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Inspection on 04/05/06 for Weymouth Care Home

Also see our care home review for Weymouth Care Home for more information

This inspection was carried out on 4th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The social care provision achieves a good standard and is continually being developed. Residents are supplied with wholesome home baked meals; special diets are catered for and the chef confirmed that alternative options and choices to the menu are made available on request. The home is generally well maintained, pleasantly decorated and comfortably furnished. Level access is achieved throughout the home by the provision of two passenger lifts. The home is situated close to shops and other local amenities. There is unrestricted street parking outside of the home and a parking area at the front of the house for visitors. The home`s policies and procedures manual is comprehensive and provides good guidance for staff it is also openly available in the hallway of the home for visitors` reference: some policies need to be reviewed and Mr Westlake said he undertaking this task at the current time. The home has a good system in place for managing residents` finances, eg payment of fees and personal allowances with accurate records kept.

What has improved since the last inspection?

The manager and training & development nurse have started to develop a new care planning system, with a 24hr accountability care record. The associated care related risk-assessments provide more information about how risk decisions are made: some care records are signed by relatives to demonstrate their involvement. Daily care records written by staff appear to be less judgemental. Management have written to the local Adult Services and PCT to request confirmation that the current staffing arrangements are sufficient to meet residents` needs: a conclusive response has yet to be received. The monitoring of the temperature of the medicines fridge had improved to ensure that medicines are stored at the correct temperature and medicines were stored securely. The home`s activities organiser has worked hard to implement the weekly Activities programme in the home and this is welcomed by residents.

What the care home could do better:

Statement of purpose and guide should be updated to provide prospective service users with up to date information. (Following the production of this report in draft, a copy of an updated statement of purpose and guide was supplied Mr Westlake). Prospective resident`s pre admission assessments must be thorough and include all relevant details of their care needs, eg specialist mattress, hoist equipment. Although the Commission has received a retrospective application to vary the home`s registration to continue to accommodate a resident with Alzheimer`s, a delay in supplying further information has hindered the approval process. The home should be able to demonstrate that residents had chosen to share. (Following the production of this report in draft, the manager supplied copies of forms either signed by the resident or their representative confirming their agreement to share a bedroom). In future, the home should be mindful that residents who are out of category for the home must not be admitted unless a variation to registration has been approved by the Commission unless their nursing needs clearly outweigh other needs, eg mental health, learning disability. All care plans must be updated each month and demonstrate that they are reviewed at times of significant change. Care plans when updated must be improved to include information about catheter care, specific arrangements regarding additional medication practice, eg diabetic care, special dietary needs, as required sedatives and the circumstances when they may be administered, how medicine is given when a person has a `peg fed`. Wound care records must clearly show the current situation with each resident`s skin condition while care records need to evidence how decisions are made concerning the type of specialist equipment used, eg mattress, hoist, walking frame or wheelchair. Procedures for checking medicines received need improving and there were concerns about some medicines not being given correctly or accurately recorded that put residents at risk. An immediate requirement was made to address these issues and ensure that medicines are offered as prescribed andaccurately recorded. (Following receipt of the immediate requirement letter, the manager has supplied information regarding improvements made to the home`s medicines policy, the auditing of medicines in the home and the care risk-assessments associated with particular resident`s medication). Staff and management must undertake further local training in relation to `No Secrets` and the protection of vulnerable adults to ensure that allegations and incidents are appropriately referred for investigation. Although an incident resulted in a resident being admitted into hospital with an unexplained injury an immediate requirement was not issued on this occasion: the manager and RI agreed to make the referral the following day. In future the home must be diligent in referring incidents of suspected abuse to the local Social Services through the `No Secrets` process for investigation. The home must demonstrate that the local Primary Care Trust (PCT) and Adult Services department approve of the sleeping arrangements in one resident`s bedroom and that the equipment in place is suitable for it`s purpose. The management must provide an action plan regarding the upgrading of two bathrooms situated on the home`s first floor. In the meantime the residents` weekly bathing routines should be reviewed to ensure that individual choices are promoted. Management must ensure that a copy of the Building Control completion certificate confirming that the work for internal alterations to a toilet is approved is obtained and forwarded to the Commission. (Mr Cotterill supplied a copy of the certificate to the Commission on May 18th 2006). The staff training programme should continue to be developed to include training specifically related to residents` needs and medical conditions, for example managing challenging behaviour. The new manager should apply to become registered with the Commission as soon as possible. The home`s business plan must demonstrate how the improvements identified in the recent quality assurance survey will be implemented. (Following the production of this report in draft, Mr Cotterill has evidenced that improvements have been made to the environment in accordance with the quality assurance survey). The home must be able to demonstrate that all staff have undertaken up to date mandatory health & safety training in the five recommended subjects. The induction records for new staff must clearly evidence the details of the induction process and demonstrate that it meets the standards set out by `Skills for Care` (formerly known as TOPSS a National Training Organisation (NTO). Fire safety training must be supplied twice within the first month of employment.DS0000020502.V292323.R01.S.doc Version 5.1 Page 9Individual supervision sessions for all staff must be implemented: including clinical supervision o

