Care Home: Greengates

What the care home does well People are assessed before being offered a service so they can be assured that their needs will be met. People have a varied range of traditional, home cooked food. People have regular access to health care services which enables their health care needs to be met. A clear record of all medical intervention people receive is maintained. Visitors are encouraged and hospitality is evident. People benefit from a good standard of cleanliness within the home. People have easy access to their call bell within their bedroom. A clear, robust recruitment procedure is in place. Clear systems are in place to test and service equipment such as portable electrical appliances and the fire alarm systems. The service readily informs us of any incident which adversely affects a person`s well being. What has improved since the last inspection? People have their risk of developing a pressure sore assessed so that measures to minimise any risk can be taken. Following an incident which adversely affects a person`s well being, immediate or non urgent medical assistance is sought. Medicines which are to be administered by specialist means have been authorised by the person`s GP. Records are in place to demonstrate this. New chairs, carpets and curtains for various areas of the home have been purchased. The dining room has been redecorated and the carpet and furniture replaced. Manual handling training by an external training provider has been arranged to ensure staff members have the knowledge and skills to move people safely. What the care home could do better: Care plans should be reviewed so that key information about people is easily accessible. All information should be clear and easy to read to ensure staff have accurate information to support people effectively. Any care charts used to monitor aspects such as a person`s food and fluid intake and bowel management must be fully completed and evaluated. Staff must ensure that they use clear, specific and factual information when recording entries within a person`s daily record. Consideration should be given as to how staff could work in a more person centred way. Interactions with people could be improved upon. While social activity is arranged, consideration should be given to how this is targeted to people`s individual needs. Staff must ensure that they sign the medicine administration record when they have given medicines to people. Staff must ensure that identification labels are not removed from any topical creams. Staffing levels and staff practice at mealtimes must be reviewed so that people receive individual support to eat their meal without interruption. An on going programme of staff training in dementia care by an external provider must be devised and implemented so that staff have the knowledge and skills to support people effectively. Staff must ensure that they move people safely in accordance with current manual handling procedures. A review of the high number of falls within the home must be undertaken. Measures must be put in place to minimise further occurrences. Key inspection report Care homes for older people Name: Address: Greengates Redland Lane Westbury Wilshire BA13 3QA     The quality rating for this care home is:   one star adequate 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: Alison Duffy     Date: 1 7 1 2 2 0 0 9 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 42 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 42 Information about the care home Name of care home: Address: Greengates Redland Lane Westbury Wilshire BA13 3QA 01373822727 01373822727 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Greengates Care Home Limited Name of registered manager (if applicable) Mr Chong Siam Yeoh Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Greengates is situated in a residential area of Westbury. The original property has been extended on several occasions. The home is built around a central patio area, which may be accessed directly from the communal lounges. The majority of peoples bedrooms are on the ground floor. Many look onto the central courtyard. Seven bedrooms are located on the first floor. The home is registered to provide care for up to 54 people. Around half of these places are in shared rooms. The home has some on site and street car parking. The town centre and its railway station are about fifteen minutes walk from the home. There is a bus stop at the end of the road. The fax Care Homes for Older People Page 4 of 42 Over 65 0 0 51 51 3 0 0 6 0 8 2 0 0 9 Brief description of the care home number as indicated above is incorrect. The correct number is 01373 822727. Care Homes for Older People Page 5 of 42 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: one star adequate 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: Before visiting Greengates, we sent the home an Annual Quality Assurance Assessment (AQAA) to complete. The AQAA is the homes own assessment of how they are performing. The AQAA tells us about what has happened during the last year and about the homes plans for the future. We sent surveys, for people to complete if they wanted to. We also sent the home surveys to be distributed to staff and health/social care professionals. This enabled us to get peoples views about their experiences of the home. We received surveys from five people using the service, two members of staff and two health/social care professionals. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home. This visit took place on the 15th and 17th December 2009. Mr and Care Homes for Older People Page 6 of 42 Mrs Yeoh were available throughout and received feedback at the end. During our visit, we toured the accommodation and met with people who use the service. Due to some peoples communication needs, we were not able to gain detailed verbal feedback about the service they received. We spoke to staff members on duty and observed how they interacted with people. We saw people having lunch. We looked at care-planning information, staff training records and recruitment documentation. We also looked at documentation in relation to health and safety and complaints. The last key inspection of this service took place on 5th March 2008. There have been three random inspections in relation to safeguarding referrals. These took place on the 29th October 2008, 10th December 2008 and the 6th August 2009. The inspection on the 10th December 2008 was undertaken by our pharmacy inspector. An Annual Service Review was undertaken in March 2009. All key standards were assessed on this inspection. Observation, discussions and viewing of documentation gave evidence, which showed whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Care Homes for Older People Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should be reviewed so that key information about people is easily accessible. All information should be clear and easy to read to ensure staff have accurate information to support people effectively. Any care charts used to monitor aspects such as a persons food and fluid intake and Care Homes for Older People Page 8 of 42 bowel management must be fully completed and evaluated. Staff must ensure that they use clear, specific and factual information when recording entries within a persons daily record. Consideration should be given as to how staff could work in a more person centred way. Interactions with people could be improved upon. While social activity is arranged, consideration should be given to how this is targeted to peoples individual needs. Staff must ensure that they sign the medicine administration record when they have given medicines to people. Staff must ensure that identification labels are not removed from any topical creams. Staffing levels and staff practice at mealtimes must be reviewed so that people receive individual support to eat their meal without interruption. An on going programme of staff training in dementia care by an external provider must be devised and implemented so that staff have the knowledge and skills to support people effectively. Staff must ensure that they move people safely in accordance with current manual handling procedures. A review of the high number of falls within the home must be undertaken. Measures must be put in place to minimise further occurrences. 