Care Home: The Cedars Nursing Home

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well The Cedars provides a very pleasing modern, comfortable environment for people. Facilities have been designed and are provided with the current client group in mind and can meet the needs of people with complex disability. Whilst the home is fully equipped to function to meet the needs of people who need nursing care, this does not predominate, and the atmosphere remains homely and non-clinical in style. Residents are supported by a very stable team of staff, who are trained in their roles. High standards of documentation were in place, so that staff can be aware of how to meet residents` nursing and care needs. People commented on the quality of care provided. One person reported "Oh yes, I`m comfortable", another that the home was "very, very good", another that it was "all right here" and another "I don`t think we`ve anything to complain about". People described the supports from staff. One person reported "very kind helpful and supportive nursing health assistants and admin staff", another "the staff are always very pleasant and put themselves out to help", another "I was admitted here from hospital and have to say the care is fantastic. All staff are friendly and have time to talk at any time of day or night" and another "I am very happy here its like a large family". What has improved since the last inspection? At the last key inspection, the home was one star rated, assessed as providing "adequate" outcomes for residents. At the random inspection, progress was noted in some areas but matters identified at previous inspections had not been addressed in full and four additional requirements and three good practice recommendations were identified. By this inspection, the home has improved service provision to the extent that they are now rated as two star, providing "good" outcomes to residents. As well as addressing requirements, some of which had been unmet for more than one inspection, the services have moved out of older accommodation, into new purposebuilt accommodation. The home now provides full information about its services to advise people, prior to admission. The home have also fully improved its care planning system. Where a resident has a nursing or care need, there is now always a care plan in place to direct staff on how the resident`s need is to be met. Full monitoring systems are in place so that the managers can ensure that residents` individual needs are being met. Staff now use care plans as working documents, to direct them on how to meet individual residents` needs. Major improvements have been made in the practice in administration of medication, with registered nurses showing safe practice when administering medication. There are now full records relating to medicines, including medicines given to residents and disposed of from the home. All medicines, including medicines for disposal, are safely stored. There are clear care plans relating to the administration of medication to residents. Major improvements have been made in the provision of equipment, including pressure relieving mattresses and variable height beds with integral safety rails. The cleanliness of sanitary items has much improved. Staffing levels have been increased and staff were more evident supervising residents in the sitting rooms and at mealtimes. Induction programmes have been further developed. Improved systems for staff training have been put in place and this inspection evidenced the diverse areas that staff have received training in. Systems for staff supervision have been put in place across all staff groups. What the care home could do better: A few areas still need to be developed by the home. The home needs to improve their care planning and practice in relation to residents who are insulin dependant diabetics, to ensure that such residents` conditions are maintained in as stable a condition as possible. Documentation relating to fluid and dietary intake, wounds and crushing of medicines would benefit from more clarity and consistency in approach in certain areas. There should be improved communication and coordination in relation to residents expressing choice in their social lives. Complaints documentation would benefit from consistency in approach to documentation. Improvements in relation to health and safety, including prevention of spread of infection and manual handling is needed. This includes adequate systems for ensuring hand cleansing and drying for cleaners and in certain sanitary facilities. Improvements are needed in practice in the separation of infected, potentially infected and used laundry. Systems must be put in place to ensure that underclothing, including socks and tights are not used communally. Lifting slings for hoists must not be used communally and there need to be clear systems to ensure that slings are laundered on a regular basis. Staff need to always perform safe practice when performing manual handling of residents. All records relating to manual handling must be clear and senior staff must ensure that all staff always comply with appropriate practice in relation to manual handling. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Cedars Nursing Home Northlands Landford Salisbury Wiltshire SP5 2EJ     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: The Cedars Nursing Home Northlands Landford Salisbury Wiltshire SP5 2EJ 01794390284 01794390068 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Alphacare Holdings Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users that can be accommodated is 40. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum of 4 places Physical Disability (Code PD) - maximum of 4 places Old age, not falling within any other category (Code OP) - maximum of 40 places Date of last inspection 1 4 1 1 2 0 0 8 4 0 4 Over 65 0 40 0 Care Homes for Older People Page 4 of 40 Brief description of the care home The Cedars Nursing Home is registered to provide nursing care for 40 people. The home is a recently-completed purpose-built building, situated in rural location on the A36 mid-way between Salisbury and Southampton. Accommodation is provided over two floors with a passenger lift in-between. All of the rooms are single and provide modern, comfortable accommodation. The home has large surrounding grounds and pleasant views of the countryside. Currently an older building attached to the home is being fully refurbished. There is car parking on site and a bus stop at the end of the drive. The Cedars is owned by Alphacare Holdings Ltd and the Registered Manager is Mrs Marilyn Bulmer. She is supported by registered nurses, care assistants and ancillary staff. The fee range is 563 pounts to 800 pounds a week. Additional charges are made for services such as hairdressing and chiropody. A copy of the service users guide is available in each residents room. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection, 30 questionnaires were sent out and 25 were returned. Comments made by people in the questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the homes file was reviewed and information provided since the previous inspection considered. We also received an Annual Quality Assurance Assessment (AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We also performed a random inspection on 14th November 2008 to review progress towards meeting the requirements from the previous inspection. We looked at the AQAA, the surveys, the random inspection and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visits to the home. Care Homes for Older People Page 6 of 40 As the Cedars is a larger registration and was given a one star adequate rating at the last inspection, two inspectors performed the site visits and the site visits took place over two days. These people are referred to as we throughout the report, as the report is made on behalf of the Commission for Social Care Inspection (CSCI). The first site visit was on Thursday 2nd April 2009, between 9:45am and 5:25pm. The second site visit was on Tuesday 21st April March 2009, between 9:40am and 11:30am. The first visit was unannounced. Mrs Bulmer, the manager was on duty for the first