CARE HOMES FOR OLDER PEOPLE Weymouth Care Home 21-23 Glendinning Avenue Weymouth Dorset DT4 7QF Lead Inspector Rosie Brown Key Unannounced Inspection 10:00 4th & 11th May 2006 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 DS0000020502.V292323.R01.S.doc Version 5.1 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. DS0000020502.V292323.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Weymouth Care Home Address 21-23 Glendinning Avenue Weymouth Dorset DT4 7QF 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) 01305 784518 01305 206145 info@weymouthcarehome.co.uk www.altogethercare.co.uk Altogether Care LLP Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (10) of places DS0000020502.V292323.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2005 Brief Description of the Service: Weymouth Care Home is registered as a nursing home to accommodate fortythree service users, 33 in the old age (OP) category and 10 in the Physical Disability (PD) category including younger and older persons. The home is situated in a residential area close to local amenities. The home is easily accessible by bus or taxi to the town centre of Weymouth and beaches. Altogether Care LLP owns the home and Altogether Care (Weymouth) Ltd manages the home. The designated manager is a registered nurse and has been in post since January 2006,the Commission has yet to receive an application for approval to become the registered manager: the Responsible Individual (RI) for the home is Mr Cotterill. There are twenty-five single and nine sharing rooms, the majority are en-suite with a toilet and washbasin. The home is set in two wings and first floor bedrooms are accessed by two passenger lifts that can accommodate wheelchair users. Residents’ bedrooms are attractively furnished and many are highly personalised. The communal rooms include a comfortable quiet lounge/library at the front of the house, a separate open plan dining room and lounge with views of a courtyard garden at the rear of the property. There is ample off street parking at the front of the home for visitors’ convenience. DS0000020502.V292323.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over two days: 4th & 11th May 2006 and was undertaken by, Rosie Brown. On the first day the CSCI pharmacy inspector, Christine Main, accompanied the inspector. The inspection commenced at 10:00am on the first day and was concluded by approximately 6.45pm on the second day. The purpose of the visit was to assess the actions taken to meet requirements and recommendations set out the previous report dated 2nd December 2005 and to review 28 of the National Minimum Standards (NMS), in fact 31 standards were reviewed. Other matters reviewed included the application to vary the home’s registration for one resident with mental health problems, concerns relating to recent staff dismissals and the need to report such matters to the NMC and POVA, and a recent complaint regarding inadequate night staffing. The outcome and issues raised by an Adult Services (formerly known as Social Care & Health or Social Services) adult protection investigation that commenced in October 2005 and was concluded as substantiated in February 2006 were also considered. Observation skills were used when viewing the communal areas and a selection of residents’ bedrooms. Residents’ care and medication records were examined as were a selection of policies and procedures and maintenance records. The inspectors also spoke with the manager, the Training & Development nurse, Mr Cotterill (RI), Mr Westlake company member and owner of the home, the nurse in charge of the morning and afternoon shifts, four service users and four members of staff. Comment cards were issued by the Commission prior to this inspection. Eighteen replies were received: these included 15 cards from relatives and visitors and three from general practitioners. The comments received have been shared with the manager and are included where appropriate in this report. The pharmacy inspector issued an immediate requirement on day one and this is repeated from the previous inspection. On this occasion, the inspector did not issue an immediate requirement but did highlight on day two the need to report an unexplained injury sustained by a resident through the ‘No Secrets’ procedure for investigation: the inspector was assured by the manager and Mr Cotterill that the referral to the local Social Services department would be made the next day. DS0000020502.V292323.R01.S.doc Version 5.1 Page 6 There are 16 requirements and 7 recommendations made as a result of this inspection. Nine of the requirements are repeated from previous reports and must now be promptly addressed to avoid future enforcement action being taken by the Commission. It is most encouraging that following receipt of this report in draft Mr Cotterill has supplied the Commission with an action plan demonstrating how the requirements and recommendations made will be addressed. What the service does well: What has improved since the last inspection? The manager and training & development nurse have started to develop a new care planning system, with a 24hr accountability care record. The associated care related risk-assessments provide more information about how risk decisions are made: some care records are signed by relatives to demonstrate their involvement. Daily care records written by staff appear to be less judgemental. Management have written to the local Adult Services and PCT to request confirmation that the current staffing arrangements are sufficient to meet residents’ needs: a conclusive response has yet to be received. DS0000020502.V292323.R01.S.doc Version 5.1 Page 7 The monitoring of the temperature of the medicines fridge had improved to ensure that medicines are stored at the correct temperature and medicines were stored securely. The home’s activities organiser has worked hard to implement the weekly Activities programme in the home and this is welcomed by residents. What they could do better: Statement of purpose and guide should be updated to provide prospective service users with up to date information. (Following the production of this report in draft, a copy of an updated statement of purpose and guide was supplied Mr Westlake). Prospective resident’s pre admission assessments must be thorough and include all relevant details of their care needs, eg specialist mattress, hoist equipment. Although the Commission has received a retrospective application to vary the home’s registration to continue to accommodate a resident with Alzheimer’s, a delay in supplying further information has hindered the approval process. The home should be able to demonstrate that residents had chosen to share. (Following the production of this report in draft, the manager supplied copies of forms either signed by the resident or their representative confirming their agreement to share a bedroom). In future, the home should be mindful that residents who are out of category for the home must not be admitted unless a variation to registration has been approved by the Commission unless their nursing needs clearly outweigh other needs, eg mental health, learning disability. All care plans must be updated each month and demonstrate that they are reviewed at times of significant change. Care plans when updated must be improved to include information about catheter care, specific arrangements regarding additional medication practice, eg diabetic care, special dietary needs, as required sedatives and the circumstances when they may be administered, how medicine is given when a person has a ‘peg fed’. Wound care records must clearly show the current situation with each resident’s skin condition while care records need to evidence how decisions are made concerning the type of specialist equipment used, eg mattress, hoist, walking frame or wheelchair. Procedures for checking medicines received need improving and there were concerns about some medicines not being given correctly or accurately recorded that put residents at risk. An immediate requirement was made to address these issues and ensure that medicines are offered as prescribed and