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the following gender: Either Whose primary care needs )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 204.02 Tm (on admission to the home are within the following category: Physical disability \(PD\))Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 182.59 m 315.25 182.59 l S 0.001 w 1 1 1 RG 20.58 w 317.5 182.59 m 346.55 182.59 l S 0.001 w 20.58 w 348.8 182.59 m 377.9 182.59 l S 0.001 w 20.58 w 380.15 182.59 m 409.2 182.59 l S 0.001 w 20.58 w 411.45 182.59 m 440.55 182.59 l S 0.001 w 20.58 w 442.8 182.59 m 471.9 182.59 l S 0.001 w 20.58 w 474.15 182.59 m 503.2 182.59 l S 0.001 w 20.58 w 505.45 182.59 m 534.55 182.59 l S 0.001 w 20.58 w 536.8 182.59 m 565.9 182.59 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 194 m 568.1 194 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 171.17 m 568.1 171.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 195.08 m 30.07 170.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 195.08 m 316.37 170.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 195.08 m 347.67 170.09 l S 0.001 w [] 0 d [] 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149.67 m 568.1 149.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 150.75 m 30.07 34.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 150.75 m 567.02 34.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 168.92 m 568.1 168.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 149.67 m 568.1 149.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 35.8 m 568.1 35.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 170 m 30.07 148.59 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 170 m 567.02 148.59 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 35.5 155.74 Tm (Brief description of the )Tj ET /F1 12 Tf BT 1 0 0 1 177.31 155.74 Tm (care home)Tj ET /F1 12 Tf BT 1 0 0 1 35.5 136.49 Tm (Peartree House Rehabilitation Centre consists of an extended house, 3 two-bedroom )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 119.49 Tm (bungalows and four self-contained flats and a four bedroomed house within the )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 102.49 Tm (perimeter of the grounds. The home is situated on the outskirts of Southampton city )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 85.49 Tm (and is within easy access of Bitterne and local amenities.)Tj ET /F1 12 Tf BT 1 0 0 1 35.5 68.49 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 35.5 51.49 Tm (The home is registered with the Care Quality Commission to provide nursing care and )Tj ET endstream endobj 8 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 9 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (3)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 17 w 31.2 776.72 m 565.9 776.72 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 767.1 m 568.1 767.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 768.18 m 30.07 491.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 768.18 m 567.02 491.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 786.35 m 568.1 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 767.1 m 568.1 767.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 492.85 m 568.1 492.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 766.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 787.43 m 567.02 766.02 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 35.5 773.16 Tm (Brief description of the )Tj ET /F1 12 Tf BT 1 0 0 1 177.31 773.16 Tm (care home)Tj ET /F1 12 Tf BT 1 0 0 1 33.25 756.16 Tm (accommodation for up to forty-six people who have sustained an acquired brain injury. )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 739.16 Tm (The service can accommodate people over the age of 18 years who have a physical )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 722.16 Tm (disability on admisison. Service users who require only personal, emotional and living )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 705.16 Tm (skills support and have no nursing needs are housed in the flats and bungalows with a )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 688.16 Tm (dedicated team who enable these service users to live an independent life suited to )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 671.16 Tm (their capabilities. Service users who need nursing care are accommodated in the main )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 654.16 Tm (house and the four bedroomed house named Wyncroft.)Tj ET /F1 12 Tf BT 1 0 0 1 33.25 637.16 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 33.25 620.16 Tm (Peartree House employs a multidisciplinary team that comprises an occupational )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 603.16 Tm (therapy team, physiotherapy, psychology, speech and language therapist, a )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 586.16 Tm (rehabilitation consultant, dietician, registered nurses and care staff as well as a full )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 569.16 Tm (housekeeping, maintenance and administration staff.)Tj ET /F1 12 Tf BT 1 0 0 1 33.25 552.16 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 33.25 535.16 Tm (The home is owned by Peartree House Rehabilitation Limited and does not have a )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 518.16 Tm (registered manager.)Tj ET /F1 12 Tf BT 1 0 0 1 33.25 501.17 Tm ()Tj ET endstream endobj 10 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 11 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (4)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 745.27 Tm (What we found:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 691.53 w 31.2 389.44 m 580.26 389.44 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 736.33 m 582.46 736.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 737.41 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 737.41 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 720.15 Tm (Three inspectors, including a pharmacy inspector, visited the home on the 9th July 2009 )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 705.57 Tm (to undertake an unannounced random inspection. Information and requirements resulting )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 690.98 Tm (from this visit are included in this report as well as information gained from the local )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 676.41 Tm (safeguarding team and other information received at the commission.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 661.83 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 647.24 Tm (We found that six of the seven requirements made following the previous key )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 632.66 Tm (unannounced inspection undertaken on the 19th March 2009 had not been met and the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 618.09 Tm (home was continuing to fail to ensure that people are safe. Additional requirements were )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 603.51 Tm (made following this random inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 588.92 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 574.34 Tm (The home does not have a registered manager and we have been informed that since the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 559.77 Tm (random inspection on the 9th July 2009 that the person who was in the process of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 545.18 Tm (applying to the commission to become the home's registered manager is no longer )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 530.6 Tm (employed at the home.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 516.03 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 501.45 Tm (Since the key unannounced inspection of 19th March 2009 serious safeguarding concerns )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 486.86 Tm (have been brought to the attention of Social Services and these continue to be )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 472.29 Tm (investigated.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 457.7 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 443.13 Tm (The home has voluntarily agreed not to admit new people during the ongoing )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 428.55 Tm (safeguarding investigation. Social services and placing authorities are in the process of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 413.96 Tm (reviewing people living at the home.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 399.39 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 384.8 Tm (Following the key inspection undertaken in March 2009 a requirement was made in )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 370.23 Tm (relation to the way that medication is managed in the home. A requirement was made )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 355.64 Tm (that the responsible person must ensure that medication is correctly recorded, managed, )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 341.07 Tm (stored safely, administered and disposed of correctly. The safe handling of medicines was )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 326.48 Tm (assessed by a Commission specialist pharmacist inspector. They looked at the medication )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 311.9 Tm (records and medicine supplies for ten people, the care plan for one person, the policies )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 297.33 Tm (and procedures for medication handling and talked to staff. The inspection focused on the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 282.74 Tm (requirement made on the safe handling of medicines made at the key inspection of 19th )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 268.17 Tm (March 2009. We found that this requirement had not been met.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 253.59 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 239.01 Tm (All medicines were stored securely for the protection of people who use the service. )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 224.43 Tm (Medicines needing cool storage were kept in a fridge. The temperature of the fridge was )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 209.85 Tm (monitored and recorded daily. The records showed it to be running too cold and at a )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 195.26 Tm (temperature that would damage the medicines kept in it. No action had been taken by )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 180.68 Tm (the staff despite their recording that the fridge was too cold. This places people at risk of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 166.1 Tm (recieving medication at an incorrect temperature which may cause them harm.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 151.52 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 136.95 Tm (Medicines that can be misused, known as Controlled Drugs, were stored correctly. The )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 122.36 Tm (excess stock that had been in the home when we last visited had been removed and )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 107.79 Tm (disposed of safely.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 93.21 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 78.63 Tm (Most people have their medicines given to them by either registered nurses or by care )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 64.04 Tm (staff who have been trained and assessed as competent to handle medicines. Two people )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 49.47 Tm (in the independent living units look after their own medicines. One person had the risks )Tj ET endstream endobj 12 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 13 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (5)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (associated with this assessed but the other person had not. The assessment of risk did )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (not say how the risks that had been identified were to be minimised. There was no )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (reference to risk assessment in the service's policy on self medication. This could put )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm (people at an unnecessary risk of harm.