Inspection on 02/09/05 for Westcroft

This inspection was carried out on 2nd September 2005.

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

Westcroft 11/02/09

Westcroft 12/02/08

Westcroft 04/09/07

Westcroft 29/06/06

Westcroft 24/03/06

Westcroft 21/02/05

Westcroft 27/07/04

Westcroft 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Westcroft 1 Cleveland Walk Bath Bath & N E Somerset BA2 6JS Lead Inspector Kathy Marshalsea Unannounced 2nd September 2005,10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westcroft Address 1 Cleveland Walk Bath Bath & N E Somerset BA2 6JS 01225 466685 01225 443367 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jean Uter Ms Pamela Anne Ramjutton Care Home with nursing 21 Category(ies) of OP Old age,21 registration, with number of places Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 21 Patients aged 50 years and over requiring nursing care Staffing Notice dated 03/10/1996 Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 21-Feb-2005 Brief Description of the Service: Westcroft is registered as a Care Home with nursing for 21 older persons. The Home is situated in Bathwick which facilitates easy access to Bath and can be accessed by car or bus. There is access to local shops and social venues. The Home is a converted older property, providing a mix of single, double and 1 en-suite room. Care is offered over three floors, with communal space on the ground floor. There is a passenger and chair lift providing access to all service user areas. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted as part of the annual inspection process to examine the care provided and monitor any progress with the requirements and recommendations made at the last inspection. This was this inspector’s first visit to the home. The acting manager, Mrs Ramjutton, was not on duty for the first day of the inspection so a second day was arranged to allow feedback to be given to Mrs Ramjutton, as well as the proprietor. The information gathering was achieved by direct and indirect observation, document reading, and discussion with staff, residents and one relative. The inspector also joined the residents for lunch and was given a tour of the building. The following records were examined: Samples of care files and associated information. Staff training records Medication records Fire log Accident records Minutes of the first residents meeting Home’s newsletter Activities programme Pre-admission assessments What the service does well: The home cares for those persons who are elderly and need nursing care. The interactions between staff and residents were respectful. A relative was very positive about the care staff and how kind and helpful they are to them and their relative. Care plans examined as part of the inspection gave sufficient information about how to deliver the care needed. The new manager has introduced a monthly newsletter which is very informative. A residents meeting has also been held and a staff meeting has Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 6 been arranged. This shows that the manager has an inclusive style of managing the home. The manager has also re-introduced regular activities and has organised an increased frequency of trips and outings. At the conclusion of the second day of the inspection the inspector was invited to attend a Dementia awareness session delivered by one of the staff. This session had been well researched and presented, and was particularly welcome as many of the residents in the home suffer from dementia. What has improved since the last inspection? What they could do better: Some Fire safety precautions were not being adhered to compromising resident and staff safety. An immediate requirement notice was issued so that the emergency lights and fire fighting equipment was tested on the first day of the inspection. This test revealed that 4 emergency lights were not functioning. Immediate steps were taken to request replacements which were fitted during the second day of the inspection. Fire training was not being offered at the recommended timescales, compromising resident and staff safety. The night staff should be updated 3 monthly as this is considered to be the high risk due to less staff being on duty. Day staff should be updated 6 monthly. An immediate requirement notice was issued so that all night staff are updated within 2 weeks of the second day of the inspection. During the tour of the building it was noted that some areas were not clean, particularly bathrooms and toilets. Bath aids were also grubby. One bathroom had a layer of dust around the edge of the sink and radiator, the bath was also stained. The cleanliness of the home, particularly the bathrooms and toilets, must be improved. Improve one to one social time spent with residents who may not be able to or want to join in group activities. This could be done through time Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 7 spent with the residents’ own key worker. This time needs to be recorded. Review care plans and assessments as needs change. One resident was unwell during the first day of the inspection and had suffered numerous falls the previous month. The care plan and risk assessment had not been updated to note the significant risk from frequent falls. The manual handling assessment did not reflect this person’s fluctuating mobility so that staff respond accordingly. This was witnessed by the inspector as one member of staff tried to assist this resident on their own which became more difficult during the course of that day. Despite this obvious difficulty no other member of staff was asked to assist this resident during transfers. Consider the dependency levels in the home when