DS0000020502.V292323.R01.S.doc Version 5.1 Page 8 accurately recorded. (Following receipt of the immediate requirement letter, the manager has supplied information regarding improvements made to the home’s medicines policy, the auditing of medicines in the home and the care risk-assessments associated with particular resident’s medication). Staff and management must undertake further local training in relation to ‘No Secrets’ and the protection of vulnerable adults to ensure that allegations and incidents are appropriately referred for investigation. Although an incident resulted in a resident being admitted into hospital with an unexplained injury an immediate requirement was not issued on this occasion: the manager and RI agreed to make the referral the following day. In future the home must be diligent in referring incidents of suspected abuse to the local Social Services through the ‘No Secrets’ process for investigation. The home must demonstrate that the local Primary Care Trust (PCT) and Adult Services department approve of the sleeping arrangements in one resident’s bedroom and that the equipment in place is suitable for it’s purpose. The management must provide an action plan regarding the upgrading of two bathrooms situated on the home’s first floor. In the meantime the residents’ weekly bathing routines should be reviewed to ensure that individual choices are promoted. Management must ensure that a copy of the Building Control completion certificate confirming that the work for internal alterations to a toilet is approved is obtained and forwarded to the Commission. (Mr Cotterill supplied a copy of the certificate to the Commission on May 18th 2006). The staff training programme should continue to be developed to include training specifically related to residents’ needs and medical conditions, for example managing challenging behaviour. The new manager should apply to become registered with the Commission as soon as possible. The home’s business plan must demonstrate how the improvements identified in the recent quality assurance survey will be implemented. (Following the production of this report in draft, Mr Cotterill has evidenced that improvements have been made to the environment in accordance with the quality assurance survey). The home must be able to demonstrate that all staff have undertaken up to date mandatory health & safety training in the five recommended subjects. The induction records for new staff must clearly evidence the details of the induction process and demonstrate that it meets the standards set out by ‘Skills for Care’ (formerly known as TOPSS a National Training Organisation (NTO). Fire safety training must be supplied twice within the first month of employment. DS0000020502.V292323.R01.S.doc Version 5.1 Page 9 Individual supervision sessions for all staff must be implemented: including clinical supervision of nurses. Recruitment records for new staff must demonstrate that every effort has been made to gain a complete employment history with any gaps accounted for. Night staff, including agency workers must be supplied with fire safety training every three months. The home’s fire risk-assessment must be up to date and reviewed at times of significant change, eg when alterations to the premises are made. (Following the production of this report in draft, Mr Westlake has supplied copies of the home’s updated fire safety risk-assessment). 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. DS0000020502.V292323.R01.S.doc Version 5.1 Page 10 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 DS0000020502.V292323.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 1 and 3. Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The home’s statement of purpose and guide although adequate because it describes the services available, is out of date. Therefore the information available does not enable a service user or their representative to make an informed choice about moving into a large nursing home. The manager undertakes a pre-admission assessment for each prospective resident, to ensure that the home can meet identified needs: assessments do not routinely include all details referred to in the National Minimum Standards 3.3 and other information concerned with nursing needs. Standard 6 does not apply to this home, as it is not registered to provide intermediate care. DS0000020502.V292323.R01.S.doc Version 5.1 Page 12 EVIDENCE: The home has a statement of purpose and service users’ guide but some information is misleading and out of date. It does not provide accurate details about the current management arrangements for the home: for example there has been no registered manager in post since December 2004. In addition, certain internal changes (the home no longer has an activities room and the hairdressing room has been altered to provide an additional ground floor single bedroom). Other improvements have been made to the facilities available, eg an additional ground floor bedroom and most recently an improved assisted toilet near to the lounge. The home was unable to demonstrate that a copy of the statement of purpose and service users’ guide is supplied to the prospective resident and/or their representative: it was not clear how a copy of the home’s most recent inspection report is made available. However, the home has policy and procedure files that are openly kept in an area close to the home’s entrance hall and these contain copies of the home’s statement of purpose and guide. The pre admission assessment information obtained for two recently admitted residents were examined. The assessment paperwork is good and includes the topics noted the National Minimum Standards (point 3.3). However, one assessment form did not make reference to the specialist equipment necessary for the persons nursing care, wound care or that the person would be nursed in bed both day and night; the form was not signed by the assessor, the resident or their representative. The other assessment contained more information and both initial care plans identified how each resident’s care needs would be met by staff. The new manager was not aware that the home must provide written confirmation stating that the assessed needs of a prospective resident can be met, prior to admission. DS0000020502.V292323.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 7, 8, 9 & 10 Quality in the outcome area is poor; this judgement has been made using available evidence including a visit to this service. Individual care plans are in place for all residents and some progress has been made to ensure they include all identified needs. Until all care plans are routinely updated there is potential for putting residents’ at risk with the possibility of some care and health care needs not being met. Some aspects of medicine administration, handling and recording must be improved to ensure that residents receive their medication correctly. One resident confirmed that their privacy is respected by staff that work in the home. DS0000020502.V292323.R01.S.doc Version 5.1 Page 14 EVIDENCE: Care plans and care records for four residents were examined. The training & development nurse has improved the format and detail contained in approximately eight residents’ files and it was noted that these care plans and associated risk-assessments were a significant improvement since the previous inspection. The manager has implemented 24hr accountability care record charts that are kept in residents rooms to note when residents are checked, turned in bed, given fluids or their continence pads changed by staff: this recently implemented recording system is also an improvement. However the remaining residents’ care plans and associated risk-assessments