Care Home: Birchlands Care Home

Similar services:

• Abbey The
• Snydale Care Home
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well People answered `always` or `usually` when we asked them in their surveys `Do you receive the care and support that you need?`, and `Do the staff listen and act on what you say?`. Everyone agreed that they always get the medical support that they need. Health and social care professionals who returned their surveys said the home `always` or `usually` properly monitors and reviews people`s needs, and meets them, and that they seek advice . One commented `Dedicated staff. Know their patients well. Good level of individual care`. Staff have begun to make people`s care plans more individual. This makes it easier to identify people`s personal needs, and choices about how they like to receive their care. Those staff who returned their surveys said the way they share information `usually` works well, although we did receive comments that the time they have to hand over information between shifts could be improved. Staff spoken with on the day were thinking in quite a person centred way when asked about people`s daily lives and choices. These staff said they had time to read the care plans, and that they received a good handover, so they were told when people`s care had changed. We observed how staff spoke to people. Both care staff and nursing staff showed people respect. We spent some time looking at people`s care plans in relation to how staff manage the care for people with skin or pressure damage. There was evidence to show that, where people have pain associated with skin damage, staff have thought about this when writing the plan, and when caring for the person. We could see for one person that prescribed medication had been given to ease the pain the person experienced. The daily records for someone recorded that they were experiencing no pain related to their skin damage. This shows that staff were remembering to monitor this. On the day we visited, staff had made sure that people with pressure damage, or at risk from developing this, were seated on a pressure relieving cushion, and their bed was supplied with a pressure relieving mattress which was inflated and ready for use, should the person be tired and wish to lie on their bed. There were a number of entries in care plans which showed that people`s family had been informed if they have become ill, or have been admitted to hospital. We spoke to staff and the manager, and they told us that it is the practice of the home that people are escorted to hospital by a staff member, or a family member. One file explained how the family had been contacted, so they could be present when the person arrived at the hospital. People in their surveys had mixed views about the activities, although this is an area which the home is trying to improve upon. One person commented `The activities are good for everyone`. Someone else said `Good activity`. Although we did receive some comments that people would like to go out more. We were told that this is planned for better weather. The manager said in the information provided before the site visit that `The high dependency and poorly condition of our residents means that so much of the staff`s time is taken up with the job of giving physical and nursing care, leaving little time for social interaction with other residents`. However, there is now an activities person employed at the home. Her input will help to make people`s social lives more interesting. We spent time on each of the units watching the general activity there. The activities person spent some considerable time chatting with people, sharing photographs, andreminiscing about recent events at the home, which included a St Patrick`s Day celebration, and a baking session. She also took time to ask people what other events they may like to take part in. The manager told us that the activities person is now compiling a memory diary for each person living there. We also observed staff sitting with people and enjoying some light hearted banter, which was enjoyed by all. This made the atmosphere feel cheery and welcoming. One person said they liked living at the home, and that the staff were always nice to them. People`s clothes looked well cared for, and the laundry appeared reasonably organised. One person said they `sometimes` liked the meals at the home. The remainder who returned their surveys said this was `always` or `usually` the case. Someone commented `The food is good in the home`. We observed a mealtime. There were sufficient staff to spend time with people individually, so they could assist with their meal in an unhurried way. We saw that two people were assisted with their meal using a dessert spoon. However, this was done at a slow pace, and the staff member explained later why this was used, as opposed to a smaller spoon. Staff were quick to assist people who needed help, who struggled with their meal, or where they believed they could be at risk from choking. We spoke to staff working in the afternoon, who said they had been told about the people who did not eat their meal, so this could be monitored. People who needed to have their meal liquidised were served this in separate portions, which means they can still enjoy different textures and tastes. And the cook told us that these people get a choice of menu, as do those who enjoy a `normal` diet. In between meals, people were offered drinks, to help stop them from becoming thirsty. The cook told us that all meals are enriched with extra calories, to help people maintain a healthy weight. They use full fat milk, cream and extra cheese to fortify meals in order to achieve this. People who returned their surveys all agreed that there was someone they could speak to informally if they were not happy. They also knew