day and the operations manager also visited the home during the visit. Mrs Bulmer and the operations manager were available for the feedback at the end of the site visits. During the site visits, we met with nine residents and observed care for six residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day and in different areas of the home. We reviewed care provision and documentation in detail for eight residents, including residents who had recently been admitted to the home. As well as meeting with residents, we met with four registered nurses, at least five carers, the housekeeper, a domestic, two laundresses, the administrator, the receptionist, an activities person and the chef. We observed two lunchtime meals and two activities sessions. We reviewed systems for storage of medicines and observed one medicines administration round. A range of records were reviewed, including staff training records, staff employment records, complaints records, the statement of purpose and service users guide. What the care home does well: What has improved since the last inspection? At the last key inspection, the home was one star rated, assessed as providing adequate outcomes for residents. At the random inspection, progress was noted in some areas but matters identified at previous inspections had not been addressed in full and four additional requirements and three good practice recommendations were identified. By this inspection, the home has improved service provision to the extent that they are now rated as two star, providing good outcomes to residents. As well as addressing requirements, some of which had been unmet for more than one inspection, the services have moved out of older accommodation, into new purposebuilt accommodation. The home now provides full information about its services to advise people, prior to admission. The home have also fully improved its care planning system. Where a resident has a nursing or care need, there is now always a care plan in place to direct staff on how the residents need is to be met. Full monitoring systems are in place so that the managers can ensure that residents individual needs are being met. Staff now use care plans as working documents, to direct them on how to meet individual residents needs. Major improvements have been made in the practice in administration of medication, with registered nurses showing safe practice when administering medication. There are now full records relating to medicines, including medicines given to residents and disposed of from the home. All medicines, including medicines for disposal, are safely stored. There are clear care plans relating to the administration of medication to residents. Major improvements have been made in the provision of equipment, including pressure relieving mattresses and variable height beds with integral safety rails. The cleanliness of sanitary items has much improved. Care Homes for Older People Page 8 of 40 Staffing levels have been increased and staff were more evident supervising residents in the sitting rooms and at mealtimes. Induction programmes have been further developed. Improved systems for staff training have been put in place and this inspection evidenced the diverse areas that staff have received training in. Systems for staff supervision have been put in place across all staff groups. What they could do better: 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 40 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents will receive information about services provided by the home and have a full assessment prior to admission, so that they can be assured that the home can meet their needs. Evidence: Of the ten people who responded to this section of the questionnaire, eight people reported that they felt they had received enough information to decide if the home was the right place for them. Comments included we came and visited the home and matron showed the whole family around, I was not at all well when I moved to the Cedars, my [relative] considered it to be the right place for me and it is the one and only choice. One person suggested that information of staff structure and names of members of staff would be helpful. In their AQAA, the home reported that they now had a comprehensive statement of purpose. During this inspection, we noted that each persons room had Perspex holder Care Homes for Older People Page 11 of 40 Evidence: by the door which contained the homes statement of purpose, a welcome pack, the summary from last inspection report, a newsletter and the current months activity programme. The homes statement of purpose had been updated recently and contained all information required by us. It was a readable document, which conveyed the providers aspirations to provide a quality service. The service users guide was in a frequently asked question style, which gave an effective impression of the service provided. During this inspection, we met with several people who had recently been admitted. Due to their frailty some people could not recall the admissions process. One person recalled the manager visiting them in hospital to do their assessment and being given information about the home. They also recalled worries about not returning to their own home and adjustment to life in the home, but they reported that staff had helped them to express those feelings and said that they now felt at home at the Cedars. Another person who could not recall their admissions process, had clear records relating to them coming to visit the home before admission, with a member of their family. We looked at three peoples pre-admission assessments. The home uses a standard pre-assessment format for all prospective residents. One persons pre-admission assessment noted their medical history and their current personal care needs, including equipment needed to prevent risk of pressure damage. Their admission form also included consideration of the residents and relatives understanding of reasons for admission. Another persons admission assessment included evidence that their relative had confirmed that they were consulted on contents of the residents care plan. A third persons assessment was clear, stating who information on their nursing and care needs was obtained from and when. This persons reasons for admission included social as well as medical needs for admission. The persons past history and skills were clearly documented and provided a very individualised assessment for that person. All assessments were dated and signed. Residents had letters on file confirming that the home can meet their needs, following assessment. These detailed pre-admission assessments also provided a good basis for future dependency assessments for residents. Care Homes for Older People Page 12 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be supported by the homes much improved systems for meeting individuals personal and healthcare needs and by staff who understand the importance of ensuring the persons privacy and dignity. A few areas only need attention, to fully reduce risk. Evidence: Of the twelve people who responded to this section of the questionnaire, nine reported that they always received the care and support that they needed and three that they usually did. Comments included things have improved a lot since I moved into the new building & get looked after very well, the staff are always on hand to help, some days better than others depending on the staff on duty and according to my observations [my relative] is well cared for and happy. We also discussed how the home met residents needs with people during the inspection. One person reported I quite enjoy it, it think its good, another that they were very happy with the care received, that staff always explained what they had to do and how they were to do it and another person reported they do enough washing about provision of personal care. One person reported that care staff varied in attitude and motivation, most were Care Homes for Older People Page 13 of 40 Evidence: very caring and explained what they were doing. They also reported that staff motivated them to improve their mobility. One person reported that staff did not appreciate