considering potential admissions to the home. The home has a high level of very dependent residents who need full assistance with their care. Before an admission is considered the decision to admit needs to include the dependency levels in the home at that time, and staff skills. s. Due to the number of residents with some form of dementia already at the home, thought must be given when receiving a referral. It must be appropriate by meeting the categories for which the home is registered. The current registration does not include residents whose primary need is mental health or dementia. So all admissions to the home must have a primary need which is physical, not mental health. The care given to those who suffer from dementia must be based upon current good practice and reflect relevant specialist and clinical guidance. There was no evidence that this is the case. This is particularly so for the environment which has not been adapted to assist those who have dementia. In order to care for these residents as detailed above staff need to be provided with the training in order for them to be confident and competent at dealing with the problems associated with dementia. It was noted during a tour of the building that there were not aids and signs which could help those who have dementia to be orientated. The environment can be adapted, for example, by using contrasting colours, pictorial signs for toilets and having large face clocks. Also using an orientation board to include the day, date and staff on duty. It will be recommended that the home seek the advice of a specialist service such as Dementia Voice. The communal lounge/dining room would benefit from being updated. The manager has started seasonal themes which at the moment are autumn, this is commended. Large print books were present but stored on a windowsill out of reach of most people. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 8 There has been no formal quality assurance monitoring of the home. This should seek the views of the residents themselves and should be done at least annually. This measures the success of meeting the statement of purpose. The accident log and falls should be audited to try and identify trends and be able then to take preventative action where possible. Incidents/accidents need also to be reported to the CSCI using the Regulation 37 reporting mechanism. This enhances the monitoring of the home’s practice in between inspections and ensures that the safety of residents is being assessed and reviewed. 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. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Although pre-admission assessments are completed appropriately, this information is not always used to determine the suitability of the prospective’s resident’s admission to the home. There are a number of residents in the home who suffer from Dementia and this needs to be considered when deciding upon future admissions as the home is not registered for Dementia care. EVIDENCE: Completed pre-admission assessments were examined. This is a comprehensive document which covers every aspect of care needs. It was evident in two instances that the primary need was mental health and not physical. The home does not have the appropriate registration to accommodate those people whose primary need is mental health. This was discussed with the proprietor Mrs Uter who completed these assessments. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 11 It was also of concern that many of the residents are heavily dependent upon staff for all activities of daily living. Before an admission is agreed consideration needs to be given to the dependency levels. Local authority care plans and assessments were also seen. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Resident’s health needs are assessed and set out in the care plan. Social care needs are not yet well documented. Medication procedures were in order and only one requirement was made about information being given to the home in a written format. Evidence gathered confirmed that residents are respected and treated with dignity. Records seen showed that reduction of risk was not always being updated, particularly in relation to falls/accidents. EVIDENCE: Care plans viewed offered some valuable information about the physical needs of residents. There was also an assessment of daily living skills. There was a Waterlow assessment, which determines the level of risk of developing a pressure sore. Equipment used to reduce this risk was identified. A consent form for the use of bedrails was present. One resident’s daily notes showed some worrying incidents, which should have been notified to the CSCI using the Regulation 37 reporting mechanism. These included an episode of absconding from the building and a series of falls. These incidents should also have triggered a review of the risk assessment for Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 13 “wandering” and a risk assessment for falls should have been completed. Neither of these things happened, leading to concerns at what steps were being taken to reduce the risks for this resident. Staff spoken with were not able to say how they were reducing the risk of this resident falling. The proprietor stated that she had spoken to this resident’s relative about whether it would be appropriate for them to wear hip protectors. During the inspection the inspector expressed concern at this resident’s condition. The proprietor then informed the GP of these concerns. After visiting this resident the decision was made to admit this resident to hospital. Manual handling assessments are kept in each resident’s bedroom. These were not examined on this occasion to see if they