Care Home: The Arches

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What the care home does well Each resident had a plan of care drawn up to meet their needs. The home was clean and tidy and there were no malodours. The gardens provided a lovely area for residents to sit outside in the warmer weather. The homes recruitment processes ensured that staff had appropriate checks prior to employment. The home ensured that staff had access to training courses, both mandatory and service specific. The percentage of care staff that had gained a national vocational qualification (NVQ) in care at level 2 and 3 was 61%. This was a good achievement and exceeded the national minimum standard. The staff team spoken with enjoyed their jobs and told us that the provider was approachable and supportive. What the care home could do better: Although residents had care plans in place, these could be more personalised to contain preferences and wishes for how they would like to be supported. The care plans and risk assessments must be kept up to date. Also monitoring charts, for example for pressure relief and fluid intake need to be more consistently completed so that there is an accurate record of the care provided. There were some shortfalls with the management of medication and these need to beaddressed to ensure that accurate records are maintained and people do not run out of their medicines. There were some activities provided but the home has not got it quite right for everyone. The employment of dedicated activity staff may help to improve the provision of social stimulation. There were also mixed comments about the provision of meals. Some people enjoyed them but others clearly did not. These two important areas can have an impact on peoples` wellbeing and ability to make choices. Some people felt able to make choices and live their life as they choose but for others choices were limited. As stated the home ensured that staff completed mandatory training. However, some staff were unsure about local safeguarding of adults procedures and refresher training was required. Also all staff that administered medication should complete the more thorough, accredited medication training course. The environment was generally clean and tidy, although some parts of the home could be updated. A refurbishment/redecoration plan needs to be produced with long and short term goals. This will enable us to monitor progress. The hot water outlets need to be a more constant, ambient temperature and paper towels should be supplied in communal bathrooms and toilets to help infection control. The environment needs to be checked more frequently so that the things we picked up, for example, the absence of bed rail protectors and a window restrictor, and some issues in the kitchen, are noted and addressed by the staff team themselves. Because of the high number of oversees staff working in the home and some comments about language difficulties, the manager needs to be assured that all residents are able to understand the staff and this is not an ongoing issue for people. Staff told us that a reduction in staffing numbers in the afternoon has led to them struggling on occasions. This needs to be investigated and addressed. The home needs to have stable management as soon as possible. It is acknowledged that the provider is overseeing the management of the home at the moment but a decision needs to be made quickly about future management arrangements. The quality assurance system has slipped this year and needs to be re-started so that audits are completed and people are widely consulted about the running of the home. Staff need to have more frequent, formal supervision - at least six times a year. This will enable practice to be monitored, training to be identified, and provide an opportunity for staff to discuss issues of concern. Random inspection report Care homes for older people Name: Address: The Arches The Arches 11 Priory Road Cottingham East Riding of Yorks HU16 4RR one star adequate service 24/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Beverly Hill Date: 2 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Arches The Arches 11 Priory Road Cottingham East Riding of Yorks HU16 4RR 01482842222 Telephone number: Fax number: Email address: Provider web address: samantha@the-arches.net Name of registered provider(s): Name of registered manager (if applicable) Mrs Lota Hopewell,Mr Derrol Paul Hopewell Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 39 Number of places (if applicable): Under 65 Over 65 39 39 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 2 4 1 1 2 0 0 9 The Arches is located in Cottingham, close to Hull and not far from local amenities, transport and shops. The home is currently registered to care for thirty nine older people, some of whom may have dementia care needs. The accommodation is situated on two floors with a passenger lift and stairs providing access to the first floor. All the bedroom bar one are for single use and eighteen have Care Homes for Older People Page 2 of 17 Brief description of the care home en-suite toilet facilities. Communal areas consists of a large lounge with two dining tables at one end, a smaller quiet lounge and a separate dining room. The secure garden is accessible with paved pathways, seating areas, lawn and a pond. It provides a pleasant environment for people to enjoy fresh air in warmer weather. Some bedrooms have patio doors leading directly onto the garden. There is a car park to the front of the home. The weekly fees range between £369.25p and £434.50p. There is a top-up to the basic fee paid by the local authority, which is determined on an individual basis. People pay extra for hairdressing, clothing, toiletries and magazines. People are give information about the home before they move in, and they have their own copy of the service users guide to refer to in their room for when they arrive. People also have access to a copy of the most