the degree of pain they experienced on being moved and did not always explain the movements they were asking of them. This aspect of care was not apparent in their care plan. At the previous inspection requirements were set relating to care planning and records of care provision, particularly in relation to people who were very frail. The home have put much work into making improvements in this area. New care planning documentation is in the process of being introduced. The new format follows personcentred principles, identifies what are an individuals preferences, and provides a clear basis for future evaluation. The home manager reported on the involvement of managers across the providers group to determine what was considered most useful in the new system. All people now have assessments for areas of risk such as manual handling, risk of pressure damage, risk of falls and nutritional risk. Where risk was identified, care plans were developed to direct staff on how risk was to be reduced. In their AQQA, the home reported that they ensured that staff are aware of service users individual needs and abilities. Care staff reported to us that they felt involved in care planning as key workers and through daily records of care. One registered nurse reported that key workers observations were central to evaluation of care plans. One care assistant commented in their questionnaire that handovers were limited, however others stated that they were good. A care assistant reported during the inspection that they were informed of residents care needs at handover and that nurses listened to what they said. A registered nurse described how the handover worked in the morning had how they decided how they were going to work for that shift. Laundry staff reported good communication with nurses and carers, particularly in relation to letting them know when residents had infections. Staff were observed to be kindly and supportive to residents, for example we observed a resident who went to the toilet frequently and could not remember where the toilet was. Care assistants were observed to be very supportive on each occasion, with no sense impatience with the resident and an impression that they enjoyed the company of this resident. All residents documentation included their preference for a male of female carer for their personal care. They also included significant details, such as their preferred name. The home has systems for marking residents clothes apart from net underwear, socks and tights (see Environments below). However we did observe two bags of un-named clothes during the inspection. The housekeeper reported on improvements which had been made in ensuring that residents clothes were marked and future developments planned to ensure that all residents would have Care Homes for Older People Page 14 of 40 Evidence: their own clothes returned to them. All people had care plans in their rooms relating to manual handling needs, so that staff had ready access. One persons care plan had good additions relating to the persons anxieties on being moved and how staff were to reassure the person. It was noted as good practice that residents who needed topical applications had clear information in their rooms to advise staff on what creams were to be used and where, with a signature record to provide evidence that such topical applications had been used. One person reported that staff showed attention to hearing aid needs, and this was documented in their care plan. This persons care plan also described how their privacy and dignity were to be upheld. Where people were assessed as being at risk of pressure ulceration, most had clear care plans in place. One care plan which needed some adjustment was in the old-style care planning format and it was reported would be addressed when it was changed to the new style. Another persons evaluation indicated that due to their restlessness they might not require regular pressure area care, however their risk assessment for prevention of pressure damage did not show that their risk had changed. This person did have clear evidence that the risk of tissue damage presented by certain furniture had been assessed. On occasion information was inserted in inappropriate parts of care plans, for example evaluation of environmental issues for a person was mixed with details of GPs visits and medicines changes changes. This will make audit complex. Generally nearly all care plans were very clear and detailed how the persons needs were to be met, in an individualised manner. One person had a very clear care plan which directed how their dementia care needs were to be met. Their plan relating to communication was also very clear and included reference to mood-altering drugs prescribed by their GP, to facilitate assessment of the effectiveness of such drugs. One persons care plan detailed that they were unable to feed themselves and how staff needed to assist the person in maintaining adequate nutrition. We observed staff complying with this care plan at lunchtime. Records showed that the persons weight was regularly assessed. It was clear that the person had been referred to the dietician. All people who had continence needs had an assessment performed and a care plan drawn up, which included what specific aids were to be used to support the person. Where people were unable to turn themselves or give themselves food or fluids, they had monitoring charts in place, so that staff could assess how much the person had been able to eat and drink and when they were due to be turned next. One care Care Homes for Older People Page 15 of 40 Evidence: assistant reported to us on how it was important to keep turn charts up to date. A resident commented on how carers completed records for them when they were turned. Most of these charts had been initialled by the person who had provided the care, but not all. All turn charts had been fully completed and complied with directives in care plans. We observed that staff completed records at the time care was given. We looked at fluid charts for three people and observed that for one person there were no records of fluids for the day before between 8:00pm and 6:00am, for another person their last drink was documented as being at 7:00pm, with no more records until 5:20am and for a further person there were no records of fluids being offered between 7:00pm and 6:30am. The home should advise staff on evening and night shifts that they should also document fluids offered, even if the resident only takes sips, to provide evidence that residents hydration needs are being met. Where residents were prescribed thickening agent, there were instructions in residents rooms to state how thick the fluids were to be and this was observed to be followed by staff. Where residents were prescribed dietary supplements, there was a lack of consistency in documenting in care plans. The manager reported that this was a matter which was being dealt with as care plans were up-updated into the new format. Staff were not always providing evidence on food or fluid charts that such supplements are being given to residents. Some food charts stated what residents had eaten but others were ticked or a comment such as half documented. It is advisable that food charts detail what or what parts of the meal the person has eaten, to assist in the evaluation process. One area which the home needs to develop further, is care planning and provision of care in relation to diabetes. One person who was a diabetic had a care plan, but it did not state the parameters for blood sugar levels for the person and what do if blood tests showed that the persons blood sugar levels were outside these parameters. This persons daily records showed evidence of low blood sugar levels on four occasions just before the inspection. This was documented but there were no records of what actions had been taken by staff to address these low blood sugar levels. The person had a record of changes in injection sites to prevent tissue damage but most records showed that the injections were given to the persons arms, which is not currently advised, and the reasons for the use of these injection sites were not documented in the