have not been updated since March 2006, were not being reviewed each month or at times of significant change. Two resident’s wound care records were not up to date, details of care given to wounds is not routinely recorded into wound care records and therefore do not provide a clear account of the current situation. One resident’s care plan did not make reference to catheter care and another did not contain sufficient details of when a ‘peg feed’ was administered or detail what soft foods might be occasionally provided for the resident concerned and the risks concerning the administration of medication. Another resident’s care plan had not been updated since March 2006. The plan did not include guidance on personal interactions with staff and other residents, the management of challenging behaviour and the use of sedative type medication. However, it was noted that the daily care records being written by care staff were less judgemental than before, particularly in relation to one resident. Care plans include some information regarding residents care when dying but the information should be expanded to include all relevant information, eg medication, visitors, religious presence, and may vary according to individual preferences. In February 2006 and following a requirement set out in the previous report the home made a retrospective application for a variation to their registration regarding the placement of a resident with a diagnosis of Alzheimer’s but further details are required before an informed decision for approval can be made by the Commission. It is understood that the manager has arranged a multidisciplinary meeting to reassess the suitability of this placement and to ensure that the home can reliably meet the resident’s collective needs. The home is registered to provide nursing care to young adults with a physical disability and to elderly people. Whilst it is acknowledged that some residents’ DS0000020502.V292323.R01.S.doc Version 5.1 Page 15 with mental health care needs are accommodated by the home but this must be when nursing needs clearly outweigh mental health care needs. One resident confirmed that they are well looked after by staff and that personal daily choices are honoured, eg ‘I like to stay in my room, although I do go to the religious service sometimes but only if I feel like it’. One comment card from a relative stated that they are entirely happy with the care provided by the home and one comment card from a GP noted that the home offers the best care in Weymouth. It was not clear how decisions had been made regarding residents who share a bedroom and no evidence to demonstrate that residents had chosen to share. The pharmacy inspector discussed the home’s medicines with two nurses and checked a sample of 10 residents’ medicines with the records to see if they were given as prescribed and appropriately monitored. On four of five residents’ Medicine Administration Record (MAR) charts checked on one side of the home there were gaps where the administration of some medicines was not recorded. Two medicines were recorded as given when they were still in the blister pack. One medicine was signed as given for 10 days in the morning and at night when it was only prescribed once a day. The morning records had been crossed through but there was no explanation for this and there were 2 more capsules left in the blister pack than there should have been. Similar problems were also found on the other side of the home. The quantity of new medicines received was sometimes not recorded. The system for receipt of medicines was not robust enough to pick up errors in supply. These problems with receiving, giving and / or recording medication put residents at risk of not having their medication as prescribed. The date of opening some medicines with a limited life after opening was not recorded to ensure that they were not used beyond the expiry date. The audit trail for medicines not in monitored dosage system blister packs was not easy to follow as for most there was no recent reference point. The medication policy had been improved but does not include arrangements (how it is provided and record keeping) for when a resident takes medication away from the home. Medicines that staff give were stored securely and monitoring of refrigerator temperatures had been implemented. A few were above the maximum or DS0000020502.V292323.R01.S.doc Version 5.1 Page 16 below the minimum recommended and action must be taken to address this to ensure that medicines are stored at the correct temperature. There was an excess stock of some medicines and some were out of date. There was no clear guidance on the administration of one medicine prescribed when required on the MAR chart or in the care plan. One resident’s diabetes was monitored once a day instead of twice a day as in their care plan. The care plan did not include other details for managing potential problems with this condition e.g. high and low sugar levels etc. There was a risk assessment for residents having a tube feed but no clear care plan. Although there was a letter in one resident’s file about a change to their feed there was no evidence of the pharmacy being informed and nurses spoken to were unaware of this. DS0000020502.V292323.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 12, 13, 14 & 15 Quality in the outcome area is good; this judgement has been made using available evidence including a visit to this service. Group and individual activities are provided for those residents who are able to participate and this aspect of the home is developing. The home encourages service users to have regular contact with their relatives, friends the local community. Some records evidenced that residents are enabled to exercise choice in their daily lives. Residents are supplied with wholesome home baked food, which offers choice and meets special dietary needs. EVIDENCE: The home’s visitors book, daily records and comment cards received note that most residents receive regular visitors and on both days of the inspection some residents were receiving visitors while others were taken out by relatives. The home has an activities organiser who works in the home five days a week: there is also an assistant activities worker who provides additional assistance and support and this enables one to one activities and attention for residents. DS0000020502.V292323.R01.S.doc Version 5.1 Page 18 A copy of the weekly activities programme was given to the inspector and this demonstrates the activities on offer each day. Records of residents who have participated in activities are kept in a book and the deputy manager is planning to include this and more detailed information about social care into all care plans. The activities information is circulated for residents’ information and includes, reading newspapers and magazines with staff, scrap books, craftwork, being taken out by for a walk, simple gardening tasks, reading library books and listening to audio books, memory box, gentle extend exercises, aromatherapy, hairdressing and manicures, fun and games and sing- a-longs. One resident told the inspector that they had decided not to go to the religious service while another was seen making a model ship with staff assistance. Another resident said they enjoy making floral decorations. There are photographs of residents enjoying and participating in social care events displayed in the home. One resident attends a day centre three days a week and this has been arranged by their social worker. On day one of the inspection several residents were taken out by staff to vote in the local elections, the manager said that other residents had been assisted with postal