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. 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 9 of 42 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 10 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before being offered a service, so are assured that their needs will be met within the home. However, the quality of the assessments could be improved upon in order to give staff more information about the person. Evidence: A staff member told us that Mr Yeoh would always assess new people before they were offered a placement at Greengates. They said that Mr Yeoh would visit people in their own home or in an environment such as a hospital or another care home. They said he would also liaise with peoples families and others such as the persons care manager, GP or their Community Psychiatric Nurse. The staff member said this enabled Mr Yeoh to gain as much information about the person as possible to ensure the home was suitable for them. The staff member told us that Mr Yeoh would then tell the staff team of the persons needs and the support they required. We saw within the AQAA that religious or cultural dietary needs were catered for as agreed on admission and recorded in the care plan. Within their survey, one health/social care Care Homes for Older People Page 11 of 42 Evidence: professional said that the services assessment arrangements always ensured that accurate information was gathered and the right service was planned for people. They said the one person I have placed at Greengates feels very much at home. Another health/social care professional said the service usually ensured that accurate information was gathered. We looked at the assessment documentation of two new people to the service. We saw that the assessment format contained basic information about peoples needs. For example, one persons physical health was described as fair yet it was not clear what this meant in practice. Independent with supervision was documented in relation to the assessment of the persons ability to manage their personal care routines. This did not give staff specific information about what the person could do independently and the actual support they needed. There was a section within the assessment format which highlighted social interest and hobbies. This had not been completed. The persons spiritual needs were not identified. We saw that peoples preferred times of going to bed and getting up were stated. There was also a settling in care plan. This showed how the person was to be supported during their transition process. The assessment continued with a personal description of the person. The format of the description gave a number of terms, which could be circled, in order to describe the person. These included wandering, cooperative, resistive, repetitive, confused and hostile. We advised that the terms be reviewed as they all portrayed negativity and were subjective without the context of a situation. We said that people were at risk of being labelled and discriminated against rather than having their strengths recognised. We saw that the assessments highlighted the need to inform health care professionals of specific health care needs. There was also written confirmation from Mr Yeoh that the home could meet the persons needs. Within their surveys, two people with staff support told us that they received enough information about the home to help them decide if it was the right place for them, before they moved in. Mr Yeoh told us that people and/or their families were always encouraged to visit the home before making a decision. Mr Yeoh also told us that an assessment from the persons care manager and information from other stakeholders such as their GP, family members and formal carers would be gained, as part of the assessment process. Mr Yeoh told us that people were given written information such as the Service Users Guide to help them come to a decision about using the home. Care Homes for Older People Page 12 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans would benefit from being more person centred and easier to follow in order to ensure peoples needs are fully met. People have good access to health care provision. People are at risk through staff not consistently following procedures when administering peoples medicines. Evidence: The AQAA stated the service users health, personal, social care needs are set out in their individual care plans. The individual care plans are reviewed regularly, at least once a month, taking into consideration all aspects of care needs including physical, mental, personal, social, spiritual, cultural and emotional care needs. As most of our service users are unable to understand or speak for themselves, we usually involve the relative/advocate or representative, if we can. We looked at three care plans in detail. Peoples family members had been asked to review the plan and add any further information. We saw that each plan contained a high level of documentation yet the format made finding key information difficult. The plans were generally written in handwriting that was not easy to read. We saw that Care Homes for Older People Page 13 of 42 Evidence: peoples needs were identified yet the information was not always specific. Within one plan for example, in relation to confusion, it was stated encourage independence but assist if necessary, staff to be patient and remain helpful, maintain stimulation and engage in activities. Within another plan, in relation to continence needs, it stated wears incontinence pads day and night, one carer to assist, make sure s/he is toileted from time to time. We advised that specific step by step information be written within care plans to ensure that staff were aware of the exact support people needed. This also applied to the management of specialised care issues such as a colostomy and specific health care conditions, such as depression. As good practice we saw that it was identified in one persons care plan that they were to receive pain relief before the District Nurse visited them. Some interventions detailed within care plans initially started with ensure all staff are aware. Removing this terminology was recommended at a previous inspection. We asked staff how they were informed about peoples needs. They said that they had generally worked with people for a long time and therefore knew them well. They said they read the care plans and were regularly given information from Mr