persons care plan. A registered nurse reported that they were using a pen injection system and re-sheathing needles, this is contrary to the Medicines and Healthcare Regulatory Authority directives. The reasons for such practice and why it is in the best interests of the resident need to be documented in the persons care plan, together with a risk assessment on how risk of needle stick injury is to be reduced for Care Homes for Older People Page 16 of 40 Evidence: registered nurses. Where a resident had a wound, there were clear care plans and documentary evidence that the wound was regularly evaluated. We noticed as good practice for one resident, that when the presence of a sore area was documented, that their GP was contacted the same day and records of its improvement following that were made, until the area was heeled. Where a person had a complex wound, this was photographed. Some photographs included the date the photograph was taken, others did not and it is advisable that the date the photograph was taken be always included on the photograph itself. Of the thirteen people who responded to this section of the questionnaire, twelve reported that they always and one that they usually received the medical support that they needed. One person reported when I have not been well the staff have called the doctor when necessary and I have always been looked after very well and another I have always seen a Dr when I need one only have to ask the nurse and she will send him in. In their AQAA the home reported that they maintain good communication and working relationships with other healthcare professionals in the multi-disciplinary teams. Staff reported on the effective working relationship with the local GPs. One registered nurse described the service as very good and another, supportive. A senior registered nurse from the GP practice also visits the home weekly to provide clinical support. In their AQAA the home reported on how during the past year, they had forged closer links with this registered nurse and how this registered nurse advises and trains staff, for example in wound management. We met with this nurse practitioner and there was clearly a good rapport with the registered nurses from the home and they were able to discuss treatment alternatives for individual residents. One resident commented new glasses were prescribed soon after being admitted to the Cedars. Also regular chiropody treatment. Medication revised and given daily. We observed a medicines administration round and observed that it was correctly and safely performed, in accordance with guidelines. All medications were safely stored, including Controlled Drugs, with full records for all Controlled Drugs. All medicines cupboards and trolleys were tidy and well organised. We noted that temperatures were documented for the medicines fridge and where a raised temperature was documented, that actions taken to reduce the temperature were noted. All limited life medicines had their date of opening documented on the bottle, to ensure that they were not used after the expiry date. There were safe systems and full records for found, dropped or spat out medicines. Care Homes for Older People Page 17 of 40 Evidence: We noted as good practice that medicines administration records included guidance on how each resident liked to take their medication. Where residents were prescribed a drug on an as required basis, there were full protocols drawn up to direct registered nurses on when such drugs were to be administered. Variations were clearly documented, for example omission of a dose of Digoxin when a resident had a low pulse. At present the home transcribes prescriptions onto medicines administration records, however it was reported at feedback that the system was to change during May 2009 and that the home would go over to pre-printed medicines administration records, to eliminate the risks associated with hand-written transcriptions. We observed that at least three residents were having their drugs crushed. Where this was necessary, the person or their relatives consent was obtained as well as seeking consent from the GP. Mrs Bulmer reported that they also sought the pharmacists consent. The home does not maintain records of consent from pharmacists and as some drugs can alter their effect when crushed this is recommended. Care Homes for Older People Page 18 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by the home is exercising choice about their social and recreational activities. Meal times are seen as a key area in the life of the home. Evidence: Of the twelve people who responded in questionnaires, six reported that they always, four that the usually and two that there were sometimes activities arranged by the home that they could take part in. One person commented I enjoy them, particularly the music. Perhaps we could have a bit more variety, another they are very good we do all sorts of things if we want to, another bedridden but a room was provided near day room so I can hear activities e.g. singing, quizzes and another activities take place on Monday, Wednesday and Fridays and these are generally quite good - bingo, quizzes, singing, painting some each week. Sadly nothing happens at weekends. In their AQAA, the provider commented on the comprehensive diary of activities tailored to individual needs and abilities of the service user. We discussed recreational activities with people during the inspection. They said that they appreciated the thought put into activities, which also gave them an opportunity to socialise. One person said they felt independent in the home, there were plenty of opportunities given and they chose what they wanted to do and when. They also Care Homes for Older People Page 19 of 40 Evidence: reported that they could be private in their own room when they chose. One person reported that staff came into them with a good attitude and gave extra time to talk with them when they were anxious or upset. Another person described the daily offer to join activities groups, which they sometimes did. This person reported that they equally felt comfortable in their own room, reading, watching TV and enjoying the outlook. We met with one of the three activities coordinators who said the activities staff plan activities together, whilst allowing for resident choice to vary from planned activities. She reported that they tend to expect the same groups of residents to join activity sessions. If regular people do not come, they remind them and offer involvement. Sometimes they give people resources to use in their own rooms, for example sketch pads. Groups incorporated throwing, bowling and other such activities, to encourage movement. It was reported that main activities groups took place Monday, Wednesday and Thursday. A reminiscence specialist also comes in on Tuesdays, mainly for 1:1. Care staff told us they had time for talking and walking in the grounds with residents. Activity programmes are distributed to all residents rooms and are available on notice boards. There was no evidence that residents are helped to be familiar with this. We observed several activities sessions during the inspection. At 11:00am, two activities workers conducted a quiz session in the main lounge/diner with eight residents. There was music in the background, but this was turned of at residents request. Staff successfully developed conversation around quiz answers. At 2pm the activity group was sketching, painting and writing. Activity workers had brought source material and people had their own sketch pads that had been supplied previously. On the first floor, during the morning, we observed the activities person leading a singing group using a keyboard, residents in the room were clearly enjoying themselves and the activities person ensured that they were supported in being fully involved. We reviewed care plans relating to social care needs. One residents plan included a separate social assessment which noted the person was keen on needlework and restrictions presented by their medical condition. A person had a care plan to ensure that they did not feel isolated, and the offering of TV and radio. This plan was evaluated and how