voting. Sixteen comment cards confirmed that visitors are welcomed by the home. One card noted that there is a notice that greets and asks visitors to sign in, but they had never seen the owners while another card clearly stated they did not feel welcomed into the home. The manager explained that residents are now offered the option of when to take a bath or shower during the morning or twilight shift when extra staff are available for this purpose and care records confirmed that this practice has been implemented. The home employs a chef and kitchen assistant 7 days a week to ensure that residents are supplied with three full meals a day. It was evident that management provide an adequate budget for food supplies as the chef felt confident he could offer a number of alternate options to residents if necessary. Food records indicate that a varied menu with seasonal options is provided. Residents were observed either eating independently in the dining room or being assisted by staff. All meals were pleasantly presented including in some cases individual pureed portions of vegetables and meat. The minority of residents choose to have their meals in their rooms. The home also has a small kitchenette where breakfast, snacks and drinks as requested can be made by support staff. DS0000020502.V292323.R01.S.doc Version 5.1 Page 19 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 the following standard(s): 16 & 18 Quality in the outcome area is poor; this judgement has been made using available evidence including a visit to this service. The home has a complaints policy and procedure and this is supplied to residents and their representatives in the service users guide. Concerns when raised are taken seriously with appropriate action taken. The home has guidance available on the proper response to be made following any suspicion or allegation of abuse to ensure residents are protected from harm. However, concerns are not routinely raised with Adult Services (formerly known as the local Social Care & Health Department or Social Services) for guidance or investigated. EVIDENCE: The home has a complaints policy and procedure that provides assurance that complaints will be responded to within 28 days. The procedure states that staff are supplied with training in receiving complaints but there was no clear evidence available to demonstrate this has taken place. The Commission has received one anonymous complaint in March 2006 concerned with insufficient night staff being on duty to meet resident’s needs. The home was asked to supply copies of staff rotas and these evidenced shortfalls in night staffing arrangements: the manager and RI have both responded to the Commission about changes made to staffing arrangements and this is reported upon later in the report. DS0000020502.V292323.R01.S.doc Version 5.1 Page 20 The new manager has investigated one in-house complaint since the previous inspection and this related to a resident who had returned to the home from hospital: the concern being that their bag had been left unpacked in the bedroom for two weeks containing dirty washing including the person’s toothbrush. This complaint has been upheld and the manager is due to meet with the complainant to apologise and is intending to ensure future practice improvements. The homes complaints procedure has been properly followed with written records kept. A number of grumbles were received in comment cards sent to the Commission and these issues were shared with the manager during the inspection so that the concerns could be investigated in-house. Issues raised included, residents teeth not being cleaned/brushed, informing relatives of changes in ‘peg fed’ regime and why, feeling that the home cannot meet a relatives nursing needs, not enough staff on duty and not being able to find anyone in charge. An adult protection investigation about poor care practice and issues with night staffing was investigated by the local Social Care & Health Department (now known as Adult Services) through ‘No Secrets’ procedures following an anonymous complaint received in October 2005. The investigation substantiated the complaint. It should be noted that at all times the home was co-operative and it was evident from the information provided by the home following an internal investigation that appropriate action was taken and some staff were disciplined and dismissed. During the inspection, the manager supplied copies of letters referring two nurses to the NMC in connection with poor practice but the home has yet to demonstrate these and other staff have been referred for consideration for inclusion on the Protection of Vulnerable Adults (POVA) register. (Following the production of this report in draft, copies of letters acknowledging the referral of two staff for consideration and inclusive onto the POVA register were supplied to the Commission. Mr Westlake also clarified that because staff dismissals had gone to appeal the POVA was delayed). On day two the manager supplied a Regulation 37 notice: this detailed that a resident was in hospital with an unexplained injury to their right hip. The inspector asked the home to refer this matter to Adult Services through the ‘No Secrets’ process. Mr Westlake ensures that the home has comprehensive policies concerning adult protection and the recognition of abuse and has recently drawn up a DS0000020502.V292323.R01.S.doc Version 5.1 Page 21 procedure regarding adult protection. The manager confirmed the home has copies of the local ‘No Secrets’ and Department of Health POVA guidance. Staff are supplied with in-house adult protection training by Mr Cotterill as part of their induction. The requirement for management and the senior staff team to undertake the local two-day awareness training concerned with the local ‘No Secrets’ procedures and the protection of vulnerable adults is repeated in this report. The home was unable to demonstrate that care staff had been supplied with refresher training relating to ‘Whistle Blowing’ and the local ‘No Secrets’ adult protection procedures since the previous inspection. DS0000020502.V292323.R01.S.doc Version 5.1 Page 22 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 the following standard(s): 19, 21, 22, & 26 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. Residents are cared for in an attractive comfortable environment. Improvements are being made to the assisted bathing and the toilet facilities available and an action plan has been required in this regard. Most residents’ rooms are personalised and comfortably furnished with specialist equipment available. The home is generally clean and free from unpleasant odours. DS0000020502.V292323.R01.S.doc Version 5.1 Page 23 EVIDENCE: Communal facilities comprise of a quiet lounge/library and a more central open plan dining room and lounge, which provides a pleasant view of the home’s back garden. A new lounge and corridor carpet has been fitted since the previous inspection. A selection of residents’ rooms were viewed and appeared clean, homely and safe with the majority being highly personalised. During the previous inspection one resident commented that they would like to be able to open a window in their room as opposed to opening the large patio door that was fitted with a chain for safety reasons and a recommendation was made in this regard. It was noted that some bedrooms with patio doors do also have a window in the room. It is recommended that consideration be given to ways of improving the ventilation in bedrooms that only have a patio door and this matter is being progressed via separate correspondence. As stated in the previous report it was noted that one resident has no bed and their specialist mattress