Yeoh. Within their survey, one member of staff told us that they were always given up to date information about people they supported. Another staff member told us they were usually given up to date information. They said personal care, hygiene of each service user were things the home did well. As a means to develop care plans, we advised them to be more person centred. We said peoples strengths and aspirations should be addressed in order to enhance peoples quality of life. We said that work in relation to peoples previous lives should be taken into consideration as part of care plans. Mr Yeoh told us that this work was being done. He said that staff talked to people about their earlier life and their interests. He said staff members also talked to family members regarding any information they wanted to share about the person. We saw that the care plans were regularly reviewed on a monthly basis. People had their risk of developing a pressure sore assessed. There were also assessments about manual handling, nutrition and the risk of falling. We saw that one person did not have a drink or anything to eat within the period of mid morning and late afternoon. Staff told us that s/he often has days like that. They said the person would eat later. There was no evidence within the persons care plan about this or its management. A record of peoples weight was maintained. We saw that one person had lost weight yet their nutritional assessment and care plan had not been reviewed. Within another care plan, a body map showed that a person had a sore and red area on their sacrum yet Care Homes for Older People Page 14 of 42 Evidence: their tissue viability assessment showed no risk. We advised that documentation be reviewed as a whole, in the event of changing need. This was identified at a previous inspection but has not been addressed. We saw that there were records which evidenced peoples bowel management. Not all charts had been consistently completed. We advised that staff fully completed the charts if there was a need for them to be in place. This would ensure accurate monitoring, as detailed within the persons care plan. Within the AQAA, it stated the carers record their observations of the service users every day in the service users Daily Record. We saw this was so yet advised staff should ensure all accounts were factual and person centred. For example, some entries stated went to the toilet and put back to bed, was confused and continued to grizzle most of the night. We also read went to bed carried on shouting yet there was no evidence as to whether staff had established the reason for this or how staff supported the person. The need to use clear, specific, factual information was identified at a previous inspection. Within surveys, two people told us that they always received the care and support they needed. One person said they usually did. Another person said they didnt know. Due to their health care conditions, the people we met were not able to tell us in detail about the care they received. One person told us they do help me. Theyre very nice. Another person told us I like it here. Theyre good to me. We saw that people appeared well groomed and were wearing clothing that was coordinated and well laundered. A health/social care professional told us within their survey, family are very impressed with the care my service user is receiving. Within surveys, health/social care professionals told us that peoples social and health care needs were usually properly monitored, reviewed and met by the service. They said the care home usually sought advice and acted on it to meet peoples needs and improve their wellbeing. They said the home sometimes responded to the diverse needs of individual people. The AQAA stated the service users have access to specialist medical, dental, pharmaceutical, chiropody and therapeutic services and care from hospitals and community health services according to need. Staff told us that people had good support from local GPs and District Nurses. We saw within peoples care plans that a record of all visits and interventions were maintained. Mr Yeoh told us that if there were any concerns about a person, medical assistance would be sought without delay. He said that after a fall for example, a visit from the GP or District Nurse would be requested. Mr Yeoh told us that regular consultation was Care Homes for Older People Page 15 of 42 Evidence: also held with the local Mental Health Team and the Consultant Psychiatrist. The AQAA stated that all medicines in the custody of Greengates are handled according to the requirements of the Medicines Act 1968, guidelines for the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971 and nursing staff abide by the UKCC Standards for the administration of medicines. We saw however that staff were not consistently signing the medicines record to show they had administered peoples medicines. The records also did not give an accurate account of when topical creams had been applied. Staff had countersigned some handwritten instructions of how medicines were to be given yet this had not consistently been undertaken. There were some topical creams within peoples rooms which were not named. The labels had been removed. This was identified as a requirement at the random inspection in December 2008. The requirement has therefore not been met. We previously recommended that any medicine given in a specialist way should be detailed within the persons care plan and agreed with the GP. We saw that this had been addressed. We also required that protocols for as required medicinces be detailed within the persons care plan. Documentation had been devised for this yet further clarity would be of benefit. Following our visit, Mr Yeoh informed us that staff members are being retrained to record the level of agitation that the service user is having and what techniques/therapies have been tried eg. distraction techique etc before deciding to give a PRN sedative. Staff told us that they had received training in the medicine administration system currently used within the home. We advised that further training be undertaken in relation to the safe handling of medicines. We saw that there was a medication error in the early part of last year. Additional training would minimise the risk of further errors. We saw that staff asked people quietly if they wanted to use the bathroom. People were supported with their personal care in the bathroom or their bedroom. As stated earlier, people were well groomed with clean, well cut finger nails, brushed hair and well laundered clothing. This enhanced peoples dignity. However, there were occasions when staff were not attentive to peoples needs. For example, one person was asleep in their chair with their clothes pulled up above their knees. Staff did not immediately address this although one staff member did then cover the person with a blanket. Another person was standing yet reaching towards the floor. Staff did not immediately support the person. These examples did not promote peoples dignity. We saw one person in bed, wearing a hospital gown. Mr Yeoh was not aware of the reason Care Homes for Older People Page 16 of 42 Evidence: for this but said that sometimes people come back from hospital with hospital property. Within their survey, health/social care professionals told us that the service usually respected peoples privacy