they responded well to regular talking with staff and visitors. This plan did not note if the person had been referred to activity coordinators. Another persons care plan reported on their choice of socialising or staying in room. It documented that the person was to be offered 1:1 reminiscence, trips out, support for Christian beliefs and enjoyment of the TV. This plan was not developed into priorities or how these to be accomplished, could be promising area of liaison between resident, Care Homes for Older People Page 20 of 40 Evidence: key worker and activities co-ordinator. This person reported that staff did not support their use of the TV. On the day of the inspection it was put on a programme which they reported they had no interest in, on changing channels we found a programme, which they reported was one of their favourite things. They reported that they would like time spent planning what was on and getting confidence in changing channel themselves. Activities people kept simple records to show which residents participated in different activities and any particular observations, for example XXX not herself today. There was no evidence of appraisal of activities themselves. There was no evidence that care plan information was used in making activity plans and activities staff did not report that they reviewed social care plans. Some links with the community could be further developed, for example one residents records showed that there was an intention to make a link with the church the person had attended for years, this was not seen as an activities matter and it was not clear as to who should progress this need. This was discussed at feedback and the managers advised us that they would progress this area as a field where key workers could become more involved. The home works closely with residents families and works to try and forge links with the local communities. For example each year the residents decide on a local charity to support. One person reported my family come and visit when they want to, another persons records noted that their spouse visited them on a daily basis. One member of staff reported that relatives were very, very supportive to the home. One persons records noted that practice of religion was important to them but as they experienced short-term memory loss, they may miss the religious services held in the home unless reminded by staff of the day and the time. One persons care plan explained the persons wish to remain in bed. It stressed how to uphold their personal choices, for example in choice of clothes, toiletries, light level. Of the eleven people who responded to us about the meals in questionnaires, five reported that they always and six usually liked the meals. Comments included Very good. Always ask for more if we want it, usually they are well presented. Sometimes we have 2 hot meals a day & I dont think I want this. I would like a sandwich for supper, If I want something special the staff will get it and food tastes okay ish not enough choice. We also discussed meals with people during the inspection. One person reported we have a nice evening meal, another fairly good meals, suppers not so good, another meals are very good now, we get a hot meal on Sundays now and another Im not a big eater so they give me what I can eat. During the inspection we observed a mealtime. Each floor has a sitting/dining room, Care Homes for Older People Page 21 of 40 Evidence: so people do not have to move floors unless they wish to. We observed that the residents who wished to eat off a tray in their own room and those who needed assistance from staff to eat were given their meals at a first setting. Residents who wished to eat in the dining rooms and who did not need assistance, ate their meal at a second sitting. This fosters the social atmosphere for the meal. We noted as good practice that meals for the second sitting were plated immediately before the meal and not left for a period in a hot trolley. The food was well presented and in quantities to suit individual requests. Where residents did need assistance to eat their meals, care assistants sat down with them supporting and encouraging them to eat. We observed that a choice of drinks was given at lunchtime. One residents care plan showed that they had a preference for cranberry juice as regular drink and there was open carton on their table. We met with the chef who had newly come in post. He was very enthusiastic in his role. He reported that he was reviewing the menus. At present no choice as such is offered at lunchtime. There is a choice at breakfast and supper. It was reported by the managers at feedback is that the current plan is to offer a choice of meals at lunchtime, beginning in May 2009. The chef reported that he was happy to prepare ad hoc choices for meals for residents when asked for. He reported that he makes nearly all meals up from raw ingredients, including soups, sauces and gravies. He reported that at the time of the inspection, he did not have anyone on a special diet, however he showed a good knowledge of the ranges of diets that he might need to provide in the future, including vegetarian diets. He reported that a chef always plated up liquidised diets, to try to make them as attractive as possible. He reported that he was informed of all newly admitted residents and that once he has been in post for a longer period, he was planning to go out at least once a week to meet with residents and receive their comments on food. Care Homes for Older People Page 22 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have their concerns and complaints listened to and will be safeguarded from abuse. Evidence: All eleven people who responded to this section of the questionnaire reported that they knew how to make a complaint. Ten of the thirteen people to this section of the questionnaire reported that they knew who to speak to if they were not happy. Comments included that they would speak to the Matron or member of staff, another fortunately I have always been very happy but if these was a problem I would speak to Matron and another person reported that information on how to complain had been given on admission. All of the staff who completed questionnaires also reported that they knew what to do if a person had concerns about the home. Comments included if there were any concerns I would go to person in charge of the shift or the manager if she was on duty and all service users are allowed to comment or raise their views. They have a right to be treated with dignity. In their AQAA, the provider reported The Home Manager (HM) operates an open door policy in respect of being readily available to meet with and listen to any concerns of Residents, their relatives and staff. This way issues are dealt with as they arise. Residents are given a copy of the homes complaints procedure in the service users guide, a copy of which is available to them in their room. The complaints procedure is also displayed in the main entrance area. We talked to people about how Care Homes for Older People Page 23 of 40 Evidence: they raised issues during the inspection. One person reported Ive no complaints about them, another If Im not happy I tell Matron - I can make an appointment and another Id tell my daughter & shed sort. Mrs Bulmer maintains a record of complaints made to her. It was noted as good practice that she documents verbal concerns as well as complaints. These records show how she has investigated matters and actions taken to address and issues that have been up-held. More than one person raised with us the issue of practice in the laundry relating to residents clothing in questionnaires. We noted that these matters had also been reported to Mrs Bulmer and her records noted actions taken to address the concerns raised. The provider also reported on actions to be taken to improve laundry services in their AQAA. The home is not currently keeping records of complaints in a standard format, they tend to be written on different pieces of paper and held in a loose-leaf fashion, so records vary. This was discussed at feed back and the operations manager reported that the provider is in the process of introducing