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (Some people have their medicines given to them via their PEG feeding lines. This means )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (that if a liquid medicine is not available from the manufacturer then tablets have to be )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (crushed. In line with best practice guidance the service's policy is that when medicines )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (are crushed this needs to be done with the agreement of the prescriber, as crushing can )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (alter the characteristics of the medicine. Of the three people looked at whose medicines )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (were given in this way only two had the agreement of the GP in place.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (Any handwritten additions to the medication administration record charts, supplied by the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (pharmacy, were signed and dated by the nurse making the entry and then checked by a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (second nurse to see that they were correctly written. If people were allergic to any )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (medicines this was clearly documented on the front of their medicines record files. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (However allergies were not always listed on the medication administration record charts. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (It is important that details of people's allergies is clearly and consistently recorded so as )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (to prevent someone being given a medicine that they are allergic to and becoming ill.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (The records and medicines supplies showed us that most people get their medicines as )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (prescribed. However one person had been without one of their medicines for three days. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (This could have lead to deterioration in their condition. Another person's record showed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (that they had been given one of their regular medicines on just two occasions in the last )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (three weeks. When we looked at the supplies for this person all of their tablets had gone, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (indicating that they had possibly had their medicine but the nurses had failed to record )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm (this. The records for another person showed that they were being given their medicines, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (which are prescribed to be given twice daily, with a very short time gap between the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (doses. This was being done to fit in with this persons lifestyle. However no consideration )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (had been taken as to whether it was safe to give the doses so close together and then to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (have a long interval before the next dose was given. This could be detrimental to the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (health of this person.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (A care plan was available for one person who had been prescribed a strong pain killer to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (be given only when they needed it. This had been reviewed and updated when the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (person's needs changed.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (Staff had access to detailed written procedures on the safe handling of medicines. They )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (were dated 2004 and referred to outdated and illegal practices that are no longer in place )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm (in the home. So as to avoid confusion the procedures must be updated and describe the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (current ways staff are expected to work. The presence of policies and procedures that are )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (out of date places people at risk of harm.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (Following the key unannounced inspection in March 2009 concerns were noted and a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (requirement made in relation to care planning and the responsible person was required to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (ensure that care plans contained all the information necessary for staff to be aware of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (people's current needs so that people's needs are met.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (We viewed care plans for four people. The home has separated out the current and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (historical information that had previously been held in one file. Many of the care plans )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (have been re-written since the inspection in March 2009 and care plans and risk )Tj ET endstream endobj 14 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 15 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (6)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (assessments were in place for most areas of daily living providing basic information but )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (lacking clarity about how individual needs should be met. People living at Peartree House )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (have complex needs however the care plans do not provide a useful working tool to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm (inform care and it was not evident how information from these is used to inform the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (delivery of care on a day to day basis. There were inconsistencies within care plans and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (between other records held for the same person. Care plans have not been consistently )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (reviewed. The requirement in respect of care plans has not been met and the home )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (cannot show that people's needs are being met and they are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (One care plan viewed was for a person who required support to manage their behaviours )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (appropriately. There was an ABC \(assessment chart\) completed for an incident in the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (person's care plan however there was no further reference to this incident in the person's )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (care plan. We asked staff about this and were informed that the incident would have )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (been discussed at the multi-disciplinary team meeting however there was no evidence in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (the multi-disciplinary team meeting minutes concerning this or other events in the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (person's file that were of a safeguarding concern. Staff were therefore recording events )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (and no action being taken to address the issues or of the information being used to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (inform care for the person.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (Within care plans there did not appear to be any correlation or cross referencing between )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (one part of a plan and other parts of the plan and risk assessments. An example being a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (care plan for a person whose behaviour could present a risk to themselves, staff or other )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (people. The commission had received notifications about incidents involving this person, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (however there was no reference to behaviour in respect of how staff should provide )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (personal care or moving and handling. An example being of a risk assessment and plan )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (for moving and handling which describes a particular procedure which was different to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm (that shown to the inspector for use with the person. Staff are therefore working outside )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (of all guidelines and placing people at risk.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (Another care plan had inconsistencies in place in respect of the person's fluid intake. The )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (multi-disciplinary team meeting dated 7th July 2009 referred to fluid intake via a PEG and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (that the person can also have juice with a specific amount of thickener in it. The care plan )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm (states that the person is required to drink 2 litres of fluids every day and does not refer )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (to PEG fluids or the risks of chocking or the need for thickened fluids. The same person's )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (care plan to manage continence also states that the person must drink up to 2 litres of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (fluid a day and output to be monitored and a risk assessment states that the person is at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm (risk of retention dehydration and that input and output are to be monitored. There is no )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (mention as to how this is to be achieved and no reference to the person's PEG feed.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm (Fluid charts were seen for this person however these had not been fully completed. On )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (the 1st July 2009 there was a new form dated but with no entries and no record for the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (2nd July 2009. On the 3rd July 2009 there was 400mls records and no totals. On the 4th )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (July 2009 600mls of juice and 500mls water via a PEG x3 and that there had been four )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (wet pads. On the 5th July 2009 there was 400mls juice and no information about fluids )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (via the PEG or any urine output. On the 6th July 2009 600mls juice and one wet pad )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (recorded. On the 7th July 2009 there was no fluid intake recorded and one wet pad and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (on the 8th July 2009 600mls juice and three wet pads. The enteral feeding plan for the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm (person states that they should receive PEG 1500ml water, soft diet and at least 500mls )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (drinks and to record intake. We had a discussion with senior nursing staff about the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (monitoring of the person's urinary output and were informed that as the person uses a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (continence pad that it is not possible to monitor the output. We asked if they were aware )Tj ET endstream endobj 16 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 17 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (7)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (how they could calculate fluid output for people who use continence pads and there were )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (unaware how to achieve this. This is possible if pads are weighed. Staff do not have the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (necessary skills to meet this person's needs and they are at risk of becoming dehydrated.