how to make a formal complaint. Three out of four health and social care professionals said that the home had `always` responded well if they had raised any concerns. The fourth said this was `usually` the case. We looked at the record of complaints kept by the manager, since April 2009. There were thirteen complaints, some of which the manager had made to other organisations on behalf of people who live at the home. The complaints recorded had been acted upon, to help stop the same issue from arising again. And there was some evidence that the complainant had been informed about the outcome of the investigation into their concerns. People in their surveys said staff are `always` or `usually` available when they need them, and that they listen and act on what they What the care home could do better: Some of the care plans we looked at were not set out logically. There were discontinued care plans mixed with current ones. The manager identified this herself on the day, when we told her about one of the care plans we had looked at. She took steps straight away to review this care plan, so current needs would be easier to identify. This included the introduction of a short term care plan where the person`s health had deteriorated. Clear instructions had been given for staff to follow, by the doctor. However, a short term care plan to alert staff had not been written. This increases the risk of important information getting lost. We looked at some care plans in relation to the management of pressure damage to the skin. There was, in some cases, a care plan to show what treatment should be followed when someone had already developed a pressure sore. However, this was not always clear, so it was difficult to tell whether the sore still existed, and what treatment was being given. For instance, one member of staff had recorded that someone had sore skin, and added `Applied lots of cream`. This does not give enough information about what cream has been applied. We asked a nurse in the case of one person, whether a pressure sore still existed. They were unable to tell from looking at the records. They checked the person concerned and confirmed the wound was healed. We asked another bank nurse whether they were aware that a person had a pressure sore. They had not been informed about this, but regular staff said this was still a problem. The records were contradictory and suggested this person had been referred to the tissue viability nurse, but we were unsure as to whether this information was correct, as there was no information in the daily records about the wound. In only one case did we see a wound assessment chart, which gives a good indication as to how the wound is progressing. It is good practice for this to be completed in all cases, so staff, who may not have seen the wound for some time, are alerted if the treatment is proving unsuccessful. Missing from each of the care plans looked at was information for staff to follow about what steps they needed to take to prevent pressure sores from happening, especially where people have been identified as being at risk. Having this sort of information inplace helps staff to work in a more proactive way, and should be introduced into the care plan where relevant. We asked a nurse at what stage they would refer someone to the specialist community nurse. This person is called the tissue viability nurse. The notifications we have received over the past year show that often a referral is made via the doctor, although the manager told us that the home is able to make referrals direct to the tissue viability nurse. The nurse we spoke with told us they would make a referral if the person`s skin has broken down. A clear protocol needs to be agreed so staff are clear about what stage they need to make a referral, and whether this should be to the doctor, or to the specialist community nurse. We were told that staff have not received training in tissue viability. The manager is looking into this, and we strongly recommend that key members of staff, including care staff, are given training in the prevention and management of pressure sores.The manager said a community matron is now available to give advice, and the home intends to use this resource in the future. The manager told us that it is now the protocol that the Primary Care Trust will no longer provide pressure relieving equipment to a service such as Birchlands. So the company now has to provide their own for people. This must be given serious consideration in future admissions to the home, when deciding whether or not the home has the resources to maintain people`s skin condition, before they are admitted there. The manager said will always be considered. People have a completed nutritional risk assessment, although in one case this was missing. Because of this person`s health, it should have been completed. The nutritional assessment is reviewed regularly by staff. The tool advises staff at which point they need to seek advice from the dietitian. Instead, it appears staff have referred to the doctor for advice. The manager said that staff are able to refer direct to the dietitian, although the nurse we spoke with said it is the decision of the doctor as to who needs to be referred. Again, clear protocol needs to be agreed. And all care plans need to include this assessment, how risk to the person will be monitored, and by whom, so staff are following the policy of the company, and seeking nutritional advice and support consistently and correctly. People prescribed supplement drinks keep these in their room. It is the policy that staff sign the medication chart to show when these have been provided. We looked at the medication charts for these people, which had not been signed to confirm the drinks had been offe Random inspection report Care homes for older people Name: