Care Home: Aldbourne Nursing Home

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What the care home does well Aldbourne Nursing Home is a purpose built home. All resident accommodation is provided on the ground floor and there is disabled access throughout all resident areas. The home is light and airy throughout, with modern furniture and fittings. The home has easy access for local people. The home benefits from very good relationships with the local community and is well supported by the community in a range of areas. The home foster good working relationships with residents` families. Residents benefit from a stable workforce, with a low staff turnover, where training is actively encouraged by management, and taken up by staff. People commented to us on service provision. One person reported that one of the strengths of the home was in "ensuring that every individual`s needs are met", another "the nursing and daily care is very good", one person reported that they visited a lot of homes and "Aldbourne, without a shadow of a doubt, is by far the best" and one resident reported "I am being well looked after". People commented on the staff. One person reported "the staff, very helpful and caring and that is very rare these days", another person described a particular member of staff as "top notch" and another described the manager as "a cracker". One person summed up their opinion of the home by stating that it did "everything" well. What has improved since the last inspection? The home have invested in staff training, developing both induction and mandatory training for staff. Records are detailed and fully reflected what staff told us about. Staff were observed to treat residents with respect at all times. Surveys indicated that all staff were aware of the complaints procedure. Accidents are now being audited in detail, to identify any trends and reduce risks to residents. The home has invested in the environment, including provision of more chairs in the sitting room, following comments from people. The conservatory has been improved to make it a more pleasing sitting area. Additional garden seating has been provided. to develop communication systems, the home have also ensured that more regular team briefings take place. What the care home could do better: The home should develop its systems for giving people information before admission, to fully reflect what the home offers in such areas as mealtimes, people being supported in self-medication and information on staffing levels. Pre-admission assessments would benefit from details of from whom information about residents` needs was obtained from. Improvements are needed to ensure that residents` health and personal care needs can be met. Care plans need to be in place for all residents` needs including dementia care needs. All documents relating to nursing and care provision need to agree with each other to fully direct staff on how to meet individuals` needs. Developments should be made in diabetic care and continence care plans to make them more specific and measurable are needed. The home should evidence that it is attending regularly to frail residents, for example documenting that their positions are changed regularly. The home should consider developing a key worker and named nurse system and support carers in completing documentation. Improvements are needed in medicines management. Medicines must not be signed for until the person giving out the medicine has observed that the person has taken their medicine. Medicines must only be left with a resident after full risk assessment. The home must be able to demonstrate that medicines sent for destruction are managed by a company with an appropriate licence. Where a person needs regular administration of a medicine by injection and is not able to inform staff of where they were last injected, a system needs to be put in place to ensure that injection sites are rotated. The homely medicines policy should be reviewed. Care plans relating to medicines which can affect a person`s daily lives should be further developed. Some development would support residents in their daily lives. The home needs to develop full activities and recreational care plans for residents. The provision of activities in the home should be further considered, seeking the views of residents and relevant other persons. Any activities records should include the benefit of the activity to the resident, to assist in evaluation. The home`s systems for offering choice at mealtimes should be made more user-friendly and applicable to the current clientgroup. In order to safeguard residents, where a person is not able to use their call bell, a risk assessment and care plan needs to be developed to show how people are to be supported. When, due to certain of their behaviours, the home restricts a resident`s activities, this should be documented to show that actions taken are in the best interests of the person. Where the home is aware of informal complaints raised by people, they should document these and show actions taken to address such matters. Some matters relating to the home environment would benefit from improvement. In order to prevent risk of cross infection, receptacles for used laundry should not be part of equipment for clean items, laundry should be separated at source, not in the laundry and residents` underclothing and socks must not be used communally. We also recommend that carpets in the home be reviewed for staining and any stained carpets improved or replaced. The home needs to be able to demonstrate that all registered nurses have maintained their registration with the Nursing and Midwifery Council (NMC). Where the home are aware of reasons why they have not followed their own recruitment procedures, a written record should be made, this should include any occasions where issues are identified in relation to peoples` criminal records checks. Training records should document all the informal training supports given to staff. The home needs to ensure that risks presented by oxygen cylinders is reduced by always ensuring that they are secured. They should develop individual care plans for residents relating to fire evacuation. Their bed rails risk assessments should include current directives from the Health and Safety Executive (HSE). Records relating to maintenance of hoists and checking of shower heads would benefit from more detail, to ensure audit is facilitated. Key inspection report Care homes for older people Name: Address: Aldbourne Nursing Home South Street Aldbourne Marlborough Wiltshire SN8 2DW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 2 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Aldbourne Nursing Home South Street Aldbourne Marlborough Wiltshire SN8 2DW 01672540919 01672540997 guy@dghservices.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aldbourne Nursing Home Limited Name of registered manager (if applicable) Mrs Wendy Elizabeth Sheen Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 2 physically disabled users between the ages of 18 and 64 years may be accommodated at any one time. No more than a total of 2 service users with a terminal illness may be accommodated at any one time and these must not be less than 50 years of age Only rooms 2, 3, 4, 7, 9, 10, 11, 17 and 19 may be used for double occupancy and no more than 2 double rooms may be occupied at any one time That the deputy matron is on duty in the home in a managerial capacity for a minimum of 14 hours per week, over 2 days Care Homes for Older People Page 4 of 40 Over 65 1 40 0 2 0 0 2 2 That the registered manager is on duty in the home in a managerial capacity for a minimum of 21 hours per week, over 3 days, That these conditions of registration are formally reviewed on 1st March 2006 The maximum number of service users who may be accommodated in the home at any one time is 40 The minimum staffing levels set out in the notice of decision dated 18th April 2005 must be met at all times. The only service user who may be accommodated in the category DE(E) is