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (We looked at other fluid charts and found that these had also not been fully completed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (and did not provide an accurate record of what people have received. An example being )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (fluid charts for a person where records were available for 20th June 2009 when the chart )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (was not totaled and only 500mls output was recorded for that day, and on the 21st June )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (2009 only 800mls intake was recorded and the chart had not been totaled. No charts )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (were then available for this person until the 26th June 2009 when again the chart had not )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (been totaled. There were concerns noted in the inspection report following the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (unannounced key inspection in March 2009 when it was noted that staff had failed to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (monitor the fluid intake of a person who required a restricted fluid intake on medical )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (grounds.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (A care plan identified on the 11th June 2009 that staff should monitor a person's )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (continence however there were no records on this. Nursing staff provided a chart that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (was in the person's bedroom however this had not been completed since the 4th July )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (2009. One senior nurse stated that staff must have missed filling in the form and another )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (that the form had been discontinued as recording was no longer necessary \(although the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (form was still in the person's bedroom\). We asked if the person's needs had changed and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (were informed that the person's needs had not changed however it had been agreed at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (the multi-disciplinary team meeting that it was no longer necessary to keep records. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (When we looked at the multidisciplinary team meeting minutes for the 7th July 2009 the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (meeting stated that the recording should continue. There was no mention of the person's )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (needs changing in the service users notes or care plan.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (A number of people living at the home receive nutrition via a PEG feeding system. The )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (records for these were viewed and most contained no reference of the additional fluid )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (that people would have been receiving when the systems were flushed prior to or )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (following a feed or medication being received. The charts had also not been consistently )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (totaled at the end of each day to record the full amount a person had received.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (Other inconsistencies in care plans and Multi-disciplinary team meeting notes were also )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (identified. One care plan viewed stated on the personal hygiene sheet that they should )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (have a bed bath except on a Thursday when they should have a shower using an )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm (varifoam pillow to aid the base of the shower chair. There was no information in the care )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (plan about the use of the shower chair with the varifoam pillow. The records for the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (person's personal care for June 2009 stated that they had had a bedbath every day, the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm (personal care records for other months did not state which month they related too and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (had not been fully completed. There was no evidence that the person was receiving a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (shower on a Thursday. Another care plan viewed contained gaps on their personal )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (hygiene record throughout June 2009 when it would appear from records that no )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (personal care was provided.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (There was other information in care plans viewed which indicates that people are not )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (getting their personal and health care needs met. One care plan stated that a person )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm (should be weighed weekly with records showing that they had been weighed on the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (8/6/09 \(59kg\), 28/6/09 \(56.5kg\) and 3/7/09 \(55.5 kg\). There was other information in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (the person's care plan that indicated that the person was not receiving all their nutritional )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (needs as stipulated by the dietitian, with notes of not all feed being given.)Tj ET endstream endobj 18 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 19 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (8)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (The person's care plan stated that they had received new glasses in June 2009 however )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (they were not wearing these on the day of the inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (One care plan viewed stated that a person should receive thickened fluids however there )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (was no indication throughout the care plan on pages relating to nutrition how thick these )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (should be. At the end of the care plan we found guidelines provided by the Speech )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (Therapist dated January 2009 which stated that the person should have thickened fluids )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (to syrup consistency, pureed diet and that they should have their meals in an area free )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (from distractions. The person was seen having their lunch time meal in the busy dining )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (room. We asked the senior nurses how care staff would know what type of diet and fluids )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (the person should have and were informed that copies of the speech therapist guidelines )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (were kept in the dining room. We looked at this in the dining room and a folder )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (containing a number of people's guidelines was present. The one for the person whose )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (care plan we were viewing was dated July 2008 and stated normal fluids and mashed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (food. it was later confirmed by the speech therapist that the person should be receiving )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (thickened fluids and pureed diet.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (Another person whose care plan was viewed was observed in their bedroom resting in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (bed. They had been identified at high risk of developing pressure injuries \(the home using )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (the term pressure sores in care plans\) and were on an airflow pressure mattress. The )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (person did not look as if they weighed much and the pressure mattress was set on level )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (4. We checked the person's weight and asked the senior nurse about the pressure )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (settings as these appeared high considering the person's weight. The senior nurse was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (unsure about the mattress settings and informed us that the maintenance person set the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (mattress settings. We asked her to find the manual and she returned approximately ten )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm (minutes later stating that the settings were on the reverse of the power pack. We )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (returned to the person's bedroom with another senior nurse and looked at the settings )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (and information. These indicated that the settings should have been at level 3 based on )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (the person's weight. Senior nursing staff should be aware of how to use equipment )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (correctly.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm (Within care plans there were daily record sheets however these did not always appear to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (run consecutively. One viewed contained two page 85's and also an added page for the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (4th June 2009 and another page with information for the 4th June 2009 and following on )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (to the 5th June 2009.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (Care plans are written on to forms which have limited space for the actions that staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (should take to meet the person's needs. It was noted that some staff had continued onto )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm (the reverse of the form and others had tried to squeeze information into the available )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (space. The limiting of space on care plan forms means that staff may be discouraged )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (from writing enough information or that the information is not in order as more is written )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (at the bottom or reverse of the forms.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (There was no information in any care plans viewed about access to dentists. There was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (reference to podiatrists and opticians however one person was seen not wearing their )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (new glasses. One care plan daily notes stated that a person had vomited 'coffee grounds', )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm (which may indicate a gastric bleeding problem. We asked what had happened about this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (as there was no further information in the care plan. We were informed that it would )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (have been reported to the GP but the senior nurses could find no record of this and the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (senior nurses had been unaware of the incident.)Tj ET endstream endobj 20 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 21 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (9)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (In one care plan there was a bowel chart which evidenced that the person was not having )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (regular bowel actions. Recordings had not been made every day but when they had )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm (either small or smeary had been recorded for ten days until one nurse gave )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (suppositories. Other records in the person's care plan stated that the person was agitated )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (and unsettled during these ten days. There was no specific bowel management plan in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (place for this person.