Address: Birchlands Care Home Moor Lane Haxby York YO32 2PH two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anne Prankitt Date: 2 2 0 3 2 0 1 0 Information about the care home Name of care home: Address: Birchlands Care Home Moor Lane Haxby York YO32 2PH 01904760100 01904765050 birchlands@mimosahealthcare.com www.mimosahealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Judith Cumiskey Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mimosa Healthcare (No4) Limited care home 54 Number of places (if applicable): Under 65 Over 65 54 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 54 The registered person may provide the followig category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Mimosa Healthcare Limited owns Birchlands. It is a purpose built, three storey home providing nursing care for up to 54 people and is situated in Haxby, close to a variety of shops and amenities. The home currently uses the second floor to provide transitional care for up to nine people following discharge from hospital and before Care Homes for Older People Page 2 of 14 Brief description of the care home being permanently placed in a home. City of York Council makes placements to this unit. Information about the range of fees charged, and what people pay extra for, can be obtained by contacting the manager of this service. The home provides people with a brochure and service users guide that gives them information about what services it provides. The inspection report is also available at the home for those who wish to see it. Care Homes for Older People Page 3 of 14 What we found: This is a report of the findings of a random unannounced inspection, which took place on 22 March 2010. This inspection included a visit to the service, after a concern was raised about whether certain areas of care were properly managed. This included: How staff manage skin damage, and whether professional advice is sought in a timely way. What staff do to make sure people get pain relief when they need it. Whether people get the right support when they are admitted from the home to hospital. Whether people are offered varied meals, whether they enjoy pleasant mealtimes, and whether they get sufficient drinks. How staff communicate with each other, whether there are enough of them to meet peoples needs in a timely and consistent way. And whether staff are well supported by the management systems there. Whether people and their family are listened to, and their concerns acted upon. To obtain evidence, we: Looked at the Annual Quality Assurance Assessment (AQAA) completed by the registered manager for the home. The AQAA is a self assessment that tells us how the manager believes the home is achieving good outcomes for people. It also gives us some numerical information. Looked at returned surveys completed by seven people who live at the service, four staff and five health and social care professionals. Spent time on each of the floor observing the general activity. Carried out a short observation over the lunch period, to see what sort of attention and support staff gave to people during their mealtime. Looked at the record of complaints and safeguarding referrals kept at the home, to see how well the manager had responded to these. Spoke to people, staff and the manager. As part of this visit, we also considered one requirement and three recommendations made at the last key inspection which took place on 2 June 2008. These were around making sure enough staff are available to meet peoples needs, and also about making the care plans easier to follow and more individual. One inspector completed the site visit in seven hours, and the registered manager was provided with feedback about what we found at the end. Care Homes for Older People Page 4 of 14 What the care home does well: People answered always or usually when we asked them in their surveys Do you receive the care and support that you need?, and Do the staff listen and act on what you say?. Everyone agreed that they always get the medical support that they need. Health and social care professionals who returned their surveys said the home always or usually properly monitors and reviews peoples needs, and meets them, and that they seek advice . One commented Dedicated staff. Know their patients well. Good level of individual care. Staff have begun to make peoples care plans more individual. This makes it easier to identify peoples personal needs, and choices about how they like to receive their care. Those staff who returned their surveys said the way they share information usually works well, although we did receive comments that the time they have to hand over information between shifts could be improved. Staff spoken with on the day were thinking in quite a person centred way when asked about peoples daily lives and choices. These staff said they had time to read the care plans, and that they received a good handover, so they were told when peoples care had changed. We observed how staff spoke to people. Both care staff and nursing staff showed people respect. We spent some time looking at peoples care plans in relation to how staff manage the care for people with skin or pressure damage. There was evidence to show that, where people have pain associated with skin damage, staff have thought about this when writing the plan, and when caring for the person. We could see for one person that prescribed medication had been given to ease the pain the person experienced. The daily records for someone recorded that they were experiencing no pain related to their skin damage. This shows that staff were remembering to monitor this. On the day we visited, staff had made sure that people with pressure damage, or at risk from developing this, were seated on a pressure relieving cushion, and their bed was supplied with a pressure