a standard format for complaints and concerns. It was also discussed that as part of the homes quality audit system, a system for reviewing complaints and concerns for trends should be developed. Staff reported on their awareness of protecting vulnerable adults in questionnaires. One person reported all staff are familiar with abuse privacy & dignity & who to report to if worried, another if the situation did arise I would contact the manager immediately and another I have my no secrets booklet which explains everything. Mrs Bulmer is aware of the local safeguarding procedure and has experience of working within it. We discussed staff awareness of safeguarding vulnerable people with a range of staff and all reported that they had recently been trained in the area. When we discussed this with non-care staff such as the laundresses, we noted as good practice that both laundresses reported that they had been trained in the protection of vulnerable adults and both laundresses showed a good understanding of their responsibilities in this area. Care Homes for Older People Page 24 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home will be supported by a clean, modern, attractive facilities. Practice and equipment to prevent risk of cross infection needs more attention. Evidence: Since the last key inspection, a purpose-built extension has been completed to the rear of the original building and all the residents have moved into this extension. The original building was in the process of being fully refurbished and up-graded at the time of this key inspection. All of the new extension has been completed to a very high specification indeed, with new furniture and equipment throughout. People expressed their appreciation of the environment. One person reported I feel that Cedars is a well maintained home, where the clients are looked after and are happy within the environment, another excellent home, beautifully fitted and furnished and another so much better in this building. The main entrance to the main home is via automatic doors which will assist anyone using or pushing a wheelchair. There is also a lobby in-between the automatic doors, which will ensure that a person can be warm and dry if they have to ring the bell to request entry to the building. The bedrooms are all large and exceed minimum room sizes. There is a sitting/dining room on each floor, which are light and pleasant. There are a range of assisted bathrooms, showers and wcs, which are spacious and designed with disabled people in mind, to allow space for manoeuvring of hoists and Care Homes for Older People Page 25 of 40 Evidence: wheelchairs. New furniture and equipment have been provided throughout the home, including new profiling beds. Furniture such as armchairs are all new and suitable for people who are frail. Furniture provided is domestic in style and of a high quality. New hoists to aid manual handling have been provided. The scales are sit-on and are new. There is a hairdressing room, which is very attractive but neither particularly male or female in tone, so as to support people of either sex. New bed linen has been provided. The new linen is in attractive pastel colours. During the inspection, we met with a cleaner. She was fully aware of principals of prevention of spread of infection and the importance of her role in this. She reported that she had all the equipment and chemicals she needed to perform her role. People commented on the cleaning. One person reported all the rooms are lovely and clean and smell very fresh - no unpleasant odours at all, another the team of cleaners are great - as well as being good at their job they are cheerful and chatty with the residents and another the home is always clean it is new and the standard of hygiene is very high. We observed that communal bathrooms were all very clean and that aids like non-slip mats were left clean and dry after use. Bath thermometers to aid testing of the temperature of bath water were readily available and records in each bathroom showed that bathwater temperatures were regularly tested. All jars of topical cream were labelled with the residents name. Certain areas relating to prevention of spread of infection needed attention. The cleaners cupboard included a sink but it did not have a wash hand basin, soap or towels provided. Hand washing is regarded as one of the most significant factors in prevention of spread of infection, so these are needed, to ensure that the cleaner can properly cleanse her hands when performing her role. In one wc, one bathroom, and the visitors toilet, a pile of paper towels had been left on the surface and there was no dispenser for this type of towel available. A wc did have a different type of dispenser, but this was empty. If paper towels are left on a surface like this, there is the potential for the whole pile to become contaminated, as water will soak through the paper. In wcs and bathrooms, gloves were left on surfaces near the wc or on the cistern. This is not regarded as good practice and to prevent contamination, gloves should be placed in wall dispensers. During the inspection, we noted that there were no shelves in the cleaners cupboard, so a range of items had to be stored on the floor. This is not regarded as good practice. This was discussed at feedback and it was agreed that shelving would be provided in the cleaners cupboard by the end to the following week. Care Homes for Older People Page 26 of 40 Evidence: In a linen cupboard, we observed a container of net underwear, another of mens socks, ladies pop socks and tights. None of these had been named. We discussed this with the laundresses, who reported that such items were often used communally. At feedback, we advised that such practice did not support ensuring residents dignity. We also discussed that communal use of some items such as socks can be a risk to cross infection and that the home must put systems in place to ensure that underwear is not used communally. During the inspection, we visited the laundry, met with two laundresses and the housekeeper who manages the laundry service. The new laundry is large and spacious and its layout encourages safe principals of prevention of cross infection, including in and out doors. We observed that infected and potentially infected items were placed in red alginate bags. However through the plastic of one bag, we observed that some items which needed a high temperature wash were mixed with items which needed a lower temperature wash. This meant that, to prevent damage to residents personal clothing the red bags would need to be opened and re-sorted. This was discussed with the laundress who reported that this was not an isolated occurrence. Re-sorting infected and potentially infected laundry is a major risk to cross infection. The laundress reported that carers used to separate used laundry at source but that this practice had gradually stopped in the new building. It was advised that in order to prevent some risk of cross infection, used laundry should be separated at source, using an appropriate system, such as a three laundry bag system, to facilitate this. Many of the residents in the home have complex manual handling needs. Staff reported that lifting slings for hoists are not allocated to one resident but are used communally. We asked laundresses and carers about laundering of hoist slings but there did not appear to be a set system. One carer reported that they thought slings for hoists were washed about once a week. Slings used in manual handling may be a risk to cross infection, so all residents who need to be lifted using slings need to be allocated their own sling, which must be is labelled with their name. There also need to be clear systems for ensuring that slings are laundered on a regular basis. Care Homes for Older People Page 27 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be supported by sufficient numbers of staff, who have been safely recruited and are trained in their role. Evidence: As well as employing registered nurses and carers, the home also employs cleaning, laundry, catering, activities, maintenance and administrative staff. People responded about staffing levels in