recent inspection report written by the Care Quality Commission (CQC). Care Homes for Older People Page 3 of 17 What we found: We had received information that the acting manager and deputy manager had left the home on short notice and the provider was currently overseeing the management of The Arches. There had also been concerns raised from a visiting professional and others who chose to remain anonymous. We wanted to ensure that the home was being managed appropriately and the residents safety and welfare had not been compromised by the changes. Two inspectors, Bev Hill and George Skin, completed a unannounced visit to the home from 9am to 6pm. We spoke to residents, staff and the providers, and examined a selection of documentation. We completed a tour of the environment. Comments from discussions have been used throughout this report. Choice of Home Not assessed at this inspection. Health and Personal Care We looked at a selection of care files to check that care plans and other documentation was in place to provide staff with guidance on how to support people. We found in general that the care plans contained information about peoples needs and gave direction to staff on how to meet them. However, those care plans we examined should be more personalised to include preferences and wishes about how the person likes to be cared for. There were also instances when the care plans had not been updated when significant needs had changed. For example, one person had a fall and fractured their hip but the care plan sections relating to this aspect of their care, had not been updated. The care plans also need to be signed and dated by the person formulating them. There was evidence that the resident or their representative signed their agreement to the care plans. Risk assessments were in place for a range of areas such as, nutrition, falls, skin integrity, moving and handling and the need for bed rails. There were also instances when the risk assessments had not been updated when needs had changed. Staff had reviewed the risk assessments monthly but this had been a quick tick box exercise rather than a thorough look at whether there had been a significant change in risk. Care plans and risk assessments must be evaluated and updated when needs change so that staff have up to date information about how to care for people. The home completed a, patient passport for each resident. This was to provide specific information about care needs to hospital staff should the person be admitted to hospital. Completing the documentation was good practice, however, it was noted that a person had been recently admitted to hospital and the patient passport had not accompanied them. We also checked monitoring charts, used when staff needed to keep a close eye on nutritional intake or peoples pressure areas. We found that some staff were more Care Homes for Older People Page 4 of 17 conscientious than others when completing them and there were gaps noted in the charts examined. We accepted that this could be due to recording deficiencies rather than care not carried out. The monitoring charts for nutritional intake should have more precise amounts of food and liquids recorded to provide a more accurate picture. To improve, the pressure relief chart could detail how often the pressure is to be relieved and in what way. It could also detail the skin condition each time pressure is relieved and whether any cream was applied. At the key inspection on 24th November 2009, the home received a requirement to ensure that medication was managed effectively. We checked medication management at this inspection and found that the requirement had not been met. The home was in the process of transferring services from one pharmacy to another and this had not been as smooth a process as expected. There had been instances when residents had been without their medication. For example, one resident did not have their anti-inflammatory medication for six days and two another residents were short of their medication for a day. One resident was prescribed a medicine three times a day but had missed one of their doses during the transfer of records. There were other times when people had not received their medication but the codes used on the medication administration record (MAR) had not been defined so it was difficult to establish the reason why. On others there were gaps but no code at all. Topical products such as creams and ointments were not recorded as applied on the MAR. A senior carer told us that these were recorded on a chart kept in bedrooms but when checked these were only completed intermittently. Some of the medication administration records had various alterations by staff that made them difficult to follow. Generally medication was signed when received into the home but this was not consistent on all the MARs seen. The medicines were stored in three trolleys in one of the sitting areas. This was not the most ideal place for the storage of medication but space was at a premium. There needs to be a thermometer near the trolleys so the storage temperature can be recorded. Daily Life and Social Activities There was evidence that some activities and social stimulation was carried out in the home but it was also clear from discussions, that this was not satisfactory for everyone. The home had not employed an activity coordinator yet and the task of social stimulation was left to care staff. However, there were times when activities would be interrupted, as staff were needed to support other residents. This detracted from their enjoyment. Comments from residents were, we need more outings, there are no activities which suit us and activities dont occur when advertised, there is entertainment every two months, a singer visits once a month and we have manicures on Wednesdays and a hairdresser on Wednesdays and Thursdays. Some people told us they participated in exercises to music, bingo and dominoes. Others enjoyed going