relieving mattress which was inflated and ready for use, should the person be tired and wish to lie on their bed. There were a number of entries in care plans which showed that peoples family had been informed if they have become ill, or have been admitted to hospital. We spoke to staff and the manager, and they told us that it is the practice of the home that people are escorted to hospital by a staff member, or a family member. One file explained how the family had been contacted, so they could be present when the person arrived at the hospital. People in their surveys had mixed views about the activities, although this is an area which the home is trying to improve upon. One person commented The activities are good for everyone. Someone else said Good activity. Although we did receive some comments that people would like to go out more. We were told that this is planned for better weather. The manager said in the information provided before the site visit that The high dependency and poorly condition of our residents means that so much of the staffs time is taken up with the job of giving physical and nursing care, leaving little time for social interaction with other residents. However, there is now an activities person employed at the home. Her input will help to make peoples social lives more interesting. We spent time on each of the units watching the general activity there. The activities person spent some considerable time chatting with people, sharing photographs, and Care Homes for Older People Page 5 of 14 reminiscing about recent events at the home, which included a St Patricks Day celebration, and a baking session. She also took time to ask people what other events they may like to take part in. The manager told us that the activities person is now compiling a memory diary for each person living there. We also observed staff sitting with people and enjoying some light hearted banter, which was enjoyed by all. This made the atmosphere feel cheery and welcoming. One person said they liked living at the home, and that the staff were always nice to them. Peoples clothes looked well cared for, and the laundry appeared reasonably organised. One person said they sometimes liked the meals at the home. The remainder who returned their surveys said this was always or usually the case. Someone commented The food is good in the home. We observed a mealtime. There were sufficient staff to spend time with people individually, so they could assist with their meal in an unhurried way. We saw that two people were assisted with their meal using a dessert spoon. However, this was done at a slow pace, and the staff member explained later why this was used, as opposed to a smaller spoon. Staff were quick to assist people who needed help, who struggled with their meal, or where they believed they could be at risk from choking. We spoke to staff working in the afternoon, who said they had been told about the people who did not eat their meal, so this could be monitored. People who needed to have their meal liquidised were served this in separate portions, which means they can still enjoy different textures and tastes. And the cook told us that these people get a choice of menu, as do those who enjoy a normal diet. In between meals, people were offered drinks, to help stop them from becoming thirsty. The cook told us that all meals are enriched with extra calories, to help people maintain a healthy weight. They use full fat milk, cream and extra cheese to fortify meals in order to achieve this. People who returned their surveys all agreed that there was someone they could speak to informally if they were not happy. They also knew how to make a formal complaint. Three out of four health and social care professionals said that the home had always responded well if they had raised any concerns. The fourth said this was usually the case. We looked at the record of complaints kept by the manager, since April 2009. There were thirteen complaints, some of which the manager had made to other organisations on behalf of people who live at the home. The complaints recorded had been acted upon, to help stop the same issue from arising again. And there was some evidence that the complainant had been informed about the outcome of the investigation into their concerns. People in their surveys said staff are always or usually available when they need them, and that they listen and act on what they say. When asked what the home does well, they made comments like Friendly staff, and All aspects of care and support. Staff replied in their surveys that there were usually or sometimes enough staff. However, those staff spoken with on the day agreed that there were enough of them, and that they usually worked on the same unit, so they could get to know people well. They said that the manager always tried to cover staff shortages when they arose, even at short notice. We did receive a comment that staff morale was low, although on the day, the staff we spoke with were happy with their working conditions, and the support of the manager. We also received a concern about whether staff had enough time to rest, if they had to work days and nights in the same week. We spoke to the staff and the manager on the day. They said working days and nights in the same week happens very rarely, and all agreed they had sufficient rest time inbetween. We asked the manager about the previous requirement we made at our last key inspection, when the home was asked to Care Homes for Older People Page 6 of 14 make sure that staffing levels were adequate at all times, so people got consistent care from staff who know them well. The manager said whilst there were no more staff, they were now better organised. She also told us that she has permission from the company to have extra staff on duty if someone living