and dignity. Care Homes for Older People Page 17 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to join in with arranged social activity provision yet a more person centred approach would be of benefit to individuals. Visitors are welcomed at any time so people are able to maintain contact with their family and friends. People enjoy the meals provided yet more staff are needed to support people effectively. Evidence: A staff member told us that a hairdresser visited on a weekly basis. People were also able to use a hairdresser of their choice, if they wanted to. They said that a Church service and Holy Communion were regularly held in the home. The staff member told us that some people liked to watch the Sunday services on television. They said people were also encouraged to maintain contact with their minister through additional arranged visits to the home. Staff members told us that peoples families and friends were welcome to visit at any time. They said some people chose to have a meal with their relative when they visited. We saw within care plans that people had a social activity planner in place. The planners we saw showed similar detail. They contained activities such as music Care Homes for Older People Page 18 of 42 Evidence: appreciation, reality orientation, beach ball and balloon games, exercises and arts and crafts. A staff member told us that during the morning an occupational therapist visited to do activities with people. They said they did activities such as chair dance and floor skittles. They would also read to people and bring their dog in for people to see and touch. During our visit, we saw staff members play quoits and skittles with people. Some people were watching the television. A local radio station was playing in the lounge/dining room. Later in the day, staff were singing and clapping to music with people in the lounge. Some of the music involved nursery rhymes. We advised that more age related music, in line with peoples preferences be considered. Mrs Yeoh told us that people appeared to enjoy the musical rhymes and would sing along with them. She said she was aware that the choice of music could be perceived as childlike yet this was what people wanted. Mrs Yeoh told us that lots of events had been arranged in relation to the festive season. These included carol singers, a Christmas party, school children singing and a visiting pantomime. While activities were taking place within the home during our visit, we saw that there were some people who did not join in. These people slept for long periods of time and had very little interaction with others. Staff did not engage well with people in the lounge/dining area and communication was limited. We saw staff assist people to the bathroom or to the dining room table for lunch yet they did not make conversation with people. We did not see staff undertake any one-to-one social activity linked to peoples personal preferences. Mr Yeoh told us that staff always did this. He said it was something the staff were very good at. Mr Yeoh explained that some people enjoyed a foot spa or a manicure. Mrs Yeoh told us that people often went out for a walk with staff. Some outings, further a field were also arranged. Within surveys, people told us that there were always activities within the home that they could join in with. One person told us that activities were an area the home did well. Within surveys, one staff member told us that more activities and days out were things the home could do better. A health/social care professional also agreed. They said more activities and stimulation for the residents would improve the service. They said that the home supported people to live the life they choose. Within surveys, people told us that they liked the meals provided. One person said very nice meals and looked after well. Discussion with people during our visit, confirmed this. One person said the foods very good. Another person said I eat very well here. Staff told us that the menus were developed in accordance with peoples preferences. They said that food was always discussed at a residents meeting. The Care Homes for Older People Page 19 of 42 Evidence: menus showed a range of traditional foods. There was a choice of each meal with traditional items such as shepherds pie or pork meatballs, pork casserole or turkey burgers and fried fish or fish and potato pie shown on the menu for lunch alternatives. At tea time, people either had a hot snack or soup and sandwiches. The snacks included fishcakes, baked beans and bread and butter or scrambled egg and spaghetti hoops. During our visit we saw that lunch was an omlette or fish in parsley sauce with mushrooms, broccoli and mashed potato. The meal was plated according to peoples preference and appeared well cooked and appetizing. Some people had their food liquidized. We saw that all the food had been liquidized together. This looked unappetizing and did not enable people to taste the individual foods. Following our visit, Mr Yeoh informed us that staff were being retrained to use the compartmentalised plates now in place for liquidised food, to ensure that the liquidised food being offered to the service users are kept separately on the plate. We saw that a high number of people needed assistance or prompting to eat their meal. The AQAA confirmed that twenty one people required help, supervision, prompts to eat meals. Staff served those people who ate independently first. They also delivered meals to some people in their bedrooms. The meal was arranged neatly on the tray and was covered appropriately. Staff then supported people needing assistance to eat. There were however insufficient staff to do this. One member of staff supported a person to eat yet regularly got up to prompt another person. Another staff member helped two people at the same time. Some staff were standing at the side of the person rather than sitting down with them. There was little discussion during the meal between staff and people using the service. Some people started their meal but then stopped. Due to supporting others, staff were not able to prompt these people to continue eating. Within feedback, Mr Yeoh told us that if staffing levels were insufficient at mealtimes, he would look at deploying additional staff during these times. Care Homes for Older People Page 20 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to enable people or their representatives to raise any concerns about the service. The high number of falls within the home gives evidence that people are not, at present, safeguarded from harm. Evidence: The AQAA stated our complaints procedure is robust but we are not complacent. We will continue to be vigilant. Within surveys, staff told us that they knew what to do if someone had a concern. During our inspection, staff told us that they would immediately report any concern or complaint or an allegation of abuse to the senior member of staff on duty. They said they would make the person safe and would document any information they had within the persons daily records. We spoke to senior staff about their remit with regard to complaints and allegations. They said they would inform Mr or Mrs Yeoh who would then inform the required people. We asked what would happen if Mr Yeoh was not available. They told us that they would contact the Vulnerable Adults Unit directly. They said the contact numbers