. The meal was tasty and nutritious. Assistance was available from care staff and given in a sensitive manner. Residents spoken with said that they had enjoyed the food and made comments such as, “the food is always good.” The kitchen was visited. Temperatures of fridges and freezers were recorded and a cleaning schedule was in place and signing to say that work had been done was up to date. The kitchen was mainly clean and well organised but whilst the schedule said that the external parts of fridges and freezers had been cleaned daily they were quite dirty. There was spilt sugar on worktops in the room housing fridges and freezers, which could encourage insects and vermin and cause contamination. Fly screens were in place to prevent flying insects entering the kitchen. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure for the home was displayed on the home’s notice board. Residents and visitors spoken with said that they knew who to talk to if they had any concerns and would be able to do so. This indicated that complaints were taken seriously and that staff were approachable. Complaints records showed that there had been two complaints made to the home. Both of these were regarding the behaviour of a resident who had been admitted to the home for assessment and whose behaviour was distressing other people staying at the home. These were resolved by the home when the service user was transferred. According to training records viewed, the majority of the staff had undertaken recent training related to protection of vulnerable adults thereby giving them the knowledge to be able to identify abuse and to protect people at the home from abuse. Staff spoken to on the subject showed an adequate awareness. There was also a notice in the reception area regarding abuse to older people advising staff, visitors and residents of what to look for. The home uses the Local Authority Protection of Vulnerable Adults policy. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 25 A safeguarding complaint made to us regarding the actions of a member of staff had not been recorded in the home’s complaints file. This had been investigated by a senior person in Social Services and no requirements needed to be made by us as a result of the outcome. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25, 26 Quality in this outcome area is adequate. The home offers the people living there fairly comfortable surroundings, which are clean, mainly free of offensive odour and generally safe and well maintained but with some shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were areas of the home that were attractive and comfortable but some areas were badly in need of redecoration and looked gloomy and out of date, particularly the ground floor areas. The assistant manager advised that the corridors and the downstairs lounge were due for decoration after Christmas. Several kick plates at the bottom of doors were broken. The main lounge on the first floor was in the process of being redecorated at the time of the visit and fund raising by the home was financing this. It was not clear if the remaining planned decorating was being funded by the Local Authority or by fund raising. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 27 Mayfield provides accommodation on two floors. There are three lounges with kitchenettes as well as the main dining area. There is also a day care unit with a lounge and a kitchenette. A conservatory adjacent to the dining room was attractively furnished and was suitably heated. Residents agreed that this was a pleasant sitting area. The main lounge on the ground floor offered comfortable and homely surroundings although was due for decoration. A resident was also entertaining their visitors in a smaller lounge/kitchenette adjacent to this. It was noted that that there was a large quantity of cartons of prescribed supplement drinks in the easily accessible fridge in this room and a carton of thickening powder was left on the worktop. These need to be stored in a more secure place. All bedrooms had en-suite toilets and washbasin. The bedrooms looked at were comfortable and of a good standard, apart from the curtains. These were pretty and coordinated with the room but were not lined and would let in the early morning light or summer evening light that could disturb the sleep of residents. Those beds seen were nursing type beds and many of the bedrooms viewed had a track hoist round the bed for transferring residents safely from and to their bed. Bedrooms of permanent residents had been personalised and personal possessions had been brought in from home, such as photos, ornaments, small pieces of furniture and plants. The bedrooms of people staying at the home on a short-term basis had been made to look homely with artificial flowers, ornaments, a television and pictures. Residents therefore had mainly comfortable, safe and pleasant private accommodation. On each floor there were bathrooms and toilets suitable for people who need assistance and in sufficient numbers and locality to meet the needs and the number of residents. Whilst the bathrooms were clean and free of offensive odour, two toilets on the ground floor had stained floors, were cluttered and had and offensive odour. A visitor said that they avoided taking their relative to one of these toilets as, “It was always smelly”. This is unpleasant for residents and could be a source of cross infection. There were no unpleasant odours in any of the other areas visited. Disposable towels and soap dispensers were provided in bathrooms apart from the walk-in shower that had neither, toilets, laundry and kitchen. These facilities minimise the risk of cross infection and the walk-shower should also have them to enable staff and residents to wash their hands appropriately. From observations made and discussion with staff some lighting in communal areas of the home was found to be of sufficient brightness for people to see clearly, mainly due to the Tiffany-type shades and low energy bulbs used. Wall lights assisted in the dining room when turned on. The shades were attractive and domestic in character but may benefit from the use of brighter bulbs. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 28 Lights were not working at the top of the stairs/outside the lift. Some light was gained from adjacent areas but this was not ideal. The care officer advised that the fittings had been reported for repair. The home had a small staff room that was very cold and unwelcoming. During the tour of the home a resident was visited in their bedroom had been taken for a lie down on their bed at their request. The resident said that they had been trying to use the call bell for assistance for some time but had received no response. When checked it was found to be not working. A member of staff who was passing by was summoned for assistance. The call bell was checked by the assistant manager, who found that it had not been plugged in properly. This was distressing for the resident and care needs to be taken when leaving someone in their room to ensure that this is prevented. The home’s infection control policy did not refer to the need for facemasks. A box of these was seen in several bathrooms/toilets. As previously discussed the care officer said that they were for use when dealing with diarrhoea and when emptying catheter drainage bags. This should be discussed with an infection control nurse as being cared for by someone in a mask could be unnecessarily upsetting for residents. Disposable aprons and gloves were also seen to be available for staff to use when there is a risk of cross infection or contamination. The laundry area on the ground floor was inspected. It was clean and well organised with walls and floor finishes readily cleanable. Laundry equipment had the appropriate programmes for infection control purposes. All clothing looked at was clearly labelled with the owner’s name to ensure that they were returned to their rightful owner. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. There are not always sufficient care staff available relying on management staff to assist meeting the care needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assistant manager advised that there were currently twelve members of staff on sick leave – one care officer, six care staff and five domestic staff. At least three of these were long-term sickness. This was having affect on the morale of staff, many of whom were said to be discontented about the staff shortages. Agency staff were being used to cover absences where available, and the assistant manager said that they attempt to use the same agency staff for continuity whenever possible. However other staff said that it was difficult to supervise new agency staff so frequently. In an attempt to manage to meet the needs of residents the home was not admitting any new permanent residents for the time being, although at the same time not all absences were covered if the occupancy levels were down. Senior staff were also forsaking their management duties to work with care staff and this was witnessed during the late afternoon and the evening. The lack of staff was not apparent during the visit but one visitor said that they felt sorry for the staff as, “they always seem to be short staffed”. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 30 Rotas were not clear and were without any information regarding the capacity in which staff were working. Any absences and subsequent cover were recorded on a separate sheet. The assistant manager said that this worked very well but the home must have a rota that shows what staff are meant to be working and in what capacity and whether they actually worked it or not. There was no evidence to show that staff were not maintaining good personal or professional relationships with each other. Training records showed that 65 of the staff had achieved National Vocational Qualification Level 2 in Care. This qualification shows that staff have been assessed as competent to carry out their job. Three staff files were inspected. All three files had the appropriate documentation and Criminal Records Bureau and Protection of Vulnerable Adults checks. Correction fluid had been used on one of the references for one member of staff and had been written over. There was no evidence that this, or any of the other references, had been validated, creating the risk of inappropriate people being employed. None of the staff files showed any evidence of induction training or staff supervision, although senior staff said that this had been carried out. The assistant manager said that the reason for this not being recorded was due to senior staff having to cover care staff absences and therefore records were not up to date. Whilst there was no senior staff present able to discuss the training, records available were looked at. These appeared well organised. The records showed that the majority of staff had undertaken mandatory training and training related to dementia with further dementia training planned for January 2008. Further training had been undertaken related to continence, hoisting, mental health, sexuality in older people, podiatry, Control of Substances Hazardous to Health (COSHH) and the Mental Capacity Act. The majority of staff had also undertaken Equality and Diversity training. There continues to be a need for staff to undertake training related to specialist needs such as sensory and physical impairment and other age related needs. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 31 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. A person with the appropriate qualification and management experience manages the home but insufficient numbers of staff of all levels create shortfalls in management tasks. The financial interests of residents are generally safeguarded apart from one shortfall noted. There are shortfalls in practice that create risks to the health and safety of people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was not on duty at the time of the visit. The assistant manager was in charge until the end of her shift in the afternoon. She had worked at the home for 31 years and was familiar with all aspects of the home that were discussed. A care officer was in charge for the rest of the afternoon and evening. She had been at the home for six months and was disappointed WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 32 that the sickness absence of so many staff had meant that she had not had the opportunity to “get into her role” as well as she would have liked. She demonstrated a keen interest in doing so and showed that she had a good knowledge of the residents and their needs and the routines of the home. Previous reports showed that the registered manager has the appropriate qualifications and had considerable experience in managing a care home for older people. Staff spoken with said that they found the management team supportive and that they had made themselves available to assist when they were short staffed. The home uses the Local Authority Quality Assurance Programme, which is extensive, covering all areas of the service. Feedback is also gathered from residents regarding the service and action taken to address issues. A third party carries out an unannounced visit each month to audit sections of the Quality Assurance and a report of the visit is forwarded to us and to the manager. These practices support standards being maintained and any necessary improvements to be implemented. Some money for some residents is held by the home for safekeeping. Any transactions made from this are recorded and receipts held, safeguarding the financial interests of residents for whom money is held. A random check of records and cash balances was made and all balanced appropriately, showing that the financial interests of these residents were being safeguarded. However a post office cash card was held for one resident. It had originally been kept in a sealed/signed and envelope but the seal had since been broken and the writing almost illegible. There was no receipt and no documentation to show that it was being held for safekeeping. This does not safeguard the interests of the owner. Some staff supervision had taken place since the last inspection but was far off target to be carried out six times a year. The assistant manager and care officer said that this was one of the management tasks that was being neglected due to having to cover other staff absences. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. The home had raised funds for the benefit of the residents but at the time of the visit current fund raising was being used for basic improvements of the premises by financing the decorating of the first floor lounge, rather than for additional things such as entertainment or leisure. The AQAA showed that all maintenance and servicing was up to date. In house fire alarm checks were inspected and were not up to date and had not always WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 33 been carried out at the required weekly intervals. There was no record of recent fire drills. These shortfalls put residents’ health and safety at risk in the event of a fire. Emergency lighting had been checked at the required monthly intervals. Fire equipment maintenance was up to date having been carried out in May 2007 and had been checked monthly until October 2007. There was no record of hot water temperature checks since January 2007, creating the risk of residents sustaining accidental scalding if the temperatures rose above 43°C. There was no record of call bells being checked, which would be good practice in order that residents could summon assistance when required. According to training records staff had undertaken mandatory training related to health and safety issues, including moving and handling, basic food hygiene, first aid and fire training. WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 2 3 X 3 X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All people staying at the home must have a written care plan that is detailed, up to date and devised, if possible, with that person or their representative. This will ensure that they receive the support that meets their needs. The previous timescale of 30/11/06 was not met. All people staying at the home must have an assessment regarding the risk of pressure sores and a record of any treatment maintained. This will ensure that the needs will be met. Medication at the home must be kept safe and secure. This will ensure the safety of people staying at the home. Accurate records and labelling must be maintained for all medication for people staying at the home. This will safeguard the well being of people staying at the home. The correct medication must be DS0000034958.V344637.R01.S.doc Timescale for action 29/02/08 2. OP8 14 15/02/08 3. OP9 13 15/02/08 4. OP9 13 15/02/08 5. OP9 13 30/01/08 Page 36 WCC Mayfield Version 5.2 6. OP9 13 7. OP27 18(1) 8. OP29 17(2) schedule 4(6) 17 Sch 4 given to the correct person at the correct time. This will safeguard the well being of the people staying at the home. People staying at the home must not be at risk of being in unnecessary pain. This will safeguard the well being of the people staying at the home. There must be an assessment of staff required to meet the residents’ needs and sufficient staff employed to achieve this. This will ensure that residents’ needs are met. References must be checked and validated. This will ensure that residents are safeguarded by the employment of suitable staff. A record must be kept of any valuables kept by the home on behalf of a person using the service, including the date received, and a written acknowledgment when it is returned to the owner. This will safeguard their financial interests. The home must take proper precautions to ensure that equipment for detecting a fire is in full working order and that people at the home are familiar with fire drills. This will safeguard people using and working in the service in the event of a fire. The temperatures of hot water that is accessible to residents must be checked at regular intervals in order that close to 43°C is maintained. This will safeguard the people using the service from accidental scalding. DS0000034958.V344637.R01.S.doc 30/01/08 30/01/08 30/01/08 9. OP35 30/01/08 10. OP38 23 30/01/08 11. OP38 13(4) 20/01/08 WCC Mayfield Version 5.2 Page 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Refer to Standard OP1 OP3 OP4 Good Practice Recommendations The amount to be paid for accommodation fees should be included in the Service User Guide. A record of the pre-admission assessment carried out by the home should be made and the prospective resident be informed in writing of the outcome of the assessment. Steps should be taken to meet the needs of people living at the home with an ethnic minority culture and/or religion. Information in care plans should be easily accessible to enable care staff to provide the appropriate care. A homely remedy policy should be in place in order to treat minor ailments safely. People staying at the home should be consulted about their social interests and the content of the home’s activity programme including community based activities. Staff should ensure that people visiting the home are identified and made welcome. For the benefit of the people using the service the home should be in good decorative order throughout. Call bells should be checked to be in full working order when leaving a resident alone in their room to enable them t summon assistance when necessary. Lighting should be of sufficient brightness to enable people using the home to be able to see clearly. All areas of the home should be clean and free of offensive odour including all areas of food storage, preparation and handling. Advice should be sought regarding the use of facemasks and plastic glasses for infection control purposes. Appropriate hand washing facilities should be available in all areas where staff and residents will need to wash their hands to maintain infection control. Staff should undertake training related to needs in later life, including physical and sensory impairment. Staff supervision should take place at a minimum of six times a year. OP7 OP9 OP12 OP13 OP19 OP22 OP25 OP26 OP26 OP26 OP30 OP36 WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI WCC Mayfield DS0000034958.V344637.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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