is on the floor and this situation remains unchanged, although the resident concerned is currently in hospital. The care record for this person noted that the family had approved this arrangement by way of a risk-assessment with the home, most generally to prevent the person falling out of bed even though bed rails were in place. This mattress is situated next to a central heating radiator, which is covered by a bed rail bumper for safety. It was not clear if the home had checked with the manufacturers of the ‘air mattress’ or the bumper that these items could be used effectively in this way. There continues to be no evidence to demonstrate that other care professionals had agreed that this arrangement was satisfactory and meets the resident’s needs. In addition, the cord to the call facility in the same room had been shortened and could not be reached by the resident once in bed on the floor. The reason given during a previous inspection for shortening the cord was that the resident had put the cord around their neck and that it was safer this way. Care records for the resident concerned did not evidence that care professionals had been informed of this incident and nor had the Commission. The home’s records reflected that the resident has dementia: the home is not registered to provide mental health care. The home was required to make a retrospective out of category application to the Commission seeking approval to vary their registration by submitting the relevant information to demonstrate that the home can meet this resident’s needs. The toileting facilities close to the lounge were refurbished and upgraded to a high standard prior to the previous inspection. A large disabled toilet facility with a wheelchair friendly entrance has been created so that staff can use all forms of manual handling equipment to meet residents’ needs and maintain their privacy. At the time of the inspection the RI had not supplied the DS0000020502.V292323.R01.S.doc Version 5.1 Page 24 Commission with a Building Control completion certificate or confirmation from the Fire Safety Officer to demonstrate satisfaction with the completed works. The home has assisted bathing facilities on both floors and the bath in one first floor bathroom has been re-enamelled. Although there are sufficient in the home an action plan must supplied regarding the improvement of two first floor bathrooms: one where a ‘medibath’ is fitted but not used and another that is a conventional but it is not clear if the shower facility meets with water fitting regulations. Additional separate toilets and sluice rooms are situated near to resident’s rooms. Incontinence pads, protective aprons and gloves and items of equipment are stored inappropriately in bathrooms and en-suites. The home should make proper provision and identify adequate storage facilities and a recommendation is repeated in this report. The home’s laundry is established in an outbuilding in the home’s back garden. It is properly equipped with a large commercial washing machine that meets disinfection standards and a commercial tumble dryer: a sink unit is available for handing washing purposes. Specialist laundry bags are appropriately used. It was noted that the laundry floor finish is not impermeable and the wall finishes are not easy to keep clean. An area in the laundry with shelving is well organised and used to store resident’s individual linen baskets. DS0000020502.V292323.R01.S.doc Version 5.1 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The home operates a staff rota, which is based on average occupancy and on the day of the inspection there were managers, trained nurses, care assistants and domestic staff on duty to ensure residents’ needs are met. The home has documented policies to follow regarding staff recruitment, employment and disciplinary procedures in order to protect residents living in the home. A programme of staff NVQ training is being developed to include other topics related to the diverse needs of the service user group. EVIDENCE: A blank rota supplied by the manager demonstrates that 38 staff are employed to work in the home and that agency staff are used to cover shortfalls. On the morning of day two the manager said that the following care staff were on duty: 2 RGN’s, 2 team leaders, 4 care assistants on duty from 8am to 2pm. Afternoon (2pm to 8pm) cover comprised: 2 RGN’s, 1 team leader and 4 care assistants. The night cover was explained as follows: wakeful 1RGN with 3 care assistants from 8pm to 8am with a twilight worker on duty between 6-11pm. In addition the manager and deputy manager were on duty, as were 2 activities organisers, 3 cleaners, a laundry assistant, a chef and kitchen DS0000020502.V292323.R01.S.doc Version 5.1 Page 26 assistant: the maintenance worker was off sick. A copy of the staff rota was shown to the inspector by the manager. It is recommended that the rota should include the full name of each staff member and their employment position. It should also detail the hours of each shift and clearly indicate agency staff including their names and role and when they are used to cover shortfalls. Mr Cotterill sent a letter to the Commission in December 2005 describing the staffing arrangements and explaining that nursing levels are determined by the average occupancy, the night staffing was described as one trained nurse with 4 care assistants. As mentioned earlier, an anonymous complaint received by the Commission in March 2006 highlighted that night staffing levels were insufficient. The staff rotas supplied by the manager at the time demonstrated that there had been shortfalls and that night staffing arrangements had been changed. The manager explained she is reviewing the nighttime arrangements and has introduced one twilight staff and an early morning staff to assist at times when assistance is most needed by residents. She said that she has recruited two night nurses although they have yet to commence working in the home. In the meantime the deputy and manager confirmed that they are covering any shortfalls if agency staff are not available. It is acknowledged that the home has suffered set backs in maintaining a stable rota because of night staff dismissals in connection with an Adult Protection investigation. The Commission is open to further discussion about staffing arrangements when sufficient numbers of night nurses are employed to work in the home. On day two of the inspection there were 34 service users accommodated in the home. Staffing levels appear adequate with the current occupancy level, but management should also consider the guidance from the Department of Health (Residential Forum Calculator), which recommends other factors that should be taken into consideration. These include; the size and layout of the home, the needs of the service users, staff training and supervision when on duty and social care provision. Mr Cotterill has written to the local adult services department and primary care trust to request confirmation of their satisfaction with staffing arrangements but has yet to receive an conclusive response: however, both departments continue to place service users in the home. Staff recruitment records for two new care staff were examined. These demonstrated that application forms were completed and two references were taken: one from a previous employer. While checking records it was noted that both applicants had gaps in their employment history that were unaccounted for. CRB checks were in place before both staff started working in the home. DS0000020502.V292323.R01.S.doc Version 5.1 Page 27 The interview record form for one worker was not dated. A statement of terms and conditions of employment had been