Enter & View Report

Good practice observed on our visit and Recommendations

Hospital Discharge – Issues:

• Residents discharged without a discharge letter.
• Residents discharged too early with too high support needs.
• Residents discharged without the correct medication.
• One resident was discharged without her walking frame which resulted in a lot of staff time being spent to rectify this.

Hospital Discharge  – Good practice:

• Always send an ‘Improving Discharge’  form when difficulties are encountered.
• Only accept residents from hospital with a discharge letter.
• Always assesses a client’s needs prior to hospital discharge and where appropriate advocate transferring a patient to a community hospital before returning to the home.
• As appropriate living wills and DNR (Do Not Resuscitate) instructions accompany residents to hospital.
• A summary of care needs is sent with residents to the hospital.
• MARS (Medication Administration Record Sheets) are sent with residents to hospital.

Staff – Good Practice:

• All care staff either, have or are working towards an NVQ or CQF qualification.
• Other statutory training is also given to all staff and includes topics such as catheter care, abuse, emergency situations and the ‘Mental Capacity Act (2005).’
• One member of staff is a ‘Dignity Champion’ and also takes a lead role in advising about end of life care.
• The home carries out an in-house dignity audit every six months.
•  All staff are given a laundry marker pen at Christmas to help ensure that new clothes do not go missing.
• Shifts are planned to overlap so that staff are available to residents during handover times.

Staff – Recommendations:

• It is recommended that all staff receive training in ‘Equality and Diversity Issues.

Activities – Good practice:

• An activities timetable was displayed on the wall and a copy was given to each resident. Activities lists were also available on their web site.
• Residents encouraged walk around the garden.
• Nintendo Wii exercise; Visits from the owl sanctuary; Art class; Trips out to coffee shop or garden centre;One to one manicure; Flexercise; Knitting circle; Singing; Quizzes and Bingo; Drumming for the brain; Town trip; Songs of praise; Britannia Inn pub lunch; Reminiscence.
• Time was put aside for staff to spend one to one time with residents.

Activities – Recommendations:

• It is recommended that, where residents would like to share an interest such as ballroom dancing, and that no other residents in the home share this interest, then the home (with the resident's permission) contact other homes in the area to see if a resident there may wish to share an activity. 

Control and Choice –  Good Practice:

• The home has started to work with residents on life story books.
• Some residents are involved with writing their memoirs with the help of a volunteer from ‘Age UK’.
• A resident can choose when to go to bed and when to get up.
• Married couples can be accommodated.
• Shift patterns changed in order to accommodate residents who wish to rise early.
• Residents’ pets considered.
• Resident meetings are minuted and action taken recorded.

Communication – Good Practice:

• Handover notes and care-plans are updated on the computer.
• Staff observed to have time to talk to residents about their life and interests.
• The home conducts a ‘Resident and Visitor Satisfaction Survey’ every six months.
• Staff were observed to check that a resident was satisfied with the answers given to questions.
• A suggestions and comments form and a suggestions box was available for residents and visitors use.
• Use of communication flash cards for resident with communication difficulties.
• Residents’ brochure and information pack was viewed to be jargon free and containing essential information about the home as well as details about how to complain or comment on the service.
• The home has a computer which is set up for residents to use. It has internet access and ‘Skype’ video calling so as to provide residents another way of keeping in touch with family.  
• The manager explained that the home has a portable induction hearing loop.

Communication  – Recommendations:

• It is recommended that local advocacy and Somerset LINk leaflets be placed in resident information packs.
• It is recommended that the home investigate the government grant called ‘Get Connected.’ More details can be found at… http://www.scie.org.uk/workforce/getconnected/faq.asp 
• It is recommended that the home look at systems for ensuring the timely passing on of messages and concerns with all staff regardless of their role, and this be addressed in supervision, handover and team meetings.
• It is recommended that the home seek advice about hearing loops and other aids, from ‘Action on Hearing Loss - Royal National Institute for the Deaf (RNID).’

Eating and Nutritional Care –  Good Practice:

• Good choice for meals.
• Snacks available between meals.
• Staff were observed to be respectful when supporting a resident to eat lunch.
• Residents could choose to eat in their rooms if they so wished.
• Menus are discussed at residents meetings.
• Deserts were served from a trolley and a good selection and display of deserts were noted.
• 4 choices for lunch were given.
• Menus change 4 weekly.
• Staff were observed to be aware of medical factors affecting residents’ nutritional needs.

Eating and Nutritional Care –  Recommendations:

• It is recommended that individual portions be decanted to plates to avoid the need to ask for assistance.
• It is recommended that that fruit bowls be checked regularly to ensure the contents are fresh and that prepared fruit is also offered.
• It is recommended that ingredients and allergy advice be included in the menus.
• It is recommended that portion size preferences are recorded for all catering staff.

Hydration – Good Practice:

• Jugs of water and glasses were available in common areas.
• Water and fruit juice were served at meal times.
• Hydration – Recommendations:
• None identified.

Pain Management in Practice – Good practice:

• The home uses a computerised medication administering system called PCS (Proactive Care System). It is understood to reduce human error, save staff time and help to ensure that medicines are administered more efficiently.

Personal Hygiene – Good practice: 

• There is a hairdressing facility in the home and the E+V team were told it opens twice a week.

Practical Assistance – Good Practice:

• Regular district nurse’s and doctors surgeries held at the home.  An extra member of staff is present during these times.
• There are regular dental visits at the home.
• A resident  was supported to order plants for their patio containers via the gardener.
• Escorts for residents to attend medical appointments can be arranged at a cost to the resident.
• Cheques can be cashed and the home can provide safe keeping of resident’s cash for up to £50.

Practical Assistance – Recommendations:

• It is recommended that the manager proceed with plans to monitor call bell response times at different times and use the results to regularly reaffirm the importance of prompt responses to call bells within the staff team.
• It is recommended, that when volunteers are needed, the home consider the following suggestions for finding volunteers: 
• Ask at residents meetings if any of them would like to volunteer.
• Send a letter to family and friends of the home asking for volunteers.
• Contact the local volunteer bureau.
• Advertise volunteering opportunity on notice boards.
• Contact students studying local health and wellbeing boards
• Contact the local scouts or girl guides organisation regarding volunteering opportunities.

Privacy in Practice – Good Practice:

• Staff always knock before entering their room.
• Residents can have their own phone line installed.
• All rooms in the new part of the building have en-suite facilities.

Social inclusion in Practice – Good Practice:

• The home hosts local neighbourhood watch meetings.
• Outings to a local pub are organised.
• A fete is held at the home at Christmas time.
• The local school visit at Christmas and at Harvest time.
• The local Beaver Scouts visit the home.
• The home welcome students from Strode College and Blue School on block work placements or young people studying for their Duke of Edinburgh award scheme.
• The home conducts its own audit of external activities.
• Church services are held at the home.

Social Inclusion in Practice – Recommendations:

• It is recommended that the home investigate some of the below transport options.
• Local volunteer transport schemes such as Slinky, and Wheels.
• The local Rotary club
• Renting a minibus from other services such as a local stroke club or school
• Contact near by Active Living Centres who may have transport recourses to share.
• Negotiate a discounted service for residents with a local taxi firm.

For more information

For more information, read the full report or contact Jonathan Yelland on jonathon.yelland@helpandcare.org.uk.