questionnaires. Of the twelve people who responded to this section of the questionnaire, seven people reported that there were always and five usually, staff available when they needed them. Comments included and when XX needs help in [the persons] room/toilet theres always help on hand and the staff are always around when I need them. Two people did report that they felt there were not so many staff on duty at weekends and one felt that the lounge was not always fully supervised. Of the eight members of staff who responded to this section of the questionnaire, four reported that there were always, two usually and two sometimes enough staff to meet individual needs of residents. Nearly all of the staff who commented that the home could be short of staff reported that this related to when people went off sick at short notice. During the inspection, we discussed staffing levels with people. One person reported ring a bell and they come, another ask for help, they come, very good mostly at doing what you want and another said they got quick responses to call bells, Care Homes for Older People Page 28 of 40 Evidence: sometimes for staff to explain they had to finish elsewhere and would be back - which they always were. One person did report they could always do with more about staffing. In their AQAA the home commented particularly upon their stable work-force, some of whom had worked in the home for many years. During the inspection, we met with a range of staff, some of whom had worked in the home for a long time, some of whom had been more recently appointed, as the home was growing in numbers. We were also made aware of plans to expand the catering staff numbers as the home expanded. We reviewed five files of staff who had been recently appointed. All included a proof of identity, employment history, two clear references, health checks and police checks. One person had changed roles in the home and their file did not show that they had been interviewed for this new role, although the manger reported that this had taken place. Where this happens, as good practice, this should always be supported by documentation. In their AQAA, the home reported that they had recently introduced a core induction, which complied with guidelines. This induction has standard systems, outlining certain topics which are covered over a series of weeks, to ensure that all matters are covered and that the inductee received information in a structured manner over time, without overload. One person who had worked in the home for a period of time reported on these improvements in their questionnaire, stating have been working at the home a long time and it has improved. Another person commented particularly on how it was great on my first day to be shown the fire exits, fire alarm and where to go if a fire occurred. This did not happen when I worked in another home. We discussed their inductions with two newly employed staff and they reported on the detailed induction and the supports that they had received. We reviewed five peoples induction files. A review of these files indicated that the home were not keeping to their policies and procedures on induction on all occasions, with some inductions covering a lot of areas in the first week, others not receiving areas such as manual handling by the due date and some areas being missed out, but this not being considered at the persons first supervision. This was discussed at feedback and the operations manager reported that this had already been identified as an issue and that from the following week, systems had been put in place to ensure that all people received a detailed structured induction programme, in accordance with company policy. People reported that the company had taken on a new training manager. This person facilitates courses. Staff reported in questionnaires and to us, on how supported they Care Homes for Older People Page 29 of 40 Evidence: felt by the systems for training them in their roles. One carer reported I have just completed my NVQ 3. I was given lots of support by Matron & the RGNs. We are kept up to date with current changed and standards in this working environment and another training in something every month now. Two registered nurses described the dementia care training that they had received, that this was a detailed course, taking place over four weeks. Mrs Bulmer reported that two registered nurses had completed a train the trainers course. A cleaner told us that they had lots and lots of training. The new chef reported that his training had included food hygiene, infection control, health and safety and safeguarding adults. Some areas relating to prevention of spread of infection and manual handling practice may continue to need more attention (see section on Environment above and Management below). Care Homes for Older People Page 30 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by nearly all management systems in the home, which will ensure that service provision is reviewed and principals of health and safety upheld. However residents and staff could be put at risk by unsafe practice in manual handling. Evidence: The manager of the home, Maralyn Bulmer has been in post for many years, she is also a registered nurse. People responded to us in questionnaires about supports from Mrs Bulmer. One person reported my manager is very supportive if I have any work issues and another the support she gives is tremendous. The providers are currently recruiting a deputy to support Mrs Bulmer in her role. A new operations director has been appointed since the last inspection to oversee management of the home. This person reports that she visits the home regularly. We reviewed reports of her visits, they were clear and completed in detail, including reviews of progress towards meeting requirements and recommendations from the previous inspection. Care Homes for Older People Page 31 of 40 Evidence: People commented on supervision and records showed that they were planned for bimonthly. Each head of department supervises their own staff, including housekeeping where very clear and detailed records were in place. Mrs Bulmer reported that supervisions for nursing and care staff included working with the member of staff as well as 1:1 meetings. When we reviewed records, we observed that only one activities person had received supervision. Supervision records for care and nursing staff included training needs. Mrs Bulmer reported that now she had established a supervision programme, she was planning to work through records to identify trends in training requests, to ensure that staff received all training supports which they felt were needed to perform their role. As part of quality audit systems, it would also benefit the home if other matters identified in supervision sessions were identified. For example, one record we reviewed indicated that a person had reported on poor manual handling practice by staff, this was found to be the case during the inspection (see below). The provider has systems for reviewing quality of service provision. The operations manager reported that questionnaires were to be sent out to people shortly, results will then be analysed and used to develop service provision. The home also audits infection control, tissue damage and other clinical areas. The incidences of falls are audited and it is recommended that time of day for accidents be audited as well as day of the week, to identify any trends. The home does not have a printout for response times to call bells and it would be advisable as good practice that response times were audited periodically. The provider has a management system for charges for additional services such as hairdressing, podiatry and newspapers. There is a clear audit trail for these additional services. During the inspection, we observed practice and reviewed records relating to health and safety. We observed a carer carefully and correctly taking off single use gloves and disposing of them after performing personal care. Discussions with registered nurses and observations in the clinical rooms showed that there was a good supply of sterile gloves for performing wound dressings. Laundry staff showed good