Care Home: Mavern House Nursing Home

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What the care home does well Management of the home are keen to extend and develop services to residents in a person-centred manner. They review quality of care provision and put in plans to improve and develop services. They consider deficits in systems in the home and put in extensive action plans to improve services. They support staff in changing practice to develop services to residents. This had also included the provision of modern equipment to ensure that residents can receive the care that they need. Individual members of staff showed a very detailed knowledge of their residents` needs and showed a very caring and thoughtful approach to provision of care. Managers are keen to innovate and work with staff to improve service delivery. At the same time they take action to ensure that staff are performing their roles. People expressed their appreciation of the services provided. One person reported "Everything about the care home is done extremely well. The care is first class, the food is well balanced and the home is very clean" another "I am happy with the "feel" and environment of the care home", another "A thoroughly good nursing home in every respect and we are very happy that my mother receives excellent treatment at every level" and another "The surroundings, the facilities and meals are very good". People also expressed their appreciation of the staff. One person reported "Staff seem to care", another "The staff, above all have an amazing amount of patience with the varying needs of the residents" and another "Catering is excellent. Domestic and laundry girls are great. The handyman is really helpful. The weekly hairdresser most pleasant." What has improved since the last inspection? The last key inspection of this home was on 26th June 2006. At that inspection, five requirements and three recommendations were identified. All had been addressed in full by the random inspection. Improvements have been made across a wide range of areas. Care planning has been fully revised. This has included improvements in manual handling and falls risk assessments and care plans. Care plans are regularly reviewed and reflect the needs of the residents. The home have concentrated on developing staff in ensuring that residents` individual needs are fully documented and that their choices and preferences are seen as key areas for care provision. An emphasis has been placed on improving the meals service to residents, with improvements in the sourcing of ingredients and a wider range of choice at all meals. This has taken place with full consultation with residents, their supporters and staff. Activities programmes have been developed and a full-time activities coordinator has been appointed to lead the service. At the same time, as part of the development in person-centred care, all staff are expected to be involved in supporting residents in meeting their recreational needs. The home environment has been much improved by the development of the new, modern extension and refurbishment programme for the existing building. All new rooms are purpose-built to meet the needs of people with a disability and who have complex nursing and care needs. A further lounge has been added to facilities. Equipment to meet the needs of residents, particularly those with a disability has been provided, including fully profiling beds and ceiling-track hoists. The managers have fully reviewed policies and procedures relating to staffing. All staff files now include all required information, so that safe recruitment practices can be verified. An analysis of staff training has taken place and an action plan developed, so that the home can ensure that staff have the right skills base to meet residents` needs. What the care home could do better: As would be anticipated in a home where much improvement was needed, some areas still need attention, to ensure that residents` needs can be met. At this inspection, nine requirements and eighteen good practice recommendations were identified. Information systems need to be developed so that a copy of the most recent inspection report summary and standard contract are included in the service users` guide. Some areas relating to care planning and documentation need attention. Where residents are unable to change their positions independently, to prevent risk of pressure damage, a full record of changes of position must be maintained. This must be completed regularly and be in accordance with the person`s assessed degree of risk. Care plans for frail residents should state how often their positions need to be changed and if they are having their fluid intake measured, the amount of fluid they have taken in, in 24 hours. Risk assessments for lap belts should include the risk to the resident of sliding down out of their chair. If a person needs support to apply a skin cream or lotion, their care plan should document which preparation is to be used and where. The jars of creams and lotions should always be labelled with the person`s name. Where residents` needs continence aids, the type needed should be documented in their care plan. Some improvements are needed in medicines management. Registered nurses must always fully complete the medicines administration record to show that the person as taken their prescribed medication and if they have not, the reasons for this. The homely medicines policy should be reviewed to comply with current guidelines and be agreed with GPs. When residents are prescribed drugs which can affect their daily lives such as painkillers or mood-altering drugs, a care plan should be drawn up so that the effectiveness of the drugs treatment can be evaluated. A few improvements are needed to the home environment. The metal drugs cupboard in the clinical room should be replaced, before it becomes more rusty. Where a resident is artificially fed, improved storage systems for artificial food stuffs is needed, to prevent them being very obvious in residents` rooms. As the hot meals trolley does not go in the lift, systems for keeping meals hot for people on the first floor need to be provided. All store rooms andclinical rooms should be tidied up and all out of date items and items no longer required be disposed of. Attention is needed to the prevention of risk of cross infection. All relevant areas need to be provided with single use methods of hand washing and drying. Staff who handle laundry and other items such as drugs must always handle such items in a safe way so as not to increase risk of cross infection. Non-slip mats should be stored dry after use. Mobile hoists should have intact surfaces, so that they can be wiped down easily. A few areas need to be addressed in relation to staff recruitment and training. Records of registered nurses personal identification numbers and of ongoing registration with the Nursing and Midwifery Council need to be in place. An interview assessment record should be completed when assessing prospective members of staff; this could include necessary risk assessments. Copies of induction programmes, including agency staff inductions should be retained on file. Managers must ensure that all staff are effectively supervised in their work, to ensure that residents can exercise choice and their dignity is up-held. Where a resident is not able to use the call bell system, a risk assessment and care plan are needed, to detail how the person is to be supported. Response times when call bells are used should be included in the homes` quality audit assessment. CARE HOMES FOR OLDER PEOPLE Mavern House Nursing Home Corsham Road Shaw Melksham Wiltshire SN12 8EH Lead Inspector Susie Stratton Unannounced Inspection 09:15 28 April & 1st May 2008 th X10015.doc Version 1.40 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 Mavern House Nursing Home DS0000015927.V359472.