the female service user named in the application dated 1st July 2004. Records, including care plans and risk assessments, must demonstrate that the care home is able to meet this service users mental health needs. In addition, the the well-being of other service users must not be compromised. Date of last inspection Brief description of the care home Aldbourne Nursing Home provides care with nursing for up to 40 people. The majority of these will be aged over 65. The home is also registered to care for some younger adults. Some short-term care places are offered. The current range of fees is 585 pounds to 900 pounds per week. The home is privately owned. The owners, Mr and Mrs Adey, live nearby and have regular contact with the service. They are supported by a Responsible Individual Mr Guy Montezuma. The registered manager is Mrs Wendy Sheen. Registered nurses are on duty at all times, supported by care assistants. Catering, domestic, laundry and administration services are also available. The home was purpose built in 1988 and has since been further extended. It is set in its own grounds with ample care parking, in the village of Aldbourne, which offers various local amenities. Swindon is only 10 miles away. Market towns such as Marlborough, Hungerford, Newbury and Wantage are all within driving distance and there are also easy connections to the M4 motorway. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection, surveys were sent out to residents, their relatives, staff and external professionals who visit the home, and 26 were returned. Comments made by people in the questionnaires and to us during the inspection process have been included when drawing up the report. The homes file was reviewed and information obtained since the previous inspection considered. The home also submitted an Annual Quality Assessment Audit (AQAA). This is their assessment of the quality of their service provision. It also provided numerical information on services provided. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what areas we should focus on when doing the inspection. The site visit was performed by one inspector. This person is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The site visit took place on Monday 25th January 2010, between 9:50am and Care Homes for Older People Page 6 of 40 4:30pm. The visit was unannounced. Mr Montezuma, the responsible individual (who is a registered nurse) was in charge of the home when we commenced our visit and Mrs Sheen, the manager came on duty during the morning. Mrs Sheen was available for the feedback at the end of the inspection. During the site visit, we met with a range of residents and also observed their care. We toured all of the home and observed care provided at different times of day and in different areas of the home. We reviewed care provision and documentation in detail for four residents, including a resident who had recently been admitted to the home and looked at specific records relating to a further four residents. As well as meeting with residents, we met with a registered nurse, five carers, a domestic, the chef, a catering assistant and the laundress. We observed a lunchtime meal. We reviewed systems for storage of medicines and observed one medicines administration round. A range of records were reviewed, including staff training records, staff employment records, complaints records and maintenance records. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: The home should develop its systems for giving people information before admission, to fully reflect what the home offers in such areas as mealtimes, people being supported in self-medication and information on staffing levels. Pre-admission assessments would benefit from details of from whom information about residents needs was obtained from. Improvements are needed to ensure that residents health and personal care needs can be met. Care plans need to be in place for all residents needs including dementia care needs. All documents relating to nursing and care provision need to agree with each other to fully direct staff on how to meet individuals needs. Developments should be made in diabetic care and continence care plans to make them more specific and measurable are needed. The home should evidence that it is attending regularly to frail residents, for example documenting that their positions are changed regularly. The home should consider developing a key worker and named nurse system and support carers in completing documentation. Care Homes for Older People Page 8 of 40 Improvements are needed in medicines management. Medicines must not be signed for until the person giving out the medicine has observed that the person has taken their medicine. Medicines must only be left with a resident after full risk assessment. The home must be able to demonstrate that medicines sent for destruction are managed by a company with an appropriate licence. Where a person needs regular administration of a medicine by injection and is not able to inform staff of where they were last injected, a system needs to be put in place to ensure that injection sites are rotated. The homely medicines policy should be reviewed. Care plans relating to medicines which can affect a persons daily lives should be further developed. Some development would support residents in their daily lives. The home needs to develop full activities and recreational care plans for residents. The provision of activities in the home should be further considered, seeking the views of residents and relevant other persons. Any activities records should include the benefit of the activity to the resident, to assist in evaluation. The homes systems for offering choice at mealtimes should be made more user-friendly and applicable to the current clientgroup. In order to safeguard residents, where a person is not able to use their call bell, a risk assessment and care plan needs to be developed to show how people are to be supported. When, due to certain of their behaviours, the home restricts a residents activities, this should be documented to show that actions taken are in the best interests of the person. Where the home is aware of informal complaints raised by people, they should document these and show actions taken to address such matters. Some matters relating to the home environment would benefit from improvement. In order to prevent risk of cross infection, receptacles for used laundry should not be part of equipment for clean items, laundry should be separated at source, not in the laundry and residents underclothing and socks must not be used communally. We also recommend that carpets in the home be reviewed for staining and any stained carpets improved or replaced. The home needs to be able to demonstrate that all registered nurses have maintained their registration with the Nursing and Midwifery Council (NMC). Where the home are aware of reasons why they have not followed their own recruitment procedures, a written record should be made, this should include any occasions where issues are identified in relation to peoples criminal records checks. Training records should document all the informal training supports given to staff. The home needs to ensure that risks presented by oxygen cylinders is reduced by always ensuring that they are secured. They should develop individual care plans for residents relating to fire evacuation. Their bed rails risk assessments should include current directives from the Health and Safety Executive (HSE). Records relating to maintenance of hoists and checking of shower heads would benefit from more detail, to ensure audit is facilitated. 