into the garden in the warmer weather and local clergy visited specific residents. Staff stated there were card games and ball games in addition to the activities mentioned by residents. Although there was a limited amount of activities taking place this was not meeting everyones needs and there was a risk that people who chose to remain in their bedrooms could become isolated. Visitors were welcomed at any time and residents told us they only went out on visits and outings when their family took them. There was little evidence of people accessing Care Homes for Older People Page 5 of 17 community facilities on a day to day basis via the care staff team. There were mixed comments about the provision of meals. Some residents were very happy with the food provided but others commented on the lack of variety and in one instance the lack of quality. The problem occurred when one of the cooks left earlier in the year and care staff were asked to cover the shifts. There has been no change in the situation since then. We spoke to one staff and they told us they were unskilled in baking and cooked the meals they would cook at home for their family. This may not fully reflect the needs of older people with differing nutritional needs and the menus should be checked out with a local dietician to ensure they meet specific needs. One resident did tell us that the meals had improved over the last two to three months, the timing is better and they are trying to bring in variation. Another resident told us how much they had enjoyed their lunch but another stated that sometimes the meat and vegetables were tough and the bread was not always nice. One resident commented that the breakfasts were good. It was very important for people to like the food provided, as this could impact on their health and wellbeing. This was discussed at length with the providers so they could check out the issues with residents and address the shortfalls. The limited social stimulation and issues with meal provision has affected the choices available for people. One resident also told us that their routine for rising and retiring was dependent on whether there was enough staff on duty to assist them at the times they preferred. The provider had also moved the large screen television from the main lounge into the quiet lounge with the view to providing more able residents with a quiet space to watch television. A small television was placed in the large main lounge. However, some residents were unable to see the small screen and did not like the arrangement and the quiet room remains underused. We discussed this with the providers and they are to purchase another large screen television to solve the problem. Complaints and Protection The homes complaints procedure was on display and a copy was available in each residents bedroom. The majority of people spoken with told us they felt able to complain and that they would approach the manager/provider, I would tell the manager and I would speak to the owner, they are approachable and most obliging. One resident had a different view and would like management to be even more approachable. They stated, I just follow the rules. They did state though, that things could be brought up in residents meetings. Staff members told us that all complaints are mentioned to the senior in charge so they can be addressed. The home had not recorded any formal complaints since the last key unannounced inspection. However, the provider stated they had addressed minor issues. The Care Quality Commission had received two anonymous complaints and these were passed to the local authority to investigate. The outcome was, in the main unfounded, but there were some recommendations made regarding the administration of medication and ensuring residents were included in decision-making about aspects of the home. The local authority had also received a concern from a professional visitor and another from an ambulance crew. These were checked out and no further action required although some of the concerns from the visiting professional were further examined during this site visit. Care Homes for Older People Page 6 of 17 The home used the multi-agency policy and procedure for safeguarding adults from abuse. The provider has completed training in local procedures in another local authority but would benefit from, as well as other senior staff in charge of shifts, completing the training specifically for managers in this area. Some care staff spoken with were unclear about the procedures to alert poor practice and abuse and need to complete refresher training in safeguarding. The local authority received a complaint about care issues and investigated it via the safeguarding team. The team was unable to substantiate the allegation. Environment During the site visit we completed a tour of the premises. The home was generally clean and tidy with no malodours. People commented that the laundry service was, excellent and very speedy, although one person stated it was fine when the laundry assistant was on shift but went, haywire at the weekend. We checked a selection of bedrooms and they were clean and tidy. There was sufficient communal space and the dining room, although a little dark, had individual tables and chairs set out with table cloths. The garden area was well maintained and a lovely environment for people to sit out in warmer weather. There was no refurbishment and redecoration plan in place with long and short term actions. Some sections of the home were in need of updating. We noted that the ceiling in the main lounge had a brown water stain around a downlight fitting and across another area. The provider confirmed a water leak had occurred during extreme weather approximately six weeks ago and they were unable to find the source of the leak. We issued an immediate requirement notice to ensure the provider contacted an electrician for advice in case of further water leaks. An electrician visited the premises