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mavern House Nursing Home Address Corsham Road Shaw Melksham Wiltshire SN12 8EH 01225 708168 01225 793372 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) Mavern Care Limited Vacant Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following category of service only: Care home providing nursing and personal care only- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 48. 26th June 2006 Date of last inspection Brief Description of the Service: Mavern House Nursing Home is registered to provide nursing care for 48 older people aged 65 years and older. The home provides single room accommodation and shared rooms. A large purpose-built extension has recently been built onto the ground floor. A full refurbishment programme to the original building is also in the process of being completed. Mavern Care Limited owns the home, which is a family run business. The Registered Manager’s post is currently vacant and an acting arrangement is in place. An application is being made by the acting manager to become the registered manager. The home manager leads a team of nursing, care and ancillary staff. Mavern House is situated in the village of Shaw just a few miles from the town of Melksham in Wiltshire. There is parking on site and public transport connections close by. A copy of the service users’ guide is available in every room and the main entrance area. Fees range from £600 to £750 per week. Additional charges are made for items such as hairdressing, chiropody and newspapers. Mavern House Nursing Home DS0000015927.V359472.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 2 star. This means the people who use this service experience good quality outcomes. 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 views and experiences of people using the service. As part of the inspection, 60 questionnaires were sent out to residents and their relatives and 36 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. A random inspection took place on 12th April 2007. This was to investigate a complaint. No requirements or recommendations were made as a result of this inspection and all the issues identified in the previous inspection were shown to have been addressed. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. This included the home’s annual quality assurance assessment of October 2007. As Mavern House is a larger registration, the site visit took place over two days, on Monday 28th April 2008, between 9:15am and 4:15pm and Thursday 1st May 2008 between 9:15am and 2:15pm. The acting manager was on duty during the inspection. The acting manager, her deputies and proprietors were all available for the feedback at the end of the inspection. During the site visits, we met with fifteen residents, three visitors and observed care for six residents for whom communication was difficult. We reviewed care provision and documentation in detail for six residents, two of whom had been admitted recently. As well as meeting with residents, we met with three registered nurses, six carers, the activities coordinator, the catering manager, the laundress, two domestics and the finance manager. We toured all the building and observed practice, including a lunch-time meal. We observed systems for storage of medicines and observed a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Management of the home are keen to extend and develop services to residents in a person-centred manner. They review quality of care provision and put in plans to improve and develop services. They consider deficits in systems in the home and put in extensive action plans to improve services. They support staff in changing practice to develop services to residents. This had also Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 6 included the provision of modern equipment to ensure that residents can receive the care that they need. Individual members of staff showed a very detailed knowledge of their residents’ needs and showed a very caring and thoughtful approach to provision of care. Managers are keen to innovate and work with staff to improve service delivery. At the same time they take action to ensure that staff are performing their roles. People expressed their appreciation of the services provided. One person reported “Everything about the care home is done extremely well. The care is first class, the food is well balanced and the home is very clean” another “I am happy with the “feel” and environment of the care home”, another “A thoroughly good nursing home in every respect and we are very happy that my mother receives excellent treatment at every level” and another “The surroundings, the facilities and meals are very good”. People also expressed their appreciation of the staff. One person reported “Staff seem to care”, another “The staff, above all have an amazing amount of patience with the varying needs of the residents” and another “Catering is excellent. Domestic and laundry girls are great. The handyman is really helpful. The weekly hairdresser most pleasant.” What has improved since the last inspection? The last key inspection of this home was on 26th June 2006. At that inspection, five requirements and three recommendations were identified. All had been addressed in full by the random inspection. Improvements have been made across a wide range of areas. Care planning has been fully revised. This has included improvements in manual handling and falls risk assessments and care plans. Care plans are regularly reviewed and reflect the needs of the residents. The home have concentrated on developing staff in ensuring that residents’ individual needs are fully documented and that their choices and preferences are seen as key areas for care provision. An emphasis has been placed on improving the meals service to residents, with improvements in the sourcing of ingredients and a wider range of choice at all meals. This has taken place with full consultation with residents, their supporters and staff. Activities programmes have been developed and a full-time activities coordinator has been appointed to lead the service. At the same time, as part of the development in person-centred care, all staff are expected to be involved in supporting residents in meeting their recreational needs. The home environment has been much improved by the development of the new, modern extension and refurbishment programme for the existing building. All new rooms are purpose-built to meet the needs of people with a disability and who have complex nursing and care needs. A further lounge has been added to facilities. Equipment to meet the needs of residents, Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 7 particularly those with a disability has been provided, including fully profiling beds and ceiling-track hoists. The managers have fully reviewed policies and procedures relating to staffing. All staff files now include all required information, so that safe recruitment practices can be verified. An analysis of staff training has taken place and an action plan developed, so that the home can ensure that staff have the right