28 February 2013
During an inspection looking at part of the service
On this visit we looked at three care plans and associated records in detail. We spoke with the registered manager and deputies, nursing staff and care staff. Because of the specific nature of the visit we did not involve people who lived in the home in this inspection.
We found it was easy to find specific information and to follow a course of events. There were helpful references between different parts of people's care plans. For example, they showed the links between nutritional needs and risks to skin integrity.
Care plans contained detailed guidance to meeting nursing and social needs. Where a person had a wound, a specific folder containing all related information and guidance was kept in the front of the care plan until the wound was healed. Guidance on managing a person's catheter was very clear and detailed, in contrast to when we last visited.
Food and fluid intake charts used were fully completed. Staff understood the importance of doing so. We could track where concerns were identified from these records and used as a basis for accessing medical advice or other attention.