during our site visit and made the light safe. The provider is to write to us with details of any further action. We noted that the records for the water temperature when bathing residents was approximately 36 degrees centigrade. This is quite cool for some residents and should be nearer 43 degrees for a more ambient temperature. The last hot water outlet records were completed in March 2010 and these also recorded low temperatures of 20 degrees in communal bathrooms and toilets and bedrooms. We checked the temperature of some bedrooms and toilets during the day and these seemed satisfactory but we were unable to get an accurate reading, as there was no suitable thermometer available. The provider advised that the home did have an intermittent problem with the supply of hot water throughout the building and a plumber had visited the home to deal with a blockage. The provider is considering the possibility of installing four new boilers to rectify the problem. There were no comments from residents about the temperature of the hot water. On the ground floor the home had a shower room, an assisted bathroom, a bathroom with a small bath for more able people and four toilets. On the upper floor the home had a bathroom and three further toilets. It was noted that the majority of communal toilets had toweling hand towels instead of paper hand towels, which are recommended to Care Homes for Older People Page 7 of 17 prevent the spread of infection. One toilet checked had no hand towel at all. The toilet rolls were also placed on the floor in some of the toilets, which, apart from being an infection control issue, could cause the resident to overbalance when reaching for them. The toilet rolls should be at the appropriate height and secured to the wall on holders. We had received information that hand washing areas lacked sufficient soap, however, soap was present in those areas checked. Staff need to make sure they are replenished when required. Although there was a cleaning rota in the kitchen for catering staff, some sections of the kitchen required a deep clean. The fly screen had holes in it making it ineffective and the kitchen window, which did not have a fly screen was open. These points were fed back to the providers to address. Staffing In discussions staff told us there were usually four to five carers in the morning and three to four carers in the afternoon/evening to support thirty-two residents. They advised that generally this was sufficient to meet the residents needs but on days when the lower figures applied it could be a struggle, as some residents required two carers to support them. On the day of the site visit there were five carers in the morning and four in the afternoon. The manager confirmed that figures dropped to four and three only when there was short-notice sickness. Some of the care staff had dual roles of catering/caring or domestic/caring roles but these were clearly defined on the rotas. The provider/manager was supernumerary. Most residents spoken with made positive comments about the staff team, stating that they, got on very well with them and they are excellent. However, this was not consistent with all the residents spoken with and some stated that at times a more empathetic and friendly attitude was required. One person also stated that there did not appear to be sufficient carers at certain times of the day and they had to wait longer than expected to be taken to the toilet and also at night when requesting to go to bed. Although most residents stated that on the whole the staff were, quite nice and caring, some also stated there was a language issue regarding specific staff members. The residents were referring to care staff from overseas, and whilst we did not have any particular difficulties speaking with care staff during the site visit, some residents told us it was difficult to have a social chat with some staff, they dont speak much and some cant speak enough so you cant have a chat. The comment was not implying any care deficits only that the residents would like to able to chat more freely with care staff. This was mentioned to the manager to check out and try to resolve. The home had records of which training courses staff had completed and used various training methods to ensure that mandatory training was available. Good progress had been made, although there were some refresher training required in fire safety and safeguarding adults from abuse. Some staff had completed service specific training, for example, catheter and sheath care, managing continence, dementia care, challenging behaviour, care of people after a stroke, nutrition in older people and mental capacity awareness. Most staff had completed a medication system training with the pharmacy supplying the medicines and some had completed a more in depth accredited medication course. It is recommended that all staff administering medicines should complete the more in depth course. Care Homes for Older People Page 8 of 17 The training documents required updating to fully reflect the existing staff team and to plan for the year ahead. Out of a care staff team of eighteen, eleven had a national vocational qualification in care at level 2 or 3. This equated to 61 of the care staff team and was a very good achievement. Other staff were progressing through level 3. A selection of staff recruitment records were checked and evidenced that all checks were carried out prior to the start of employment. This helped to ensure that only appropriately vetted people worked with vulnerable adults. Management and Administration There has been a significant change in management, when, four weeks ago, the acting manager and deputy manager both decided to leave at the same time and on short notice. The provider reacted quickly and has been overseeing the management of the home since then. She is a qualified registered general nurse and is the registered manager of the companys sister home in Nottingham. She