Inspection on 26/01/09 for Loxley Lodge Care Home

This is the latest available inspection report for this service, carried out on 26th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Loxley Lodge Care Home Loxley Lodge Care Home School Street Kirkby-in-ashfield Nottingham Nottinghamshire NG17 7BT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Macukiewicz     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Loxley Lodge Care Home Loxley Lodge Care Home School Street Kirkby-in-ashfield Nottingham Nottinghamshire NG17 7BT 01623757475 01623720635 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jayne Heaton Type of registration: Number of places registered: Leyton Healthcare (No. 4 Limited) care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places, 42 Date of last inspection Brief description of the care home Loxley Lodge provides care and accommodation for up to 42 people with dementia. It also provides day care, where spaces allow. The home is situated in Kirkby in Care Homes for Older People Page 4 of 28 Over 65 0 42 Brief description of the care home Ashfield. It is close to the Town centre, shops, community and leisure facilities. It is accessible for people who use public transport. The home is purpose built and provides accommodation over two floors, serviced by a passenger lift. The accommodation is spacious and therefore suitable for people who may use a wheelchair. One of the bedrooms has an en-suite. Each floor has bedrooms, toilets, bathrooms and lounges. The first floor is secured through use of a key pad locking device. This floor is mainly used to accommodate people with a higher level of need. Outside, there is a car park and small gardens. All of which are accessible. The weekly fees range between 338.00 GBP and 350.00 GBP. Extras include Chiropody, Hairdressing and toiletries. The manager gave us this information during this Inspection. Copies of the Inspection report will be available from the managers office. Or you can get copies by visiting our website at www.csci.org Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first time we have inspected this home since it was re-registered in July 2008. In planning this visit we looked at our Computer held records of all contact with the service to see if there had been any events we needed to discuss. We sent out preinspection surveys to people living in the home and their relatives, staff and care managers from Social Services. What these told us about the service helped us to plan our visit. We also asked the Manager to complete a self- assessment of the home called an Annual Quality Assurance Assessment (AQAA). We also used that information to tell us about the service and what we needed to look at during our visit. During the day we spoke to people living in the home, staff and relatives. We also spoke to the manager. We looked at paperwork and care records and did a brief tour of Care Homes for Older People Page 6 of 28 the premises. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to choose a home that an meet their needs. Pre-admission procedures ensure appropriate admissions. Evidence: The information about the home was written in two booklets called the Statement of Purpose and the Service Users Guide. These mostly gave people accurate information about the home although the complaints procedures were not written in full in the Statement of Purpose and the information about allowing pets in to the home was not fully explained to reflect the Homes policy on pets. This meant that people did not have the full information about what they could expect from the home. However, in their completed pre-inspection questionnaires people told us that they had enough information about the home before they moved in and that they had received a contract stating terms and conditions of the accommodation. The Statement of Purpose and Service User Guides were seen on display in the foyer, Care Homes for Older People Page 10 of 28 Evidence: in the managers office and in peoples own bedrooms meaning that people had access to information about the home and the services provided. The manager said that both documents had been updated to reflect the change of ownership for the home. The manager went out to assess a person before they were admitted, during this Inspection. Relatives were also phoning and visiting to plan a persons admission. The manager had paperwork to help her to assess whether the home could meet peoples needs. There had been quite a few admissions to the home within recent months and we looked at the care files for four of the most recent ones. We saw that the manager did complete pre-admission assessments and that she also obtained assessments from social services. However, we did find that the paperwork was not always completed in full and that assessment of emergency admissions were not always documented. Some of the paperwork was not dated or signed so we were unable to tell whether it was obtained before or after the admission, although the manager confirmed it had been sent beforehand. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their care needs met in a private and dignified way. Evidence: Visitors told us that they had been offered the chance to look at care plans to make sure they were accurate, but this was not always recorded as evidence. We looked at the care plans for four people with varying degrees of need. We saw variances in the standard of documentation. Some records were very detailed and gave staff clear information about the persons needs and how to meet them. Some were less clear and had not been fully reviewed. The manager showed us monthly audits that she had completed on care plans. She told us that she had identified the same issues as us. She had put some new paperwork in place to help staff to record better. She was also planning to send staff on a record keeping course. Visitors were able to confirm that their relatives had been seen by specialists such as the continence nurse and hospital Consultants. Staff also told us they linked in with specialist nurses for advice such as the tissue viability nurse. One person was attending an outpatient appointment