understanding of the principals of infection control, including correct practice in the soaking of stained clothes. Both laundresses & housekeeper reported that they had recently completed Health and Safety training. We observed some manual handling practice which concerned us. On one occasion a resident was observed to be sliding out of an armchair, two carers observed this and lifted them back manually with hands under the persons arms and legs. The person was not able to assist with this in any way. On a second occasion carers were observed to push a person in a wheelchair to a table. They then placed their arms Care Homes for Older People Page 32 of 40 Evidence: under the persons arms and lifted them. The residents feet were in contact with the floor but this person also did not appear to be able to assist in being moved, including taking weight through their feet. Both these methods of manual handling are regarded as unsafe practice. If a person needs to be bodily lifted, an appropriate manual handling aid must always be used to prevent risk to the resident and staff. We reviewed the records of one individual whose manual handling assessment stated that they needed assistance from a hoist to be transferred from bed to chair and a slide sheet to turn them in bed. The persons records documented that they preferred to be up, sitting in a chair, during the day and they were observed to be so during the inspection. Their turn chart documented that they were repositioned regularly when they were in their chair. We discussed with a carer how they did this and they described standing the person by having two carers to assist them to stand. The carer reported that the person was able to stand, although their manual handling care plan indicated that they could not do so. Care plans need to be clear to correctly direct staff on how the person is to be assisted and if the person is able to stand with support, it remains advisable for an aid to be used, to reduce risks to the resident and care staff by inappropriate practice. We reviewed records relating to equipment and services. The homes fire log book was fully up-to-date and included all required records. Equipment and services are all new and so were under guarantee. It was noted in one record as good practice, where water temperatures in one bathroom were noted to be high, prompt action was taken to ensure that the water was returned to safe temperatures. Records showed that wheelchairs were regularly checked and actions taken if deficits were observed. Plans were in place to further ensure resident safety by putting key pad locks on the laundry doors. Accident records were clear, completed in full and documented by the person who observed the accident. Care Homes for Older People Page 33 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The home must ensure that 30/06/2009 where they are caring for a person with diabetes, that there is always a clear care plan in place, to direct staff on actions to take to meet the individuals needs, particularly in the event of instability in their diabetic condition. Where instability is observed, records need to state actions taken by staff to support the resident. Where practice in administration of insulin does not conform to current guidelines, the care plan must always state why this is in the best interests of the resident. Diabetes is a complex medical condition. Therefore care plans must always precisely direct staff on actions to take to meet the residents needs. Records Care Homes for Older People Page 35 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action must be maintained of how registered nurses meet the persons needs in event of an instability. Directives and good practice guidelines on administration of medicines by injection need to be followed, unless they are not in the best interests of the resident. Where this is the case this needs to be documented and regularly evaluated. 2 26 13 Where people need manual 28/08/2009 handling they must be provided with a sling which is used only for them. The sling must be named for the person and systems must be put in place to ensure that slings are regularly laundered. Communal use of lifting slings for hoists can present a risk of cross infection. To reduce risk of cross infection, slings need to be regularly laundered. 3 26 13 Infected and potentially infected laundry must correctly placed in appropriate bags and not be re-sorted. Infected and potentially infected laundry must be 05/06/2009 Care Homes for Older People Page 36 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action correctly placed in appropriate bags and not be re-sorted. If infected and potentially infected laundry needs to be re-sorted in an areas such as the laundry, there is a real risk to cross infection of other items of laundry by air-borne microorganisms. 4 26 13 Items such as net underwear, socks and tights must not be used communally. Communal use of clothing does not up-old a persons dignity. It can also present a risk of cross infection. 5 26 13 Where paper towels are needed, a dispenser must always be provided. If paper towels are placed on a surface, not in a dispenser, there is risk that lower paper towels can become contaminated and present a risk of infection, or re-infection when used. 6 26 13 Cleaners rooms need to be provided with adequate facilities to ensure that safe hand cleaning and drying can take place. Hand washing is regarded as 31/07/2009 26/06/2009 05/06/2009 Care Homes for Older People Page 37 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action one of the most significant factors in the prevention of spread of infection. As cleaners are key people in ensuring hygiene standards, they need to be provided with effective facilities to enable them to cleanse and dry their hands. 7 37 13 The home must ensure that 29/05/2009 staff undertake safe practice when performing manual handling procedure. This must be supported by clear records, which are regularly evaluated. There is a large body of research-based evidence relating to safe manual handling practice. Manually lifting people presents a risk to both the resident and the member of staff. Assessments and care plans relating to manual handling need to reflect the current situation and be complied with by staff. 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 All care charts should be initialled by the carer providing support, in accordance with the providers policy. Care Homes for Older People Page 38 of 40 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 2 7 Staff on evening and night shifts should document all fluids which have been offered to residents, even if the resident is only able to take sips of fluid or if they are offered fluids and decline to take them. Staff should follow the providers procedures on where to document in records and when performing evaluations. All photographs of wounds should be dated on the photograph. Food charts for residents should consistently include clear information on what diet the resident has been able to take, including the use of prescribed dietary supplements. Where a resident is having their medication crushed, written consent from a pharmacist should be obtained and kept on the persons file. The home should further develop systems for choice and activities, to ensure a coordinated approach across all staff, to ensure that all people are aware of information in care plans and that residents expressed preferences are supported. The providers documentation systems for complaints should be promptly introduced and there should be evidence that concerns and complaints are analysed over time to identify any trends. Appropriate facilities should be provided so that used laundry can be separated at source, not in the laundry. Records from supervisions should be reviewed to identify any matters which need to be addressed as part of the homes quality audit systems. Response times to call bells should be assessed as part of the homes quality audit systems. Audits of accidents to residents should include time of day, to identify any trends. 3 4 5 7 8 8 6 9 7 12 8 16 9 10 26 37 11 12 38 38 Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!