there needs extra support. The manager has thought about how she can make all staff groups feel more included in decisions about the home. For instance, she had arranged a night staff meeting to take place at a time of their choice, so that more staff could attend. She is also taking recurrent staff sickness more seriously, so this can be better monitored. This will help to support those staff who work regular extra shifts, so they too get a good rest. We spoke to the manager about moving and handling training for staff. Although new staff have to wait for the next moving and handling course before they receive formal training, the manager said basic training was provided in their induction, and she said that no one works alone. A new staff member confirmed that this was the case. Staff spoke with all said they found the manager to be very approachable and accommodating. This will help to make sure they have someone to go to if they have any problems with their work. Professionals who were able to comment said staff always or usually had the right skills and experience to support peoples social and health care needs. What they could do better: Some of the care plans we looked at were not set out logically. There were discontinued care plans mixed with current ones. The manager identified this herself on the day, when we told her about one of the care plans we had looked at. She took steps straight away to review this care plan, so current needs would be easier to identify. This included the introduction of a short term care plan where the persons health had deteriorated. Clear instructions had been given for staff to follow, by the doctor. However, a short term care plan to alert staff had not been written. This increases the risk of important information getting lost. We looked at some care plans in relation to the management of pressure damage to the skin. There was, in some cases, a care plan to show what treatment should be followed when someone had already developed a pressure sore. However, this was not always clear, so it was difficult to tell whether the sore still existed, and what treatment was being given. For instance, one member of staff had recorded that someone had sore skin, and added Applied lots of cream. This does not give enough information about what cream has been applied. We asked a nurse in the case of one person, whether a pressure sore still existed. They were unable to tell from looking at the records. They checked the person concerned and confirmed the wound was healed. We asked another bank nurse whether they were aware that a person had a pressure sore. They had not been informed about this, but regular staff said this was still a problem. The records were contradictory and suggested this person had been referred to the tissue viability nurse, but we were unsure as to whether this information was correct, as there was no information in the daily records about the wound. In only one case did we see a wound assessment chart, which gives a good indication as to how the wound is progressing. It is good practice for this to be completed in all cases, so staff, who may not have seen the wound for some time, are alerted if the treatment is proving unsuccessful. Missing from each of the care plans looked at was information for staff to follow about what steps they needed to take to prevent pressure sores from happening, especially where people have been identified as being at risk. Having this sort of information in Care Homes for Older People Page 7 of 14 place helps staff to work in a more proactive way, and should be introduced into the care plan where relevant. We asked a nurse at what stage they would refer someone to the specialist community nurse. This person is called the tissue viability nurse. The notifications we have received over the past year show that often a referral is made via the doctor, although the manager told us that the home is able to make referrals direct to the tissue viability nurse. The nurse we spoke with told us they would make a referral if the persons skin has broken down. A clear protocol needs to be agreed so staff are clear about what stage they need to make a referral, and whether this should be to the doctor, or to the specialist community nurse. We were told that staff have not received training in tissue viability. The manager is looking into this, and we strongly recommend that key members of staff, including care staff, are given training in the prevention and management of pressure sores.The manager said a community matron is now available to give advice, and the home intends to use this resource in the future. The manager told us that it is now the protocol that the Primary Care Trust will no longer provide pressure relieving equipment to a service such as Birchlands. So the company now has to provide their own for people. This must be given serious consideration in future admissions to the home, when deciding whether or not the home has the resources to maintain peoples skin condition, before they are admitted there. The manager said will always be considered. People have a completed nutritional risk assessment, although in one case this was missing. Because of this persons health, it should have been completed. The nutritional assessment is reviewed regularly by staff. The tool advises staff at which point they need to seek advice from the dietitian. Instead, it appears staff have referred to the doctor for advice. The manager said that staff are able to refer direct to the dietitian, although the nurse we spoke with said it is the decision of the doctor as to who needs to be referred. Again, clear protocol needs to be agreed. And all care plans need to include this assessment, how risk to the person will be monitored, and by whom, so staff are following the policy of the company, and seeking