Random inspection report
Care homes for older people
Name: Address: Winterbourne Winterbourne London Road Salisbury Wiltshire SP1 3YU The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 0 5 0 5 2 0 0 9 Information about the care home
Name of care home: Address: Winterbourne Winterbourne London Road Salisbury Wiltshire SP1 3YU 01722428210 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Gillian Brinkley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Caring Homes Healthcare Group Limited care home 80 Number of places (if applicable): Under 65 Over 65 41 80 dementia old age, not falling within any other category Conditions of registration: 0 0 Service users whose primary care needs on admission to the home relate to their dementia may only be accommodated to receive personal care and not nursing care. The maximum number of services users who can be accommodated in 80. The registered person may provider the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category (Code OP) - maximum of 80 places Dementia (Code DE) maximum of 41 places Date of last inspection
Care Homes for Older People Page 2 of 21 Brief description of the care home The Winterbourne Care Centre is registered to provide nursing and personal care for up to 80 people. It was purpose-built and first registered on 5th February 2009. Accommodation is provided over three floors. The home is divided into six units. At the time of this inspection, three units were opened. One unit on the ground floor to the right of the entrance area provided nursing care to people who were medically frail. The two units to the left of the entrance area on the ground and first floor provided dementia care for people who needed personal care only. The home is owned by Caring Homes Healthcare, a national provider of care. The registered manager for the home is Gillian Brinkley. The home is on the London Road, leading into the city of Salisbury. There is ample car parking on site, a bus stop close by and a train station about 10 minutes away by bus or car. Care Homes for Older People Page 3 of 21 What we found:
This random inspection of the Winterbourne Care Centre was performed on Tuesday 5th May 2009, between 9:05am and 2:45pm. The inspection was performed by a regulation inspector and a pharmacist inspector. Throughout the inspection, they are referred to as we because the inspection is being performed on behalf of the Care Quality Commission. This random inspection was carried out following a complaint made to us about standards of care, provision of meals and availability of equipment, particularly disposable gloves. At this inspection, as the Winterbourne had only been recently registered, only three sections of the home had been opened. We met with eleven residents and reviewed five peoples records. These people were cared for in all opened parts of the home. We toured all parts of the home which were open, including the kitchen, laundry and support facilities such as sluice rooms and store rooms, as well as facilities for residents. We observed care provision during the morning and at lunchtime. We met with a range of staff, including the agency registered nurse in charge of the shift, the two senior carers in charge of each of the two dementia care units, care assistants across the home, the temporary chef and the receptionist, who was also performing a laundress role. At the end of the inspection, we gave the manager and a senior manager from the provider a feedback on our findings. What the care home does well:
The Winterbourne is a new, purpose-built care home. Facilities have been provided with the client-group in mind. For example the entrance is via automatic doors, so a person who is wheelchair dependant, or a person supporting someone who is frail, will be able to enter the lobby with ease and be able to wait in a dry area until the main entrance door, which is also automatic, is unlocked. The entrance hall is welcoming and provides comfortable seating. The standards of finishes across the home are high and provides standards equivalent to a good class hotel. There are a wide range of communal facilities which residents and their visitors can use if they wish. The windows are large and so people are able to benefit from natural light. Support facilities such as the laundry and kitchen have been designed with the homes purpose in mind and allow for the separation of clean and dirty functions, to support good hygiene practice. We met with a range of staff, many of whom were highly motivated. A care assistant on the first floor had worked in the home since it opened. They showed a very kindly attitude towards the residents under their care. They were consistently respectful towards them and did not rush any resident who had difficulties in recall, due to dementia. We observed that before lunch-time this care assistant supported a social atmosphere by offering drinks such as sherry. They also encouraged the people on the unit to use an attractive dining room at lunch-time. A care assistant on the ground floor had worked in the home for only two weeks but already clearly had familiarised themselves with the residents on their unit. They were observed to be very supportive towards residents, including at mealtimes, where they ensured that residents were offered choice, including choice of drinks. An agency registered nurse had only worked in the home for three shifts
