Care Home: Sheerwater House

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What the care home does well The home manager, referred to hereafter in the report as the manager, sent us the completed AQAA on time. The content was clear and validated by evidence, supplying the information asked for. The manager is registered with the CSCI and has the qualifications and experience necessary to competently fulfil her role and meet the service aims and objectives. She has worked at the home for a number of years and her continuity of service following the home`s change of ownership enabled a seamless transition. Observations evidenced that staff are fully aware of and respect the rights of people using services to privacy and dignity. Staff interactions with them were at all times caring, inclusive and respectful. Staff were competent and empathetic in the delivery of personal care and support. The district nurse told us the home always seeks and acts on clinical advice to manage and improve healthcare needs. She commented, " The home provides excellent care to meet needs in an individualised and caring way. Staff know the needs of people using services and spend time with them. The district nursing team has always been completely happy with the care we have seen. The home manager is both caring and efficient and works well with the multi-disciplinary team". Staff numbers are sufficient to ensure that personal care needs are met. Feedback from people using services confirmed that staff usually acts on what they say and are always available when needed. One person told us, "The staff are very good", and another said, " I like the staff, they look after me very well". The environment was comfortable, warm and clean and the atmosphere stimulating, friendly and welcoming. A suitable activities programme is organised to ensure adequate and appropriate stimulation. A person using services said, " I like it here, everything is good, we sometimes dance". Interaction between staff and people using services was frequent and conversations were age appropriate. A varied daily menu that was approved by a dietician is displayed in the home. Snacks and fresh fruit were available at the time of the inspection visit and a two-course, wholesome meal was served at lunchtime. The home`s management understands the importance of making sufficient information available when choosing a care home, enabling an informed decision. This includes a statement of purpose specific to the home and the group of people cared for. A service users guide details what prospective people using services can expect and provides a clear account of the home`s services and facilities, about staff and their training and how to make a complaint. The latest inspection report can be viewed at the home on request.A comprehensive needs assessment is always carried out prior to admission to ensure individual needs are identified and can be met by the home. These are documented in care plans and personal support is responsive to the needs and wishes of people using services. The home has an efficient medication policy and procedure. Observations during the inspection and feedback from health professionals indicate the health of people using services is promoted. Arrangements are made to access health care services and other professionals as necessary. One person using services said, "They always call the doctor when I need him". Policies, procedures and guidelines promote equality in staff employment practice and in access to services. These ensure diversity needs of people using services are identified and met, including religious and spiritual beliefs. Physical disabilities are managed by obtaining suitable aids and equipment, meeting individual needs in collaboration with external professionals. Non discriminatory practice is promoted through staff training. The home has a clear complaints policy and procedure and there had been no complaints since registration. A policy is in place to safeguard people using services from harm and abuse. Staff are trained to recognise and respond appropriately to indicators of abuse. One safeguarding adults referral has been made and the correct procedures were followed. What has improved since the last inspection? Since the last inspection a new format care plan had been implemented. Staff feedback confirmed a number of positive developments under the home`s new ownership. These include provision of new uniforms and additional staff training, implementation of a key worker system and improvement in standards of cleanliness in the environment. There is also increased choice in the daily lives of people using services. The home is working towards devolving responsibility for monthly care plan reviews to key workers. We received positive feedback from a professional also a person providing a service to people living at the home during the visit. Their comments confirmed significant improvement under the new owners in cleanliness of the environment and odour control and the personal appearance and standard of dress of people using services. The manager confirmed new arrangements for district nurses to visit the home at least weekly. They maintain an oversight of health needs and liaise with GP`s where the need is identified for referral to a specialist or clinics. The owners are investing in a redecoration and refurbishment programme. A new bath hoist has improved facilities and a programme of replacing beds has been instituted. A side gate has been secured. What the care home could do better: The inspection highlighted the need to further develop care plans .The scope of risk assessments also needs to be extended and effective risk reduction solutions found. Health and safety audit systems need to be more robust. The use of validated assessment tools could be considered for nutritional screening, moving and handling and pressure sore prevention as part of the home`s admission assessment procedures. A formal system for monitoring care records needs to be in place. A lockable container for the cold storage of medication kept in the domestic refrigerator in the kitchen must be obtained. Care plans must be developed listing prescribed creams and ointments and details of instructions for their application in addition to information held on medication records. Evidence must be available of medication training undertaken by all staff delegated responsibility for medication administration. Additionally there needs to be an element of practice assessment linked to the medication training, to ensure staff competence. The GP should be requested to review the medication needs of the individual identified at the time of the inspection visit. Also to review and endorse the homely remedies in general use. A record must be made of the actual dose administered of variable dose medication also of the code explaining reasons for non-administration of prescribed medication. Bedrooms must have bedside lights, the type determined by individual risk assessments. People using the home`s services may benefit from a redecoration and refurbishment programme influenced by research based dementia design principles. The use of communication aids such as photos, symbols and plain language would create a more inclusive environment. It was positive to note the home`s management is actively addressing shortfalls in the staff- training programme. The homes safeguarding adults` procedure must be amended to ensure it is in line with the local multi-agency procedure. CARE HOMES FOR OLDER PEOPLE Sheerwater House Sheerwater Road Woodham Woking Surrey KT15 3LQ Lead Inspector Pat Collins Unannounced Inspection 29th January 2009 08:15 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 Sheerwater House DS0000072664.V374025.