keeps herself up to date with relevant training courses and is well qualified to manage the home. A decision needs to be made quickly regarding the ongoing management of the home. The disruption in management initially led to some anxiety among some residents but in the main this appears to be settling down. Residents meetings have been held and people informed of the changes. Some residents spoken with told us the manager was, approachable, agreeable, most obliging and one person said, she is alright - says hello and asks if we are ok. However, another comment was that the manager could be more approachable and although easy requests are dealt with quickly, some others may take several reminders. These comments were mentioned to the manager. Staff spoken with told us there had been a big difference in management approach, which was described as strict but supportive. They stated that the manager was good at giving advice and guidance but sometimes they felt, pushed to complete jobs. They stated the reduction in care staff numbers from five to four in the afternoons had had an impact and was not enough at times. However, the staff spoken with enjoyed working at the home. Although care staff spoken with stated the manager was supportive, we noted that formal staff supervision had slipped. We checked four staff files and found that two staff had had four supervision sessions in the last year but the remaining two had not had any. One of the latter had received an annual appraisal that looked at training needs. Care staff need to have a minimum of six, formal, one to one supervision sessions a year to cover all aspects of practice, the philosophy of care in the home and career development needs. We noted that visits by the provider, required in line with regulation 26 of the care homes regulations had not been carried out. These visits are to enable the provider to speak to residents and staff, examine documentation and to check out the environment in order to satisfy themselves that the home is being managed appropriately. A report has to be produced and kept on file for examination during inspections. We were told that the previous manager and subsequent acting manager had been completing the reports. Whilst the provider is managing the home, the reports are not required but visits and records of them must be completed should the provider return to manage the home they Care Homes for Older People Page 9 of 17 are registered for and a new manager is appointed for The Arches. We discussed quality monitoring in the home but documentation could not be located. The manager confirmed there was a quality assurance system in place but agreed it may not have been as robust during the last year as it should have been due to the changes in management. The system of questionnaires and audits is to be restarted. There was evidence that residents and their relatives were consulted in meetings. We had a brief discussion with the providers about the financial viability of the home, as currently there were seven vacancies. The provider will keep us informed if there are any issues of concern. Generally the home was a safe place for people to live in and staff to work in. As mentioned in the section on the environment, an immediate requirement was issued to check out and make safe a light fitting in the main ceiling and this was completed during the site visit. It was noted that one of beds with bed rails had only one protector and another had the rails in use without the protectors. This could cause people to trap their limbs. A window in an upstairs bathroom required a restrictor and staff need to ensure that bedroom windows upstairs are opened only to the restricted limit. Fire alarm checks and drills were carried out and equipment serviced. What the care home does well: What they could do better: Although residents had care plans in place, these could be more personalised to contain preferences and wishes for how they would like to be supported. The care plans and risk assessments must be kept up to date. Also monitoring charts, for example for pressure relief and fluid intake need to be more consistently completed so that there is an accurate record of the care provided. There were some shortfalls with the management of medication and these need to be Care Homes for Older People Page 10 of 17 addressed to ensure that accurate records are maintained and people do not run out of their medicines. There were some activities provided but the home has not got it quite right for everyone. The employment of dedicated activity staff may help to improve the provision of social stimulation. There were also mixed comments about the provision of meals. Some people enjoyed them but others clearly did not. These two important areas can have an impact on peoples wellbeing and ability to make choices. Some people felt able to make choices and live their life as they choose but for others choices were limited. As stated the home ensured that staff completed mandatory training. However, some staff were unsure about local safeguarding of adults procedures and refresher training was required. Also all staff that administered medication should complete the more thorough, accredited medication training course. The environment was generally clean and tidy, although some parts of the home could be updated. A refurbishment/redecoration plan needs to be produced with long and short term goals. This will enable us to monitor progress. The hot water outlets need to be a more constant, ambient temperature and paper towels should be supplied in communal bathrooms and toilets to help infection control. The environment needs to be checked more frequently so that the things we picked up, for example, the absence of bed rail protectors and a window restrictor, and some issues in the kitchen, are noted and addressed by the staff team themselves. Because of the high number of oversees staff working in the home and some comments about