Care Homes for Older People Page 4 of 21 but had already reviewed a range of appliances and ensured that the home had full stocks where necessary. This registered nurse had also identified that many of the residents had not had a recent medical review and had requested that their GPs visit to do this. During the inspection we observed that several GPs came to the home to review residents and the registered nurse reported that they were awaiting a visit from the tissue viability nurse during the afternoon. One person had an infection. They had a full supply of disposable gloves and aprons outside their room and safe systems for disposal of potentially infective items in their room. All staff we spoke with on the unit were aware of this persons infection and precautions to take to reduce risk of spread of infection. Where a resident needed an appliance, such as a urinary catheter, we observed that there were good supplies of catheter bags, including over-night bags. What they could do better:
We met with one newly admitted resident and reviewed their documentation. This person had had a very detailed pre-admission assessment performed. As part of this assessment, a range of actions were identified as needed to be performed as soon as the person was admitted. This included that the person must be weighed, due to a history of weight loss, that they must have a food chart commenced and a nutritional assessment performed. It also directed that the person must have a falls risk assessment, as they had a history of falls and a manual handling assessment completed. By the time of the inspection, five days after the person had been admitted, none of these directives had been complied with. This person clearly had needs relating to dementia but they had no care plan in place relating to this need. Their pre-admission assessment stated that they were prescribed a food supplement but there was no written evidence that they had been given this supplement, although a carer did know about this prescription and reported that they had given it when they were on duty. The person also had some old dressings on their legs, which they reported had been put on prior to admission to the home. The dressings gave the appearance of needing attention but there was no evidence that the district nurse had been asked to attend to look at the dressed areas. We met with other residents and noted that the home need to improve their assessment systems for people who are resident in the home. Several residents had a history of falling but had not had any risk assessment completed in relation to this. Some people clearly had nutritional needs but no assessment had been completed of this need. Where residents had assessments completed, attention was still needed. For example one resident had an assessment for risk of pressure damage but it did not consider certain medical factors which could increase risk, as documented elsewhere in their records, so their risk was assessed as being lower than it actually was. Several residents had assessments for use of bed safety rails which had not been fully completed. Where residents did have a need or a risk, care plans were not generally put in place to direct staff on how risk was to be reduced. Accident records for one resident indicated that they experienced falls on a frequent basis but they did not have a care plan to direct staff on how this risk was to be reduced. Several residents had risks in relation to pressure damage but did not have care plans to direct staff on how risk was to be reduced for them. On dementia care units, people did not have care plans about how their dementia care needs were to be met. On occasion information is assessments and care plans did not agree, for example for two people with manual handling care needs.
Care Homes for Older People Page 5 of 21 Where people had changing needs, care plans were not being re-assessed. One person had recently been admitted to hospital and observations of the resident, discussions with staff their and their records indicated that their nursing and care needs had changed but their care plan had not been up-dated to reflect this. One person had a manual handling assessment dated 20/2/09. Their records indicated that their condition had changed since this plan was drawn up but it had not been reviewed. Where people were frail, charts were in place to document food and fluids offered and when their position was last changed. These also needed attention. One persons chart provided limited evidence that their position had been changed regularly as would be anticipated by their condition. On one occasion, their records indicated that they had not had their position changed for twelve hours and on another occasion for 29 hours. As this person had already sustained pressure damage, this is of concern. Fluid charts were not totaled at the end of 24 hours, to assess how much a person had been able to drink. One person had wounds had a care plan relating to their wounds. Directives in their documentation for 30/4/09, stated that their wounds needed to be re-dressed by 2/5/09, but this directive still had not been complied with by 5/5/09. Another residents records showed that they were not given their necessary medication but the reasons for this were not documented and this had to be followed up by the registered nurse on a later shift. This could have put the resident at risk. As the home is using high levels of agency staff, this is of much concern as agency staff will not know residents well and will therefore be very reliant on up-to-date records, to ensure that they are fully advised on how to meet residents needs, particularly were residents are unable to discuss their needs with staff due to dementia or frailty. During the inspection, we visited the kitchen and spoke to the chef. It was reported that agency chefs had been preparing the meals. At