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 on page 4. Care Homes for Older People Page 9 of 40 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents will largely be given all the information they need and have a full assessment prior to admission, so that the home can ensure that their individual needs can be met. Evidence: In their AQAA, the home reported on their admissions process. They stated that they perform a comprehensive assessment of prospective residents needs. The report that they visit potential residents in order to ensure that their care needs can be met and if they are unable to do this that a thorough assessment is sought from health care professionals. They also reported that residents settle well and all relatives and residents state that their well being has improved since admission. The home also admits people for short term care for rehabilitation and that they do this successfully so that people are enabled to return home. They report that this is assisted by their close links with the community. Care Homes for Older People Page 12 of 40 Evidence: People commented on information in surveys. Six people reported that they had received enough information about the home prior to admission so that they could decide if the home was the right place for them, however five did not. One of these people qualified their comments by reporting that they had been admitted to a crisis bed, so there had not been the time. We looked at information given to people about the services offered by the home. We observed that a full copy of the homes statement of purpose and service users guide was freely available to people. Much of the information was very clear and would give a person considering admission a wide range of information, For example the section on how residents can spend their day was clear, giving a good impression on how life would be like in the home. The information states that there is a good choice of meals. This section would benefit from more detail relating to how the home provides choice of meals for residents,, to reflect the homes own practices in this area (see Daily life and Social Activities below). In their AQAA, the home report that self-medication is encouraged after careful risk assessment. The information given to people states that residents can self-medicate if they wish, but no mention is made of the homes risk assessment process to enable a resident to do this safely. The information gives overall staffing levels and we recommend that this be expanded to inform a person of how many staff, and their skill mix, on duty during the 24 hour period. The homes statement of purpose should be dated and signed by a registered person, to show ownership and to support regular review of the document as services are developed or changed. We met with one resident who had been recently admitted. They were not able to recall their admissions process and thought that most of the process had been organised by their next of kin. We looked at the persons pre-admission assessment and found that much of it had been completed in detail. For example, the person had an eye condition, their assessment in this area was very detailed, documenting how their individual needs were to be met in the light of this. We also met with other people who had been in the home for a longer period. One of these people was confused and not able to report on their condition. When we reviewed their admission assessment, we observed that it was detailed, however the record did not state who they had obtained the information from and this is advisable as the person was not able to report on such matters themself. Two other assessments stated wears glasses without stating what the person wore glasses for. Care Homes for Older People Page 13 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs will largely be met by the homes systems, however certain areas relating to care planning, documentation and medicines management need to be developed to fully prevent risk to residents. Evidence: In their AQAA, the home stated that all residents have comprehensive individual care plans tailored to their health and personal care needs which are reviewed at least monthly or if the persons condition changes. They also report on the good support from GP services. They report that they receive positive feedback from residents, relatives and other professionals. They also report that self-medication is encouraged after careful risk assessment. People commented in surveys about the provision of nursing and care. Of the ten people who commented, five reported that they always and five that they usually received the care and support that they needed. Eight people commented that they always and two that they usually received the medical care that they needed. Four relatives felt that the home always and two usually met the needs of their relative. All Care Homes for Older People Page 14 of 40 Evidence: the staff who responded to surveys reported that they were given up-to-date information about the people they cared for. Comments included that staff react swiftly, efficiently and kindly to XXs frequent needs, another the nursing and daily care is very good and another they are very kind and caring. Staff commented on the home. One person reported on the good multi-disciplinary in-put, another on the good teamwork and another that the home makes residents feel well cared for. External professionals also commented on the service provided. One person reported that the home places a high emphasis on clients achieving full potential in physical and mental wellbeing and another that the home provides comprehensive individual care to dependant patients in a dignified and professional way. During the inspection, we met with a range of residents, in different parts of the home and at different times of day. We discussed how the home met different peoples needs with staff, observed care provision and reviewed residents records. One carer informed us that they were absolutely informed about different resident needs, another reported that weve brilliant RGNs here. An external health care professional reported on the good working relationship between them and the home. We observed that staff worked effectively as a team, planning together how they were to meet different peoples needs. For example a resident rang their bell for assistance, a member of staff attended, advised the resident that they needed two people to assist them and promptly went to find another member of staff, so that the persons needs could be met. Staff respected residents privacy and dignity. All personal care was performed behind closed doors and when assisting people to transfer using a hoist, staff worked to ensure that the resident remained fully covered. We observed that staff consistently called residents by their own preferred name. This included catering staff, who also took the opportunity to chat to residents about matters of interest such as the weather or the clothes that they were wearing that day. We observed that the home uses brief outline care plans which are kept discretely in residents rooms, this gives staff a quick resume of each residents needs. The home has full, detailed care plans in the main office. They also maintain a communication book in the office to inform people of changes in residents condition, which staff reported was very helpful if they had been off-duty for a few days, so that they could be quickly up-dated on residents changed needs. All residents have assessments of their needs, including manual handling, risk of pressure ulceration and nutritional risk. Where a need or a risk is identified, a care plan is put in place to direct staff on how the persons individual needs are to be met. For example one residents admission assessment documented that they preferred to Care Homes for Older People Page 15 of 40 Evidence: have a bath on a certain day of the week, this was documented in their care plan and their personal care records showed that they were receiving the bath on their preferred day. Another person whose mobility was decreasing had a clear care plan about how they were currently able to mobilise and the supports they needed. Another persons care plan documented that due to their need for a urinary catheter, they needed to be encouraged to take in fluids and we observed that a jug of fluid had been left to hand for the person and that they were regularly