supplied. Clear documentation confirming that the induction process meets ‘Skills for Care’ specifications was not available. A certificate supplied by the company’s training officer in relation to manual handling, infection control and catheter care made reference to induction training. An in-house induction programme for agency staff has not been documented but a file containing relevant information for agency staff has been compiled. The home was unable to evidence how identification and CRB checks of new agency staff are checked: this check should also include mandatory training. Staff training records and a general training spreadsheet did not demonstrate that all staff have up to date training in first aid, fire safety, basic food hygiene, infection control and moving and handling. The training & development nurse said that a programme of NVQ training is set up to ensure that 50 of the care staff working in the home are NVQ trained: this target has yet to be fully achieved. Information concerning the number of care staff with NVQ qualifications was not made available. Training is also being arranged for staff in topics directly related to residents’ specific needs, for example managing challenging behaviour, understanding people with learning disability and dementia care. The home was unable to evidence that individual supervision is taking place at least six times a year: this includes clinical supervision for nurses. The manager explained that informal supervision takes place and staff meetings are being held. DS0000020502.V292323.R01.S.doc Version 5.1 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The home has a new designated manager but has been without a registered manager for 18 months. This has affected the quality of care provided to residents because no one oversees the home as a whole service to ensure consistent care provision. The home operates an approved ISO Quality Assurance programme, which seeks the views of residents and other stakeholders on an annual basis. It was not clear how the findings of the audit are implemented. Residents’ financial interests are protected by the companies’ procedures. The home’s management have set up processes to ensure that residents’ health and safety is promoted. DS0000020502.V292323.R01.S.doc Version 5.1 Page 29 EVIDENCE: The new designated manager is a registered nurse has previous management experience and has been in post since January 2006. During a meeting held with Mr Cotterill and the manager at the beginning of the inspection Mr Cotterill said he is hopeful that the manager will apply to become approved and registered by the Commission. Prior to this appointment another manager was employed but ceased working in the home after 3 months for personal reasons in December 2005 and before applying for registration. It is acknowledged that management have been striving to employ and registered a suitable manager for the home. In the meantime, Mr Cotterill is the registered individual (RI) for the company and has an office based at the home. The manager confirmed that he undertakes monthly visits as required by Regulation 26 to access the conduct of the home but written reports of these visits were not available for inspection during the visit. A recent change in the legislation concerning such visits means that the record of visits should be kept in the home and available to the Commission on request: copies no longer need to be sent to the Commission each month. Although the home operates an approved Quality Assurance programme, which seeks the views of residents and other stakeholders on an annual basis no evidence was made available to demonstrate how recommendations from the audit are implemented. Resident’s fees are paid directly through the bank to promote and protect service users. The home has policies and procedures in place concerning the management of residents’ personal allowances and these are followed by staff. The inspector sampled two records in this regard and found they were accurately kept. Mandatory Health & Safety training is supplied to staff but it was not clearly evidenced that it is up to date for all staff. Mr Westlake has the responsibility for reviewing the business’ policies and procedures and endeavours to achieve this task on an annual basis. An up to date insurance policy is displayed in the home. The home’s fire records were examined and evidenced that regular in-house checks of the fire precautionary system and fire fighting equipment are undertaken. An external contractor services the fire safety system at the DS0000020502.V292323.R01.S.doc Version 5.1 Page 30 required intervals and certificates were available to demonstrate this. A recommendation in the two previous reports for the home’s fire risk assessment to be updated is changed to a requirement in this report. The fire training records for staff did not demonstrate that night staff are supplied with three monthly training or that agency staff are provided with fire safety training although the information file for agency staff does contain a copy of the home’s fire procedure: it was not clear from the records seen that new staff are supplied with fire safety training twice in the first month of their employment. Records noted that the home’s last fire drill took place on 18th September 2005. At the previous inspection documentary evidence demonstrated that the laundry and sluice equipment and gas and electrical installations are regularly serviced. Precautions are taken to prevent the risks of Legionella developing in the home’s water supply and a clinical waste disposal contract is in place. DS0000020502.V292323.R01.S.doc Version 5.1 Page 31 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 DS0000020502.V292323.R01.S.doc Version 5.1 Page 32 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. Standard Regulation Requirement Pre admission assessments of care must include information and details recommended in the National Minimum Standards and all relevant information concerning a service users needs, eg other nursing care needs. The service user or their representative must be involved in the pre-admission assessment of need. (Previous timescale of 31/10/05 and 31/01/06 not met). Care plans and care related riskassessments must be updated at times of significant change. The care plans must set out in detail the actions that staff have to undertake to meet the assessed needs of each service user. Care plans must evidence service user/relative or representative involvement. (Previous timescale of 01/08/04, 22/03/05, 31/10/05 and 31/01/06 not met). The registered person must ensure that service users who are accommodated in the home are not out of category. A multidisciplinary care review must be held for each service DS0000020502.V292323.R01.S.doc Timescale for action 1. OP3 14 (1) 12 (1) 13 (4) (c) 30/06/06 2. OP7 15 (1) 30/06/06 3. OP7 12 (1) & (2) 30/06/06 Version 5.1 Page 33 4. OP8 13 (4) 5. OP9 13 (2) user identified during the inspection. The Commission must be informed of the outcome of these meeting and if appropriate a variation to registration applied for. (Previous timescale of 31/01/06 not met). This requirement was issued in a letter of serious concern following the previous inspection. A variation application has been received by the Commission but more up to date information has been requested before an informed decision can be made: the manager said that a multi disciplinary review has been arranged. Following receipt of this report in draft the home has informed the Commission that the resident concerned is currently in hospital and has been discharged from the home. The incidence of pressure sores, their treatment and outcome must be