the time of the inspection, a chef from the provider was temporarily providing meals until after the bank holiday period when the agency would continue to provide the meals service. The manager reported that the home was actively recruiting a chef. Kitchen store contained tins of vegetables and fruit, juice and dry items such as soup mix, rice and cereals. The manager had purchased broccoli and fruit that morning. The freezer had a small range of items such as sausages, chips, frozen sprouts, cauliflower and ice cream. There were no other supplies of fresh vegetables and fruit. A delivery of bread and milk had taken place. The fridge had a quiche, some chicken and some 20 eggs. The fridge labeled raw food was empty. The chef came on duty at 9:45am. This person stated that they had taken over the kitchen on Monday and had not been able to contact the home before this. The provider used a standard menu system but this would have to be changed. The ched reported that they relied on care staff to give them information about peoples particular needs. They had asked for the broccoli the day before and would use what was available in the kitchen for the meals. Residents would be given chicken or sausages with potato croquettes, frozen cauliflower and fresh broccoli for lunch with a lemon sponge to follow. In the evening the chef would use the quiche and jelly. This situation is clearly not satisfactory. It indicates a reactive approach to provision of meals, not a planned approach, which takes into account residents needs, likes and preferences. There was no evidence that the home were keeping to the providers polices
Care Homes for Older People Page 6 of 21 on menus. There was a limited supply of food in the home to meet the needs of 22 residents, particularly fresh vegetables. One resident was identified as needing a high protein diet, which the days lunch was not providing. As many of the staff were agency staff, and records were inadequate, they would not be able to inform the chef of special diets, where indicated. We discussed this matter with the two managers at feedback and we were minded to issue immediate requirements. The two managers undertook to rectify the situation by the end of that day and to confirm in writing that they had done this, which they did. We reviewed the availability of disposable gloves during the inspection. We observed that on each corridor, their was a trolley with clean sheets, a plastic aprons and a box of disposable gloves. The trolleys were of the type where a bag for used laundry could be placed at one end. We observed that on some occasions, these did have a container for used laundry placed in the area. This is regarded as a risk to cross-infection as clean laundry must not be placed next to used laundry. As part of the complaint, the complainants commented on the lack of availability of disposable gloves. We observed that on one unit, all the gloves were small size and another unit all the gloves were large, although staff on duty had a range of hand sizes. On one corridor, the box was nearly empty and when we asked where there were further supplies of gloves, we were directed to a store room, however this room did not have any boxes of gloves in it. We checked in store rooms on the other units, none had boxes of gloves. We asked about the locked store rooms but the registered nurse informed us that they had checked these and they were currently all empty. In order to ensure effective practice in prevention of spread of infection, there must be full supplies of disposable gloves of all sizes readily available to staff. We observed that there were generally no supplies of disposable gloves in bathrooms, toilets or sluice rooms. We also observed that in some toilets, disposable wipes had been left in a box on top of the toilet cistern. If disposable gloves or boxes of wipes are placed on flat surfaces such as a toilet cistern, there is risk that they will become contaminated. Dispensers for such equipment had not been provided in toilets, bathrooms, sluice rooms or the laundry, as would normally be anticipated. We also noticed that, unusually for a new build home providing personal care, disposable glove dispensers had not been provided in residents en-suite facilities. Several of the toilets did not have a container for rubbish in them. We found that we had to leave the room to dispose of a used paper towel. This is not good practice. We discussed sterile gloves with the registered nurse, who reported that they were available and used for all aseptic procedure. We observed that only one size of glove was available in the clinical room and as staff were observed with a range of hand sizes, in order to ensure correct sterile procedure, a range of sterile gloves are needed. Several of the residents needed to use a hoist for all transfers. Staff reported to us that hoist slings were used communally. They reported that if the slings were observed to be contaminated, they would be sent to the laundry, but there was no system as such for ensuring regular laundering of slings. Hoist slings can present a risk to cross infection, due to where they are placed on an individual. Unless disposable slings are used, if a person needs a hoist for all transfers, they need to be allocated their own sling, which will be named and used only for them. This communal use of slings is of particular concern as there were at least two residents who needed to use a hoist who also presented an
