Care Home: Greenhills

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What the care home does well The service continues to offer a homely environment for the individuals who are resident. The staff are knowledgeable with regards to the residents` needs and aspirations and meet these in an empathetic manner. Staff communicate well with the residents having built up a developed knowledge of how each individual can interact with them, be it through body language, preferred speech or through the use of sign language. The staff work well with other agencies in achieving stated outcomes for the resident. Another feature of this service is the range of good community and in house leisure activities on offer to the resident group. The people who live at the home go on holidays, sometimes in small groups, sometimes on their own with one to one support, this evidences normal life principles. The comment cards that were returned from people important to the individual resident appeared to evidence that they are satisfied with the service offered by the home. What has improved since the last inspection? The registered manager has looked at the recommendation to review staffing numbers/ to reflect the needs of the residents at all times and made the necessary changes. This is ongoing and is reviewed in light of the changing and emerging needs of the resident group. What the care home could do better: CARE HOME ADULTS 18-65 Greenhills 32 St Andrews Road Bridport Dorset DT6 3BQ Lead Inspector John Hurley Key Unannounced Inspection 2nd April 2008 08:30a Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhills Address 32 St Andrews Road Bridport Dorset DT6 3BQ 01308 422159 01308 422159 greenhills@btopenworld.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dorset Residential Homes Christopher John Stevens Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9) of places Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: Greenhills is a registered care home that provides accommodation and specialist nursing care for 9 learning disabled people. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care homes in Dorset. Greenhills is located in a residential area close to the town centre of Bridport. It is a large detached property that has been carefully extended and adapted to meet the needs of residents; the home does not stand out from neighbouring properties in any way. The home has 3 floors, the main communal rooms and some bedrooms being on the ground floor, remaining bedrooms on the 1st floor and an office and storage area on the 2nd floor. Most of the residents have lived at Greenhills for a number of years. As the home is registered to provide nursing care, the home ensures a qualified nurse is on duty at all times; staffing is provided throughout each 24 hour period, including ‘waking’ night staff. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that the people who use this service experience good quality outcomes. The inspector carried out this unannounced inspection over five hours. They viewed all areas of the home and observed the residents who were at home at the time. The inspector spoke with three care staff on duty and the manager. The inspector did not have an opportunity to meet with any relatives at the time. Due to the residents limited ability to communicate with the inspector their comments are not recorded in this report. The inspector also looked at the homes recent Annual Service Review (ASR) which was conducted by the commission. Some reference to this review is made within this report. In order to carry out the ASR people important to the residents were asked to comment on the service by way of questionnaires. Where possible the comments received have been included in this report. A number of records were examined including a sample of the residents care plans, health and safety records, the corporate vulnerable adults policy, staff rota’s and recent employment records. Current fees are £1212.00 but may vary according to the individual’s support needs. What the service does well: The service continues to offer a homely environment for the individuals who are resident. The staff are knowledgeable with regards to the residents’ needs and aspirations and meet these in an empathetic manner. Staff communicate well with the residents having built up a developed knowledge of how each individual can interact with them, be it through body language, preferred speech or through the use of sign language. The staff work well with other agencies in achieving stated outcomes for the resident. Another feature of this service is the range of good community and in house leisure activities on offer to the resident group. The people who live at the home go on holidays, sometimes in small groups, sometimes on their own with one to one support, this evidences normal life principles. The comment cards that were returned from people important to the individual resident appeared to evidence that they are satisfied with the service offered by the home. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The registered manger must ensure that: • There is a recorded rationale and practice guidelines for the administration of medication via the per required needs route to ensure safe medication practices. All environmental and personal risks are assessed and the identified action to minimize the risk is recorded and acted upon to minimize the risk of harm to people who use the service and staff. The organizational complaints policy is updated to reflect its statutory obligations in order to protect the residents. Where necessary there is a person specific infection control policy. Means to assist residents to the ground floor in the event of a fire are available in order to protect those with limited mobility who reside on the first floor. • • • • It is recommended that: • • • • All staff have the opportunity to undertake training in vulnerable adults procedures to ensure the protection of residents and staff. The storage of person care items such as continence aids and gloves should be stored more discretely. That handrails are available on the first floor. All accidents are evaluated by the home on a monthly basis and action taken to minimize risks taken as a result of these evaluations. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 7 • The manager or designated person undertake training in the Mental Capacity Act 2005 as the introduction of this legislation will have an impact on the service offered. The manager carry out a risk assessment with regards to ensuring there are enough qualified first aiders on duty to meet the needs of the residents. • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. As there have been no new admissions since the last inspection this group of standards were inspected on the basis of the corporate admissions documentation, stated practice combined with discussions with the staff and a manager. If these practices are followed it should ensure a good quality outcome for the prospective resident. EVIDENCE: Comprehensive pre-assessment documents evidence a good approach to any new admissions. The manager or designated staff member undertakes an initial consultation with other professionals and considers any previous documented assessments by other care professionals. The documentation evidences that the home’s manager and other staff should visit the prospective resident in their home environment or significant other place such as a day service, to build a holistic picture of this individual needs. The documentation also states that wherever possible the individual should also attend the home to meet the other residents. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 10 Following on from these visits and discussions with the individual if possible or people important to them a draft plan of care will be drawn up and agreed with the individual and their advocates. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care planning and review of existing plans demonstrate how resident’s needs are being met. EVIDENCE: The inspector briefly sampled the resident files, case tracking two individuals. Each resident has a comprehensive life support plan generated from the assessment information. These plans did not appear to be formerly reviewed every month, but daily assessments and comments inform and guide the overarching plan. Areas covered in these ongoing assessments include health, daily living, choices, activities, individual risk assessment and communication. Due to the nature of the residents’ disabilities it is not possible for staff to ascertain whether residents fully understand their individual plans. However, there is good evidence that people important to the residents are involved in, and agree to the objectives of the plans. Feedback from the residents’ families Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 12 gathered from the recent ASR continue to be supportive of the care provided, comments such as “My relative is loved and well looked after we received. Staff advised the inspector that intensive interaction courses were available that enabled them to improve their communication skills with residents. In addition to this staff used sign language and their own intuition. Residents’ records are kept safely in a locked office. The staff were able to demonstrate a good understanding of the rights of the individual and the need for confidentiality. Observation during the inspection showed that staff and residents were very comfortable and relaxed together in each other’s company. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents have good opportunities to be part of the community and attend meaningful activities as appropriate. EVIDENCE: The inspector sampled the records of the home and observed the interactions between the staff and residents as they went about their individual routines. A sample of the records observed demonstrated that the residents engage in a variety of age appropriate leisure activities with their peer groups. These included walks, swimming, shopping as well as day services. The feedback from relatives showed satisfaction with the services on offer and confirmed that they are consulted as appropriate. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 14 The home has a multi sensory room, which residents can enjoy when relaxing at home. During the inspection staff were observed to encourage residents in a respectful manner. Resident’s plans showed that they continue to be supported in maintaining contact with their family and friends and this may be in the form of regular visits or through e-mails and telephone calls. The routines of the day are structured, yet flexible with staff supporting each person according to their personality and preferred timescales. As with previous inspections observations showed staff supporting and giving residents appropriate time to complete tasks. Details in the support plans continue to identify residents preferred routines e.g. one stated, “to be woken gently”, another “likes to sleep with a soft toy”, and another “likes to go to bed early”. This is good attention to detail and all the information supports staff in ensuring they meet the needs and personal preferences of all the residents. The inspector observed that there were enough food stocks of both fresh and other foods to provide the basis for a nutritious meal. Staff informed the inspector that they were aware of the individuals likes and dislikes and provided that the choices made by the individual ensured a degree of a balanced diet their wishes would be met. Meal times are flexible, however, everyone has breakfast, mid day meal and then an evening meal, which commences from 17:00. Residents that have been away from the home during the day are welcomed home with a drink and a cake, scones or biscuits of their choice. The staff in consultation with the residents has developed the menus. This information is recorded in their Life Support plans. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support according to their individual needs and staff provide both personal and emotional support. In general terms medication records are well kept but more needs to be done to ensure there is sufficient information available to staff when administering medication by the Per Required needs Route in order to meet the residents health care needs. EVIDENCE: The inspector sampled the records relating to residents and found there were simple but clear plans relating to the provision of person care. Through limited observation and discussion with the staff it is reasonable to say that the residents receive a person centred approach with regards to this issue. The records observed evidence that residents have regular health care checks from the GP and community nurse. They also see other professionals including a psychiatrist, psychologist and physiotherapist. The inspector viewed the Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 16 relationship between the residents present at the time of the inspection as both empathetic and professional. It was also observed that staff use positive encouragement to gently assist the individual when making choices. At present residents are not able to retain or administer their own medication. The reasons for this are documented in the individuals file. It was noted that the medication records do not give clear instructions for the use of all medication given via the Per Required Needs route. The inspector discussed this issue with the registered manager who agreed to include this information in the medication file. Medication is securely stored and administered by staff who are qualified nurses. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home takes reasonable steps to ensure the safety of the residents through its complaints and vulnerable adults policies. However these policies need to be revised to reflect statutory requirements and reflect local procedures. It would also be helpful if staffed undertook training with regards to the protection of vulnerable adults. EVIDENCE: Some residents, due to the nature of their disabilities, communicate via means other than speech. Due to this reason it was not possible for the inspector to communicate effectively with these residents. However through discussion with the staff, and through feedback from people important to the residents it is clear that residents were listened to. There has been one complaint that has been dealt with in line with the homes stated policy. The inspector sampled the homes policy with regards to complaints and vulnerable adults (Whistle blowing). The organisation stated that these policies would be reviewed in 2007, however this had yet to be achieved. It would therefore be helpful if some priority was given to addressing this issue. At the previous inspection it was noted that a series of training workshops on the protection of vulnerable adults was being organised by DRH and staff from Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 18 Greenhills would be attending. The training records viewed did not confirm attendance; the registered manager was unaware of recent training with regards to this issue. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents have rooms, which suit their needs within a comfortable and safe environment. The home is clean and hygienic. The registered manager needs to ensure that all infection control policies are robustly applied for the protection of staff and residents. Risk assessments must be in place in order to protect the staff, residents and visitors. EVIDENCE: At the time of the inspection the home was found to be clean and comfortable. The residents’ rooms are personalised to reflect their individual tastes and preferences. The home has bedrooms on the ground and upper floors. The ground floor is fully accessible to those who require the assistance of a wheelchair. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 20 The communal areas are domestic in nature providing comfortable seating and dining facilities. The facilities available for bathing are maintained in good order and have a good range of adaptations to suit individual needs. Throughout the home there are a number of aids and adaptations to assist the resident with their independence. For example in the bathrooms there is specialist hoists, lifting aids, baths and a purpose built wet room. In the lounge there is a handle to assist a person to pull them self up from a sitting position and in the ground floor corridors there are hand rails, although these hand rails are not on the first floor. The registered manger agreed that these are needed on the first floor. The home has a newly fitted kitchen, which is assessable by all. Residents are encouraged to use the kitchen and individual risk assessments are in place. The inspector discussed the use of the kitchen with the manager and what would happen if there were an infection control issue, as people do not wear aprons or gloves. Whilst it is clear of the benefits to the resident group to access this area free of some of the important restrictions of food hygiene legislation more thought needs to be given to this issue. Therefore it is suggested that a comprehensive risk assessment is in place regarding the use of the kitchen. Outside of the kitchen there is a large raised balcony, this area also requires a specific risk assessment to protect residents staff and visitors. The home has a lift to gain access to the first floor. It was noted that there were no means to evacuate residents with mobility problems in the event of fire. The registered manger acknowledged the inspector observations. The laundry facilities are generally in good order with two commercial type units. The storage of soiled lined was not in line with good practice guidelines in relation to infection control as the bins used did not have lids and had large holes in them (by design). Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The recruitment practices establish the suitability of the prospective employee. There is evidence that new staff receive a structured recorded induction into the care home The staff team are well trained and knowledgeable with regards to the resident’s needs and aspirations. EVIDENCE: The inspector sampled a number of staff records relating to staff who had been employed since the last key inspection. Through this process they were able to verify that new staff member’s had under gone all statutory checks including the Criminal Records Bureau checks and taking up references. The inspector asked all staff spoken too about their job description and roles and they were clear on what this entailed. The records sampled confirmed that all staff receive the induction training as well as ongoing training in areas such Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 22 as food hygiene, health and safety, manual handling and non-violent crisis intervention. The home has certificated first aider. The registered manager needs to carryout a risk assessment to establish if this is acceptable or not Staff were clear about their roles and responsibilities and were also very complimentary about the management of the home. The rotas viewed indicate that there is sufficient staff on duty to meet the residents needs. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and this benefits residents and ensures their needs are well met. The staff group are formally supervised and their work appraised to ensure the residents’ needs are being met in a consistent manner. More needs to be done with regards to the health and safety for all who work, visit and reside at the home. EVIDENCE: The registered manager has been in post for a number of years. In general terms they have kept up to date with their own training. However, with the introduction of the Mental Capacity Act 2005, which came into force in 2007, has made a number of wide ranging implications for the type of service this Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 24 home offers. Therefore it is strongly recommended that the registered manager secures training in this important legislation without delay. The inspector viewed a number of key documents during the inspection ranging from care plans to staffing records, these documents were found to be well laid out and in good order, although some more historic documents could now be archived. The staff the inspector spoke with said that the manager was approachable and fair, often working with them and the residents. The relationships with other professionals and people important to the resident remain positive and professional. During the sampling of the staffing records the inspector noted that staff undergo one to one formal supervision on a regular basis. This compliments the ongoing informal supervision that happens on a day-to-day basis. The home assists with small amounts of the residents’ money. The inspector sampled the documentation and carried out a brief audit. They found the system was easy to use and the monies held tallied. The standard of the health and safety documentation is good but more needs to done with regards to risk assessment of areas noted in this report. Fire maintenance was up to date and fire drills and training had regularly taken place. A fire risk assessment was also in place. As mentioned earlier means to evacuate people with mobility problems needs to be made. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 2 2 3 Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Timescale for action 12/05/08 2 YA9 13(4) 3 YA40 22(1) The registered manager must make ensure that there is a recorded rationale and practice guidelines for the administration of medication via the per required needs route to ensure safe medication practices The registered manager must 12/05/08 make ensure all environmental and personal risks are assessed and the identified action to minimize the risk is recorded and acted upon to minimize the risk of harm to people who use the service and staff The registered manager must 12/05/08 make ensure the organizational complaints policy is updated to reflect its statutory obligations in order to protect the residents. The registered manager must make ensure where necessary there is a person specific infection control policy. 12/05/08 4 YA30 13(3) Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 27 6 YA42 13(3)(6) The registered manager must ensure means to assist residents to the ground floor in the event of a fire are available in order to protect those with limited mobility who reside on the first floor. 12/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard YA6 YA9 YA23 YA18 YA24 YA9 YA32 YA32 Good Practice Recommendations Further evidence to demonstrate the residents’ plans are reviewed at least six monthly to reflect changing needs need to be clearly presented in the residents’ records. All risk assessments should be dated and regularly reviewed to reflect any changing needs or strategies to minimise risk to the resident. All staff have the opportunity to undertake training in vulnerable adults procedures to ensure the protection of residents and staff. The storage of person care items such as continence aids and gloves should be stored more discretely That handrails are available on the first floor. All accidents are evaluated by the home on a monthly basis and action taken to minimize risks taken as a result of these evaluations. The manager carry out a risk assessment with regards to ensuring there are enough qualified first aiders on duty to meet the needs of the residents. The manager or designated person undertakes training in the Mental Capacity Act 2005, as the introduction of this legislation will have an impact on the service offered. Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenhills DS0000020469.V361748.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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