nutritional advice and support consistently and correctly. People prescribed supplement drinks keep these in their room. It is the policy that staff sign the medication chart to show when these have been provided. We looked at the medication charts for these people, which had not been signed to confirm the drinks had been offered the day we visited. We spoke to staff, which confirmed that only a small number of those prescribed the drinks had received them on the day. Staff had to ask each other whether they had been given. One persons medication record from the previous month showed that they had only received them regularly. Their fluid chart also confirmed this. We spoke to the nurse, who said that this person did not really like the drinks, and preferred water. This is the sort of information that needs to be fed back to the doctor, so the persons nutritional health can be monitored by them, and an alternative drink, which the person likes, prescribed. A better system also needs to be organised so these drinks are not forgotten. Information about how often they should be given also needs to be made clearer on the medication charts. Some said as directed. One staff member though this meant three times a day. This needs to be checked with the doctor who has prescribed the drinks, added to the medication charts, and detailed in the persons care plan, so people get the drinks they are prescribed in the correct quantity. Care Homes for Older People Page 8 of 14 For some people, staff complete a chart to monitor how much fluid they take each day. The amount that one persons care pan said they should be drinking each day was not always being reached by them. However, there was no evidence that this had been referred to their doctor for advice. People do not have drinks, other than drink supplements, in their room. Nor were there any drinks in the communal areas for people should they get thirsty. The manager said a number of people are unable to take drinks without special thickener added, to aid swallowing. She said therefore that this could be problematic. However, thought could be given to ways in which drinks could be made more accessible for people. We observed that someones medication had been left on the office desk on one of the units unattended. This poses risk to people living on the unit, who may enter the room and have access to it. The nurse returned to the room and locked them away. The mealtime was pleasant, but there were areas where improvements could have been made. For instance, there were no napkins on the table, and we saw someone try to wipe their mouth with their plastic apron, until a staff member came and helped them with their hygiene. Neither were there any cruets on the table, for people to flavour their meal as they wished. Peoples plate guards were the wrong way round. This meant that they were of no use, and the risk of the persons meal dropping onto their clothes was as great as if the guard had not been fitted. This does not help to protect peoples dignity. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 14 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 Care plans relating to the 30/04/2010 treatment of pressure sores must be clear and kept up to date, to record current treatment, and condition of the skin. This is so that anyone reading the plan has a clear indication as to how the wound is progressing, and what treatment has been prescribed. 2 8 15 Preventative care plans must 30/04/2010 be completed where people have been identified as being at risk from developing pressure damage. This is so staff know what action they must take to maintain good skin condition, and what to do if problems occur. 3 9 13 As stated at the time of the 01/04/2010 site visit, peoples medication must be kept safely locked away, and must never be left unattended. Page 11 of 14 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to reduce risk to people who may access it, from potential harm. 4 9 12 People prescribed supplement drinks must be offered these as directed by their doctor or dietitian. Where these are not being taken as prescribed, further advice must be sought. This is so peoples nutritional health can be maintained. 5 30 17 Training in the prevention 31/05/2010 and management of pressure damage must be organised for key members of staff. This is so they have up to date information and knowledge about the management of pressure damage. 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 30/04/2010 1 7 Care should be taken to make sure that care plans are set out so relevant information is easy to follow, so staff know what current care needs people have. This will assist them to act consistently when providing day to day care. Short term care plans should be completed where instructions have been given by the persons doctor, about what signs staff must look out for which would alert them to ask for further advice from the relevant professional. This will help to make sure that the correct action is taken Care Homes for Older People Page 12 of 14 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 quickly to maintain the persons health. 2 8 A clear protocol should be developed between the home and appropriate health professionals, so it is clear about who to staff are to report to for advice about pressure damage, and nutritional issues. This is so staff are clear about at what stage they should make a referral, and to whom. Thought should be given as to whether it would be possible to safely make drinks more accessible to people in their own rooms, and in the communal areas. People should have napkins and cruets at their dining table wherever this is appropriate, so they can be independent in managing their own hygiene, and also flavour their meal to their taste. 3 15 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!