Care Homes for Older People Page 7 of 21 infection risk, due to their current needs. Practice in the laundry presents major risks to cross-infection. We visited the laundry several times during the inspection. When we commenced this inspection, we did not observe any staff in the laundry. The room was untidy and we observed red bags for infected and potentially infected laundry overflowing from a laundry container. The home has equipment to enable laundry to be sorted at source. This is to prevent risks associated with the re-sorting of laundry. However it was observed that staff were not complying with this system and different categories of laundry were placed in all the laundry skips. This means that items would need to be re-sorted in the laundry. This included items in red bags. This is regarded as a risk to cross-infection, particularly if infected or potentially infected items need to be re-sorted. This was of additional concern as there were no gloves or aprons provided in the laundry. By 11:30am there were still no staff in the laundry and we observed that the red bags had overflowed onto the floor. Used laundry was also observed to have overflowed on to the floor, in another part of the room. At 12:50 we observed that the receptionist was performing the laundry. The receptionist reported that they had been trained in this role. They reported that the appearance of the laundry was not an isolated occurrence and that there had been instances when she had had to open red bags, and re-sort them as they had woollies in them. During the inspection we met with several frail people who spent most of their time in bed, who needed assistance from staff for all their personal care needs. Two people who were able to converse and use a call bell had not been left with their call bell to hand. They were unable to report on how they would summon assistance when they needed it. Most of the staff we met with had been newly employed and a proportion of staff were agency staff. We discussed this with staff, who reported that there had been a turnover in staff since the home opened and that the home were trying to recruit more staff. This was confirmed by the manager. People commented on the agency staff, some were reported to come to the home regularly and be highly motivated, however other staff, including the manager also reported that they had sometimes had to send some agency staff away, due to poor performance. We were concerned about staffing levels in the home. During the inspection, we observed on the first floor dementia unit, that there was one care assistant, who had to care for seven residents, who had complex dementia care needs. We observed a range of matters on this floor which related to lack of staff, not the performance of the carer themselves. We observed one resident who was confused, wandering the corridor in a state of nearly full undress. We talked with another resident who was trying to sit down in the sitting/dining room in a place where there was no chair. They would have fallen if we had not been available to assist them. On another occasion, a resident was observed wandering the corridors with see-through nightwear. At 11:00am, we observed a resident had wandered into another residents room and the resident in the room was asking them to leave their room, but the first resident was not able to comprehend this. Another resident was wandering along the corridor, unsure of their surroundings. During all these observations, the carer was not neglecting their duties, they were busy with other residents. Residents with such complex behaviours will be at risk if they are not fully supported by staff. We observed that staff were performing catering duties as well as caring duties. On all
Care Homes for Older People Page 8 of 21 floors, care assistants were preparing breakfast, as well as providing care, including the first floor dementia care unit. We observed that washing up from breakfast was still in all three kitchenettes by lunchtime, as staff were concentrating on providing care. Additionally, we also observed that a member of the care staff was at lunchtime supporting the chef in the main kitchen and therefore was not available to provide care. We reviewed the duty rosters and observed that there were between two and three staff rostered on night duty. This would mean that if a member of staff needed assistance on one unit, they would have to leave residents on their unit unsupervised, while they assisted on the other unit. This would particularly be the case the dementia units as on the ground floor nursing unit, nearly all the residents needed moving using a hoist, which is an activity which needs two staff, to enable safe practice. Additionally it was reported that night staff were performing laundry. This is clearly not satisfactory as they would not be able to support residents. The off duty record showed that there was always one registered nurse on duty. Many of the residents on the nursing unit had complex nursing care needs, including terminal care needs. As noted above, dressings were not being changed at the frequency directed in care plans. The registered nurse was also observed to have a range of duties, including management of the home and supervision of more junior staff in support of the manager. Registered nursing staffing levels needs review, to ensure that all residents can have their nursing needs met. One of the matters reported by the complainant related to a resident who had a fall. We reviewed the accident book but there was no report of this fall in the book. However when we reviewed the persons daily record, a fall had been documented. Accidents need to be always fully documented in the accident book as well as the persons record, to ensure follow-up and review. We reviewed the accident book