giving themselves drinks. Where a persons needs had changed, care plans were up-dated and dated and signed by the person changing the plan. For example one persons increasing confusion meant that they needed more support in washing and dressing than they had previously. This was clearly documented in their records, in a non-judgemental style. A few areas need attention. Not all residents who had assessed needs had care plans relating to this. for example, several residents were observed to have additional dementia care needs, which could affect their daily lives. Some such residents did not have care plans to direct staff on how their dementia care needs were to be met. Not all documentation agreed. One residents resume in their room stated that they were to be given Oxygen on a continuous basis. The resident reported to us that they did not use the Oxygen concentrator. The persons records in the office stated that the person was to be given Oxygen as required. Their daily record showed that the person had been refusing the Oxygen for a period of time and that this had been consulted with their GP. This could be confusing to staff and all records need to state the same approaches to nursing and care. We observed that staff attended to residents who were unable to change their positions independently, assisted residents to the toilet who needed support for continence and gave residents fluids where they were not able to assist themselves. Where a resident needs such supports with activities of daily living, in order to show that care plans are being followed, the home needs to put monitoring records in place, so that the manager can ensure that the person is receiving the care that they need in accordance with their care plan, throughout the 24 hour period. Some care plans would benefit from improvement. We observed records relating to people with diabetes and noted that they did not state the blood sugar levels aimed at for the individual and what actions staff were to take if the persons blood sugar levels fell outside these parameters. There was also no mention of the importance to tissue viability for the person of rotating injections sites. Where residents used continence pads, care plans should state the type of pad needed to meet the individuals needs as this can vary from individual to individual. Where a person has an appliance such as a supra-pubic catheter, care plans should direct staff on the frequency and how the Care Homes for Older People Page 16 of 40 Evidence: stoma site is to be cleaned. Where a person uses a conveen appliance, care plans should clearly direct staff on actions to take to put the appliance on the person. Each resident has a daily record of their care and condition completed. Carers report to the registered nurses on the residents condition and the registered nurse then documents what has been reported to them. It is advisable that the person who performs the care of a resident should document what care they have given and any observations they have made, rather than such matters being documented by a third party. Carers are allocated to care for residents on a daily basis, and there is no named nurse or key worker system as such. We advise that the home develops a key worker and named nurse system, to enhance continuity of care and to support the care planning process and ensure that key workers are fully involved in the care planning process. There were full written records of links with residents GPs and external health care professionals. Where residents needed support from a medical consultant, the home facilitated this and full records of consultations were included in residents records. Where a resident had a wound, there was evidence of consultation with the tissue viability nurse. All records relating to wounds were clear and followed guidelines about wound car monitoring. Where a resident needed a urinary catheter, there were clear records relating to the type of appliance used and when it was changed; records complied in full with guidelines. We observed a medicines administration round and systems for storage of medicines. The home has a designated medicines room. All medicines were securely stored and the room was tidy. Controlled drugs were safely stored and full records maintained. Full records of drugs received into the home were in place. We reviewed the homely medicines policy. We noted that this included some medications which are not generally included in homely medicines, such as suppositories. The manager reported that these were not currently used. We advised that the homely medicines policy be revised to reflect current guidelines and agreed with residents GPs. We looked at systems for disposal of medicines. The home reported that they were sent back to their supplying pharmacist for disposal. They were not able to confirm that their supplier held a Waste Disposal Licence. Under current legislation, care homes with nursing must only return medicines for destruction to a pharmacist or other approved contractor who holds such a licence. Where a resident was prescribed a medicine on an intermittent basis, for example every third day, there were clear systems to ensure that the resident received their medication at the frequency intended. There were clear systems for anticoagulant Care Homes for Older People Page 17 of 40 Evidence: medicines, with all changes to the prescription being in writing. Limited life medicines were dated on opening, so that they would not be used after their expiry date. At the start of the inspection, we observed that a resident had been left with their tablet. Staff were able to report why this was. At the lunch-time medicines administration round we observed that the registered nurse left two different residents with their medicines when they were eating at the table and then signed for the medicine before the resident had taken their medication. Registered nurses must not sign to document that a resident has taken a medicine until they have observed that they have done so. Leaving residents with their medicine has the potential to present risk, particularly in a home where some residents have additional dementia care needs. If a resident wishes to be left with their medicine, this must only be done after a full written risk assessment. This assessment must include risks to other residents as well as the resident themselves. This was not the case for residents left with their medication. We observed that the registered nurse did explain carefully to residents what their medicines were for and ensure that they had enough drinking water to enable them to swallow their medicine. We looked at the medicines administration records and observed that one resident was prescribed three different painkillers to manage their condition, all to be given on a different basis. Their care plan stated only that they were to be administered their prescribed analgesics. We advised that care plans should include much more detail of what painkiller was to be used and when, to ensure evaluation of their pain management. There were records relating to the management of residents with insulin dependant diabetes. We discussed rotation of injection sites with the manager and they were aware of the risks to the person presented by the over-use of a particular injection site, however the home does not have a documentary system to ensure that injection sites are rotated regularly. Where a resident is unable to remember where they were last injected this is needed to prevent risks to tissue viability and ensure correct up-take of insulin. We observed that the home did monitor diabetic residents blood sugar levels. We observed that for two different residents, on two separate occasions, they had had a low blood sugar level. There was no documentation in either of these residents records of actions taken by staff to address the matter. As low blood sugar levels have the potential to present a medical emergency, the home needs to document what actions they have taken to meet the residents needs. Care Homes