language difficulties, the manager needs to be assured that all residents are able to understand the staff and this is not an ongoing issue for people. Staff told us that a reduction in staffing numbers in the afternoon has led to them struggling on occasions. This needs to be investigated and addressed. The home needs to have stable management as soon as possible. It is acknowledged that the provider is overseeing the management of the home at the moment but a decision needs to be made quickly about future management arrangements. The quality assurance system has slipped this year and needs to be re-started so that audits are completed and people are widely consulted about the running of the home. Staff need to have more frequent, formal supervision - at least six times a year. This will enable practice to be monitored, training to be identified, and provide an opportunity for staff to discuss issues of concern. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 This requirement remains unmet and has been reworded and a new timescale issued. People must be protected by the way staff handle their medication, they must not run out of medication and good clear records must be kept. This will ensure people receive medication safely and as prescribed. 16/07/2010 Care Homes for Older People Page 12 of 17 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 13 The provider must seek advice from an electrician regarding the safety of the light fitting which was compromised by water six weeks ago. The leak causing the problem could reoccur during any further heavy rainfall and place the residents at risk. 07/06/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be updated when significant needs change. This will ensure that care staff have full and up to date information about peoples needs. 30/06/2010 2 8 13 Risk assessments must be updated when significant needs change. This will ensure that care staff have full and up to date information about peoples needs. 30/06/2010 3 12 16 Social needs assessments must be completed to establish peoples ongoing 31/08/2010 Care Homes for Older People Page 13 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action needs regarding the activities and stimulation they are able, and would prefer, to participate in. This will enable staff to tailor activities to suit individual needs. 4 15 18 All staff completing catering tasks must have the skills required to cook the meals designated in the menus. This will help to ensure that residents enjoy well prepared meals that are the highlight of their day and promote good nutritional intake. 5 18 18 All staff must have up to date training in how to safeguard vulnerable people from abuse. This will help to ensure that residents are protected and will provide staff with the confidence and knowledge to deal with any concerns or allegations. 6 25 38 Hot water outlets must 30/06/2010 provide residents with a temperature of appoximately 43 degrees. A plan must be put in place to address any ongoing deficiencies with the boilers. This will ensure they have access to hot water at a safe and ambient temperature. 31/08/2010 31/07/2010 Care Homes for Older People Page 14 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 33 24 The quality assurance system must be re-started. This will enable a range of people to be consulted about the management of the home and the services provided. 30/06/2010 8 38 13 Environmental audits must 30/06/2010 be carried out and recorded to enable safety issues to be picked up quickly and addressed. This will help to maintain the safety and welfare of residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should contain more personalised information so that care staff have full and up to date information on how people wish to be cared for. Monitoring charts, obviously in place for a reason should be fully and consistently completed so there is an accurate picture of the care provided. The recording of codes to explain why medication has been ommitted should be clearly defined. This will enable a clear audit trail of medication. There should be a thermometer positioned near the storage of medication to ensure that it is stored at the correct temperature. The providers should consider the employment of an activity coordinator. This will enable a more focused approach to activities and social stimulation and prevent Page 15 of 17 2 8 3 9 4 9 5 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations some activities being disjointed as care staff leave to support other people. 6 14 The television arrangements in the lounges should be reorganised to take account of residents wishes or a new larger television purchased for the main lounge as stated by the providers during the visit. Communal bathrooms and toilets should have hand paper towels to prevent the spread of infection and appropriately sited toilet rolls. The manager should check out and address the perceived staff shortage at certain times of the day by speaking to residents and staff. This will enable residents to have their wishes and needs met regarding waiting times for staff support. All staff administering medication should complete an accredited medication course and have their competence tested. This will ensure they have the skills required to administer medication safely. A decision should be made quickly about the future management arrangements of the home and the manager should then apply to be registered with the Care Quality Commission so their fitness to manage can be tested. Care staff should receive a minimum of six, formal supervision sessions each year. This will enable their practice to be monitored, training to be identified and any issues of concern discussed. There should be a checking system in place to ensure that bedrails and protectors are in place and in working order. 7 26 8 27 9 30 10 31 11 36 12 38 Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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