they would need were displayed on the notice board. Mr Yeoh told us that all staff had received a copy of the local safeguarding procedures, No Secrets in the last year. We saw that staff had signed to acknowledge their receipt of this information. There was little evidence that staff had received recent safeguarding training. Mr Yeoh told us that this was arranged on an annual basis and Care Homes for Older People Page 21 of 42 Evidence: all staff would have attended. We said that the staff training records must evidence the training in order to ensure all staff had received up to date knowledge in keeping people safe. Mr Yeoh told us that people using the service and their families were given a copy of the homes complaint procedure on admission. We saw there was a complaint file yet there had not been any entries since June 2008. We advised that any concern and its investigation and outcome be documented. This would evidence how complaints were managed. It would also form part of the homes quality assurance in terms of ongoing improvement. Within surveys, people told us that they knew who to speak to if they were not happy. They also said they knew how to make a formal complaint. We have undertaken three random inspections of the service in response to safeguarding alerts, since the last key inspection. As identified later in this report, there have been a high number of falls within the home. Without action to minimise the risk of further occurrences, peoples wellbeing is not safeguarded. Care Homes for Older People Page 22 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was clean, comfortable and well maintained yet people would benefit from greater personalisation of their bedrooms. People were safeguarded from the systems in place to reduce the risk of infection. Evidence: People benefitted from a number of communal areas. These were light, comfortable and well maintained. The external doors of the home were kept locked so that people could walk around safely without leaving the building unsupported. The AQAA stated that over the last twelve months, new chairs, carpets and curtains for various areas of the home had been purchased. The dining room had been redecorated and the carpet replaced. New easy to clean dining room tables had been purchased. The AQAA stated that the fire alarm system had been updated and a large orientation board had been installed in the main lounge. To carry on changing carpets and redecorating throughout the home as and when needed was stated as a planned improvement for the next twelve months. We saw within a bathroom that the room did not have curtains or a blind. Mrs Yeoh explained this was because the room was not overlooked. She said a blind or curtains would be purchased. Within their survey, a health/social care professional told us that nicer bedrooms, i.e. better furniture, cleaner carpets, brighter decoration was something the home could Care Homes for Older People Page 23 of 42 Evidence: do better. A staff member told us that security was something the home did well. Many of the bedrooms within the home were twin rooms. This enabled people to share or use the room as sole occupancy. Mrs Yeoh told us that people, who had lived at the home for a long while, enjoyed sharing whilst new people generally chose to have a room of their own. We saw within the twin rooms that despite only being used by one person, there were two single beds. The second bed was covered only with a counterpane. To make the room appear more personalised we advised that the second bed be removed. Mr Yeoh told us that due to storage limitations, this would not be possible. Mr Yeoh said the spare beds would be used to replace others, so they would be removed in time. We saw that some of the bedrooms were sparse and did not reflect the persons interests or personality. Mr Yeoh told us that he had talked to peoples relatives about making the bedrooms more homely yet little interest had been shown in doing this. Mr Yeoh said however, that he would revisit this again with people and their families. Mr Yeoh told us that when moving into the home, people were encouraged to bring in small items of furniture and personal possessions with them. We saw that people had a personalised picture on their bedroom door to help them with locating their room. Mr Yeoh told us that each person had chosen their own picture. We found that whilst people were not in their room, their bedroom door was locked. A staff member told us that this was to stop some people from aimlessly walking in and out of bedrooms and removing peoples belongings. They said that if a person wanted to go into their room, they would ask a staff member and the room would be unlocked. We advised that this practice be reviewed to enable people to enter their room when they wanted to without asking. We saw that people had easy access to their call bell in order to gain help if needed. Staff told us that there had not been any changes in the decoration of the home. All areas were cleaned to a good standard yet there was an unpleasant odour when entering the home. This was especially pronounced in the morning. Mr Yeoh told us that this was because people needed support with their continence during the night and the rooms had not had time to air. One staff member told us that they cleaned one bedroom carpet on a daily basis to minimise the odour yet this remained unsuccessful. We advised that Mr Yeoh should give further consideration to how peoples continence could be better managed. Staff told us that they had access to disposable protective clothing as required. We saw that systems to minimise the risk of infection were in place. This included single Care Homes for Older People Page 24 of 42 Evidence: use soap, hand sanitiser and foot operated pedal bins in toilets and bathrooms. We did not look at the laundry or the laundry systems on this occasion. Care Homes for Older People Page 25 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples physical needs appear to be met yet additional staffing levels and ongoing staff training in dementia care would enable a more person centred approach. People are protected by a robust recruitment procedure. Evidence: A member of staff told us that there were five care staff and a deputy manager on duty during the morning. In the afternoon there were five care staff and a team leader. In the evening there were five carers. In addition to the care staff team there were catering and housekeeping staff. We saw that the staffing roster confirmed this. At night there were two waking night staff and a sleeping in member of staff who could be called upon for advice or assistance, as required. Staff told us that they could also contact Mr or Mrs Yeoh. Within their survey, a staff member told us that there were never enough staff to meet the individual needs of people. As stated earlier in this report, we saw that at lunch time, there were not enough staff members to effectively help people with their meal. We saw that one member of staff was feeding a person yet they needed to repeatedly get up, to help another person. Another staff member was feeding two people at the same time. Some staff were helping people with eating and drinking whilst standing. There was little communication with people whilst they were being supported. Mr Yeoh was responsive to the need of deploying more staff to support Care Homes for Older