for Older People Page 18 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported in living the daily lives that they chose. Evidence: In their AQAA, the home stated that residents usual routines are discussed on admission, implemented as far as possible and that they allow their residents to have choice and control over their lives and their independence. They report on the positive feedback from residents and relatives, both verbal and written. They report that family and friends feel at ease to visit at any time. We received comments from people in surveys about activities provision. Two people reported that the home always, seven usually and one sometimes arranged activities that they could take part in. People also commented about activities provision in surveys. One person reported that the home needed to provide more stimulus, another that the home needed to arrange more social events for the residents, another it would be good to have a social co-ordinator on the payroll rather than relying on volunteer help, another that the home needed more activities for residents, that entertainment was strictly limited and another that the home needed to spend more time with the residents on a one-to-one basis. Given these comments in surveys, we recommend that the provider seeks feed-back from Care Homes for Older People Page 19 of 40 Evidence: residents and their supporters on activities provision and then develops an action plan to detail how additional supports can be given to residents in this area. We observed that an activities programme is displayed in the main entrance hall together with pictures of activities participated in by residents. We discussed activities provision with the manager and they reported that activities were arranged by the Friends of Aldbourne who would be supported by a carer, on a daily basis. We observed that Mr Montezuma was leading an activities group during the morning. He clearly knew the residents well and encouraged them in participation. One resident said to us I play all the games people organise. We looked at records and observed that while residents had profiles of their past lives drawn up, some of which were very detailed, none of the residents had care plans relating to their needs for activities and social engagement. The home does maintain a list of which resident has engaged in which activities but it does not document the benefit to the resident or how they were able to participate. In order to ensure that all of a residents social care needs are met, the home must develop care plans relating to need for activities for residents and they should document the benefits to residents and participation in activities arranged, to assist in evaluation of care plans. Residents relatives commented in surveys about the home. Two people reported that the home always and four usually kept them up to-date with important matters relating to their relative. Three people reported that the home always and two usually responded to their relatives different needs. One person commented that there was always someone at hand who can give an up-date on residents health needs, another person commented on the good holistic care, however one person did comment inter staff communication is not good and requests have to be repeated over and over again to get implemented. People commented on the supports from the community. One member of staff reported relatives are in and out all the time, so almost part of the workforce and another anyone can walk in any time and feel comfortable. One resident reported we please ourselves about how they spent their day. A member of staff described to us how they had worked with the residents family to meet a particular need for the resident which was becoming more complex due to their changing dementia care needs. We received a range of comments about meals provision. Four people stated that they always, five usually and one sometimes liked their meals. Comments about meals varied. One person reported the food is of a high standard and well presented, Care Homes for Older People Page 20 of 40 Evidence: another the food is excellent with fresh meat and vegetables, another reported on the plenty of variety and another reported on how their relative enjoys their food. However one person did comment the food is ok but very little choice and monotonous. We also discussed meals with residents during the inspection. One person described the food as very good, another as alright, another as so so and another that they were not very often given a choice of meal. A resident told us that they had fancied a grapefruit, had asked for one and been given one by the kitchen. We observed that the meal for the day is put up on a white board in the dining room. We discussed this with staff who reported that there was a choice for residents and that the kitchen was very flexible about meals provision. Most homes of this size will provide a menu-type service with residents being actively offered a choice rather than a main meal with alternatives if a person does not wish to have the main meal. While some residents will be able to voice their preference for a different meal, others are more likely to exercise choice if there is a menu choice readily available. We observed a lunch-time meal. Residents who wish to eat in the light, airy dining room at different sized tables. Domestic-style crockery and cutlery were used. We observed that the meal-time was well organised, with the catering manager serving the meal from a hot trolley in the dining room. Meals were served hot and table by table. We observed a resident who looked at their meal and asked for a smaller portion and that they were promptly given one. We observed a care assistant sitting with a resident who needed assistance to eat, encouraging them to eat, not rushing them and using the opportunity to make it a social occasion. We observed that another care assistant was quick to notice when a frail resident lost concentration in eating and was quick to support them. We observed a carer taking a meal on a tray to a resident in their own room. They correctly adjusted the residents bedside table to a height to enable the person to eat their meal independently, taking time to stop and chat with them and not rush the resident in anyway. We discussed residents who needed thickening agent to enable them to swallow safely, with a care assistant. They knew which resident needed thickening agent and what consistency each individual needed their drink to be. We met the catering manager. They were highly motivated in their role and reported on the importance of being in the dining room to serve meals so that they could keep their eyes and ears open as to how residents felt about the meals. They reported that this was particularly important where residents could be confused, so that they could observe what the resident liked to eat and what they did not, so that the person could have the meals that they preferred. All meals are cooked up from raw ingredients, including soups and gravies. The catering manager showed a detailed knowledge of different diets needed by residents. They were particularly knowledgeable about diets Care Homes for Older People Page 21 of 40 Evidence: to support people who were at risk of weight loss, due to their condition. Care Homes for Older People Page 22 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have their concerns listened to and acted upon and they will be safeguarded however the home needs to improve documentation in two specific areas, to fully evidence this. Evidence: In their AQAA, the home report that staff remain aware and committed to maintaining the physical and mental well being of their residents. They report that their open door policy and welcoming culture of senior staff encourages residents and relatives to express views and comments, which are acted upon quickly. They report that staff are aware of safeguarding policies and procedures through mandatory training and supervision sessions. Also that a clear complaints