James Hutchison

(5) Recommendations I make the following recommendations (where I refer to a nursing home it should be understood that I am referring to a nursing home for elderly and mentally infirm persons, an EMI home) :- (a) When any elderly and mentally infirm person (probably therefore a person suffering from dementia) is to be admitted to a nursing home there ought to be a full assessment of the needs of that person by the nursing home prior to admission. There should be supplied to the nursing home a copy of the care plan for that person devised by their social work care manager and the nursing home should, in advance of the person's admission, devise a provisional care plan. (b) The care plan relating to any person, while it will require to address many aspects of the person's needs, should contain a clearly identifiable section detailing all incidents of violent or aggressive behaviour, any measures taken in response and the strategies recommended for avoiding repetition of such behaviour. (c) The nursing home should, within an appropriate period (perhaps six weeks) refine and finalise the care plan, building on the initial assessment and social work care plan but taking account of the home's experience of the person since admission. (d) When any elderly and mentally infirm person is transferred from one nursing home to another, whether both homes are run by the same organisation or not, the accepting nursing home should fully assess the needs of that person prior to admission. The accepting nursing home should be supplied with a copy of the social work care plan and the care plan of the previous home in advance of the transfer taking place. (e) Where the transfer requires to take place as an emergency the accepting nursing home should nevertheless be supplied with a copy of the social work care plan and the care plan of the previous home at the time of the transfer taking place. The accepting home should then expedite a full assessment of the needs of the person. (f) Following an emergency transfer the nursing home should promptly revise the care plan of the previous home to reflect any needs identified by the assessment process, but in any event within an appropriate period (perhaps six weeks) refine and finalise the care plan, building on the initial assessment and social work care plan but taking account of the home's experience of the person since admission. (g) The senior nursing management of a nursing home should be aware of the detailed terms of the care plan of every person resident within the home. (h) On each shift of staff on duty within a nursing home each member of the nursing or care staff, excluding any senior manager on duty, should require to be familiar with the detailed terms of the care plans of a group of residents so that the terms of the care plan of every resident will be known to at least one member of the nursing or care staff. Managers require to put in place systems which will allow staff time to become familiar with care plans and to monitor any changes to the plans. (i) On a change of shift the staff member going off duty who is familiar with the care plans of a particular group of residents should communicate clearly and effectively to the staff member coming on duty who is familiar with the same group any relevant information about anything which may have occurred during the shift which bears upon the needs of any resident who is part of the group. This is in addition to any records of such information which the home may maintain. (j) Communal areas of nursing homes such as lounges and dining rooms should at all times be monitored by a member of staff present in that area. (k) The managers of any nursing home should have under constant review the level of staffing required to meet the changing needs of residents, regardless of the staffing levels set by the Care Commission for Scotland. (l) There should be established clear protocols for liaison and exchange of information in relation to client/patient/resident care amongst social work, health professionals and care home managers.