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. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sheerwater House Address Sheerwater Road Woodham Woking Surrey KT15 3LQ 01932 349959 01932 349959 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) Sheerwater Healthcare Ltd Ms Teresa Denton Care Home 20 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 20. This is the homes first inspection since a change in ownership. Date of last inspection Brief Description of the Service: Sheerwater House is a care home registered to provide personal care for a maximum of twenty people of either gender whose primary needs on admission are dementia or old age. The home is situated in a residential area convenient for rail and bus public transport, shops and other community amenities. The building is detached and set in its own grounds with car parking facilities and an enclosed garden with patio. The accommodation is arranged over three floors accessible by passenger lift and stairs. Bedrooms are for single and shared occupancy. All are fitted with emergency call bells and washbasins and some have en suite toilets. Assisted bathrooms and toilets are provided on all floors. Communal sitting and dining areas are on the ground floor. The fee range was £350 to £600 per week at the time of this inspection. Additional charges apply for private chiropody and hairdressing services, newspapers and dry cleaning. Sheerwater House DS0000072664.V374025.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 people using the homes services experience good quality outcomes. The inspection visit was unannounced, forming part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. One inspector undertook it in just under ten hours. The report will say what we found as it is written on behalf of the Commission for Social Care Inspection (CSCI). The registered manager and one of the homes two owners facilitated the visit. Judgements about how well the home is meeting the national minimum standards for older people and about the quality of care provision are based on the cumulative assessment, knowledge and experience of this home since the change in ownership in September 2008. We have taken account of information supplied by the registered manager in the homes annual quality assurance assessment (AQAA). This self-assessment focuses on how well outcomes are being met for people using services. It also gave us some numerical information relating to the home. We also considered feedback in two survey questionnaires completed by people using the homes services, two from staff and from a general practitioner and district nurse. The inspection process incorporated a full tour of the premises and observation of the garden. Records, policies and procedures were sampled. Care practice, medication administration, and practice at lunchtime and two group activities were observed. Discussions took place with most people using services, managers, staff, a community dental hygienist and a hairdresser. The state of well - being of individuals we were unable to communicate with was assessed based on observations of their care records, body language and general appearance, also their interaction with staff and their environment. We wish to thank all who contributed information to the inspection process; also all people using the homes services, its management and staff for their time, hospitality and cooperation during the visit. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 6 What the service does well: The home manager, referred to hereafter in the report as the manager, sent us the completed AQAA on time. The content was clear and validated by evidence, supplying the information asked for. The manager is registered with the CSCI and has the qualifications and experience necessary to competently fulfil her role and meet the service aims and objectives. She has worked at the home for a number of years and her continuity of service following the homes change of ownership enabled a seamless transition. Observations evidenced that staff are fully aware of and respect the rights of people using services to privacy and dignity. Staff interactions with them were at all times caring, inclusive and respectful. Staff were competent and empathetic in the delivery of personal care and support. The district nurse told us the home always seeks and acts on clinical advice to manage and improve healthcare needs. She commented, The home provides excellent care to meet needs in an individualised and caring way. Staff know the needs of people using services and spend time with them. The district nursing team has always been completely happy with the care we have seen. The home manager is both caring and efficient and works well with the multi-disciplinary team. Staff numbers are sufficient to ensure that personal care needs are met. Feedback from people using services confirmed that staff usually acts on what they say and are always available when needed. One person told us, The staff are very good, and another said, I like the staff, they look after me very well. The environment was comfortable, warm and clean and the atmosphere stimulating, friendly and welcoming. A suitable activities programme is organised to ensure adequate and appropriate stimulation. A person using services said, I like it here, everything is good, we sometimes dance. Interaction between staff and people using services was frequent and conversations were age appropriate. A varied daily menu that was approved by a dietician is displayed in the home. Snacks and fresh fruit were available at the time of the inspection visit and a two-course, wholesome meal was served at lunchtime. The homes management understands the importance of making sufficient information available when choosing a care home, enabling an informed decision. This includes a statement of purpose specific to the home and the group of people cared for. A service users guide details what prospective people using services can expect and provides a clear account of the homes services and facilities, about staff and their training and how to make a complaint. The latest inspection report can be viewed at the home on request. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 7 A comprehensive needs assessment is always carried out prior to admission to ensure individual needs are identified and can be met by the home. These are documented in care plans and personal support is responsive to the needs and wishes of people using services. The home has an efficient medication policy and procedure. Observations during the inspection and feedback from health professionals indicate the health of people using services is promoted. Arrangements are made to access health care services and other professionals as necessary. One person using services said, They always call the doctor when I need him. Policies, procedures and guidelines promote equality in staff employment practice and in access to services. These ensure diversity needs of people using services are identified and met, including religious and spiritual beliefs. Physical disabilities are managed by obtaining suitable aids and equipment, meeting individual needs in collaboration with external professionals. Non discriminatory practice is promoted through staff training. The home has a clear complaints policy and procedure