procedure is displayed and residents and relatives are aware of the procedure. All of the residents who responded to surveys reported that they knew how to raise issues of concern to them informally. Seven residents reported they knew how to raise a formal complaint but three that they did not. All of the relatives who responded to surveys reported that they knew how to raise a complaint. All staff who responded also reported that they knew what to do if someone had concerns about the home. One person commented in their survey a word/letter usually does the trick if they had issues they were concerned about and another that the home makes the residents feel safe. Care Homes for Older People Page 23 of 40 Evidence: We discussed with residents how they raised issues of concern. One person reported if Im not happy, I go to my daughter and another Im sure theyd do something if they raised an issue of concern to them. We observed that a resident used their bell and that a member of staff attended promptly when they did this who then said hello XX, how can I help you?, and that the member of staff responded yes of course when asked for assistance. We observed that the homes complaints procedure was displayed in the entrance hall; it has been dated and signed by a registered person. No complaints have been made to us about the home during the past 12 months. We reviewed the homes complaints records and observed that formal complaints had been responded to in accordance with the homes own procedures. In surveys, we received a range of comments of concern about the homes laundry service. For example the laundry is appalling and clothes and linen etc are ruined regularly and have to be replaced frequently, another laundry standards could be better and laundry and loss of residents clothes a slight problem. The home manager knew about these concerns and was able to report on actions taken to address them, however as these matters had not been made on a formal basis, none of them had been documented. Many homes do document such informal concerns as part of their quality audit process, as such information is useful in understanding how people are affected by service provision and managers can observe how the home aims to improve service provision. The home manager is aware of their responsibilities under local safeguarding procedures. No referrals have been made about the home or by the home in support of a person during the past 12 months. We observed training records and saw that all staff had been trained in abuse awareness annually. When we met with the laundress we discussed safeguarding vulnerable adults with them and they showed a good knowledge of their responsibilities for reporting any suspicions of abuse. They reported that they were confident that they would be listened to by managers if they had any concerns in this area. Other members of staff also showed an awareness of their responsibilities. One of the residents we met with showed dementia care needs including memory loss, confusion and a lack of recollection of their ability to mobilise. Discussions with them indicated that they would not be able to understand the purpose of a call bell. We discussed with the manager how the home would ensure this persons safety, including safety from their own actions. If a person is not able to use a call bell and could put themselves at risk, a care plan needs to be put in place to direct staff on how their safety is to be maintained. Care Homes for Older People Page 24 of 40 Evidence: The communications book indicated that staff were taking actions on a daily basis to restrict certain activities for a resident as they could have been put at risk in their relationships by their actions. Staff knew why this was needed and reported that this had been fully discussed with the persons relatives and agreed to by them. There was no documentation to support this apart from a record of the actions taken. If the home needs, in the persons bast interests, to take actions which could be considered a limitation to their freedom of choice, this needs to be supported by full written documentation. Care Homes for Older People Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment will meet residents needs but developments are needed to the laundry service to reduce risks of cross infection. Evidence: In their AQAA, the home reported we offer a safe and well maintained environment for our residents. The home is clean, pleasant and hygienic. We have a programme of continuous refurbishment. They report that during the last year, they have purchased additional lounge chairs, installed blinds in the conservatory to increase its usage and comfort and that new garden furniture items had been purchased. Nine out of the ten people who responded to this section of the survey felt that the home was always fresh and clean, the other person reported that it was usually so. One person responded in their survey that the home was always neat and tidy, another its clean, however one person did report the cleanliness of XXs room is OK and there is room for improvement. One resident said to us its my home about their room. We observed that their room contained a range of their own possessions, reflecting the persons likes and interests. Another person who spent much of their time either in bed or a chair close to their bed, reported Im very comfortable. When we came into the home, we observed that the front door opened automatically. This will assist people who are using wheelchairs as managing a door as well as Care Homes for Older People Page 26 of 40 Evidence: using/pushing a wheelchair can be a difficult manoeuvre to perform. The sitting rooms were all light, airy and attractive in appearance. All accommodation for residents is provided on the ground floor and is fully wheelchair accessible. A domestic we met with was fully aware of the duties involved in their role. They reported that they had a carpet cleaner and had been trained in its use. We observed as good pracitce that domestics cleaned residents rooms as much as possible when they were not in them, for example when they went to to dining room for lunch. We observed that all parts of the home were clean, including difficult to reach areas such as the under-sides of raised toilet seats. We observed that some of the corridor and room carpets showed visible old staining. They had clearly been cleaned regularly. Such staining detracts from the appearance of the home and all carpets should be surveyed and action plans be developed to change the carpets where indicated if the equipment used will not remove staining. The laundress reported that staff consistently comply with the homes infection control polices for the management of infected and potentially infected laundry. We observed that the laundry was clean and there was no dust or debris visible behind the machines. The laundress reported that nearly all residents clothes were named and that carers were good at recognising different residents clothes if names came off. However on discussion, we identified that net underwear and dark socks were not routinely named and were used communally. Communal use of such items can be a risk to cross-infection, particularly fungal infections, as well as not up-holding a residents dignity. There are a range of systems on the market, including individual net bags, which can ensure that such personal items can be returned to the named individual, Discussions with the laundress indicated that used linen was placed in linen skips about the home and then separated in the laundry. Current advice is that used laundry should be separated at source, to prevent risks of cross infection caused by re-sorting in the laundry. We also observed that the home uses a linen and disposables trolley which has shelves for clean linen and disposables, with an integral used linen skip. This means that used laundry is placed in close contact to clean items. This is a risk to cross infection. Equipment must be provided to ensure that used and clean items are separated. We