Inspection on 23/05/05 for Wolston Grange

This inspection was carried out on 23rd May 2005.

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.

Other inspections for this house

Wolston Grange 04/11/09

Wolston Grange 12/02/09

Wolston Grange 22/01/08

Wolston Grange 16/08/07

Wolston Grange 07/11/06

Wolston Grange 21/03/06

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

CARE HOMES FOR OLDER PEOPLE Wolston Grange Wolston Grange Coalpit Lane, Lawford Heath, Rugby, Warwickshire CV23 9HJ Lead Inspector Terri Owen Unannounced 23 May 2005 & 3 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wolston Grange Address Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ 02476 540482 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Pinnacle Care Ltd Care home 18 Category(ies) of Dementia - Over 65 (18) registration, with number of places Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Rooms 5 and 16 must not be used by residents with sight impairement. Date of last inspection Not applicable. This is the first inspection since the home opened in April 2005. Brief Description of the Service: Wolston Grange is one of seven homes owned by Pinnacle Care Limited. It is a large detached dwelling set in extensive grounds. The building was formerly a farmhouse and there are a number of small outbuildings surrounding the main courtyard. The home is set in a rural location, a short drive away from Rugby Town Centre and the villages of Dunchurch and Bilton. The home is located along a country lane with smaller domestic dwellings as neighbours. There are no local facilities or public transport close to the home. It is registered to care for up to 18 older persons over the age of 65yrs with dementia. The accommodation is over two floors. There are two rooms that are large enough to be shared rooms. These will be used as single rooms unless two residents request to share a room e.g. a married couple. There are two communal lounges, a dining room and a large sun terrace running along the front of the home. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection. Two visits were made, one during the day and the other during the evening. A tour of the premises was undertaken. Records including care plans, risk assessments, medication administration records and menus were inspected. The manager, four members of staff, four residents and two relatives were spoken to. The inspection focused upon the premises, quality of food, social contact and activities provided for residents, staffing levels, care plans and risk assessments, medication systems, infection control and safe working practices. Wolston Grange is a newly registered home and was reopened approximately eight weeks prior to the inspection. The home is under new ownership with all new staff. The home has undergone extensive refurbishment and furnishings and fittings are of a good standard. A new manager has been appointed and took up her post two weeks prior to the inspection. The home provides care to older people with dementia who need substantial assistance in all aspects of their daily living. At the start of the inspection fifteen residents had moved into the home, three were receiving treatment in hospital. Four residents required a high level of care. Many of the residents are confused and a small number have displayed agitated and challenging behaviour due to their mental condition. What the service does well: What has improved since the last inspection? Not applicable - this is the first inspection since the home opened in April 2005. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 6 What they could do better: 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. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Each resident has written “Terms and Conditions of Residency” and a “Residential Care Agreement” which contains nearly all the information required by the resident to make choices. EVIDENCE: Copies of the Terms and Conditions of Residence and Residential Care Agreement were seen at the inspection. The manager confirmed that agreements have been completed and are in place for all current residents. The agreements were not seen at the inspection as they are kept at the main offices of Pinnacle Care Ltd. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 The level of detail in the care plans are variable and do not provide sufficient detail of the health, personal and social care needs of residents. The medication systems in use at the home at the time of the inspection were unsafe putting residents at risk. EVIDENCE: Three care plans and risk assessments were assessed. The level of detail in the areas of life history and strengths and abilities is good. However, there is a lack of detail in some care needs including management of continence/incontinence, bowel monitoring and management, and management of aggression and violence. Risk assessments also lacked sufficient detail and had not been updated following serious incidents of aggression and violence occurring, particularly in relation to one resident identified to staff on 03/06/05. On the medication administration records the instructions for giving medications to residents was not always written as they appeared on the packaging of the tablets and medicines. This could lead to a potential error of administration. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 10 There were also no instructions to staff regarding when to give an “as required” medication to residents. Medication administration records did not include the amount of medication received by the home or bring forward the balance of the amount of medication held by the home. Without this information it is not possible to demonstrate medication is safely stored and administered and that no medication has gone missing. One resident had not received an essential medication for 6 days because the management had allowed the medication to run out. The medicine cabinet at the home was designed for the storage of medications in “blister packs”. However the medications now received by the home were in their original packaging. The storage space in the cabinet was insufficient for all the medication held and medicines were being stored on top of each other and also in another cupboard that was not designed for the storage of medications. Each resident’s medication was stored together in a flimsy plastic container that allowed some packets to fall out. Packets were found loose in the cupboard because they had fallen out of the containers. There was a high risk of medications getting mixed up or overlooked. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13,15 Residents are encouraged and supported by staff to maintain their preferred lifestyle wherever possible and make choices in their daily lives. They are also supported to maintain their personal and social relationships. Residents’ benefit from having a varied and nutritious diet in nice surroundings. EVIDENCE: During the inspection visits staff were observed supporting and assisting residents to make choices in the activities they wished to pursue such as watching television, having quiet periods in their own room, and 1:1 activities. An “Activities Organiser” is employed who arranges a programme of activities in and around the home and the wider community, including trips out to theatres and places of interest. The interest and preferences of residents are identified during the initial assessment and admission processes. Their “life story” identifies past occupations, hobbies and interests. Activities are planned to meet these on an individual and group basis. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 12 Two relatives of residents said they were made welcome by the staff at the home and they were allowed to visit their relatives at any reasonable time. There is an open visiting policy up to 8pm. After 8pm visitors are requested to telephone first. Relatives may take meals with the residents and are offered tea and coffee when they visit. A “Cheese and Wine” evening was being held on 26th May 2005 and trips out with residents also being planned. The dining room is pleasant and staff may take meals with residents to encourage social interaction and support for those who need prompting to eat and drink. Menus are prepared on a four-week basis and are varied and nutritious. A range of fresh foods was available in the kitchen and food cupboards and fridges were well stocked. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. They will be assessed at the next inspection. EVIDENCE: Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 The safety of residents is compromised by a number of issues. Residents and visitors find it difficult to find their way around the home. Overall the home is clean and hygienic. Some additional facilities need to be provided, and control of infection policies and practice need to be developed further to ensure residents are not put at risk. EVIDENCE: The home is set in extensive grounds in a rural setting. There are a number of exits from the home and residents may exit the home whenever they choose. An “intercall system” alerts staff that somebody has exited the home from some areas. Some staff expressed their concern that residents who leave the home unattended are at risk of getting lost and/or injured. As yet, the garden is not enclosed. Residents leaving the garden can go along two tracks or across open countryside once out of the building making it difficult for staff to locate them in the dark or if they have been delayed in answering the alarm system. One fence running to the side of the garden has barbed wire attached. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 15 At the time of the inspection the door between the kitchen and hallway was propped open with construction blocks. This practice breaches fire safety requirements, and puts residents at risk in the event of fire. The home has recently been refurbished. Furnishings and fittings are generally of a good standard. However the layout of the home is confusing because of the number of passageways. The home is on two floors and all the main hallways are decorated in the same wallpaper, which does not assist residents to find their way around. There is little signage or distinguishing features to help residents with dementia orientate themselves and find their way around. Hazardous passageways have been blocked of by sealed doors. These doors also cause confusion to residents. On the upper floor two bedrooms are accessed and exited by three stairs leading of a hallway. Although a handrail has been fitted, the stairs may present a hazard if used by some residents. The shower in bedroom 7 was not working and requires repair. A tour of the home was undertaken and all areas appeared clean. In some areas, including bathrooms and toilets there were no soap or hand towels. There were no hand-washing facilities for staff in the sluice room. There was no protective clothing for staff dealing with incontinence problems or facilities in toilets and bathrooms for the disposal of incontinence products. The policies for controlling infection and giving personal care do not include current practice requirements for the use of protective clothing for staff when dealing with body fluids and preparing and serving food. In one en-suite bathroom there was a slight malodour of urine from the carpet. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number and skill mix of staff on duty does not always meet the level required. Given the high care needs of some of the residents, the standard of care is variable. EVIDENCE: Assessment of the duty rota indicated that not all shifts were being covered with adequate numbers and skill mix of staff. There is no system in place to ensure that staffing levels are determined according to the assessed needs of the residents. At the time of the inspections four residents had high care needs and six had medium care needs. One resident was frequently exiting the building, requiring staff to monitor their movements, and on the second visit one resident was very poorly. During discussion with the manager and senior staff it became evident that the home is experiencing difficulties in recruiting and retaining sufficient staff to cover all shifts. Staff sickness is also adding to these problems. Senior staff are spending significant periods of time trying to ensure the duty rota provides the minimum number of staff required. Some staff are working over their contracted hours to cover shifts. Some shifts are being covered by agency staff. A small number of male care staff are employed. Usually the maximum number of male care staff on duty is one, although two were on duty on the evening of 3rd June 2005. Most residents are female. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 17 There was no evidence of a system for ascertaining the wishes and feelings of residents regarding the gender of their care givers being in place. A cleaner is employed 5 hours a day, Monday to Friday. The home has recently been opened following refurbishment. There is no overlap time built into the change-over of shifts to brief and update all staff coming on duty of any changes and the current needs of the residents. An activity organiser is employed for 5 hours a day, usually Monday to Friday, although this is flexible to cover planned activities. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 Residents’ financial interests are safeguarded giving them confidence. There are a number of issues that need to be addressed urgently to ensure the health, safety and welfare of residents. EVIDENCE: The amount of money held by residents is managed by their family, attorney, or advocate. Systems are in place for the payment of fees and services and the company’s Head Office rather than the home, manages these payments. Managers and staff of Pinnacle Care Limited do not act as “appointed agents” for any of the residents. A safe is available for the storage of valuables and policies are in place regarding resident’s possessions handed over for safe-keeping. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 19 A number of safety issues, including safe administration of medicines, safety of the premises and control of infection have been identified in this report. At the time of the inspection there were sharp knives, kettles and hot water in the kitchen that was readily accessible to residents. The risk assessments relating to these hazards were not robust enough to adequately assure the safety of the residents. Disinfectant, with a safety hazard warning was being stored in a food cupboard in the kitchen, rather than separate to food and in a locked cupboard, as required under the law for the safe storage of hazardous substances. In the Terms and Conditions of Residence, it is stated “smoking is permitted in all bedrooms and in the lounge and reception hall during the daytime”. The need to assess the risk regarding burns and fire, or the right of other residents to a smoke free environment in communal areas is not included. Although hot water bottles and electric blankets are not permitted, microwaved heated devices are. The need for risk assessments related to the use of these devices is not included. Many of these devices can cause burns, especially in older people and those with mental impairment. The date of opening was not seen on some foodstuffs, as required by food hygiene laws. On the first day of the inspection no “Visitors Book” was available at the home. The inspector was informed that a record of visitors to the home was not kept. There are no separate facilities in the home for staff to take breaks or store belongings whilst on duty. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 x x 1 Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 21 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Care plans must be further developed to provide more detailed information when residents have specific needs including management of medical conditions such as diabetes (to include diet and foods to avoid, signs and what to do in the case of high/low blood sugar etc), promotion of continence and management of incontinence, and management of bowels (to include monitoring of bowel activity and effectiveness of any medication given). In relation to the resident identified to staff on 03/06/05 the following requirements are made: a. Four members of staff must be on duty during the residents waking time. b. Close monitoring of the resident by staff at all times. c. Two members of staff to continue to give care to the resident. d. In the event of aggressive or violent behaviour being displayed or if the resident Timescale for action 31/08/05 2. 7 14 & 18 a-g Immediate 03/06/05 h-j 31/08/05 Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 22 3. 9 13 4. 9 13 5. 9 13 leaves the building, two members of staff are to manage the situation. e. All other residents are to be moved out of the area if necessary. f. Risk assessments for the resident to continue to be updated. g. Incident reports under Regulation 37 of all aggressive and violent incidents to be forwarded to CSCI. These requirements must remain in place until: h. The resident has been assessed by a medical consultant. i. The resident no longer displays aggressive and violent behaviour. j. All staff caring for the resident have received credible training at the appropriate levels for the prevention and management of violence and aggression and can demonstrate they have the knowledge and skills to put the training into practice. Medication administration must be safe. Medication administration records must give clear instructions to staff, receipt of medication documented, and instructions for “as required” medications provided for staff. A doctor’s prescription should be secured for the resident who has been without prescribed medication since 30/5/05, and the medication administered as soon as possible. An incident report under Regulation 37 must be completed detailing how this situation of running out of medication has occurred and action to be taken to prevent E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Immediate 23/05/05 Immediate 03/06/05 06/06/05 Wolston Grange Version 1.30 Page 23 6. 