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (There were issues identified in all care plans in respect of reviewing these. One stated )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (that a specific need should be reviewed fortnightly and was seen to have been reviewed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (on the 4/5/09, 22/5/09, 26/5/09 with no reviews in June and then 7/7/09. Within the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (same plan which stated review monthly there had been no reviews since the 26th May )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (2009.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (Care plans do not fully inform the delivery of care and therefore the requirement in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (respect of care plans has not been met.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (An additional requirement is also made that the home must ensure that full records are )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (maintained for all people to ensure that their needs have been met and keep them safe.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (An additional requirement is also made that the home must ensure that people's health )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (and personal care needs are fully met to ensure that they are safe. A requirement was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (made following the previous inspection that full risk assessments must be undertaken )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (and that risk assessments must be reviewed and updated. This was required to ensure )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (that people are safe. Risk assessments were seen in people's care plans and many, but )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (not all, had been written since the inspection in March 2009.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (As with care plans risk assessments are completed on to forms which have limited space )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (considering the needs of some of the people living at the home. One risk assessment )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (viewed had additional information on the reverse of the sheet which provided clear )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (guidelines and information as to exactly how a risk should be managed.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm (One person had a pressure area risk assessment \(waterlow\) which showed that they were )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (at very high risk of developing a pressure injury however they did not have a plan of care )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (to describe how this risk should be managed and the person's needs met. We requested )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (the senior nurses to check the file to see if we had missed this, however they confirmed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm (that it was not present and that they had omitted to do a pressure area care plan for that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (person. Pressure area plans were in place for other people.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm (One risk assessment seen was dated May 2007 and stated that a person should have an )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (airflow mattress with a fitted sheet over this. The use of fitted sheets with airflow )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (mattresses is incorrect and prevents the mattresses working effectively to reduce the risk )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (of pressure injuries. When we looked at the person's bedroom they did not have an )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (airflow mattress on their bed.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (One plan contained a risk assessment that the person was at risk of neglecting their )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (personal care due to the level of their disability, however it was not clear how this risk )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm (should be managed. The risk assessment dated 25th May 2009 stated review one month )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (however there was no evidence that this had been reviewed. In the same care plan there )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (were other risk assessments which stated monthly review or ongoing review however )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (again there was no evidence that these had been reviewed. Similar issues concerning the )Tj ET endstream endobj 22 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 23 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (10)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (reviewing of risk assessments that stated they should be reviewed monthly were found in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (all care plans viewed.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm (The manual handling profiles/risk assessments seen in care plans were general )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (documents and did not contain specific information about a person's individual )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (characteristics such as behaviours that may impact on moving a person safely. There )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (were also no risk assessments for other equipment such as shower chairs that were in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (use for people.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (The requirement for risk assessments has not been met and is repeated. The responsible )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (person must ensure that full risk assessments,, are undertaken and that risk assessments )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (are reviewed and updated to ensure that people are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (Following the previous inspection a requirement was made that the responsible person )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (must ensure that people are able to have a supper and that there is not a prolonged gap )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (between the last meal of the evening and breakfast. This was required to ensure that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (people are not hungry.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (The evening meal is served at approximately 5pm. We looked at the menu record for )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (service users. The catering staff record any exceptions to the published menu in the food )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (diary. We asked the kitchen staff if they kept a record of the supper/snacks eaten by )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (service users in the evening. We was told that the catering staff did not do this. It was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (the responsibility of the care staff.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (We were provided with a copy of a supper and snack menu available to service users.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm (When we asked senior nurses about how the home had addressed the requirement made )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (at the last inspection related to the long period between dinner and breakfast the next )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (day we were informed that 'well everyone has tea and biscuits' and 'one service user has )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (a sandwich because of his diabetes'. We asked if it could demonstrate that other service )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (users had anything more substantial than a biscuit and did the home keep any records of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (meals eaten in the evening. we were informed that there were no records available. We )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm (asked if there was any other information or examples to show that service users were )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (being offered something more than a biscuit but none was available. We were informed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (that if people request food this would be given, however many people have )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (communication needs and would not be able to request additional food if hungry.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (There is therefore no evidence that this requirement has been met and that people are )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (being provided with supper and that there is not a prolonged gap between the evening )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm (meal at 5pm and breakfast the following morning.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (It was identified during the inspection in March 2009 that staff working at the home had )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (not received safeguarding training and were unaware of safeguarding issues and the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (actions they should take if they suspect that people are at risk of abuse. This was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (required to ensure that people are safe from abuse and harm.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (Since the inspection in March 2009 the local safeguarding team and police public )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm (protection unit have been conducting an investigation into allegations of abuse at the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (home. The investigation is ongoing and concerns people's needs not being met. The )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (issues were not raised by staff from the home but by external professionals and family )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (members.)Tj ET endstream endobj 24 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 25 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (11)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (The commission received a notification from the home which should have been reported )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (to safeguarding as it related to bruising and marks of unknown origin. The commission )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm (passed this information on to the safeguarding team. Records viewed during the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (inspection indicated that there had been a delay in the home acting to protect a person )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (from injury. Records showed that night staff reported bruising but no action was taken )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (which might have prevented more significant bruising several days later. No reference to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (safeguarding was made and the home undertook an internal investigation. An incident )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (report dated 25/6/09 stated that the person's bed rail bumpers were noted to be worn )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (and cracked however a risk assessment completed on the 22/6/09 stated that the bed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (bumpers should be replaced as they were suffering from wear. Approximately two weeks )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (prior to this it was noted that the padding on the person's chair required replacing and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (had been removed and they were awaiting agreement for funding. It would therefore )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (appear that timely action was not taken to ensure that equipment was fit for purpose and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (to prevent injury to the person.