noted as good practice that hoist slings were laundered on a daily basis. We did advise that current advice is that, to prevent risks of crossinfection each resident who needs to be transferred using a hoist sling, has their own hoist sling, which is allocated to them. Care Homes for Older People Page 27 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by a stable staff team, who are trained in their role and safely recruited. Evidence: In their AQAA, the home reported on their careful allocation of work taking into account carers experience and level of care needs of our residents, and that they meet and often exceed minimum staffing levels required. They also report staff are supernumerary during induction training and are fully supervised and that feedback from new staff indicate that they feel well supported during this time. They report that 90 of care assistants have or are working towards NVQ level 2 or above. People commented about staffing in surveys. Five residents reported that staff were always and five usually available when they needed them. Three relatives though that the home always and three usually had the right skills and experience to look after people properly. Two staff felt that there were always and six usually enough staff to meet individual needs of residents. Comments included always plenty of staff on duty and attentive staff. Comments from staff included it does well in giving training, another there is a lot of staff training, another that the home provides training statutory for staff & NVQ and another that the home supplies good training: NVQ. One member of staff who reported that they were a newer member of the team stated I am pleased to be part of this home, because they have provided an Care Homes for Older People Page 28 of 40 Evidence: opportunity for me to use my skills and abilities. This home is fortunate in having a low staff turnover and not use of agency staff. Staff are committed to service delivery. For example on the day we visited, two members of staff had phoned in off sick and by the time we arrived two other members of staff had volunteered to work the shifts. We observed that when we used a bell on behalf of a resident, that a member of staff attended in under three minutes and were very polite and supportive to the resident when they attended. We reviewed records relating to newly employed staff and observed that proof of identity, police checks, two references, an employment history and health status was checked for all staff prior to employment. Staff are issued with a job description which they date and sign. Where staff are from abroad, the home retains evidence that the person is able to work in this country. Records relating to registered nurses did not include proof that they were currently registered with the NMC. The home must provide clear evidence of each registered nurses continued registration with the NMC. The home use an interview assessment record to assess peoples suitability for their role. In one case a member of staff did not supply a previous employer as a reference, using two colleagues instead. On discussion, Mrs Sheen knew why this was and it was reasonable in this individuals case, but they had not documented the reason for this being acceptable for this individual. One member of staff had a police check which showed issues in their past. A positive police check will not necessarily preclude a member of staff from employment in a home, however a written risk assessment is needed, to ensure that principals of equal opportunities have been consistently followed. Staff confirmed that they were fully supported during their induction period and worked supernumerary, so that they felt supported in learning about their role.We discussed training with a range of staff, including the laundress and a domestic. All were able to describe the training opportunities offered by the home and confirmed that they had also been regularly trained in mandatory areas such as manual handling. This was supported by the homes training records, which were clear and detailed. They also identified due dates for mandatory training, so that staff could be reminded of when training was due. Training records indicated training in a range of areas relating to resident care, including dementia care and skin care. Training was reported to be case-load based, to enhance understanding of how to meet residents needs. One-off training has also been provided, for example an optician and the tissue viability nurse recently gave study sessions. The manager reported that all staff, including night staff were keen to attend study sessions and that up-take was consistently high. We discussed meeting individual specific needs of residents, for Care Homes for Older People Page 29 of 40 Evidence: example stoma care and application of conveen appliances. The manager reported that this was cascaded to staff on an individual or small group basis. We recommended that such training also be documented in staff records. Care Homes for Older People Page 30 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by a management team who are keen to provide quality service provision. Residents health and safety will largely be up-held. Evidence: In their AQAA, the home stated that the home is well managed in the best interests of residents, procedures in place to maintain the health and safety of residents. That the home is well managed and always run in the best interests of residents. They also report that they have a continuous quality improvement philosophy. People commented to us in surveys about the home. One person reported manager and matron very friendly, professional and genuinely care for residents and another the matron is excellent - a first class nurse. A member of staff commented that the home allow room for grievances to be aired leaving no problem unresolved and another they promote teamwork which makes work very easy for everybody. The manager, Mrs Sheen has been employed in the home for many years. She is Care Homes for Older People Page 31 of 40 Evidence: supported by a senior management team who are also involved in the business. Mr Montezuma, the responsible individual works in the home at times, for example he was managing the home when we started out visit (Mr Montezuma is a registered nurse). Later on after Mrs Sheen was on duty, he was leading an activities session. Several members of staff informed us that the managers were closely involved in the home, one reported that they were very hands on and another that managers knows whats happening. We observed that the latest customer satisfaction survey was displayed in the entrance area. There was evidence from staff meetings that customer satisfaction with service provision was also discussed at that time. The home has a clear system for management of residents finances, based on a cash-less, invoicing system. There are systems for the auditing of care plans and medicines management. The home has clear systems for the regular audit of accidents, which includes monthly analysis of accidents for trends. Unexplained bruising is documented and if a resident hits their head, neurological observations are always performed. It was reported that most maintenance is by external contractors. There are systems in place for the regular maintenance of equipment and services. Records relating to servicing of hoists and checks for lime-scale in shower head should be clarified, to include a list of each piece of equipment and when it was last serviced or had limescale removed. The home has written environmental risk assessments. Some residents are assessed as needing to use bed rails. Where this is the case, the home uses written assessments. The assessment used is quite brief and we recommend that the home reviews advice on bed rails on the Health and Safety Executive (HSE) web site, to ensure that their risk assessments include all factors as set out by the HSE. The home has systems in place for ensuring fire safety, including checks on fire safety systems. We recommend that the home develop individual evacuation plans for residents in the event of a fire, so that they can assess all the supports which residents many need in the event of a fire. We observed that more than oxygen cylinders were free-standing, not restrained. Oxygen cylinders can present a risk of injury or explosion if they topple, which they can be likely do do, due to their shape. Therefore all cylinders must be placed either in an oxygen carrier or be fully restrained. Care Homes for Older People Page 32 of 40 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 40 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, Care Homes 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 7 12 If a resident has a need or a 31/03/2010 risk, a care plan must always be put in place to direct staff on how this need or risk is to be met. This must include reference to recreational and social activities for the person. All records and care plans relating to an individual must always agree. Care plans direct staff on how individuals needs are to be met in a planned and consistent manner. 