and it showed numerous reference to residents being found on floor. There was no evidence to show how long people had been on the floor. We observed that two of the residents on the first floor dementia unit showed signs of recent falls. One of the residents records and the accident book showed that they were at risk of falling and had fallen several times, including an admission to Salisbury District Hospitals Accident and Emergency unit. Many of the records of falls related to the dementia care units and/or night times, so adequate numbers of staff are needed to ensure resident safety. As noted above, many residents did not have care plans to direct staff on how their needs were to be met. Many residents had complex nursing and care needs and will not be protected without sufficient staff on duty, who are aware of all of their needs and be able to meet these needs. Staff are also clearly performing non-nursing duties, so the actual numbers of staff on duty will in effect be less than that detailed on the off duty. These concerns were discussed at the end of the inspection with the manager and a senior manager from the provider. The senior manager reported that they were concerned about the situation and would cease admissions to the home until sufficient permanent staff were on duty to meet residents needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 21 Care Homes for Older People Page 10 of 21 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 21 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 12 Where directives are made in 08/06/2009 a persons pre-admission assessment of need, the home must ensure that there is evidence that the directives in the preadmission assessment have been complied with. Pre-admission assessments of need are the baseline from which care is provided in the home, particuarly during the initial stages of a persons admission. 2 7 12 Where there is evidence that 08/06/2009 a persons nursing and care needs have changed, there must always be evidence that their care plans have been up-dated, to reflect their changed needs. Care plans are needed to ensure that people have their needs met in a consistent manner from staff. Therfore if a persons needs change, their care plan must be promptly evaluated and up- Care Homes for Older People Page 12 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action dated. 3 7 12 Where a person has or is 08/06/2009 assessed as having a nursing or care need, or if a risk to the person is identified, there must always be a care plan drawn up to direct staff on how the nursing or care need is to be met and risk reduced. Care plans direct staff on how each individuals nursing and care needs are to be met. If a person does not have a plan to direct staff on how the persons needs are to be met or risk reduced, the home is not in a position to ensure that care is being provided in the best interests of the person and that their safety is up-held. 4 7 12 Where a person has a 08/06/2009 nursing or care need or they have risks associated with their condition, an assessment must always be completed. Assessments must be completed in full, include all relevant matters and agree with other assessments. Frail elderly people, including people with dementia care needs may have needs relating to their nursing and care needs or risks assocated with their condition. In order to ensure that people are fully protected and their
Care Homes for Older People Page 13 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action safety ensures, a full asssessment must always be drawn up, to ensure that appropriate care plans are put in place. 5 8 12 Where a person is not able to 08/06/2009 change their position independantly or able to reliably give themselves food or fluids, a monitoring chart must be put in place. Records must show that peoples needs have been met in accordance with local and national guidelines. People who are not able to move their own positions will be at risk of pressure ulceration. Once sustained pressure ulcers are painful, take an extended time to heal and present a risk of infection, therfore the emphasis needs to be on their prevention. There is extensive research-based evidence on how often people at risk need to have their postions changed. If people are not able to reliably drink or take their meals, a monitoring chart is needed so that staff on all shifts can be aware of how much fluid and food the person had been able to take in. 6 8 12 Where a person needs 08/06/2009 referring to the district nurse to meet a nursing need, this should take place promptly .
Page 14 of 21 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action If a person is cared for in a part of the home which provides personal care only, if they are identified as having a nursing need, a referral to the distrcit nurse must take place in a prompt manner to ensure that their needs are met and they are not put at risk. 7 9 13 If a registered nurse omits a 08/06/2009 drug for any reason, this must always be based on clear clinical evidence. The reasons for omission must always be clearly documented. Drugs are prescribed to ensure that a persons medical needs are met, therefore they must only ever be omitted if it is in the best interests of the person. 8 15 12 The home must set us a system to ensure that the chef and other relevant persons are informed about different residents dietary needs Residents may need certain diets to meet their medical needs, other people may have specific preferences about food. Unless the chef and other people are informed about such needs, there is a risk that people will not have their needs met.