and there had been no complaints since registration. A policy is in place to safeguard people using services from harm and abuse. Staff are trained to recognise and respond appropriately to indicators of abuse. One safeguarding adults referral has been made and the correct procedures were followed. What has improved since the last inspection? What they could do better: Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 8 The inspection highlighted the need to further develop care plans .The scope of risk assessments also needs to be extended and effective risk reduction solutions found. Health and safety audit systems need to be more robust. The use of validated assessment tools could be considered for nutritional screening, moving and handling and pressure sore prevention as part of the homes admission assessment procedures. A formal system for monitoring care records needs to be in place. A lockable container for the cold storage of medication kept in the domestic refrigerator in the kitchen must be obtained. Care plans must be developed listing prescribed creams and ointments and details of instructions for their application in addition to information held on medication records. Evidence must be available of medication training undertaken by all staff delegated responsibility for medication administration. Additionally there needs to be an element of practice assessment linked to the medication training, to ensure staff competence. The GP should be requested to review the medication needs of the individual identified at the time of the inspection visit. Also to review and endorse the homely remedies in general use. A record must be made of the actual dose administered of variable dose medication also of the code explaining reasons for non-administration of prescribed medication. Bedrooms must have bedside lights, the type determined by individual risk assessments. People using the homes services may benefit from a redecoration and refurbishment programme influenced by research based dementia design principles. The use of communication aids such as photos, symbols and plain language would create a more inclusive environment. It was positive to note the homes management is actively addressing shortfalls in the staff- training programme. The homes safeguarding adults procedure must be amended to ensure it is in line with the local multi-agency procedure. 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. Sheerwater House DS0000072664.V374025.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 Sheerwater House DS0000072664.V374025.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, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information has been produced to enable an informed choice of home and decisions whether it can meet the expectations and aspirations of prospective people who wish to use its services. Needs are assessed before being offered a place at the home to be assured these can be met. Good practice introductory admission procedures are demonstrated and people using services have a written contract or statement of the homes terms and conditions. EVIDENCE: The homes management understands the importance of having sufficient information to enable an informed choice of home. Feedback in surveys received from people using the homes services confirmed their view that they had sufficient information on which to base an informed decision about the homes suitability. A statement of purpose has been produced specific to the homes services and facilities, setting out its aims and objectives and philosophy of care. Though currently all people using the homes services have Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 11 varying degrees of dementia the home may admit older people who do not have dementia and do not fall within any other category, provided their needs can be met and are compatable with others using services. Areas of discussion included the need to reflect in the homes statement of purpose and marketing information that non-ambulant people are restricted to ground floor bedroom occupancy. It was suggested this restriction be also specified in the terms and conditions of residency to ensure prospective people considering moving into the home are aware they may need to move rooms in the future if no longer ambulant. The manager confirmed verbally providing this information to people making enquiries about vacancies, including professionals. Intermediate care services are not provided by the home therefore this standard was not inspected. An up to date, informative service users guide has been produced, detailing what prospective users of this service can expect. It provides a clear account of services provision, the accommodation, qualifications and experience of management and staff and how to make a complaint. The manager stated that a personal copy of this guide is issued to people using services or their representatives at the time of carrying out pre-admission assessments. Consideration could be given to producing the service users guide in a variety of formats to meet the range of communication needs of people for whom the home is intended. The intention to further develop the homes website was noted. A notice prominently displayed in the entrance hall by the visitors register informs visitors they may request to read the homes latest inspection report. The home has an admission and discharge policy and procedure. Equality and diversity legislation underpins the admission criteria to ensure nondiscriminatory practice. The admission policy requires a pre-admission assessment to be undertaken before admission by the manager, who has the necessary skills and experience. This also applies in the event of emergency admissions. In the care files sampled pre-admission assessments were viewed and the assessment format noted to have been further developed. For people funded by local authorities, copies of community care needs assessments completed by care managers had been sought. People using services and their representatives may visit the home on an introductory basis before making a decision to move in. In practice it is mostly their relatives or representatives who visit on their behalf. There is a trial period following admission and a review process before confirming the offer of a long-term placement. Written contracts or statements of the homes terms and conditions were on the files sampled. Feedback from the two people using services who participated in our survey confirmed that both were unaware of these documents. Consideration could be given to issuing a personal copy of the homes statement of terms and conditions to all people using services. Sheerwater House DS0000072664.V374025.