9 13 7. 9 13 8. 9 13 9. 9 13 10. 9 13 11. 9 13 12. 9 13 13. 9 13 further occurrences must be forwarded to CSCI. The quantities of all medication received or balances carried over from previous cycles must be accurately recorded to enable audits to demonstrate medication is administered as prescribed. All medicines that are hand written on the Medicine Administration Record (MAR) chart must be transcribed from the prescription and countersigned by a second member of staff for accuracy. All occasional use medicines prescribed must be administered against a written protocol recording reasons for administration, dose, maximum daily dose and recording requirements. The medication of all new service users entering the home must be checked with their prescribing doctor to confirm the current drug regime. All prescriptions must be seen prior to dispensing and a system installed to check the dispensed medication and MAR chart against the prescription for accuracy. All medicines recorded on the MAR chart must be available for administration. All medication must be administered to the service user they were prescribed to. Managerial staff must undertake staff drug audits to demonstrate staff competence in medicine management. All staff must be trained to adhere to any new medication policy implemented into the home. E53 S62012 Wolston Grange V227878 230505 Stage 4.doc 08/06/05 08/06/05 08/06/05 08/06/05 08/06/05 08/06/05 23/06/05 08/06/05 Wolston Grange Version 1.30 Page 24 14. 15. 9 19 13 13 16. 17. 18. 19 19 19 13 13 13 19. 19 23 20. 19 23 21. 19 23 22. 19 23 23. 24. 19 26 23 13 25. 26 13 The medicines must be stored in an appropriate cabinet and/or trolley. Ordering, receipt, administration and disposal of medication must be safe and comply with the Guidelines issued by the Royal Pharmaceutical Society of Great Britain. All exits from the home must be made safe. The safety of residents exiting the home must be maintained at all times. The timescale for the creation of an enclosed safe garden should not extend beyond 30th June 2005. Action must be taken to ensure the safety of residents at risk of leaving the home and getting lost or injured from cars. The kitchen door must not be propped open and should be fitted with a mechanism to ensure fire safety. Ways of distinguishing the hallways and passageways must be found and signage around the home improved. A risk assessment must be undertaken on the two bedrooms on the upper floor that are accessed by three stairs leading of a hallway. Residents for which the stairs are identified as a risk must not be accommodated in these bedrooms. The shower in bedroom 7 must be repaired to ensure it is in working order. Hand washing facilities for residents and staff must be available in toilets, bathrooms and sluice areas. Protective clothing must be available for staff dealing with E53 S62012 Wolston Grange V227878 230505 Stage 4.doc 08/06/05 23/06/05 08/06/05 08/06/05 30/06/05 Immediate 23/05/05 Immediate 23/05/05 30/10/05 15/08/05 31/08/05 31/08/05 31/08/05 Wolston Grange Version 1.30 Page 25 26. 26 13 27. 26 13 28. 26 13 29. 9,19,27 13,18,23 30. 27 18 31. 27 12 32. 27 18 33. 27 12 34. 35. 38 38 13 13 body excreta, fluids and preparing and serving food. Bags or bins must be provided in bathrooms and toilets for the disposal of used incontinence products. Policies for controlling infection and giving personal care must be developed further to include current practice requirements. A cleaning regime to include the monitoring and cleaning of carpets in en-suite toilets and bathrooms must be put into place. Until premises are made safe, medication systems improved and staffing recruitment meet the necessary staffing levels, no new residents are to be admitted to the home. A system must be implemented to ensure staffing levels are determined according to the assessed needs of the residents. A system for ascertaining the wishes and feelings of residents regarding the gender of their care givers must be implemented and documented. Where residents are unable to express a wish, the views of their family or advocates should be sought. The amount of cleaning staff must be reviewed to ensure there is sufficient to keep the home clean. Overlap time must be built into the change-over of shifts to brief and update all staff coming on duty of any changes and the current needs of the residents The kitchen door must be kept locked when not in use. Residents must not be allowed to enter the kitchen unless they are accompanied and supervised by 31/08/05 31/08/05 31/08/05 Immediate 23/05/05 31/08/05 31/08/05 31/08/05 31/08/05 09/06/05 09/06/05 Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 26 staff at all times. 36. 38 13 Risk assessments for the kitchen area and individual residents must be in place and regularly reviewed. Disinfectants and all substances hazardous to health must be stored away from food and in compliance with the law relating the Control of Substances Hazardous to Health The policy on smoking in bedrooms and communal areas must be reviewed to take into account issues related to safety and the rights of others to a smoke free environment. The policy on the use of microwaved heated devices must be reviewed to take into account issues related to safety. The date of opening must be identified on all stored foodstuffs. 09/06/05 37. 38 13 31/08/05 38. 38 13 31/08/05 39. 38 13 31/08/05 40. 41. 38 13 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 38 27 Good Practice Recommendations To ensure correct identification, a photograph of the resident should be kept with their medication administration record To improve security, a record of visitors to the home should be recorded in a Visitors Book Provision should be made for staff to store belongings and take breaks. Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Wolston Grange E53 S62012 Wolston Grange V227878 230505 Stage 4.doc Version 1.30 Page 28 - 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. 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