Care Homes for Older People Page 15 of 21 08/06/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 9 15 12 The home must ensure that 05/06/2009 it consistently has sufficient stocks of food stuffs to ensure that residents nutritional needs can be met and their ability to choose be up-held. Maintenance of nutrition is a key area in care provision. Therefore the home must have full stocks of nutritious food-stuffs, including fresh food, to meet peoples diverse needs and enable them to exercise choice. 10 22 13 All residents must always be 08/06/2009 left with access to their call bell Frail residents with complex needs, need to be able to summon assistance as and when they require it. Such people need to be always left with their call bell so that they can do this. 11 26 13 Where a resident needs to be 30/06/2009 moved using a lifting sling, they must always be provided with their own sling, which is used only for them. There must be clear systems in place to ensure that lifting slings are reguarly laundered. Due to their function, lifting slings can present a risk to cross infection if used communally. They need Care Homes for Older People Page 16 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action regular laundering to reduce risk of infection. 12 26 13 There must be safe systems 08/06/2009 for the mangement of laundry. Clean and used laundry must not be placed next to each other. Items for laundering must be separated at source, in accordance with the homes policies. Laundry must not be allowed to spill over onto the laundry floor. Safe management of laundry is a key area in the prevention of spread of infection. If clean and used items are placed next to each other, there is a risk of cross infection. If laundry needs to be re-sorted in the laundry, or if it spills out on to the floor, contamination of the laundry area can occur 13 26 13 Adeqaute supplies of 08/06/2009 disposable gloves must be provided in all relevant areas of the home, including, sluice rooms, communal bathrooms, toilets and the laundry. A range of sizes of gloves must be provided, including sterile gloves for asceptic procedure. Disposable gloves are a key area in the prevention of spread of infection, therefore they must be readily available, in a range of sizes, in all relevant areas of the
Care Homes for Older People Page 17 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action home. 14 26 13 Rubbish bins must be provided in all communal toilets and bathrooms. In order to prevent risk of cross-infection people must be able to safely dispose of items such as hand towels and disposable gloves. 15 27 18 There must at all times be 12/06/2009 sufficient staff on duty, including registered nursing staff, to ensure that residents needs can be met, their dignity maintained and their safety ensured. Nursing and care staff must not routinely perform nonnursing and care roles while they are placed on the roster to provide nursing and care. Residents with complex nursing and care needs, including demenita care needs, need to have sufficient staff available to ensure that their safety is maintained, their nursing and care needs met and their dignity up-held. Sufficient staff need to be provided to perform ancilliary roles to ensure that staff are available to residents. The staff roster needs to be accurate and complied with in full. 16 38 13 All accidents must be documented in the accident 08/06/2009 08/06/2009 Care Homes for Older People Page 18 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action book as well as the persons records. Accident records must be regularly reviewed and an assessment made of how long it took for a resident to be found, after they have fallen. Residents can be put at risk if they have an accident such as a fall, therefore managers need to be able to assess the extent of risk to residents and take action to ensure that risk to residents is reduced. 17 38 13 Where a person is assessed 15/06/2009 as needing bed safety rails, assessments must always be completed in full and records be regularly evaluated. There is a large body of evidence to indicate that the use of safety rails can present risk to a person, therefore they must only be used if they have been assessed as being in the best interests of the person. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 7 7 The duplication of care plans about the same matter should be avoided. Fluid balance charts should be totaled every 24 hours. Care Homes for Older People Page 19 of 21 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 3 7 Care plans should include precise, measurable terminology. The use of imprecise words such as normal limits or assistance should be avoided. Where a person is prescribed a food supplement, there should be clear written evidence that they have been given this supplement. Where a person has a continence care need, the type of aid to be used should always be documented. Items such as boxes of wipes or disposable gloves should not be placed on toilet cisterns or flat surfaces in toilets or bathrooms. Disposable glove dispencers should be placed in all ensuites, bathrooms, toilets, sluice rooms and the laundry. Imprecise terminology such a found on floor should be avoided in accident records. 4 7 5 6 7 26 7 8 26 38 Care Homes for Older People Page 20 of 21 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 21 of 21 - 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!