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): 6, 7, 8, 9, 10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on assessment of their individual needs. The scope of risk assessments needs extending. Needs are recorded in a plan of care and principles of respect, dignity and privacy are put into practice. There is an efficient medication policy. EVIDENCE: Fifteen people were using the homes services at the time of the inspection visit. The inspection process included sampling three care plans and associated records and practice observations in communal areas. Though the care plans are holistic they need to be further developed. They need to be more specific about how needs are to be met and demonstrate individual preferences are taken into account. For example, a care plan viewed for memory orientation for one person recorded this persons need as, becoming more confused and forgetful and the plan to address this was, monitor the degree of forgetfulness, observe deterioration and encourage to keep informed of recent events (family). It was suggested the manager review all activities of daily living for this individual and consider aids and prompts that might be used to Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 13 reduce the impact of memory impairment on this persons day to day life. For example, to promote independence in the activity of dressing, people may benefit from labels on drawers in bedroom to help them find their clothes; also from staff laying clothes out in sequence in the morning on his beds, to promote independence. These strategies should be included in the care plan. Use of orientation boards in bedrooms could also be considered. These can provide visual prompts and information meaningful to the individual; for example, reminding people of the days events, such as the time they go to a day centre or of hairdressing or chiropody appointment or of expected visitors. A care plan headed personal hygiene stated, is able to wash himself, and does require assistance with bathing and shaving. The need to be more specific and detail how and when in care planning was discussed, e.g. establish and record whether individuals prefer a bath in the morning or before going to bed. Also information how their needs are to be met when bathing, for example, whether individuals can be left on their own for a short time when in the bath, with staff outside the door for privacy, and the type of shaver used and preferred. Under the health section of a plan examined it was recorded, He appears more frail with no specific information what is meant by this statement or how this persons needs are to be met. Since the last inspection a new format care plan had been implemented. It was suggested that the scope of the homes risk assessments might be extended to include nutritional screening on admission and regularly thereafter. As standard it was suggested the home implement use of a validated pressure sore prevention assessment tool and this be used on admission and repeated in response to a change in needs. This is important if the current excellent level of support from the district nursing team were to change, enabling prompt referral to district nurses for professional assessment for pressure sore prevention equipment. Moving and handling assessments should also be undertaken on admission, as standard practice. The staff - training programme needs to incorporate training for key workers in the use of these tools. Other discussions with management covered the importance of end of life planning. It was confirmed the home seeks out professional support for individuals who are dying and learns from best practice. The care records sampled included the preferred form of address of people using services. It would be good to also record individuals communication strategies. Care records incorporated details of individuals spiritual and religious beliefs and other diversity information. The need to consider it may not be appropriate to display symbols specific to a particular religion or faith in public areas was discussed. Though care profiles contained some background social history it was suggested that further information be sought from people using services and their relatives/representatives about their interests and personal preferences. Risk assessments need to be more inclusive of environmental hazards specific to each person. Examples include access to toiletries in bedrooms, to uncovered radiators, the low wall on the patio terrace and safety when walking in the garden on the undulating lawn surface Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 14 and the shingle access to the front door. Internal systems ensure regular review and updating of care plans. For people funded by local authorities, some care management reviews had taken place though not all. Feedback was very positive about their care and life in general at the home from people using services consulted during the inspection. Good satisfaction levels were evident and we were told that staff usually acts on what they said and were always available when needed. One person commented, The staff are very good, and another, I like the staff, they look after me very well. People using services have access to healthcare and remedial services. One person told us, They always call the doctor when I need him. A general practitioner (GP) who responded to our survey informed us that the homes management usually sought and acted on medical advice to improve healthcare needs. He confirmed that staff respect the privacy and dignity of people using services and commented, The service creates a caring environment for vulnerable adults. The home could improve by providing more staff training The manager confirmed new arrangements for district nurses to visit the home at least weekly. They maintain an oversight of health needs and liaise with GPs where the need is identified for referrals to specialist services or clinics. A district nurse who completed our survey told us the home always seeks their advice and acts on it to manage and improve healthcare needs. She had observed staff taking individuals who wish to do so, out for walks. Whilst stating it was difficult for her to judge whether staff have the right skills and experience, given the limited time spent at the home, she said the previous owners had not ensured provision of regular moving and handling training for staff, other than supplying DVD learning materials. She commented, The home provides excellent care to meet needs in an individualised and caring way. It could be improved by increased availability of staff training. Staff know the needs of people using services well and spend time with them. The district nursing team has always been completely happy with the care we have seen. The home manager is both caring and efficient and works well with the multi-disciplinary team. During the visit discussion took place with a community dental hygienist who also visits the home regularly. She spoke positively about improvement achieved in oral hygiene for individuals and said how much she enjoyed coming to this home. Aids and equipment at the home include a sling hoist and sit-on weighing scale, enabling regularly monitoring of weights. The manager said the home has a couple of pressure relieving overlay mattresses. A programme of replacing beds had commenced and it was suggested the owners consider purchasing a couple of adjustable height beds. These will enable the safe management of needs of people with acute or terminal illness. Numerous examples of good care practice were observed. Though a multicultural team, staff communicated in the English language with people using services and each other, at all times. This was the first language of all but one Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 15 of the people in their care. They also possessed a good understanding of British culture, which was evident in their interactions with individuals. Staff were observed to have a friendly, caring manner. Where we had difficulty in understanding the non-verbal forms of communication of some people using services, judgements about their wellbeing have been based on their appearance, body language, behaviour and response to staff and their environment. Records sampled and discussions with staff confirmed they were constantly monitoring pain and distress and other symptoms