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (In another person's care plan there were a number of entries where the person had made )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (allegations or raised concerns about their personal safety including specific allegations )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (that they had been assaulted by a staff member. Although these incidents had been )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (recorded on behaviour charts there was no evidence that any action had been taken in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (respect of them. We asked the senior nurses about this and were informed that this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (would have been discussed at the multi-disciplinary meeting but there was no evidence )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (that this had occurred or that the incident had been reported to safeguarding as per )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (correct procedures. The senior nurses did not appear to appreciate that this was a serious )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (allegation and were unaware of how they should report allegations or incidents of abuse )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (or where they could seek guidance about this.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (Also seen were records where a service user had expressed concern that another service )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (user may enter their bedroom at night and had requested that their door be locked to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (prevent this occurring. These had been recorded by the night staff. We asked the senior )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (nurses if any action had been taken and they had been unaware of the concerns or )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (incidents. The multi-disciplinary team record dated 7/7/09 stated in the section on )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm (behaviour 'one area of concern is that the service user has persecutory paranoid )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (thoughts. No further episodes of this behaviour since February 2008'. Discussions )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (indicated that the concerns were legitimate as the person they were concerned about was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (independently mobile and had a history of entering people's rooms. The home had either )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm (taken no action to address a real concern or taken no action when a persons mental )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (health needs had increased and previous mental health needs had returned. No action )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (had been taken to make the person feel safe at night.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (We discussed safeguarding procedures with senior nursing staff. They stated that they )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (would look into the issues, talk to staff etc and decide what action should be taken. We )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (prompted staff and they still failed to identify that social services were the lead for )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (safeguarding and should be informed of safeguarding allegations or concerns. We asked )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (the senior nurses when they last had safeguarding training and we were informed that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (this was planned for the week of the inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm (We looked at the home's training matrix and twelve of the homes seventeen qualified )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (nurses have not had adult abuse training and ten have not had POVA training. Both the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (senior nurses we spoke with were listed on the training matrix as having undertaken )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (safeguarding training, however neither were aware of correct procedures of safeguarding )Tj ET endstream endobj 27 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 28 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (12)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (issues. The training matrix also showed that no care staff have undertaken safeguarding )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (training and twenty-three of the sixty-one care staff have had adult abuse training. Five )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (of the fifteen therapist have had safeguarding training.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (The home has contracted with a management/training consultant who showed us flyers )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (about safeguarding that he stated had been placed in staff rooms to raise staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (awareness. We were also informed that staff training has commenced with sixteen places )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (for safeguarding available in July 2009 and thirteen staff had completed safeguarding )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (training in June 2009.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (People have also been placed at risk by the home as staff have not had all mandatory )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm (training and there is evidence on care records and notifications about injuries which may )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (be due to poor manual handling techniques.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (The requirement in respect of safeguarding has therefore not been met. People continue )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (to be at risk that staff will not recognise or respond appropriately to abuse.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (Following the inspection in March 2009 a requirement was made that the home must )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (ensure that all pre-employment checks are completed prior to people commencing )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (working at the home. This was required to ensure that people living at the home are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (We looked at the recruitment records for the three staff who have been recruited since )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (the previous inspection in March 2009. These all contained the necessary evidence to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (show that the home had completed all the pre-employment checks including references, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (POVA and CRB prior to people commencing working at the home. These also evidenced )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (that people had received an induction and undertaken shadow shifts.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (This requirement has therefore been met.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (Following the inspection in March 2009 the responsible person was required to ensure )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (that all staff undertake all mandatory training including updates so that staff have the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (necessary skills to meet people's needs safely.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (The home has contracted with a management/training consultant who has completed a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (review of the training situation in the home and produced new a training matrix showing )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (all staff and the training they have completed. We were provided with a copy of the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm (home's training matrix and informed about planned training that is to take place. This )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (evidenced that most staff have not completed any or all mandatory training and people )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (are therefore being placed at risk.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (The home has seventeen qualified nurses of whom none had completed first aid, only two )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (had completed infection control. One had completed manual handling and five moving )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (and handling theoretical and practical skills. Five had completed breakaway training and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (five had not completed any fire training. None had completed nutritional and diet training )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (and seven Pova and five adult abuse. Four had completed managing challenging )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (behaviour training and two deprivation of liberties and four equality and diversity )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (training. Acquired brain injury did not appear on the qualified nurses training list.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (The home employs sixty-one care staff. None had completed first aid. Thirty-three )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (required infection control training and 27 have not received any moving and handling )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (training. Twenty-nine require fire training and fifty-six health and safety and challenging )Tj ET endstream endobj 29 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 30 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (13)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 484.14 w 31.2 543.16 m 580.26 543.16 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 299.96 m 582.46 299.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 298.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 298.88 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (behaviour. Thirty-eight require adult abuse and sixty-one POVA and safeguarding )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (training. According to the training matrix none of the homes care staff have an NVQ in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (health and social care however at the inspection in March 2009 the inspector was )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm (informed that over half the staff had this qualification. There was no record of acquired )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (brain injury training for care staff.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (The home employs twenty therapists. Sixteen require infection control training, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (seventeen moving and handling and thirteen require fire drills and fire evacuation. all )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (therapists require health and safety training and eighteen require risk management and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (challenging behaviour. Nineteen require specific training on brain injury and eleven )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (breakaway techniques. All require mental capacity and equality and diversity training.