were being regularly reviewed. The instructions for staff regarding the resident’s incontinence pads being used were also on display. It is recommended that these charts be placed inside the wardrobe so that staff are kept informed but the resident’s confidentiality is maintained. It was noted that monthly checks are being completed for observations of blood pressure, pulse and weight for all residents. This is good practice. It is recommended that the home also complete nutritional assessments on admission and reviewed thereafter. Some risk assessments had been completed. All identified risks must be detailed and reviewed regularly or as things change. The inspector observed the medication round. This was conducted according to good practice. It was noted that the Warfarin dose (which is determined according to blood tests) was being communicated to staff via a telephone message from the GP. It will be a requirement that this information is received in writing from the GP. Evidence gathered during the inspection verified that residents are treated with respect. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Activities have been established and are yet to be individualised. The manager is arranging trips and outings. Visitors are welcomed at the home with no restrictions. Menus were not scrutinised but the inspector enjoyed taking lunch with the residents. EVIDENCE: 12.The manager is introducing a weekly plan of activities so that the same events take place whoever is on duty. There is no activities organiser so at the moment; the inspector was informed that the staff carry out this role coordinated by the Manager. Activities were discussed at the recent residents meeting, it was decided to hold a film show fortnightly, quizzes, a cookery activity, and trips out to local shops as well as to places of interest. A themed barbecue took pace in August and funds were raised for the activities fund. The manager has arranged a trip to Horse World and is hoping to organise a trip to Bristol Zoo. It is recommended that key worker time is used for one to one time with residents; particularly those who choose not to participate in group activities. The routines of the home were not examined at this inspection. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 15 13.It was noted that visitors were coming and going freely during the inspection. The home’s newsletter for August was in the lobby for anyone to have a copy. 15.The inspector joined the residents for their lunchtime meal. This consisted of fish, chips and peas and then a pudding. Not all of the residents sitting in the lounge came to the table for lunch. This may be because space is limited, particularly when some residents need to be assisted with their meal. The mealtime was unhurried allowing plenty of time for everyone to eat their meal at their pace. Those who needed assistance were helped discreetly and individually. The kitchen and associated records were not examined. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The manager’s ethos encourages concerns to be raised and deals with them as they occur. EVIDENCE: 16.The manager stated that apart from the odd grumble no complaints have been made since she has been in post. The CSCI have not received any complaints about the home. One resident spoken with felt able to make a complaint without any fear of reprisal. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 21, 26 The home did not look well maintained and would benefit from being updated. The cleanliness during the inspection was not of a satisfactory standard. The home has not been adapted to meet the needs of those who suffer from dementia, despite there being a high proportion of sufferers in the home. EVIDENCE: 20.As mentioned previously the home needs to ensure that the home is safe and well maintained. (See “What they could do better”). The home would benefit from a programme of updating, particularly in communal areas, bathrooms and the entrance hall. The proprietor has stated that this is scheduled to occur over the next few months. A bar of soap instead of liquid soap was in one bathroom sink, which contravenes good practice for staff hygiene. Neither bathrooms seen had liquid soap, but there were paper towels. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 18 Pictorial signs would be useful to assist those who have sight or cognitive impairments. It was noted that the call bell system was working an all points are checked monthly. The residents bedrooms were not examined at this inspection. Monthly checks are made of hot water outlet temperatures to ensure that they do not exceed the recommend temperature. This is good practice. The manager stated that staff check the temperature of individuals baths too. The standard of hygiene was not satisfactory on the 2 days of the inspection. The inspector was told that domestic time is 4 hours a day 5 days a week. There is no cleaner at weekends. This was discussed with the manager and proprietor. A requirement will be made for this standard to improve. A previous requirement to replace the flooring of the laundry was not met. This requirement will be repeated. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff have been able to participate in mandatory training and some sessions particular to the resident group. These standards were not fully inspected. EVIDENCE: Staff training records were examined. It was noted that staff had been able to access BANES training courses. These included: First Aid Health & Safety MRSA Protection Of Vulnerable Adults Food Hygiene Manual Handling The home runs an adaptation programme for overseas nurses. This is usually a 6 month course to enable to register as registered nurses in the UK.Mrs Uter the proprietor deals with this area. This will be examined at the next inspection. Recruitment records were also not examined. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 38 The home has not had a registered manager for some time which contravenes the Care Standards Act. The responsibilities of the manager have not been delegated sufficiently to fulfil the responsibilities of a manager. The new manager has started improving systems within the home. Immediate requirement notices were issued with regard to fire safety checks and staff training. This deficit compromised resident and staff safety. The standard of cleanliness was not satisfactory and could compromise resident’s health. Incidents/accidents were not always being reported to the CSCI, which compromises the monitoring of the home in between inspections. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 21 EVIDENCE: The home has not had a registered manager for some time contravening section 11(1) of the Care Standards Act. The newly appointed manager, Mrs Ramjutton, started at the home full time on 3rd July 2005.They will be subject to a fit person process with the CSCI which registers all managers of care homes. Mrs Ramjutton has been working at the home on and off for some years so is familiar with the staff and residents. She has already introduced some systems to improve the quality of life for the residents and improve consultation processes. She is realistic about the changes needed and is able to demonstrate her priorities. The home does not use a formal quality assurance process so this will be subject to a requirement. The manager has begun to implement a programme of staff supervision. This will be subject to a requirement because it has not yet started. Fire safety precautions were not satisfactory at the last inspection. It was very disappointing to note that the fire safety checks were still not being completed at the recommended times. Fire training was also not being offered to staff at the stipulated times. This was of particular concern as one of the residents smokes and had caused a small fire in March 2005. (This should have been reported to the CSCI). These factors posed an unacceptable risk so immediate requirement notices were issued accordingly. Infection control standards were being compromised by the poor standard of cleanliness in the toilets and bathrooms and lack of of liquid soap. The manager showed the inspector generic risk assessments that are being completed. One had been done for the resident who smoked. These are still being developed and will be assessed at the next inspection. As mentioned previously some incidents within the home had not been notified to the CSCI using the Regulation 37 reporting mechanism. This will be subject to a requirement. The records of the annual checks for 2005 were seen for the Boiler, Emergency Lights, Gas, Hoists, Lift, Water system for legionella. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x 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 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 2 2 x x x 2 1 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 1 3 2 x x 1 x 1 Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard 38 38 7 26 Regulation 23(4) 23(4)(d) 15(1)(2) 16(2)(j) Timescale for action The emergency lighting and fire No later extuinguishers must be tested at than the stipulated timescales. 02/09/05 All night staff must be updated in No later fire safety three monthly. than monthly. 19/09/05 Care plans should be drawn up From and reviewed with the resident 30/09/05 and/or their representative. The standard of cleanliness of From the home must 09/09/05 improve,particularly in the bathrooms and toilets. The home must notify the CSCI 05/09/05 of any incidents which could adversely affect the residents. There must be written From confirmation from the GP about 09/09/05 the dose of warfarin being prescribed. Commence the formal From supervision of staff,it is 05/10/05 recommended that this is at least six times a year. Care plans and assessments From must be updated as needs 19/09/05 change and/or monthly. The Workplace Risk Assessment No later must be updated annually or as than conditions change within the 05/03/06 home. Version 1.40 Page 24 Requirement 5. 6. 38 9 37 13(2) 7. 36 18(2) 8. 9. 7 38 15(2)(b) 23(4)c v Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc 10. 11. 12. 13. 30 22 26 26 18(1)(i)(ii ) 16(1) 13(3) & 16(2)(j) 16(2)(j) 14. 33 24(1)(a) Staff must receive three paid training days per year. The environment must be adapted to aid orientation of the residents. Provide an impermeable floor in the laundry.This is a repeated requirement. Hand washing facilites must be provided for staff in areas where clinical waste is being handled, eg paper hand towels and bottle hand soap. Put in place effective quality assurance and quality monitoring systems which seek service users views. From 19/09/05 No later than 30/09/05 No later than 05/10/05 From 06/09/05 No later than 05/03/06 15. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 19 15 15 19 19 21 Good Practice Recommendations Information pertaining to each resident must be displayed discreetly. Nutritional assessments should be done on admission and reivewed periodically. Liquified food should be presented in a manner which is appealing in terms of texture and appearance. A programme of renewal of the fabric and redecoration of the premises is produced and implemented with records kept. Improve the communal lounges decor Clearly denote bathrooms and toilets. Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westcroft D56_D05_S20315_Westcroft_V246454_0209051Stage2.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!