to ensure individuals receive the care they need. At the outset of the inspection the majority of the people using services were up, washed and dressed and eating breakfast. Observations confirmed good attention to their personal appearance and dress, appropriate to age and culture. Discussions with the manager and staff about routines confirmed night staff assist people using service to get up and dressed if awake. Mostly they are still up when night staff commence their shift and make them a hot drink and administer medication before assisting them to get ready for bed. Night staff carry out one and two hourly rounds throughout the night, though some people are not checked, respecting their right to choose not to be disturbed. Discussions with staff confirmed a number of positive developments since the change in the homes ownership. These include the introduction of a key worker system. There is increased emphasis on cleanliness in the environment and more choice in the daily lives of people using services. Care staff record care notes and it is the intention to devolve responsibility for monthly care plan reviews to them in due course. The need to ensure a robust system for monitoring care records was discussed. This was after noting an oversight in ensuring an audit trail in record keeping of the care of an individual for some weeks following his admission. The homes medication policy for receipt, storage, administration and disposal of medication ensures the safety of people using services. Medication storage is in a metal medication cabinet and medication trolley. The manager was requested to purchase a lockable container for medication stored in the unlocked domestic refrigerator in the kitchen. Though a small stock of foodsupplement drinks was stored in the kitchen these were not prescribed for a named person. The manager is aware that if supplements are prescribed a care plan must be in place detailing why it has been prescribed, how much is given, when to give and be closely monitored. Creams and ointments were recorded and signed by carers on medication administration records (marr charts), after application. The need for care plans to list these products was discussed. The manager stated staff had received medication training from the supplying pharmacy, though this information not evidenced by records for all staff delegated medication administration responsibilities. The current medication training does not include practice competence assessments. It was agreed with management that this element would in future be incorporated into their training. A homely remedies list had been signed off by a GP in 2006 and it was suggested the manager approach the GP to review this list. The Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 16 need to maintain a record of the actual dose administered for variable dose medication, for example, prescribed, take 1 or 2 tablets was discussed. Codes must also be recorded explaining why medication has not been administered. The refusal of medication recorded on a marr chart identified the need for the individuals GP to be consulted to see if this medication is available in liquid form. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. A range of social activities is available and people who use the homes services are afforded opportunities for choice in their daily lives. A balanced and varied diet is offered. EVIDENCE: A notice is displayed on a board in the hallway with information about social activities on offer. There is a choice of art and crafts, indoor bowls, games, quizzes, film shows and musical activities also regular input from a music for health therapist. Though a daily social activities plan is displayed this is flexible and responsive to the wishes, mood and interests of people using services. The owners visit the home most days, sometimes together but mostly separately and assume an active role in the social activities programme. On the day of the inspection visit, after serving the mid morning coffee and biscuits, care staff asked each person individually if they wished to engage in a social activity. A group of four people and a staff member later enjoyed an art and craft activity in the dining area. Another group joined in an animated quiz facilitated by the owner present at the time of the inspection. Other people were watching television in the lounge and another person sat listening to music on the music system. Competing sound from the television and music Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 18 system in the same area of the lounge was observed to be a distraction for another person resting in an armchair nearby. The management of noise needs review to ensure an appropriate balance to meet the needs of people who benefit from a stimulating environment and those who prefer and need less stimulation. It was understood that visitors are made welcome and people using services are encouraged to go out with their families and friends. One individual attends a day centre three times a week and likes to talk with staff on the days he stays home. Survey feedback confirmed there are always activities to take part in. It was nice to see artwork of individuals displayed in the lounge. A person using services said, I like it here, everything is good, we sometimes dance. Interaction between staff and people using services was frequent and conversations were age appropriate. Staff were empathetic in their approach to the people in their care. The general atmosphere of the home was friendly and respectful to the people living there. Staff support people in exercising varying degrees of choice and independence in their daily lives. Examples of this are respecting the choices of two people who prefer to get up late and affording people control over the frequency of baths. It was very evident that the provider, manager and staff had formed positive relationships with individuals using services. Suggestions for further developing the activities programme appeared well received by management. Staff had recently received dementia awareness training and those consulted said this had helped in their understanding of the communication needs of people with dementia. Some orientating cues were provided in the environment. Most bedroom doors had notices displayed with information to aid people using services to find their rooms. It was suggested to management that the planned redecoration and refurbishment programme be underpinned by research based dementia design principles. Also for consideration to be given to the use of communication aids such as photos, symbols and plain language to create a more inclusive environment. These can enable and empower people with dementia to participate in menu and care planning and aid understanding of menus, care plans, staff rotas and other notices displayed in the home. The homes hairdresser visited the morning of the inspection. She has been coming to the home for many years. She gave positive feedback regarding recent improvements at the home. Examples given included increased attention to environmental cleanliness and standard of personal appearance and dress of people using services. The daily menu is displayed and offers a choice of meals including the option of a cooked breakfast. Observations however confirmed none of the people using services were offered opportunity for a cooked breakfast on the morning of the inspection visit. The need to ensure people are offered food recorded on the menu was discussed with management. Snacks and fresh fruit were available Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 19 at the time of the inspection visit. The manager said the current menu had been approved by a dietician and was waiting for approval of a proposed new menu. Discussions with a senior carer who also works night duties confirmed night staff undertake some cleaning and catering tasks. On the day of the inspection potatoes had been peeled by night staff and left in a pan of cold water. The manager should consult the dietician regarding this practice to ensure this does not adversely affect the nutrient content of meals. Care staffs roles are generic and they engage in catering duties. An additional care assistant is on duty daily and staff take turns in cooking a two-course lunch, which is the main meal of the day. A substantial lunch was observed comprising of home made meatballs in gravy, prepared by night staff, potatoes and fresh vegetables and a sponge desert with custard. The kitchen was clean and staff wore protective aprons when engaging in food preparation and food handling activities. Survey feedback from people using services confirmed they sometimes like the meals. Comments were, The meals are usually good; I like some of the meals. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 20 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, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a complaint procedure. The manager and staff are clear of the action to take in the event of an allegation or suspicion of abuse. The homes safeguarding procedure needs revision to ensure compatibility with the local multi-agency procedures. EVIDENCE: The complaint procedure is displayed in the reception area by the front door and is also contained in the service users guide. A minor amendment was suggested to the procedure, clarifying the homes responsibility for investigating complaints, which is not within the regulators remit, whilst continuing to include the regulators contact details. We have not received any complaints about the home since its registration and the manager confirmed she had not received any complaints. Survey feedback from people using the homes services confirmed they knew how to make a complaint and would tell the person in charge. Both individuals commented that they were very happy with the home. Staff surveys confirmed they knew what to do if a person using services or visitor expressed any concerns about the home. Staff and people using services are informed that the home operates a zero tolerance of all types of abuse. Staff are encouraged to report any concerns about practice without fear of victimisation. The manager is aware of how to facilitate access to available advocacy services, if required. The homes Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 21 safeguarding adults procedure needs a minor amendment to ensure compatibility with the local multi-agency procedure. A copy of the latest edition of Surreys safeguarding procedure needs to be available in the home. One safeguarding referral had been reviewed under safeguarding procedures since registration. Discussions with management included advice for awareness and training for staff and a policy and procedure to be developed specific to mental capacity legislation, particularly in respect of the Governments new legal framework for depriving incapacitated people of their liberty, coming into force in April 2009. Also discussed was the importance of keeping abreast of changes relating to the new vetting and barring scheme being launched in October 2009. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 22 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, 23, 24, 25, 25. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The living environment is comfortable, clean and hygienic and a planned programme of upgrading and refurbishment has commenced. Action is necessary to minimise health and safety hazards in the home and external environment. EVIDENCE: A full tour of the home was conducted with the manager and the provider. All areas were warm, clean and comfortable, well lit and adequately ventilated. The home has three twin bedrooms. Discussions with the manager confirmed the ground floor vacant twin bedroom had, until recently, been used for the sole occupancy of person recently discharged to a nursing home. Discussions with the manager confirmed it was rare for local authorities to commission services in shared rooms unless funding placements for partners. Attention is necessary to arrangements for privacy in this bedroom before occupation by Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 23 more than one person. The privacy screen is in poor condition and if possible a privacy curtain should be fitted. Bedrooms can be locked from the inside, for privacy, with staff access in emergencies from the outside. They each have lockable small cabinets, usually used for toiletries. The intention to purchase a lockable item of bedroom furniture for all rooms was noted. Bedroom accommodation is variable in shape and size, comfortably furnished and personalised. A single bedroom on the ground floor was being redecorated and refurbished. The providers had commenced a programme of replacing the divan beds. The need to ensure all bedrooms have a bedside light was discussed, the type of light decided after carrying out individual risk assessments. A redecoration and refurbishment programme had commenced since registration and consideration is being given to fitting carpet in the entrance hall. Plans include replacement of the lounge carpet, upgrading and redecorating bedrooms, redecoration of the dining area, replacement of dining chairs and fitting wall tiles in communal bathrooms and toilets. The provider confirmed the intention to fit covers on the remaining radiators without covers that are not of a low surface temperature type. A new bath hoist has been purchased for the ground floor bathroom. Discussions with management emphasised the importance of following research based best design principles for dementia care before further progressing the redecoration and refurbishment programme. This will ensure appropriate choice of carpets and furniture and ensure decoration provides orientating cues in the environment. The large combined dining room and lounge is comfortable and light and overlooks the garden. Laundry facilities are off the kitchen with a separate outside access route. The passenger lift was in use and the call bell system sampled and found to be functioning. Observations highlighted the need for more robust health and safety audits to identify and find solutions to a number of potential hazards in the environment. Whilst windows were fitted with restrictors, the opening width of some needs to be assessed and if necessary action taken to minimise risk. Surface temperature of radiators not of a low surface type and without covers need to be made safe until covers or guards are fitted. A system for monitoring hot water temperature must be in place. A record must be kept of the same and action taken in response to variations in water temperature, ensuring this is consistently maintained at 43 degrees. Though not an immediate risk given the time of year, the owners should carry out risk assessments to reduce safety hazards in the garden and on the patio terrace. Examples of potential risks include the height of the patio wall, as there is a significant drop down to the garden, the garden steps, garden pond and undulating garden surface and need for pathways. The provider confirmed the intention to improve the garden for use by people using services in the summer. It was suggested that in the long term the owners consider making Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 24 provision of a pathway from the gate to the front door for improved access for wheelchair users, as the surface area is shingle. The fire escape door was alarmed and the providers were stated to be planning improvements to the fire exit in the twin room on the ground floor. It was recommended this door also be alarmed. The owners undertake some maintenance work. They recently obtained estimates from a plumber to replace and repair washbasin taps in bedrooms. It was suggested during the inspection visit that taps in the bedroom of a person who the manager stated had the water supply to her washbasin disconnected, reducing risk of flooding, be replaced with a type that automatically shuts off. This would ensure individual rights are respected and reduce risk of Legionella bacteria in pipes. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in staff recruitment practice and staff training were in existence prior to homes sale and the new owners are committed to best practice in staff recruitment and compliance with staff training standards. Staffing levels are adequate to meet the current needs of people using the homes services and support the smooth running of the home. EVIDENCE: The staff team excluding management comprised of four senior care assistants and ten care assistants and a carer whose role includes responsibility for cleaning five days a week between 09:00 and 12:00 hrs. This staff member has a dual role providing care for specified period during her shift and sometimes during additional shifts. Care staff are responsible for light domestic duties at weekends and night staff are designated cleaning tasks. The staff rotas sampled clearly set out staff numbers and their designation. The manager works six days a week with three staff, inclusive of a carer designated domestic duties. An additional carer is on duty designated catering duties between 09:00 and 12:00 hrs daily. Staffing levels of three care staff are maintained on the late shift and two waking staff employed at night. An extra carer is on duty when the manager has a day off. Some staff members have worked at the home for a number of years, affording good continuity of care. Observations and discussions with staff and people using services indicated staffing levels were adequate at the time of this inspection. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 26 In last few months new staff uniforms had been purchased. Plans include the intention to redesign staffs name badges to make them clearly identifiable for people using services. Equality and Diversity legislation ensures non-discriminatory staff recruitment practice at the home. The recruitment procedure defines the process to be followed. Staff recruitment shortfalls identified during the inspection did not reflect the practice of the new owners or the manager. A staff file sampled for an employee recruited just prior to the homes change of ownership only contained one reference and a reference had not been sought from the last employer as required. A full employment history had not been obtained and a record of the interview could not be found to establish whether gaps in employment had been probed and satisfactorily explained. A Criminal Record Bureau disclosure (CRB) had been obtained and a check made against the national register of people unsuitable to work with vulnerable adults (POVA list) before the worker took up post. Both of the staff files sampled contained CRB disclosures. Their storage in files is not in accordance with CRB policy and the homes management was advised to follow the CRB policy for recording, storage, retention and disposal of the same. The manager said care staff had been issued with job descriptions though a copy was not available for inspection. The need to ensure these reflect staffs generic roles and responsibilities was discussed. Copies of employees contracts were on the files examined. Survey feedback from staff confirmed references had been taken up for these workers and CRB disclosures as part of the homes recruitment procedures, in order to be satisfied they were fit, reliable and trustworthy. A staff induction and training programme was evidenced. Staff who participated in our survey expressed the view that their induction covered everything they needed to know be able to do their job well. Observations however highlighted failure to ensure safe practice by providing essential training for a care assistant with a duel role and who duties are predominately cleaning. The homes management was advised to ensure compliance with responsibilities to prevent or control employees exposure to hazardous substances (COSHH Regulations) and duty to assess the risks and ensure staff receive COSHH training. Staff feedback in surveys also told us they received training relevant to their role, helping them meet the needs of people they care for and to ensure up to date practice. One of the staff surveyed however felt the home could do better by increasing staffs access to training, a view shared by a GP and district nurse. Staff also said their manager regularly meets with them and provides them with good support. It is acknowledged that the providers are aware of training shortfalls and are pro-active in this area, working towards compliance with regulations and to ensure a skilled and competent workforce. A training needs analysis should be in place for each member of staff and for the team. Significant investment is being made in the training programme. It was positive to note three staff enrolled on a course of study for a National Vocational Qualifications (NVQ) in Health and Social Care Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 27 at Level 3. A further two staff have since enrolled on an NVQ course at Level 2. Staff feedback at the time of the visit was very positive about the owners commitment to their training and development. Discussions with management included the requirement for all staff to receive statutory training. Also the importance of ensuring senior staff acting as shift leaders in the managers absence have the required competencies and training. Staff were observed to be professional yet kindly in their approach to people using services. It was evident that they knew each individual well and were very aware of their needs. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 28 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, 32, 33, 34, 35, 36, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is overall effectively managed and run in the best interest of people using services. Quality assurance systems ensure continuous self-monitoring. There are some areas for improvement that the owners recognise and are committed to address, which we are confident they can manage. EVIDENCE: The homes management structure comprises of both owners who are actively involved in the homes day-to-day operation and have responsibilities for maintenance and financial management. The owners have the skills and background knowledge to deliver good business planning and effective financial controls. The registered manager has the required qualifications and experience and autonomy in her day- to- day management of the service. A deputy managers post is not included in the structure. The next tier of senior Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 29 staff comprises of four senior care staff that sometimes take charge of the home in the managers absence. The manager has one day off each week, through choice, and one of the owners is present at the home on her day off. A review of management responsibilities is in progress. Additional responsibilities are being devolved to senior care staff and key workers. Areas of discussion with management included the importance of ensuring senior care staff have received all statutory training and are assessed as competent before taking charge of the home. A robust system is also necessary to maintain adequate oversight of care notes and report writing by key workers. Discussions with staff confirmed a cohesive staff group and evidence of effective team working. The ethos of the home is open and transparent and people using services are clearly valued. The manager was perceived to work well with the new owners. She evidently has high regard for their commitment and additional investment in the homes resources, raising standards in a number of areas including the environment and staff training and development. The homes management is clear where there are shortfalls in standards and services. Specifically past staff recruitment and vetting practice, staff training and the environment and work is in progress for improvement. The homes management is efficient at ensuring notifications are sent to us in accordance with statutory requirements. Records are maintained of the owners monthly statutory visits. In January this visit included an audit of the environment, incorporating health and safety and fire safety checks. An action plan was generated from this audit and remedial work was in progress. A quality survey has been carried since the homes change of ownership. Questionnaire responses from the relatives and representatives of people using services have been overall very positive. It was suggested that a record of the analysis of feedback be kept for future surveys and of any action plan for improvement. A copy can then be given to relevant stakeholders and to prospective people considering using the homes services and their representatives, incorporated in the service users guide. The homes management should consider ways for the homes quality system to be more inclusive of the people using services. The homeowners and manager were not corporate appointees for any people using services at the time of the inspection visit. Currently a very small amount of money is held on behalf of some individuals in the business bank account. This was handed over to the owners on completion of the sale. The expectation for money held on behalf of users to be in an account separate from the main business account and not to form part of the business assets was discussed. Currently a record is held of this money with transactions recorded and receipts maintained for expenditure. The homes management was advised to look on our website for the publication available for supporting people who use regulated care services with their finances. Also discussed was the need to negotiate with legal appointees of people using services to help Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 30 people access their money and purchase services not included in fees, for example hairdressing and chiropody. The home has health and safety policy and procedure. A health and safety environmental risk assessment needs to be in place and safety audits must be more robust. Details of the shortfalls identified are recorded in the environment section of this report. The home has an emergency call bell system throughout the building. These were sampled and staff response was prompt when activated. Observations of potentially unsafe practice to the health of a new employee deployed on cleaning duties highlighted the need for all employees to receive COSHHE training and for COSHHE data risk assessments to be in place to guide staff in the safe use of cleaning products. Other discussions included a change to the distribution of medical device and equipment alerts; also an alert from the National Patient Safety Agency for managers to ensure staff gain the skills needed for management of choking, as part of their life support first aid training. Observations confirmed a record of fire safety training undertaken by some staff supplied by a specialist fire safety company. Not all staff had attended this training but confirmed the manager had gone through the fire safety procedures individually with them as part of their induction. The Manager stated the home had an audit last year carried out by Surrey Fire and Rescue Service and all but one of the requirements had been met. The owner present at the inspection confirmed the intention for full compliance. The manager has carried out a fire risk assessment and this reflected her understanding from past fire inspections that non - ambulant people using services must not be accommodated above the ground floor. Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 31 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 2 3 2 2 2 2 3 STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 2 2 Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 12(1)(a) Requirement Timescale for action 09/05/09 2. OP9 13(2) 3. OP9 13(2) 4. OP30 18(c)(i) For care records to include information about individuals social history, interests and preferences to enable a person centred approach to care planning. Care plans need to be further developed and the scope of risk assessments extended to ensure the welfare and safety of people using services. Medication stored in the 09/04/09 domestic refrigerator must be in a lockable container. A care plan must be developed listing prescribed creams and ointments and details of the frequency of application. For theory-based medication 09/05/09 training for staff to also have a practical assessment and supervision element. For the staff induction and 09/06/09 training programme to be further developed to ensure staff receive all statutory training to ensure safe and appropriate practice and prepare workers for entry onto appropriate Health and Social Care National Vocational DS0000072664.V374025.R01.S.doc Version 5.2 Sheerwater House Page 33 5. OP38 13(4) Qualifications (NVQ). A comprehensive environmental risk assessment must be carried out and solutions found to minimise hazards in the home and in the grounds. 23/03/09 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. Refer to Standard OP2 Good Practice Recommendations For the homes statement of terms and conditions to be issued to all people using services, irrespective of funding arrangements. It is also recommended this includes information that may prevent long term occupation of bedrooms above ground floor level in the event of a change in needs affecting mobility. For the GP to be asked to review and endorse the list of homely remedies for general use. For the planned redecoration and refurbishment programme to be underpinned by research based dementia design principles. Also for use of communication aids to create a more empowering and inclusive dementia care environment. 50 of care should be delivered by NVQ trained staff. For the fire exit door in the ground floor twin bedroom to be alarmed. 2. 3. OP9 OP19 4. 5. OP28 OP38 Sheerwater House DS0000072664.V374025.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sheerwater House DS0000072664.V374025.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. Re-publishing this information is in breach of the terms of use of that website. 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