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (Training information was also provided about the ancillary staff employed at he home )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (however it was not clear in what capacity they are employed so it is not possible to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (determine if they have undertaken training for their role. However only two of the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (eighteen ancillary staff have completed infection control training.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (We considered this information in respect of the staff on duty on the day of the inspection )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (visit in relation to those who were trained to provide assistance with moving and handling )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm (of service users. Of the six qualified nurses on duty throughout the day only one was up )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (to date with manual handling. Six of the ten care staff on duty throughout the day did not )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (have up to date moving and handling training and of the eight therapists four were up to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (date with moving and handling training and two did not appear on the training matrix.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (The home does have training planned and we were provided with information about this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (with training being contracted to an external training provider. Staff are paid for )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm (attending training and training is now compulsory with procedures in place if staff fail to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (attend training.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (The evidence shows that the requirement in respect of staff training has not been met )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (and evidence recorded elsewhere in this report gives examples of where people have )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (been placed at risk due to the lack of staff training. People continue to be placed at risk )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm (and this requirement has not been met. )Tj ET /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 281.89 Tm (What the care home)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 175.95 281.89 Tm (does well:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 20.58 w 31.2 260.41 m 580.26 260.41 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 271.83 m 582.46 271.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 248.99 m 582.46 248.99 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 272.9 m 30.07 247.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 272.9 m 581.38 247.92 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 255.64 Tm (The home is the subject of a safeguarding investigation by Southampton social services.)Tj ET /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 228.68 Tm (What they could do better:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 176.06 w 31.2 130.58 m 580.26 130.58 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 219.74 m 582.46 219.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 41.42 m 582.46 41.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 220.81 m 30.07 40.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 220.81 m 581.38 40.35 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 203.55 Tm (It is clear that the registered provider still does not have systems in place to ensure that )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 188.97 Tm (compliance with requirements is not only secured at the time but also sustained over )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 174.39 Tm (time. The service has failed to meet six of the seven requirements made following the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 159.81 Tm (key inspection on the 19th March 2009 and additional requirements which are )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 145.23 Tm (fundamental to the care of the people living at the home have been made following this )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 130.65 Tm (inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 116.07 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 101.49 Tm (The commission has undertaken management review meetings to discuss the findings of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 86.91 Tm (this inspection and will be informing the responsible person of the action it intends to )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 72.33 Tm (take concerning the failure to meet requirements made following the inspection in March )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 57.75 Tm (2009.)Tj ET endstream endobj 31 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 32 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (14)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (This inspection demonstrates that the responsible person has failed to ensure the safety )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (of people living at the home.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (The systems in place in respect of medication at the home do not ensure that people will )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (receive their medication as directed by their medical practitioner. This places people at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (risk of harm and deterioration of their health. The requirement made following the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (inspection on the 19th March 2009 with a compliance date of the first June 2009 is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (repeated. The responsible person must ensure that medication is correctly recorded, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (managed, stored safely, administered and correctly disposed of within the home so that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (medication is managed correctly and people are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 615.03 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 600.46 Tm (Care plans are inconsistent and do not inform care delivery to safeguard people living in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 585.88 Tm (the home and ensure their needs are met. The home has failed to ensure that care plans )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 571.29 Tm (contain all the information necessary for staff to be aware of people's current needs and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 556.72 Tm (people continue to be at risk that their needs will not be met. The requirement made on )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 542.14 Tm (the 19th March 2009 with a compliance date of the 1st June 2009 has not been met. The )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 527.55 Tm (responsible person must ensure that care plans contain all the information necessary for )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 512.97 Tm (staff to be aware of people's current needs to ensure that people's needs are met.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 498.39 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 483.82 Tm (Risk assessments are not in place for all activities that may present a risk, have not been )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 469.23 Tm (regularly reviewed and this places people at risk of harm. The requirement made )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 454.65 Tm (following the inspection on 19th march 2009 with a compliance date of the 1st June 2009 )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 440.08 Tm (has not been met. The responsible person must ensure that full risk assessments are )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 425.49 Tm (undertaken and that risk assessments are reviewed and updated to ensure that people )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 410.92 Tm (are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 396.33 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 381.76 Tm (This inspection has shown that there have been occasions when people's health and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 367.17 Tm (personal care needs have not been met placing them at risk. A requirement is made with )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 352.6 Tm (a compliance date of the 15th August 2009 that the responsible person must ensure that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 338.02 Tm (all health and personal care needs are met and that there is evidence to demonstrate )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 323.43 Tm (that this is the case.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 308.86 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 294.27 Tm (There was no evidence to show that people are not becoming hungry during the long gap )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 279.7 Tm (between the evening meal at 5pm and breakfast the following day. The requirement )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 265.11 Tm (made following the inspection on the 19th March 2009 with a compliance date of the 1st )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 250.54 Tm (June 2009 has not been met. The responsible person must ensure that people are able to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 235.96 Tm (have supper and that there is not a prolonged gap between the last meal of the evening )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 221.38 Tm (and breakfast so that people are not hungry.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 206.79 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 192.21 Tm (Staff have not all have safeguarding training and were not aware of the correct )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 177.63 Tm (procedures they should follow should there be safeguarding concerns. Appropriate action )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 163.05 Tm (has not been taken and people have been placed at risk of harm. The requirement made )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 148.48 Tm (following the inspection on the 19th March 2009 with a compliance date of the 1st June )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 133.9 Tm (2009 has not been met. The responsible person must ensure that all staff are fully aware )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 119.32 Tm (of safeguarding issues and the actions they should take if they suspect that people are at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 104.74 Tm (risk of abuse.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 90.15 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 75.57 Tm (Staff working at the home have not received all mandatory and service specific training )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 60.99 Tm (to ensure that they have the skills to meet people's needs. There is evidence that people )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 46.42 Tm (are at risk due to the lack of staff training. The requirement made on the 19th March with )Tj ET endstream endobj 33 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 34 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (15)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 163.38 w 31.2 703.53 m 580.26 703.53 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 620.72 m 582.46 620.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 619.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 619.64 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 775.41 Tm (a compliance date of the 1st of June 2009 has not been met. The responsible person )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 760.84 Tm (must ensure that all staff undertake all mandatory training including updates so that they )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 746.26 Tm (have the necessary skills to meet people's needs safely.