People Page 26 of 42 Evidence: people at mealtimes. Within the AQAA we saw that thirty six people required help with dressing/undressing, washing, bathing and going to the toilet. The AQAA stated that seventeen people normally required two or more staff to help with their care. We advised that staffing levels be reviewed in line with the high level of need that was currently portrayed. Within their survey, a health/social care professional told us that they believed managers and staff sometimes had the right skills and experience to support peoples social and health care needs. In relation to what the home did well, they said continuity of care staff. Most of the staff have worked there for many years. All care staff appear genuinely concerned for all the residents and seem very kind and caring. In order to improve the service, they said more one to one quality time from care staff. Within their survey, a staff member also told us more staff was something the home could do better. They said the staff are very caring. Individual needs are catered for. A person using the service, within their survey told us friendly, caring staff was what the home did well. We saw that staff engagement with people could be improved upon. Some staff came in to start their afternoon shift but did not greet people by saying hello. Whilst supporting people with their mobility, staff did not talk to people. We saw one person leaning over, trying to repeatedly reach for something in the air. Staff did not initially support the person. Another person was asleep in their chair with their clothing above their knees. Some staff walked past the person without addressing the persons dignity. Mr Yeoh told us that he would address these areas with staff. Following the inspection, Mr Yeoh wrote to us regarding the circumstances of staff members actions. Mr Yeoh told us that people benefited from a very stable staff group. Since the last key inspection, there had only been one new member of staff. We looked at the recruitment documentation of this staff member. The file contained the required information. There was a photograph, an application form and two written references. There were details of the staff members medical health, which ensured they were fit to do the job. They had been checked against the Protection of Vulnerable Adults register before commencing employment. They also had a Criminal Record Bureau (CRB) certificate in place. Within surveys, staff told us that their employer carried out checks such as CRB and references before they started work. The AQAA stated we offer a thorough Care Homes for Older People Page 27 of 42 Evidence: recruitment procedure based on equal opportunities and ensuring the protection of service users. We do our best to ensure that service users are in safe hands at all times. One member of staff told us that there was quite a lot of training going on. They told us that they had completed first aid training in November and were planning to do manual handling the following month. They said they had done dementia care training earlier in the year. Another member of staff told us that they were also due to undertake the manual handling training. They told us that they had not completed any recent training. They said they believed the next round of training had been booked in, so opportunities would be available. A further member of staff told we do lots of training here. We are always kept up to date with things and we ensure our portfolio is up to date. We looked at staff training records. These contained a large amount of information yet it was not clear, what up to date training staff members had undertaken and when refresher courses were needed. There were some certificates for some subjects but not all were in place. Some staff had completed a dementia care training course in 2009 yet there was little evidence of an on going dementia care training programme. We had made this a requirement at the last key inspection. Mr and Mrs Yeoh told us that staff had received on going dementia care training which had been facilitated by external agencies. We saw that staff had signed to acknowledge that they had read certain documentations. This included information from the Alzheimers Research Trust about the various forms of dementia. We did not see formal training sessions regarding key topics associated with dementia care such as person centred planning, communication or eating and drinking. The AQAA stated training sessions have been done with an external training provider to re-train all our staff on Dementia Care on February 6th 2009. Following our visit, Mr Yeoh informed us that Tomorrow is Another Day training had been arranged for the staff team. Within our visit we saw that one person was very loud and vocal and was increasingly agitated. Staff did not appear confident in managing this behaviour and were unable to reduce the persons anxiety. Mr Yeoh intervened and advised staff to take the person to their room. They received one-to-one staff support and later appeared more settled. This situation showed that staff would benefit from more training in relation to complex behaviours. We saw that first aid and fire safety training had been undertaken in 2009. The local pharmacy had also facilitated a training session on the medicine administration system currently used within the home. We advised that the training be developed in order to Care Homes for Older People Page 28 of 42 Evidence: address the safe handling of medicines. As stated earlier in this report, we saw limited information about staff training in safeguarding vulnerable people. Mr Yeoh told us that both medicine management and adult protection had been undertaken. Some staff had watched a video in relation to infection control, health and safety and food hygiene. Mr Yeoh had facilitated the training in these areas. We saw that some staff had signed to acknowledge that they had received instruction on pressure area risk assessment and mental health in later life. Records showed that training in diabetes and blood sugar testing had been undertaken in 2006 by the district nurse. We said that this training must be updated if staff were supporting a person with diabetes. Within staff files, we saw that senior staff had undertaken limited up to date training. We advised that training in relation to their role such as management and leadership, be considered. Senior staff told us that four members of staff had a National Vocational Qualification (NVQ) level 2. Seven staff had NVQ level 3. Staff told us that there were twenty three staff so just under half of the team had a NVQ qualification. They said that some staff had a nursing qualification in their country of origin. During our visit, we saw some examples of poor manual handling practices. We saw staff use their arms underneath a persons underarms, to help them up. Another person was assisted to sit down by being pulled backwards rather than enabling the person to feel for the arms of the chair and then support themselves. Both practices were unsafe and could harm the person and the staff members involved. Mr Yeoh told us that he was not sure why the staff used these techniques as they were all familiar with correct procedures. We saw that in response to a requirement made at the last random inspection, manual handling training from an external training provider had been arranged. Care Homes