2 9 13 The registered nurse must not sign to medicines adminstration record to document that a person has taken their medicine until they have observed that the resident has done so. Medicines adminstration reccords must always be an accurate record. 12/03/2010 Care Homes for Older People Page 34 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 3 9 13 Residents must not be left 12/03/2010 with their medicines unless a risk assessment has been completed. In a care home with nursing there are risks to the resident and other residents associated with leaving residents with their medicines, particulary in communal areas, therefore this must only happen after a risk assessment. 4 9 13 The home must be able to demonstrate that the company which takes their medicines being sent for disposal has a waste disposal licence. Medicines will present risk if they are not disposed of correctly by a company who has been licenced to safely do so. 31/03/2010 5 9 13 Where a person needs regular administration of a medicine by injection and are not able to inform staff of where they were last injected, a record of injection sites must be maintained. Over-use of the same injection sites can lead to 12/03/2010 Care Homes for Older People Page 35 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 risk to tissue viability and incorrect up-take of the medicine. 6 18 13 Where the home is taking 31/03/2010 certain actions to support a resident in a way which could be seen as a limitation in their freedom of choice, documentation as to why this is in the residents best interests must always be in place. The home needs to be able to actively justify why actions it takes are in the residents best interests. 7 18 13 Where a resident is unable to use the call bell system and may be at risk, including from their own actions, an assessment of risk and care plan must always be put in place. This is to ensure that frail residents are safeguarded. 8 26 13 Systems must be put in place to prevent communal use of net underwear and clothing by residents. This is to reduce risk of cross infection and enhance systems for ensuring residents dignity is up-held. 31/03/2010 31/03/2010 Care Homes for Older People Page 36 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 26 13 Equipment must be provided 30/04/2010 to ensure that used linen is not placed in close proximity to clean items. This is to prevent risks of cross-infection. 10 29 19 The home must always be 31/03/2010 able to evidence that all registered nurses working in the home have a current registration with the NMC. A registered nurse cannot practice unless they have demonstrate current registration with the NMC. 11 38 13 Oxygen cylinders must always be placed in an approved carrier or be restrained. Oxygen cylinders, due to their shape can topple easily, if they do this there is a risk of injury to people and/or explosion. 31/03/2010 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 1 The information given to people should state how the home provides choice to residents at mealtimes, the homes full processes for supporting people who wish to self-medicate and the numbers and skill mix of staff on during the 24 hour period. Page 37 of 40 Care Homes for Older People 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 2 3 4 5 1 3 3 7 The service users guide should be dated and signed by a registered person. Pre-admission assessments should state the reason why residents need to wear spectacles. Pre-admission assessments should state who the information was obtained from. Where people have care plans directing the frequency of such activities of daily living as needs for changes of position or supports in going to the toilet, there should be records in place to evidence that staff are meeting the residents needs in accordance with care plans. Where a resident needs to use an incontience aid, the type of aid should always be documented. The home should develop a lead nurse and key worker system. Care assistants should be supported in documenting actions taken to meet residents needs and observations about residents conditions, to avoid records relating to nursing and care being documented by third parties. Care plans relating to supra-pubic catheters should state the frequency and method of cleaning the stoma site. Care plans relating to the use of conveen appliances should state how the aid is to be applied to ensure comfort for the resident and prevent risk. Care plans relating to diabetes should state the persons blood sugar levels aimed for in a measurable manner and direct actions to be taken if the persons blood sugar levels fall outside these parameters. Where a persons blood sugar levels fall outside parameters, a record of actions taken by staff to support the resident should always be made. The homes homely medicines policy should be up-dated. Where a person is prescribed medicines which can affect their daily lives such as painkillers, their care plan should state the medicines prescribed so that the effect of the medicine for the person can be evaluated reguarly. The benefits and levels of participation in activities by in individuals should be documented and used in future care Page 38 of 40 6 7 8 7 7 7 9 10 8 8 11 8 12 13 9 9 14 12 Care Homes for Older People 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 planning processes in relation to activities. 15 12 The provider should survey relevant persons in relation to activities provision and develop an action plan to detail how residents may be further supported in this area. The actual menu choices should be displayed and made freely available in writing to residents. The home should develop a documentary system for informal concerns and complaints and show actions taken to address the matters raised. A survey of the homes carpets should take place and any which show staining be cleaned or replaced. Residents should be provided with their own hoist slings, which are named for them. Used laundry should be separated at source, not in the laundry. If a person has issues identified on their CRB return, a written risk assessment should always be completed. Where there are specific acceptable reasons for not following the homes recruitment procedures, the reasons should be documented in writing. All extended training in skills such as stoma care and application of conveen appliances should be documented. Records relating to the servicing of hoists and checks on shower heads for lime scale should be more detailed, listing each item, when it was last maintained and any matters identified. The home should develop individual fire evacuation care plans for residents. Risk assessments for the use of bed rails should take into account advice from the Health and Safety Executive. 16 17 15 16 18 19 20 21 22 19 26 26 29 29 23 24 30 38 25 26 38 38 Care Homes for Older People Page 39 of 40 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. 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