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 731.67 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 717.09 Tm (During the inspection on the 19th March 2009 on the 9th July 2009 there were gaps and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 702.52 Tm (inaccurate record keeping identified in respect of fluid charts and PEG feeding charts. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 687.93 Tm (there were also irregularities in the daily notes with additional pages added to care plans. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 673.35 Tm (A requirement is made with a compliance date of the 15th August 2009 that the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 658.78 Tm (responsible person must ensure that full and accurate records are made in respect of all )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 644.2 Tm (care provided to people. This is to ensure that their needs are being met and they are )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 629.61 Tm (safe.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 604.66 Tm (If you want to know what action the person responsible for this care home)Tj ET /F1 12 Tf BT 1 0 0 1 483.55 604.66 Tm (is taking )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 588.66 Tm (following this report, you can contact them using the details set out on page 2.)Tj ET endstream endobj 35 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 37 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (16)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 36.25 w 29.47 752.7 m 564.97 752.7 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 26.14 753.83 m 568.3 753.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 773.08 m 568.3 773.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 753.83 m 568.3 753.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 734.58 m 568.3 734.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 774.15 m 27.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 423.22 754.9 m 423.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 468.22 754.9 m 468.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 495.22 754.9 m 495.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 540.22 754.9 m 540.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 774.15 m 567.22 733.5 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 33.75 759.89 Tm (Are there any outstanding requirements from the last inspection?)Tj ET /F1 12 Tf BT 1 0 0 1 429.75 740.64 Tm (Yes)Tj ET /F2 12 Tf BT 1 0 0 1 476.37 742.58 Tm (5)Tj ET /F1 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577.34 m 568.4 577.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 434.88 m 568.3 434.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 306.98 m 568.3 306.98 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 164.51 m 568.3 164.51 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 41.42 m 568.3 41.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 682.4 m 30.07 576.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 610.97 m 92.12 576.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 610.97 m 198.52 576.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 610.97 m 290.62 576.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 610.97 m 475.02 576.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 682.4 m 567.32 576.27 l S 0.001 w [] 0 d /F1 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 664.12 Tm (Outstanding statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 645.7 Tm (These are requirements that were set at the previous inspection, but have still not )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 631.12 Tm (been met.)Tj ET /F1 12 Tf BT 1 0 0 1 95.57 631.12 Tm ( )Tj ET /F1 12 Tf BT 1 0 0 1 104.02 631.12 Tm (They say what the registered person had to do to meet the Care Standards )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 616.54 Tm (Act 2000, )Tj ET /F1 12 Tf BT 1 0 0 1 96.58 616.54 Tm ( Regulations 2001 and the National Minimum Standards.)Tj ET /F1 10 Tf BT 1 0 0 1 31.2 598.72 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 595.72 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 595.72 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 595.72 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 595.72 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 583.57 Tm (action)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 561.16 Tm (1)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 561.16 Tm (6)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 561.16 Tm (15)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 561.16 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 546.58 Tm (ensure that care plans )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 532 Tm (contain all the information )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 517.42 Tm (necessary for staff to be )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 502.84 Tm (aware of peoples current )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 488.26 Tm (needs.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 470.68 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 456.1 Tm (To ensure that people's )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 441.52 Tm (needs are met.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 561.16 Tm (01/06/2009)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 418.69 Tm (2)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 418.69 Tm (9)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 418.69 Tm (13)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 418.69 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 404.11 Tm (ensure that full risk )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 389.53 Tm (assessments are undertaken )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 374.95 Tm (and that risk assessments )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 360.37 Tm (are reviewed and updated. )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 342.79 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 328.21 Tm (To ensure that people are )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 313.63 Tm (safe.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 418.69 Tm (01/06/2009)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 290.8 Tm (3)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 290.8 Tm (17)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 290.8 Tm (16)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 290.8 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 276.22 Tm (ensure that people are able )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 261.64 Tm (to have supper and that )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 247.06 Tm (there is not a prolonged gap )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 232.48 Tm (between the last meal of the )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 217.9 Tm (evening and breakfast.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 200.32 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 185.74 Tm (So that people are not )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 171.16 Tm (hungry.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 290.8 Tm (01/06/2009)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 148.33 Tm (4)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 148.33 Tm (20)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 148.33 Tm (13)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 148.33 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 133.75 Tm (ensure that medication is )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 119.17 Tm (correctly recorded, managed, )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 104.59 Tm (stored, safely administered )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 90.01 Tm (and correctly disposed of )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 75.43 Tm (within the home.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 57.85 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 478.9 148.33 Tm (01/06/2009)Tj ET endstream endobj 38 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 39 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (17)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 418.83 w 32.32 574.68 m 564.97 574.68 l S 0.001 w 1 1 1 RG 46.74 w 31.2 657.88 m 91.05 657.88 l S 0.001 w 46.74 w 93.3 657.88 m 197.4 657.88 l S 0.001 w 46.74 w 199.65 657.88 m 289.45 657.88 l S 0.001 w 46.74 w 291.7 657.88 m 473.8 657.88 l S 0.001 w 46.74 w 476.05 657.88 m 566.1 657.88 l S 0.001 w 140.22 w 31.2 562.15 m 91.05 562.15 l S 0.001 w 140.22 w 93.3 562.15 m 197.4 562.15 l S 0.001 w 140.22 w 199.65 562.15 m 289.45 562.15 l S 0.001 w 140.22 w 291.7 562.15 m 473.8 562.15 l S 0.001 w 140.22 w 476.05 562.15 m 566.1 562.15 l S 0.001 w 125.64 w 31.2 426.96 m 91.05 426.96 l S 0.001 w 125.64 w 93.3 426.96 m 197.4 426.96 l S 0.001 w 125.64 w 199.65 426.96 m 289.45 426.96 l S 0.001 w 125.64 w 291.7 426.96 m 473.8 426.96 l S 0.001 w 125.64 w 476.05 426.96 m 566.1 426.96 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 633.38 m 568.3 633.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 490.91 m 568.3 490.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 683.45 m 30.07 361.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 683.45 m 567.22 361.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 714.92 m 568.4 714.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 682.37 m 568.3 682.37 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 683.45 m 92.17 361.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 683.45 m 198.52 361.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 683.45 m 290.57 361.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 683.45 m 474.92 361.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 786.35 m 568.4 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 714.92 m 568.4 714.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 682.37 m 568.4 682.37 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 633.38 m 568.3 633.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 490.91 m 568.3 490.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 363.02 m 568.3 363.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 681.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 716 m 92.12 681.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 716 m 198.52 681.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 716 m 290.62 681.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 716 m 475.02 681.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 787.43 m 567.32 681.29 l S 0.001 w [] 0 d /F1 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 769.15 Tm (Outstanding statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 750.72 Tm (These are requirements that were set at the previous inspection, but have still not )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 736.15 Tm (been met.)Tj ET /F1 12 Tf BT 1 0 0 1 95.57 736.15 Tm ( )Tj ET /F1 12 Tf BT 1 0 0 1 104.02 736.15 Tm (They say what the registered person had to do to meet the Care Standards )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 721.57 Tm (Act 2000, )Tj ET /F1 12 Tf BT 1 0 0 1 96.58 721.57 Tm ( Regulations 2001 and the National Minimum Standards.)Tj ET /F1 10 Tf BT 1 0 0 1 31.2 703.74 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 700.74 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 700.74 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 700.74 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 700.74 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 688.59 Tm (action)Tj ET /F1 12 Tf BT 1 0 0 1 292.3 671.43 Tm (So that medication is )Tj ET /F1 12 Tf BT 1 0 0 1 292.3 656.85 Tm (managed correctly and )Tj ET /F1 12 Tf BT 1 0 0 1 292.3 642.28 Tm (people are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 617.2 Tm (5)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 617.2 Tm (23)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 617.2 Tm (13)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 617.2 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 602.61 Tm (ensure that all staff are fully )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 588.03 Tm (aware of safeguarding issues )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 573.46 Tm (and the actions they should )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 558.88 Tm (take if they suspect that )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 544.29 Tm (people are at risk of abuse.