for Older People Page 29 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager often spends time in the home and leads through informing and instructing the staff team. Gaining peoples views as part of the homes quality assurance system could be improved upon. Clear systems to enhance peoples health and welfare are in place yet this is compromised through the occurrence of a high number of accidents within the home. Evidence: Mr Yeoh was originally registered with Wiltshire County Council, when he was considered to meet the standards in respect of supervisory experience, qualifications and competence. Mr Yeoh has completed the Registered Managers Award. The AQAA stated The Registered Manager has worked in the NHS as a Registered Nurse and then as a Ward Charge Nurse before becoming a Registered Manager in Care Home setting for 21 years. He has completed his training for the Registered Managers Award and feels he is comfortable, confident, and experienced to run the home that meets its stated purpose, aims and objectives. The AQAA continued to Care Homes for Older People Page 30 of 42 Evidence: state The Registered Manager can demonstrate that he has undertaken periodic training to update his knowledge, skills and competence, whilst managing the home, the manager and other senior staff are familiar with the conditions/diseases associated with old age and has further training in Dementia Care in February 2009. Mr Yeoh told us that he regularly spends time in the home and knows both staff and people using the service well. Mr Yeoh regularly attends handover meetings and facilitates staff meetings to share information. From documentation, we saw that Mr Yeoh always asks staff to sign to acknowledge they have received any information given. We saw that staff had signed to evidence that they had been given information on resuscitation and the Mental Capacity Act. Mr Yeoh told us that he attended all external training staff undertake and also read health journals in order to keep himself up to date with current practice. Mr Yeoh and his wife were available throughout the inspection. Mrs Yeoh told us that she also spent a large amount of time in the home. She said she adopted any role which was needed at a particular time and also provided administrative and organisational support. Mrs Yeoh told us that she was also a registered nurse and therefore gave staff members support and advice about the day to day care practices of the home. The AQAA confirmed we have formally appointed Mrs D.F.Yeoh as Head of Care at Greengates to assist the Registered Manager and his Deputy Manager. Mr Yeoh told us that he had considered various quality assurance systems but was not able to find one suitable for the homes needs. Due to this, he said he was using the framework of the AQAA as a means of identifying quality and future improvements. While acknowledging this, we advised that gaining peoples views about the service and quality auditing systems were required. Mr Yeoh told us that satisfaction surveys were sent out to people on a yearly basis. Mr Yeoh told that this was planned for January 2010. We said the coordinated information from these sources could then be used to complete the AQAA. As stated at a previous inspection, we advised that the AQAA be a critical self-assessment of how the service was provided and how it was to be developed in the future, rather than reliance on evidence from our reports. Mr Yeoh told us that residents meetings were regularly held and surveys for people to give feedback about the service were being developed. Within their survey, one person using the service told us that general administration was something the home did well. Mr Yeoh told us that the home continued not to hold any money on behalf of people for safekeeping. He said that people paid for items directly or they were invoiced for Care Homes for Older People Page 31 of 42 Evidence: expenditure such as hairdressing or chiropody. Mr Yeoh told us that when a family member or representative had responsibility for the persons financial affairs, he would invoice them, rather than the person using the service. Within their survey, a staff member told us that they sometimes had enough support and met with their manager to discuss how they were working. We saw within documentation that supervision sessions were taking place although they were not structured or consistent. We saw that staff were generally asked closed questions so that discussion was not promoted. The session was also used as a time to give information about policies and procedures rather than concentrating on the staff members performance and development. Mr Yeoh told us that he regularly informed staff of health and safety matters they needed to be aware of. We saw that staff had signed to acknowledge receipt of this information. We advised that the use of wheelchairs be included within this as some staff did not apply the brakes of the wheelchair before a person sat down. As stated earlier in this report staff members had completed first aid training, which had been facilitated by an external provider. At the last random inspection we advised that any emergency procedure that was undertaken, be fully documented. We saw that Mr Yeoh had informed staff about this. We made a requirement that all staff must undertake manual handling training on an annual basis. This was particularly apparent as we saw some poor manual handling practice during this inspection. A staff member told us that the training had been arranged. Documentation showed that some staff had completed food hygiene and infection control training. The fire log book was well maintained with checks undertaken of the fire alarm systems as required. Staff had received fire instruction yet the date of the instruction was not documented. Regular fire drills had taken place. An external company had completed the homes fire risk assessment. We met with an engineer responsible for the servicing of the fire alarm systems during our visit. A completion date of work to be undertaken was agreed with Mrs Yeoh. Within the AQAA Mr Yeoh stated we are very particular that our equipment is repaired, tested regularly and certificated, to provide a safe environment for our residents. We saw that equipment such as the fire extinguishers, bath hoists and all portable electrical appliances had been tested as required. We noted on a tour of the accommodation that the hot water from one hand wash basin was very hot to the touch. Mr Yeoh told us that all hot water outlets had been fitted with regulators to ensure a safe temperature. We advised that all hot water outlets be regularly monitored so any problems with the regulators could be detected. Care Homes for Older People Page 32 of 42 Evidence: The home informed us of any incident which adversely affected the well being of people, as required under regulation 37. Due to this and through looking at the homes accident book, we saw that there had been a high number of accidents. These were mainly falls, many of which were not witnessed by a member of staff. We said that an audit of all accidents must be regularly undertaken. Any trends or potential contributory factors to the accidents must be considered. Following the audit, measures to minimise further occurrences must be put in place. We said that risk assessments must also be updated in light of any accident. Mr Yeoh told us that after a fall or injury, staff always gained medical assistance or requested a GP or District Nurse to visit in order to review the person. Care Homes for Older People Page 33 of 42 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 12 Care plans must fully reflect 30/11/2009 peoples care needs and the support they are to be given. This must include the management of peoples health care conditions. So that staff have sufficient information to meet peoples needs effectively. 