skills base to meet residents’ needs. What they could do better: As would be anticipated in a home where much improvement was needed, some areas still need attention, to ensure that residents’ needs can be met. At this inspection, nine requirements and eighteen good practice recommendations were identified. Information systems need to be developed so that a copy of the most recent inspection report summary and standard contract are included in the service users’ guide. Some areas relating to care planning and documentation need attention. Where residents are unable to change their positions independently, to prevent risk of pressure damage, a full record of changes of position must be maintained. This must be completed regularly and be in accordance with the person’s assessed degree of risk. Care plans for frail residents should state how often their positions need to be changed and if they are having their fluid intake measured, the amount of fluid they have taken in, in 24 hours. Risk assessments for lap belts should include the risk to the resident of sliding down out of their chair. If a person needs support to apply a skin cream or lotion, their care plan should document which preparation is to be used and where. The jars of creams and lotions should always be labelled with the person’s name. Where residents’ needs continence aids, the type needed should be documented in their care plan. Some improvements are needed in medicines management. Registered nurses must always fully complete the medicines administration record to show that the person as taken their prescribed medication and if they have not, the reasons for this. The homely medicines policy should be reviewed to comply with current guidelines and be agreed with GPs. When residents are prescribed drugs which can affect their daily lives such as painkillers or mood-altering drugs, a care plan should be drawn up so that the effectiveness of the drugs treatment can be evaluated. A few improvements are needed to the home environment. The metal drugs cupboard in the clinical room should be replaced, before it becomes more rusty. Where a resident is artificially fed, improved storage systems for artificial food stuffs is needed, to prevent them being very obvious in residents’ rooms. As the hot meals trolley does not go in the lift, systems for keeping meals hot for people on the first floor need to be provided. All store rooms and Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 8 clinical rooms should be tidied up and all out of date items and items no longer required be disposed of. Attention is needed to the prevention of risk of cross infection. All relevant areas need to be provided with single use methods of hand washing and drying. Staff who handle laundry and other items such as drugs must always handle such items in a safe way so as not to increase risk of cross infection. Non-slip mats should be stored dry after use. Mobile hoists should have intact surfaces, so that they can be wiped down easily. A few areas need to be addressed in relation to staff recruitment and training. Records of registered nurses personal identification numbers and of ongoing registration with the Nursing and Midwifery Council need to be in place. An interview assessment record should be completed when assessing prospective members of staff; this could include necessary risk assessments. Copies of induction programmes, including agency staff inductions should be retained on file. Managers must ensure that all staff are effectively supervised in their work, to ensure that residents can exercise choice and their dignity is up-held. Where a resident is not able to use the call bell system, a risk assessment and care plan are needed, to detail how the person is to be supported. Response times when call bells are used should be included in the homes’ quality audit assessment. 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. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Mavern House does not admit for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Prospective residents are largely informed of the services offered by the home and receive full assessments of need prior to admission. EVIDENCE: People are provided with information about the service in a service users’ guide, which is available in every room and the main entrance hall. The home reported in their annual quality assurance assessment that they had revised their service users’ guide, to reflect changes in the home and would continue to keep it under review. The guide does not include a copy of the summary of the most recent inspection report, together with information on how the full report can be obtained. It also does not include a copy of the contract/terms and conditions of residence. This information is needed, to fully inform people of all the services offered by the home. Other information provided is clear and written in an approachable style, for example it details the amount of staff Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 11 aimed for on different shifts during the 24 hour period. Of the 25 people who responded to this section of the questionnaire, 24 reported that they felt they had enough information about services provided. The acting manager reports that she meets with prospective residents prior to admission. One person reported that the manager “met me and talked”. Residents and their supporters are also able to visit the home prior to admission. One person stated, “My daughter came to see it and she quite liked it” and another “I went to about half a dozen, I chose this one because it did not smell”. During the inspection we met with some residents who had recently been admitted. All of them were too frail to report on their own experience of the admission process. All of the residents met with who had recently been admitted had the equipment that they were assessed as needing and full records of assessments made prior to admission. The home have introduced new assessment documentation. These had been completed in detail and were highly individual. Staff spoken with at all levels reported that they were informed of prospective residents’ admission and their assessed needs. They also reported that they reviewed assessments after admission and documented additional matters relating to the resident. For example one resident had been admitted with bruising; this had been fully documented and promptly reported to relevant professionals. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. This is a home who have reviewed a wide range of practices, to ensure that residents have their personal and healthcare needs met. A few areas only remain to be addressed. EVIDENCE: The home have made extensive improvements to its systems for ensuring that nursing and care needs are met, since they were last inspected nearly two years ago. All documentation systems have been fully up-graded and systems for ensuring that staff deliver care according to care plans have been put in place. Of the 36 people who responded to this section of the questionnaire, 21 reported they always, 13 usually and two sometimes received the care and support that they needed. Residents and their supporters are involved in care planning. One relative reported “Each resident now has a named trained nurse carer and untrained carer. We have meetings to include my [relative]. This is most beneficial.” Another relative commented on how their relative had Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 13 advanced “by leaps and bounds and that compassion hasn’t been forfeited as professionalism has increased.” All residents have full assessments, including assessments for manual handling, risk of pressure damage, dietary needs and falls. Where risk is identified, care plans are put in place to direct staff on how risk is to be reduced. Care plans were clear and directed actions to be taken to meet needs. For example one resident was assessed as being at risk of falling out of bed. Their assessment identified that the person’s risk would not be reduced by the use of safety rails, instead their profiling bed was to be left on the lowest position and soft mats put beside the bed. Staff spoken with reported that the person no longer tried to climb out of bed over the safety rails and while they did occasionally roll out of bed, as the bed was so close to the floor and soft mats were beside the bed, the person did not hurt themselves. Two of the people we met with showed much improvement since admission. This was supported by their records and discussions with staff. One person had been admitted for continuing care, they had improved to the extent that the person was able to spend periods of time at home and plans were being made for an eventual discharge. This person had clear care plans relating to developing their independence skills. Another person had had complex behaviours prior to admission, including noisy behaviours. Observations and discussions with staff indicated that this person was now much calmer and able to engage in social activities at times. One relative reported “I am very pleased with the care and attention my [relative] received from the staff”. As would be anticipated in any large care home which has undergone considerable change, some areas still need to be addressed. The home cares for some very frail people who are not able to change their positions independently and are at risk of pressure damage. These people have turn charts to monitor that their positions are regularly changed, however the records were poorly completed and did not provide evidence that frail people were being turned at the frequency that they needed to prevent pressure damage. Some care plans relating to prevention of pressure damage stated how often a person needed to have their positions changed but not all. This is needed, as different people will have different needs. Frail people also had fluid charts in place, these were completed but need to be totalled every 24 hours to assist in identifying people who may be at risk of dehydration. The home draws up very individualised care plans relating to hygiene needs, which discussions with carers indicated were being followed. Some care plans detailed skin creams and lotions to be used, but not all and this is indicated so that the resident can have the treatment they need or prefer. Such creams and lotions need to be labelled with the resident’s name, so that they are used for them only, as there is a risk of cross-infection if such creams are used communally, which can happen if they are not named. Where a person needs Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 14 continence aids, this is documented, but it is advisable that care plans state they actual type used, to ensure that individual continence needs are met. Records showed that the home maintains close working relationship with external health care professionals, including the tissue viability nurse and community mental health nurses, as well as GPs. Wound care plans were clear and enabled assessment of the wound’s response to treatment. Care plans relating to diabetes were also very clear and documented blood sugar levels aimed for and actions to be taken when blood sugar levels varied from what was needed for the person. The relative of one diabetic resident commented in particular on the home’s effective approach to management of their diabetic relative’s condition. Another relative reported “All the staff we have met have been very caring and professional in their approach” and another “the nursing care seems very good. Staff have very quickly picked up conditions such as a chest infection and recently were very quick to engage emergency services” and another “All the staff are very experienced”. A medicines administration round was observed and the clinical room inspected. All medicines were safety stored, but there was some degree of over-stocking of drugs and clinical equipment. The main drugs cupboard, which included the controlled drugs cupboard, showed rust at the edges and should be up-graded before it deteriorates further. There was a full audit trail of drugs brought in and disposed of from the home. This included Controlled Drugs. Some of the medicines administration records had not been completed. This is needed so that the home can ensure that residents are given their drugs and if they had not, why this was. The home has a homely medicines policy but it has not been recently reviewed and agreed by the residents’ GPs. This is advisable, to ensure that GPs continue to be content for certain homely medicines to be used. The homely medicines policy also includes one drug which needs to be given regularly to be effective and another which is not generally indicated in a homely medicines policy, so it needs review. Registered nurses were observed performing medicines administration. They checked each medicines administration record before administering the drug and signed after administration. They consistently locked the medicines trolley when whey were with a resident. However they were observed on more than one occasion to pop the drug from the monitored dosage system onto their hand and then place in the medicines pot and also on more than one occasion were observed to place a tablet using their fingers into a resident’s mouth and not use a spoon. They were not observed to wash their hands at any time when doing this. The home lists all drugs prescribed for residents in their records and any reasons for changes in prescriptions, however it does not in all cases develop care plans relating to drugs which can have an affect on residents’ daily lives, such as painkillers, mood altering drugs or aperients. This is indicated so that the effect of such drugs on a resident’s well being can be evaluated. For example one resident was prescribed a major mood-altering drug and there was no indication in their records as to why this was. Another Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 15 resident was prescribed an aperient but their daily records relating to bowel care had not been completed, so the effectives of this drug for the individual could not be assessed. Residents met with were appropriately dressed in their own clothes. All personal care was provided behind closed doors. One resident was very unwell at the time of the inspection and the staff showed a very caring attitude towards them and were supportive of their relatives, giving them time to discuss matters and to be alone with their relative. One relative reported “My [relative] takes pride in her dress. Carers take the trouble to dress my [relative] thoughtfully and with patience. I am very grateful for their care” another “I think that a lot of effort is made from the emotional side of the care of the patient. The named carer system seems to work well” and a resident commented “Very good they are at listening and comforting”. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. The home are working towards enabling choice in residents’ daily lives and progress has been made in some areas. However other areas still need more emphasis, to ensure that residents’ individual needs are heard and acted on. EVIDENCE: The home are aware that developments are needed in the provision of choice and social activities for residents. In their annual quality audit, they reported that they are concentrating on changing the previous task orientated routines to much more resident centred, flexible care. They report that this allows time for residents to enjoy activities and gives them much more autonomy regarding their day-to-day routine. They report that they are planning to commence using a care methodology which puts residents and their lives at the heart of providing care. Work has commenced on this, with the dividing up of staff into separate teams, so that care can be provided more individually and relate to each resident, their past lives and current wishes. Work on this is still in its infancy; however training is planned and team leaders have been Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 17 appointed to lead the project forward. An activities person has been appointed since the last inspection. This person was enthusiastic in her role and was keen to provide a flexible, responsive service for residents. During the first site visit, she was observed to provide small group activities and one to one contact with residents. She has drawn up clear records relating to activities. As well as providing activities herself, she has also engaged external people, such as singers to come to the home and reported that a trip to Bristol Zoo is planned for shortly. Visitors are encouraged and several were seen coming into the home throughout site visits. One resident reported “My visitors come when they want”. A relative reported “We can pop in any time”. One resident reported “My family took me out yesterday, we had a lovely day”. As well as relatives and friends, the home is seeking to forge links with the local community, including the church and school. A communion service takes place every month and the Roman Catholic priest visits when requested. Relatives commented on the good communication between the home and themselves. One reported “I am always involved in any incident or concern which enables me to help, accompany (if a visit to hospital is relevant). The information given is always prompt and considered. An impressive service”. The home is seeking to change attitudes about supporting residents in making choices about their lives. Two people spoken with reported that they could get up and go to bed when they wanted although two other people did qualify this by stating that this also had to relate to the fact that they lived in a home with other people needing help. One resident in the sitting room told us that they did not like the noise from the music being played to support activities. We told a carer about this who moved the resident to another area of the sitting room, however instead of moving them to the quiet area of the sitting room, they moved them to the part where the television was playing loudly. A mealtime was observed and this showed that the home had actively made improvements in some areas but that others needed to be further developed. The catering manager reported on the work that has been put in to developing the meals service, all foods are locally sourced and all foods, including soup, are prepared from raw ingredients. A hot breakfast is provided for people who wish it, and a choice of meals at lunch and supper-time. Snacks are also available throughout the 24 hour period. One of the residents considered in detail was artificially fed. They had clear records about this, with a care plan to direct staff on how normal diet was to be introduced. It was discussed that more discreet storage for artificial foods should be identified, as the person’s room was full of boxes of the artificial foods, which tended to dominate the room and detracted from what would otherwise have been a homely atmosphere. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 18 At lunch, it was observed that residents were shown the choice of meals available, so that they could decide at that time, rather than making a choice the day before and not always remembering or wanting what they had chosen. This is seen as good practice. Of the 16 people who responded to this section of the questionnaire, six reported they always, seven usually, two sometimes and one never liked the meals in the home. Comments varied from “The quality of the meals is excellent” and “The home does food well” to “Food varies sometimes its nice, sometimes its not” and another person reported that they liked “Some of it” about the meals. People commented on the choice. One person reported “We have a choice of 3 at breakfast” and another “Whatever you fancy, they can usually find it”. A range of responses to assist residents in eating their meals from staff was observed. Some staff were highly supportive of residents. We observed one carer engage a resident in conversation whilst assisting them to eat. We also observed this carer giving a resident verbal support to eat and gently reminding them of how to help themselves. The activities coordinator was also available at mealtimes and actively supported residents who could not assist themselves. We observed a registered nurse patiently assist someone to eat with a small spoon, as they could not open their mouth to any extent. However other residents were not appropriately supported. We heard one carer call in a voice which was audible to several people “I’ll go and do the feeds upstairs”. We observed another carer to say over their shoulder “You eat your dinner hon” to a resident and then not watch to see if that resident needed more assistance, which they did. We observed the registered nurse performing the medication round needed to directly supervise a carer when they were supporting a frail person to eat, to advise them about what to do and how to do it. Whilst meals were taken round the ground floor in a hot trolley, meals for people on the first floor were taken up by tray. Where a resident needed assistance to eat, the plate was left in their room with a paper towel over it, whilst the carer assisted a different resident to eat. By the time a carer was able to assist the other residents to eat, their meal was cold. A carer was observed to assist a person to eat standing up, not looking at them or engaging in conversation. On the ground floor, one resident had been left with their meal, which was getting cold and when the carer came to assist them to eat, they found that they did not have the utensil they needed to support the resident, so they had to go away and get one. All the time, the resident’s meal was becoming colder. The acting manager reported that they were aware that action still needed to be taken to support some staff in providing a personcentred, rather than task orientated service. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be protected by the home’s polices and procedures on safeguarding adults and there are procedures to ensure that matters of concern to people are addressed. EVIDENCE: The home has a complaints policy, which is made available to residents in the service users’ guide. Of the 31 people who responded to this section of the questionnaire, 26 people reported that they knew how to make a complaint. One person reported, “The care service is always improving. Any concerns I have raised have been attended to”, another “I speak to the senior nurse, oh yes, they sort it out” and another “I usually just speak to care staff or the nurses”. Two complaints have been made to us about the home since the last inspection. We performed a random inspection to investigate one of the matters and no requirements or recommendations were identified following this random inspection. We referred the other matter to the home for their investigation according to their own procedures, which they did in full and the matter was resolved locally. The home maintains a log of complaints made to the home. This shows that the home are complying with their own polices and procedures. The home also maintains a log of verbal issues or concerns raised with the managers or staff. These records showed that the home is keen to Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 20 know about matters of concern to residents and their supporters and to take action to investigate matters, addressing any issues that are up-held. The home has a safeguarding adults’ procedure, which complies with national and local guidelines. One referral has been made via local safeguarding adults’ procedures since the last inspection. The referral was made by the home itself in support of a vulnerable person and did not relate to practice in the home. The home’s decision to support a vulnerable person in this way is seen as good practice and shows that their polices and procedures are working in practice. All newly employed staff receive training in safeguarding adults during their induction. The acting manager has identified that training for all permanent staff needs to take place and has put an action plan in place to ensure that this is addressed as part of her overall training action plan (see standard 30 below). Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents benefit from a well-maintained environment, where equipment is provided to meet their needs. Some work is needed to prevent risk of cross infection to residents. EVIDENCE: Mavern House has been greatly extended since the last inspection, with an increase of 19 beds in a new purpose-built, modern extension to the rear and side of the building. All the new rooms exceed National Minimum Standards. The home currently is working through an action plan to improve the older parts of the building. Some double rooms are provided; all have screening to ensure privacy. All of the home is well maintained and staff reported that the maintenance service was quick to take action to address small faults such as faulty light bulbs. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 22 The home provides two sitting rooms. One is a sun-lounge in the new building and the other in a larger area in the older building. This is divided into a television area, a quieter area and the dining room, all are slightly separate from each other. There are also gardens to the side of the building and an area between the two wings of the building. The acting manager reported that they are currently developing plans to improve the garden areas, including making them more accessible to disabled people. The home have provided a relatives room, which includes a small kitchenette, where they can relax if they need to. The home has a range of baths and showers to meet the needs of people with disability. Some baths were provided with non-slip mats. They were all clean, however they had been left wet. In order to prevent risk of cross infection, all non-slip mats should be left to dry after use. The home has invested in equipment for people with a disability. There are ceiling track hoists in all of the newer rooms. There are also mobile hoists where ceiling tracks are not provided. One hoist in the sitting room had lost its plastic coating on its base, this would make it difficult to wipe down and detracted from the otherwise well maintained atmosphere in the sitting room. Most of the beds are profiling and all are variable height. A wide range of equipment to prevent pressure damage was provided. Three people raised the issue of the call bell system for people who are not strong enough to push the call bell button. The home were aware of this issue and were investigating a range of aids to support people with such disability. They were advised that where a person cannot use a call bell, risk assessments should be drawn up and care plans put in place to ensure that, until equipment was available, residents’ had their needs met. The home has several cupboards for storage of continence aids, clinical items and other disposables. These need to be tidied, as some contain items which are out of date, sterile packs which will have lost their sterility because they have been opened and items which should have been disposed of, such as clean but un-named socks and stockings. One cupboard had an un-named set of upper dentures in it and half a bottle of Coke. At present the home launders all residents’ personal items and some bed linen. This is currently being reviewed, with a view to all items being laundered in house in the future. We met with the laundress, who showed a good knowledge of practice in the principals of prevention of spread of infection. All of the laundry room was clean, including behind machines. There were effective systems for the management of contaminated and potentially infected laundry. Several residents commented that their own laundry was not always returned to them. The laundress reported that this had already been identified and that the managers were in the process of purchasing relevant equipment, Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 23 so that the home could ensure that all items of personal laundry were promptly named, to avoid such issues in the future. The home needs to review some of its systems for prevention of spread of infection. The policy is that all rooms are meant to have single use methods of hand washing and drying. This is consistent with current good practice guidelines, which states that one of the most important factors in the prevention of spread of infection is effective hand washing. However such facilities were not available in all rooms that we went in to. Registered nurses spoken with were aware of the importance of using sterile gloves when performing clinical dressings and reported that they had good stocks available to them. The cleaners make residents’ beds and change bed linen. Observations of practice indicate that training is needed, to ensure effective systems for prevention of spread of infection. One cleaner was observed to change bed linen without using gloves, they were also observed to hold bed linen to the front of their uniform without using an apron. Used bed linen was variably observed to be placed on a resident’s chair, on the floor and the base of a cleaning trolley. To prevent risk of cross infection, bed linen needs to be handled safely and promptly placed in linen skips. Clean bed linen was observed to be placed on the top of cleaning trolleys, which also had a rubbish bin and cleaning items on it. Clean bed linen needs to be kept separate from rubbish and cleaning items. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Staff are available to support residents’ nursing and care needs. Staff are safely recruited and the home have identified that they need to further develop systems for staff training, to fully support residents. EVIDENCE: Mavern House has gone through a period of considerable staffing change since the previous key inspection, which was nearly two years ago. Due to the increase in registered beds, the home have needed to increase its staffing considerably. It has also undergone some turnover in staff due to the managers’ programme for developments in care practice. Despite all this, the use of agency staff has been kept to a minimum and there was evidence that the same agency staff are used as much as possible to ensure continuity of care. The home sets out its minimum numbers per shift in their statement of purpose and a review of their duty rosters indicated that they were working to these numbers. Some people who responded to us felt that the home was short of staff. One person commented on response to the call bell “Long wait at times due to shortages of staff I am told”, another “They’re helpful if they’ve got the time, and they’re always pushed for time”. However this was not echoed by all people, one person reported “when we have been present they give each resident more than enough time for their needs” and another Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 25 “They’re very good and they also help me”. We observed that although a member of staff was allocated to work in the sitting room, that there were period of time when they were not there. One relative also commented on how “there are times when the residents are just sat looking at one another in the main lounge”. This was discussed with the managers who considered that matters relating to staff availability may relate to previous working practice, including shift patterns and attitudes relating to response to call bells. They are currently reviewing such matters, as part of their development programmes for the home. The acting manager has performed a full review of staff training since she came into post. She reported that she had found that previous training records needed much attention and were complex to audit. She has now completed her reviews of staff training files and has begun improving individual training records, linking them to the supervision system. A comprehensive and detailed training action plan has been developed. This action plan identifies how training is to be progressed and gives dates for completion of different areas in the programme. The acting manager has identified that 50 of care staff are trained to National Vocational Qualification II (NVQ). She was meeting with an external training provider during the site visits to extend training in NVQs to more staff and also to support existing staff in training in areas relating to resident care. We identified that some residents need more complex interventions, for example with the attachment of appliances. Records did not clarify which members of staff had been trained in such areas or how carers were to be trained and their competency monitored. The acting manager has also looked at the recruitment process in full, including a review of all current employees’ files. All staff files have now been set out in the same way so that audit can take place and ensure that all relevant employment matters are being or have been considered. It was noted that not all registered nurses had a copy of their personal identification number (pin) on file. These checks need to take place on employment and annually for each registered nurse employed. They must take place in accordance with Nursing and Midwifery Council (NMC) procedures, to ensure that the registered nurse is able to continue to practice. The files of four recently recruited people and people undergoing recruitment were reviewed. All included a past employment history and health status questionnaires. Two references and police checks had been obtained for all staff. The manager was advised that if a person makes a declaration of, or has a positive criminal record, that a written risk assessment needs to be undertaken. The manager does not currently complete an interview assessment record. This is advisable, so that individual people’s strengths and weaknesses can be identified at this stage and a record made of responses to questions about significant matters, such as gaps in employment. All staff receive an induction on commencement of employment, including spending periods shadowing other members of staff. The acting manager is in Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 26 the process of introducing a full mentorship system for new staff. The home uses a short induction profile for the first few days of employment, to ensure that significant basic matters, such as fire safety, manual handling and whistleblowing are covered in the first few shifts. A copy of this is not retained on staff files. This is needed, to provide evidence of induction in such basic areas. When she took up her post, the acting manager reported that she identified that the induction used in the home did not conform to current guidelines. This has now been addressed and all newly employed staff will in future receive a full induction, which does comply with current guidelines. A new, comprehensive staff handbook has been developed and is given to all employees. While the home continues to need to use agency staff, it is advisable that a brief agency induction programme be drawn up, to ensure that agency staff are aware of their individual responsibilities for provision of care. Copies of such inductions should be signed by the inductor and inductee and dated. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People will be protected by managers, who regularly review quality of service provision and take action to address areas which need attention, in accordance with their own policies and procedures and guidelines from relevant authorities. EVIDENCE: The previous registered manager has left her post since the previous inspection. There is an acting arrangement in place and an application has been put in to us for this person to become the registered manager for the home. The person acting into the role of manager was previously employed as the deputy, and so is fully aware of systems in the home. This person is an Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 28 experienced manager and registered nurse. She is working towards her Managers’ Award qualification. She is supported by two deputies. The acting manager, together with the owners of the home have put much work into changing and improving the service to residents, at the same time as substantially increasing its bed numbers. The reviews have included nursing and care provision, the meals service and training and development for staff. There was evidence to show that the managers were prepared to take action to improve services to residents. Systems have been put in place to effectively manage sickness/absence and action taken, including disciplinary action, to improve staff performance. Some people reported on these changes. One person commented on the improvement in service provision “in recent times particularly”, another reported that “It has improved greatly in the past year” and another “many positive improvements have already taken place”. Prior to the inspection, the home completed our annual quality assurance assessment. This document provided a useful information on quality of service provision. A full internal quality assessment is being progressed, including seeking the views of relevant parties on service provision. As part of their developments in service provision, the acting manager has also introduced a range of internal quality audits. This includes reviews of accidents, wound care and infection rates. We received a range