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 526.72 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 512.14 Tm (So that people are safe from )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 497.55 Tm (abuse.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 617.2 Tm (01/06/2009)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 474.73 Tm (6)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 474.73 Tm (35)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 474.73 Tm (18)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 474.73 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 460.14 Tm (ensure that all staff )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 445.57 Tm (undertake all mandatory )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 430.98 Tm (training including updates. )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 413.4 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 398.83 Tm (So that staff have the basic )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 384.24 Tm (skills to meet people's needs )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 369.67 Tm (safely. )Tj ET /F1 12 Tf BT 1 0 0 1 478.9 474.73 Tm (01/06/2009)Tj ET endstream endobj 40 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 41 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (18)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 770.27 Tm (Requirements and recommendations from this inspection:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 754.85 Tm ()Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 108.12 w 32.32 692.47 m 564.97 692.47 l S 0.001 w 1 1 1 RG 20.58 w 31.2 649.83 m 91.05 649.83 l S 0.001 w 20.58 w 93.3 649.83 m 197.4 649.83 l S 0.001 w 20.58 w 199.65 649.83 m 289.45 649.83 l S 0.001 w 20.58 w 291.7 649.83 m 473.8 649.83 l S 0.001 w 20.58 w 476.05 649.83 m 566.1 649.83 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 30.07 662.32 m 30.07 637.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 662.32 m 567.22 637.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 693.79 m 568.4 693.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 661.24 m 568.3 661.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 662.32 m 92.17 637.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 662.32 m 198.52 637.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 662.32 m 290.57 637.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 662.32 m 474.92 637.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 748.78 m 568.4 748.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 693.79 m 568.4 693.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 661.24 m 568.4 661.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 638.41 m 568.3 638.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 749.86 m 30.07 660.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 694.87 m 92.12 660.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 694.87 m 198.52 660.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 694.87 m 290.62 660.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 694.87 m 475.02 660.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 749.86 m 567.32 660.17 l S 0.001 w [] 0 d /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 732.6 Tm (Immediate requirements:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 715.02 Tm (These are immediate requirements that were set on the day we visited this care home. )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 700.44 Tm (The registered person had to meet these within 48 hours.)Tj ET /F1 10 Tf BT 1 0 0 1 31.2 682.62 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 679.62 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 679.62 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 679.62 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 679.62 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 667.47 Tm (action)Tj ET 0.95294 0.95294 0.95294 RG 340.49 w 32.32 428.55 m 564.97 428.55 l S 0.001 w 1 1 1 RG 140.22 w 31.2 428.27 m 91.05 428.27 l S 0.001 w 140.22 w 93.3 428.27 m 197.4 428.27 l S 0.001 w 140.22 w 199.65 428.27 m 289.45 428.27 l S 0.001 w 140.22 w 291.7 428.27 m 473.8 428.27 l S 0.001 w 140.22 w 476.05 428.27 m 566.1 428.27 l S 0.001 w 96.48 w 31.2 307.67 m 91.05 307.67 l S 0.001 w 96.48 w 93.3 307.67 m 197.4 307.67 l S 0.001 w 96.48 w 199.65 307.67 m 289.45 307.67 l S 0.001 w 96.48 w 291.7 307.67 m 473.8 307.67 l S 0.001 w 96.48 w 476.05 307.67 m 566.1 307.67 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 357.03 m 568.3 357.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 500.58 m 30.07 257.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 500.58 m 567.22 257.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 532.05 m 568.4 532.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 499.5 m 568.3 499.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 500.58 m 92.17 257.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 500.58 m 198.52 257.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 500.58 m 290.57 257.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 500.58 m 474.92 257.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 601.04 m 568.4 601.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 532.05 m 568.4 532.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 499.5 m 568.4 499.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 357.03 m 568.3 357.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 258.3 m 568.3 258.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 602.12 m 30.07 498.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 533.13 m 92.12 498.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 533.13 m 198.52 498.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 533.13 m 290.62 498.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 533.13 m 475.02 498.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 602.12 m 567.32 498.42 l S 0.001 w [] 0 d /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 587.85 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 567.85 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 553.28 Tm (Standards Act 2000, )Tj ET /F1 12 Tf BT 1 0 0 1 166.31 553.28 Tm (Regulations 2001 and the National Minimum Standards. The )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 538.7 Tm (registered person\(s\) must do this within the timescales we have set.)Tj ET /F1 10 Tf BT 1 0 0 1 31.2 520.88 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 517.88 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 517.88 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 517.88 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 517.88 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 505.73 Tm (action)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 483.32 Tm (1)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 483.32 Tm (19)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 483.32 Tm (12)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 483.32 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 468.73 Tm (ensure that all health and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 454.15 Tm (personal care needs are met )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 439.58 Tm (and that there is evidence to )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 424.99 Tm (demonstrate that this is the )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 410.42 Tm (case.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 392.83 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 378.26 Tm (So that people are safe and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 363.67 Tm (have their needs met.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 483.32 Tm (15/08/2009)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 340.85 Tm (2)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 340.85 Tm (41)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 340.85 Tm (12)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 340.85 Tm (The responsible person must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 326.27 Tm (ensure that all records are )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 311.68 Tm (accurately and fully )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 297.11 Tm (completed.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 279.52 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 264.95 Tm (So that people are safe.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 340.85 Tm (15/08/2009)Tj ET 0.95294 0.95294 0.95294 RG 110.55 w 32.32 180.4 m 564.97 180.4 l S 0.001 w 1 1 1 RG 20.58 w 31.2 136.54 m 91.05 136.54 l S 0.001 w 20.58 w 93.3 136.54 m 197.4 136.54 l S 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(Recommendations)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 204.16 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 189.58 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 175 Tm (improving their service.)Tj ET /F1 10 Tf BT 1 0 0 1 34.05 154.18 Tm (No)Tj ET /F1 10 Tf BT 1 0 0 1 96.15 154.18 Tm (Refer to Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.45 154.18 Tm (Good Practice Recommendations)Tj ET endstream endobj 42 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 43 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 l S 0.001 w /F1 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 16.38 Tm (Care Homes for Adults \(18-65 years\))Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 491.55 16.38 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 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copies from:)Tj ET /F1 12 Tf BT 1 0 0 1 234.56 673.54 Tm (0870 240 7535)Tj ET /F1 12 Tf BT 1 0 0 1 335.41 673.54 Tm (\(telephone order line\))Tj ET /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 652.59 Tm ()Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 638.01 Tm ()Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 623.42 Tm ()Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 78.9 w 25.8 581.46 m 563.3 581.46 l S 0.001 w /F1 12 Tf BT 1 0 0 1 34.05 605.84 Tm (Our duty to regulate social care services is set out in the Care Standards Act 2000.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 591.27 Tm (Copies of the National Minimum Standards )Tj ET /F1 12 Tf BT 1 0 0 1 303.94 591.27 Tm (Care Homes for Adults \(18-65 years\) can )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 576.68 Tm (be found at www.dh.gov.uk or got from The Stationery Office \(TSO\) PO Box 29, St )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 562.1 Tm (Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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If you would like a summary in a )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 259 Tm (different format or language please contact our helpline or go to our website.)Tj ET /F1 18 Tf BT 1 0 0 1 28.35 232.98 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 210.26 Tm (Copyright \(2009\) Care Quality Commission \(CQC\). This publication may be reproduced )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 192.76 Tm (in whole or in part, free of charge, in any format or medium provided that it is not used for )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 175.27 Tm (commercial gain. This consent is subject to the material being reproduced accurately and )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 157.77 Tm (on proviso that it is not used in a derogatory manner or misleading context. 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put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B Tc gPUcOx {OqqQF4-UټXODU8o\kswKami%ޗﶥB$S/1LW~'T^<T4PX+ԯ({A34.KUĖn%*R_g!g(F4%ٸD K~ɕy8e!lcx# |< -}^^i(XlŨ3K a[y3E7Oz,߉1N6+Pj)cpS-mR\7߃Ra0bRTl,SQYKO׏C8y'߭sU5d}DҰMۭT[I[(㏭AK9%+,E B`6P( :8|NoYo>XImF;:Bŀÿ Kt,!fa"X0*Im Srߋ{8w;Ҵ+DIZy41Żp m`Z# 2;7aޗ8~$6<+p Uk!i͢m~~ I[z)*a0wmNQ ^\تw?@ċ=0}Ơ6YWUfo&|*aGѤrvʧ:q9h@) 6u%sBo$N?J6(Ah:m~\ZXݐ^NR(>^;:i~f6{'Y &'W|-}犁$$S Cp`Ӎ+Wǧ`q4{W_E&9YXs1sZQ<*`(SaD~e 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