2 8 12 The registered person must 18/03/2009 ensure that pressure area risk assessments, and associated care plans, reflect any changes noted in a persons wellbeing, as they occur. Many of the people being cared for have frail skin, so their pressure areas can be quickly vulnerable to changes. 3 8 12 Whenever charts are used to 18/03/2009 monitor aspects of care, such as fluid intake or regular turning, the registered person must record when and why this has been decided, and must ensure the care plan explains to staff why and how the chart is to be used. The usefulness of monitoring is diminished unless it is Care Homes for Older People Page 34 of 42 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 aimed at specific outcomes. 4 9 13 The labels of prescribed medicines must not be removed or altered. This will ensure that medicines are only used for the person they are prescribed for. 5 30 13 All staff must have regular, yearly manual handling training, which takes into account peoples complex health care conditions. Manual handling training has been arranged yet has not as yet been undertaken. So that staff have the right knowledge and skills to move people safely. 6 30 18 The registered person must 18/03/2009 arrange externally provided training for staff at all levels in communication with and care provision to people with dementia. While some dementia care training has been undertaken, there has not been an ongoing dementia care training programme in place. The home is registered as a specialist home and needs to demonstrate that staff are kept up to date with knowledge and trends in 30/11/2009 09/01/2009 Care Homes for Older People Page 35 of 42 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 dementia care, so people receive person-centred care that takes full account of their individuality and abilities. Care Homes for Older People Page 36 of 42 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 3 14 There must be greater clarity regarding peoples needs and the support they require within assessment documentation. So that staff are fully informed of the persons needs and a detailed care plan can be initialised. In the event of a persons changing need, staff must ensure that they review and up date all documentation which includes the care plan and risk assessments. So that accurate information is available to staff and peoples well-being is promoted and maintained. 30/04/2010 2 7 12 30/04/2010 3 7 15 Care plans must be written in an accessible way with sufficient clarity. 30/05/2010 Care Homes for Older People Page 37 of 42 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 So that staff have the information they require to meet peoples needs effectively. 4 9 12 Staff must ensure that they sign the medicine record appropriately when they administer medicines to people. So that an accurate record of medicine administration is maintained and the risk of error is minimised. 5 9 13 Staff must ensure that they do not remove the identification label of a topical cream. So that the medicine is not administered to the wrong person. 6 15 18 A review of mealtimes must 03/03/2010 be undertaken to ensure that people needing assistance to eat receive this effectively. So that people can have their meal without interruption. 7 16 17 Any concern raised and its investigation and outcome must be documented. So that there is evidence as 04/03/2010 03/03/2010 03/03/2010 Care Homes for Older People Page 38 of 42 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 to how the service manages complaints and how they are used to improve the service people receive. 8 30 18 Staff must receive up to 30/05/2010 date training in diabetes and blood sugar testing if supporting a person with diabetes. So that the persons health and wellbeing are maintained. 9 30 18 An ongoing dementia care 30/05/2010 training programme for staff which includes the use of external training providers must be in place. So that staff have the knowledge and skills to support people effectively. 10 38 13 A review of all accidents 30/03/2010 must be regularly undertaken. Any contributory factors must be identified and measures be put in place to minimise further occurrences. So that peoples wellbeing is promoted and people are not at risk of harm. Care Homes for Older People Page 39 of 42 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 3 The assessment format currently used should be reviewed so that it identifies peoples strengths and is more personcentred. Staff should ensure that they only use clear, factual information when making written entries in the persons daily records. Staff should ensure that any handwritten medicine instruction is dated and countersigned by another member of staff. Staff training should be arranged in relation to person centred planning and how peoples rights to dignity and respect for example, could be improved upon. Peoples choices of music should be further investigated in order to ensure social activity is age related. A more person centred approach should be adopted within the home. This would encourage greater interaction between staff and people using the service. A review of social activity provision should be undertaken to ensure that peoples individual needs, interests and preferences are being met. When a person has their food liquidized, each food item should be liquidized separately to enhance the taste and give variety. The depth of safeguarding training provided within the home should be reviewed to ensure that each staff member has sufficient knowledge to safeguard people from harm. The procedure of locking all bedroom doors should be reviewed to enable people easy access to their personal space. People should be involved in making their personal space more person-centred. Systems should be reviewed to ensure that the unpleasant odours in the home are eliminated. A review of the existing staffing levels should be undertaken in order to meet peoples individual needs effectively. Page 40 of 42 2 7 3 9 4 10 5 6 12 12 7 12 8 15 9 18 10 24 11 12 24 26 13 27 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 14 30 Senior staff should have training related to their role such as management and leadership. Staff should have up to date training in managing complex and challenging behaviours. Staff supervision should be reviewed so that staff receive regular time to formally discuss their work and ongoing personal development. The session should conclude with measurable action points that are discussed at the following supervision session. The temperature of all hot water outlets should be monitored to ensure the hot water regulators are in good working order. The fire log book should show the dates of when staff members received their fire instruction. 15 16 30 36 17 38 18 38 Care Homes for Older People Page 41 of 42 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. 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