of comments from residents and their supporters about response times to the call bell system. These included “Sometimes you have to wait 25 minutes when you’ve rung your bell”, “When you ring your bell, its wait, wait, wait” and “If I ring my bell, they come eventually”. However not all people considered this to be an issue. One person responded “I ring the bell and they do come” and another from a person who could not use the call bell system “They pop in to see how I am”. This was discussed with the management team who agreed to assess response times when call bells were used and identify reasons for slow response or perceived slow response by some individuals. The home does not handle residents’ cash and all charges for extras such as hairdressing and chiropody are handed by invoices and individual accounts. The finance manager has clear, auditable systems in place and was aware of his responsibilities, including actions needed if any residents presented with safeguarding issues. The acting manager is in the process of setting up supervision and appraisal systems, to ensure that staff are fully supported in their roles. These systems are as yet in their infancy, but the manager is to be congratulated on taking action to improve a long-standing deficit. Records seen were individually completed and training needs were documented. Systems for regular meetings with staff have also been developed. A staff meeting was taking place during the second site visit and was well attended. Staff appeared to be able to contribute and listened to the home’s future development plans with interest. It was noted that some night staff attended in their free time, which showed the level of commitment by staff, to develop service provision. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 29 The home have clear procedures for ensuring maintenance of its systems and services, such as fire safety, water checks and equipment. Records reviewed were maintained in full in accordance with current guidelines. As noted in Standard 30 above, training records have been fully reviewed. The manager has identified that some staff have not received regular training in mandatory areas such as manual handling. She has an action plan in place to address these training deficits and has set up a training matrix, so that she can fully review staff attendance at mandatory training. Accident records were clear and included all accidents, such as bruising, as well as falls. It was noted as good practice that safety rails were hardly ever used and where they were assessed as indicated, that full records were maintained, in accordance with guidelines from the Health and Safety Executive. These assessments were regularly reviewed. There are risk assessments relating to the use of lap belts. These need to consider risk to the resident from slipping down in their chair, as this has been identified as a risk for frail people. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 5(1)(a,d) Requirement A copy of the most recent inspection report summary and standard contract must be included in the service users’ guide. Where service users are unable to change their positions independently, to prevent risk of pressure damage, a full record of changes of position must be maintained. This must be completed regularly and in accordance with the person’s assessed degree of risk. Registered nurses must always fully complete the medicines administration record, to show that the person as taken their prescribed medication and if they have not, the reasons for this. Systems must be developed to ensure that food can be kept hot when being provided to service users who need assistance to eat. Where a service user is not able to use the call bell system, a risk assessment must be drawn up and a care plan put in place to DS0000015927.V359472.R01.S.doc Timescale for action 30/06/08 2. OP7 17(1)(a)S 3(3)(k) 31/05/08 3. OP9 13(2) 31/05/09 4. OP15 16(2)(i) 30/06/08 5. OP22 13(4)(c) 31/05/08 Mavern House Nursing Home Version 5.2 Page 32 6. OP26 13(3) 7. OP26 13(3) 8. OP29 19(5)(a)S 2(9) 9. OP36 18(2)(a) identify how risk is to be reduced for the person. Systems must be put in place to ensure that all relevant areas in the home are provided with single use methods of hand washing and drying. Staff who handle laundry and other items such as drugs must always handle such items in a safe way so as to minimise the risk of cross infection. Records must be available of registered nurses’ personal identification numbers and of ongoing registration with the Nursing and Midwifery Council. Manager must ensure that all staff are effectively supervised in their work, to ensure that service users can exercise choice and their dignity is up-held. 31/05/08 30/06/08 31/05/08 30/06/08 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. Refer to Standard OP7 OP7 OP7 OP7 OP9 Good Practice Recommendations Where service users are assessed as being at risk of pressure damage, their care plan should state how often their position needs to be changed. Where a service user is having their fluid intake measured, the amount of fluids they have taken in, in 24 hours should be totalled. Where a service user is prescribed or chooses to use a skin cream or lotion, their care plan should document which preparation is to be used and where. Where a resident is assessed as needing a continence aid, their care plan should document which type of aid is to be used. Where a service user is prescribed or uses a topical cream DS0000015927.V359472.R01.S.doc Version 5.2 Page 33 Mavern House Nursing Home 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. OP9 OP9 OP9 OP15 OP15 OP26 OP26 OP26 OP29 OP29 OP30 OP33 OP38 or lotion, the jar should always be labelled with the person’s name. The metal drugs cupboard in the clinical room should be replaced, before it deteriorates further. The homely medicines should be reviewed, to ensure it complies with current guidelines and be agreed by the service users’ GPs on an annual basis. Where service users are prescribed drugs which can affect their daily lives, a care plan should be drawn up so that the effectiveness of the drugs treatment can be evaluated. Where a service user is artificially fed, discrete storage systems for artificial food stuffs should be developed. All staff should be supported in maximising opportunities for social contact at mealtimes. In order to prevent risk of cross-infection, all non-slip mats should be stored dry after use. All mobile hoists should have intact surfaces, so that they can be wiped down easily. All store rooms and clinical rooms should be tidied up and all out of date items and items no longer required be disposed of. A risk assessment should be completed if a prospective member of staff has a positive declaration or police check. An interview assessment record should be completed when assessing prospective members of staff. Copies of induction programmes, including agency staff inductions should be retained. Each programme should be signed and dated by the inductor and inductee. Response times when call bells are used should be included in the homes’ quality audit assessment. Risk assessments for lap belts should include the risk to the service user of sliding down out of their chair. Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 34 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 Mavern House Nursing Home DS0000015927.V359472.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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