recorded in service users care plans and reviewed on a continuing basis. The use of appropriate pressure relieving equipment must be assessed and recorded. (Previous timescale of 22/02/005,31/10/05 and 31/01/06 not met). The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) Ensuring that medicines are offered as prescribed and the administration or reason for non-administration accurately recorded at the time they are given. b) Ensuring that medicines DS0000020502.V292323.R01.S.doc 30/06/06 04/05/06 Version 5.1 Page 34 received are checked carefully and accurately recorded. The pharmacy should be informed of any errors promptly and followed up in writing with copies of correspondence kept for reference. This was issued as an immediate requirement at the time of this inspection and the previous inspection. (Previous timescale of 31/01/06 not met). Additionally it is recommended that the home should follow guidance from the Royal Pharmaceutical Society including: a) Updating the medicines policy to guide staff on procedures to follow when a resident takes medication out for a day or longer. b) Having clear information for administering “when required” medicines on the MAR chart or in the care plan. c) Having a system for providing an audit trail for medicines not in the monitored dosage system (e.g. recording the date a new pack is started on the pack or on the MAR chart), and self-monitoring medication and the records to ensure that any errors are identified and followed up. d) Recording the date of opening medicines with a limited life so that they are not used beyond the expiry date. e) Having a system for regularly checking stock levels and expiry dates so that medicines are not over ordered and any that have expired are removed from stock. Care plans must be improved to DS0000020502.V292323.R01.S.doc 6. OP9 13 (2) 30/06/06 Page 35 Version 5.1 7. OP18 13 (4) & 37 8. OP18 18 (1) & (2) 10 (3) 9. OP19 23 include relevant information about the medication prescribed for each resident. In addition, they must refer to medication if used for sedative purposes and in other situations, for example how medicine is administered when the person has a ‘peg feed’. (Previous timescale of 31/01/06 not met). Additionally care plans must contain details for managing diabetes and potential problems with this condition e.g. high and low sugar levels. The registered person must contact the local Social Services Office to report and seek guidance concerning an unexplained injury to a resident, using the ‘No Secrets’ procedure. The RI agreed to make this referral on 12/05/06 and the Commission is aware this situation has been referred. The management/senior staff team must undertake refresher training relating to the protection of vulnerable adults and the recognition of abuse and become familiar with the local ‘No Secrets’ procedures. (Previous timescale of 31/10/05 and 31/01/06 not met). The registered person must ensure the Commission is supplied with a copy of the Building Control completion certificate in relation to the internal alterations of the ground floor toilets: to demonstrate that the finished work complies with the Building Control and Fire Safety Officer’s recommendations. (Previous timescale of 31/01/06 not met). DS0000020502.V292323.R01.S.doc 12/05/06 30/06/06 30/06/06 Version 5.1 Page 36 10. OP24 11. OP29 12. OP36 13. OP37 14. OP38 A copy of the completion certificate was supplied on 18/05/06. Therefore this requirement is met. The home must evidence that the arrangements in the identified resident’s bedroom are approved by the local PCT and meet the resident’s needs. (Previous timescale of 31/01/06 not met). In the meantime, a riskassessment concerning the resident’s vulnerability to the 16 (2) (c) central heating radiator and the 13 (4) (c) hot water pipes must be drawn up with remedial safety action taken where identified. The Commission were informed on 14/06/06 that the person concerned is no longer resident in the home. Therefore this requirement no longer applies but did reflect the situation at the time of the inspection. The registered person must ensure that recruitment records for new staff have a full 19 employment history and that any gaps in employment are accounted for. The home must be able to demonstrate that the content of the induction programme for new staff meets Skills for Care 18 (1) specifications. An induction checklist/ programme should also be developed for use with agency staff. The home must be able to demonstrate that the registered Amended person undertakes monthly visits Regulation concerned with the conduct of 37 the home and that reports of such visits are documented and kept in the home. 18 (1) All staff must have up to date DS0000020502.V292323.R01.S.doc 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Page 37 Version 5.1 15. OP38 18 (1) 23 (4) (d) 16. OP38 13 (4) (c) 17. OP30 18 (1) training in the five mandatory health & safety subjects. The home must be able to demonstrate that night staff are supplied with fire safety training every three months and that all new staff (including agency staff) are supplied with fire safety training twice in the first month of employment. The homes fire risk-assessment must be up to date, make reference to all en-suites and cupboards where extractor fans are fitted and their associated cleaning and maintenance programme and include recent changes made to the environment. This has been changed from a recommendation in the previous report. Individual staff supervision sessions (including clinical supervision for nurses) must be implemented and maintained in the home. 30/06/06 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The homes statement of purpose should be updated to accurately reflect the management arrangements in the home and the changes made to the environment/facilities. (Repeated from the previous inspection) 1. OP1 Following receipt of this report in draft, Mr Westlake has supplied the Commission with a copy of the home’s updated statement of purpose and guide. This recommendation is therefore met. Each service users wishes concerning terminal care must be discussed and recorded in their care records. DS0000020502.V292323.R01.S.doc Version 5.1 Page 38 2. OP7 3. OP18 (Repeated from the two previous inspection) All staff should be supplied with refresher training in relation to ‘Whistle Blowing’ and ‘No Secrets’ procedures. (Repeated from the previous inspection) The RI should ensure that there are adequate storage areas for items of equipment not in use, for example the walking aids and frames, trolleys and wheelchairs stored in three of the home’s bathrooms. (Repeated from the previous inspection) The RI should provide the Commission with an action plan detailing when improvements will be made to a first bathroom where a ‘medibath’ is situated and a first floor conventional bathroom with a shower facility. (Repeated from the previous inspection) The RI should provide the Commission with an action plan detailing how the laundry floor covering will be upgraded so that it is impermeable and easily cleaned. Management should supply the Commission with a copy of the home’s annual business development plan to demonstrate it includes the outcomes for service users referred to in the latest quality assurance survey. (Repeated from the previous inspection) Mr Cotterill provided relevant information on 14th June 2006.This recommendation is therefore met. 4. OP19 5. OP19 6. OP26 7. OP33 DS0000020502.V292323.R01.S.doc Version 5.1 Page 39 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000020502.V292323.R01.S.doc Version 5.1 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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