on the day of the Inspection and extra staff had Care Homes for Older People Page 12 of 28 Evidence: been provided to escort them. Transport had also been arranged by the home. The person had been able to choose which member of staff accompanied them. People told us they saw the Optician and Chiropodist. Care records also documented when people saw the Doctor, Dentist, Optician, Chiropodist and Specialist Nurses, and these records were mostly well completed. However, we saw one care plan that had no records of a visit by a Dentist since 2005. The manager agreed to look into this. One person confirmed that they saw the Chiropodist regularly. We saw that staff were recording the personal care given to people who needed extra care such as regular turns to protect skin integrity and extra fluid and food monitoring. Forms were kept in peoples bedrooms and kept up to date to show that people were getting the care they needed. Some people were being cared for on specialist beds. There were also mobile and bath hoists for staff to use. One person said they look after us well. Another told us Its nice here, the care is good. One visitor confirmed that their friend always looks smart and felt that staff treated people with respect and spoke to them in a dignified way. People living in the home also told us that staff treated them with dignity and upheld their privacy. One said they treat me with respect and we have a bit of a laugh. We noticed that one persons prescribed cream had been left in their bedroom and was therefore stored incorrectly. Staff told us that this was an oversight as the person had their cream applied that morning. We did not find any other evidence that medicines were being stored incorrectly. However, we did see that the cream had not been signed as given on the persons medication chart. A Pharmacist was present during the Inspection. She was conducting a bi-annual audit on behalf of BOOTS the Chemist. We saw her report and spoke with her. She had made some recommendations for improvement but felt confident that staff would address these areas, due to her past experience of working with staff at the home. She told us that the management of medications within the home was good. Her main recommendation was that the temperature in the medication store room needed to be maintained at the correct level as it was too warm. We also saw a wall thermometer in there that was registering over 26 degrees Celsius. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead a varied and fulfilling lifestyle of their choosing. Evidence: All the people who completed pre-inspection questionnaires for us said that there were always activities to take part in if they wanted. One visitor told us that staff took people on trips out and that the recent Christmas celebrations had been very good. People benefited from having a full time activity co-ordinator and dedicated mini-bus. The activity co-ordinator was a trained physiotherapist but did not act in that capacity. However, she was able to bring some of her past knowledge and experience for the benefit of people, through providing gentle exercises. She kept an activity log and wrote every day in peoples records to show what activities they took part in. We saw records that showed people had their social needs assessed and that they took part in regular programmes of varied activities. During the fine weather people were taken out in the mini bus for weekly trips. Some people regularly attended a local club and in house entertainers were booked every other month. People also had a monthly newsletter about social events written by the activity co-ordinator. She also participated in the residents meetings so that people were involved in choosing the activities and trips. For people who were more dependent, she undertook one to one Care Homes for Older People Page 14 of 28 Evidence: reminiscence sessions and had requested to attend a course on that subject. People living in the home told us they took part in Bingo sessions, and exercise classes and that they went on trips out and to a club. They also confirmed that they attended regular residents meetings where they got to choose what activities they wanted to do. Although peoples social needs were generally well recorded, we found that there was less information about the persons spiritual or cultural needs documented. The manager confirmed that church visitors called in regularly, but there was little in the care plans about individual needs and how they could be met and there were no individual meals provided that were culturally diverse. We spoke to the catering staff who had a good understanding about peoples dietary needs. We saw menus on display and the cook had prepared what was stated on the menu. We observed staff offering people a choice of meal and assisting those who needed help to eat and drink at lunchtime. One visitor told us that they thought the standard of meals had been variable but that this had improved recently. People living in the home told us that the food was good. One said the food is very good and you get enough. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are kept safe and have their rights upheld. Evidence: We saw records of complaints received, these showed that major concerns were being responded to quickly. The manager also told us that she dealt with minor concerns as they happened. All the people who completed pre-inspection questionnaires for us said that they were happy with the procedures for making complaints. On the day of this inspection both visitors to the home and people living there also said they were happy with the complaints procedures. People living in the home also saw the monthly residents meetings as a way to raise issues. One person told us we have a monthly meeting downstairs and they try to fix things if they can and theres always someone you can talk to about problems. There had been no safeguarding issues since the home was registered with us. We saw that staff had access to safeguarding procedures and that they had appropriate training to enable them to keep people safe. The manager had obtained some information about the Mental Capacity Act. She told us that she was going to have some training on this and that she intended to organise more training for the rest of the staff. Care Homes for Older People Page 16 of 28 Evidence: Some equipment was in use for peoples safety that carried an element of mechanical restraint, such as bed rails. We saw that the use of bed rails had been risk assessed to ensure equipment was necessary and safe. However, we found that the use of specialist tip back chairs and lap belts had not been properly assessed or documented and that full consent had not been obtained for their use. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and well maintained environment. Evidence: One visitor told us that they thought the home was looking nicer since the new Company had taken over. There had been a lot of investment in the environment, areas had been redecorated, new kitchen equipment had been purchased. New dining furniture was on order. Many areas had new flooring including the foyer and some bedrooms. There were still some areas that needed improving, such as better signage around the home to assist people to find their way about. However, visible improvements so far showed that there were internal systems in place to address any shortfalls within the environment. People told us that they could lock their bedroom door if they wanted and we saw that all bedroom doors had the capacity to be locked. People also had lockable drawers in their bedrooms. Although people told us they had enough privacy we noticed that many of the bathroom and toilet privacy locks had broken, particularly on the first floor. This would impact on the amount of privacy people could have. Staff told us that the bathrooms were also going to be refurbished by the new Company. One visitor said the home was always nice and clean. All areas were clean and tidy when we walked around. Care Homes for Older People Page 18 of 28 Evidence: People told us that their clothes were always well laundered. There were systems in place to ensure infection control within the laundry and general environment. Staff told us they had received infection control training. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by sufficient numbers of well trained staff, although gaps in recruitment practices means that people may be exposed to unsuitable workers. Evidence: We checked staffing rotas. These showed that the manager worked office hours Monday to Friday and that there were four care staff during the day and three at night. There were also daily catering and domestic staff. An activities co-ordinator and a handyman worked each week day. Most people who completed pre-inspection questionnaires for us said that there were staff available when needed. Visitors to the home also told us there were mostly enough staff on duty and said that they looked after their relatives needs. One person said they trusted the staff and said I cant fault them. Another visitor said of staff they always seem nice to her. People living in the home described staff as being lovely. One said you cant fault them, they work really hard and staff always show a smiling face. People did say that there were times when staff were busy, but that this did not affect their overall care. Staff who completed pre-inspection surveys told us they had been subject to Police clearance checks before they started working at the home. We looked at recruitment files for staff, these showed that most of the pre-employment checks were carried out with the exception of the following, Care Homes for Older People Page 20 of 28 Evidence: Not all staff had a last employer reference, one person had references from friends only. There was no recorded evidence that the reasons why the person had left previous employment working with vulnerable adults. There were some gaps in employment history that did not have a written explanation. Where there was a delay in acquiring CRBs a POVA first check was obtained but not kept as evidence to support one was done, once the CRB was back. One persons CRB check had recorded offences but there was no documentation to support what action was taken in relation to this. This means that people may be exposed to unsuitable workers. Staff who completed pre-inspection surveys also told us that communication between staff and management is excellent and that they had regular updated training. When we spoke to staff during the day they told us that they had received lots of training including courses on Dementia, continence, challenging behaviour, fire training and moving and handling. There was a training matrix on display and this clearly identified that staff had a regular programme of planned training to meet their needs. Staff also told us that they had completed National Vocational Qualifications in care and domestic duties. Almost all staff had completed qualifications to this level or above, which showed that people were receiving care form well trained and competent staff. Staff had certificates to show what courses they had attended. Staff told us that they had completed a tick box induction when they first started employment, but we saw little documentation to support that they received a full induction and foundation training. The manager had recognised this as an area for improvement and showed us a sample copy of booklets she had ordered for both purposes. If used, this documentation would provide a full and comprehensive induction and foundation training to required standards. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in peoples best interests and they are kept safe. Evidence: The manager had applied to be registered with us. She is a registered nurse. This was her first management role, but she had past experience of managing shifts in her former working environment. She had applied to the Alzheimers Society to do a management of Dementia course. She had a mentorship qualification and was doing a National Vocational Qualification Assessors award. She had just started a Registered Managers Award. In her completed pre-inspection self assessment the manager told us there were several quality assurance systems in place, including we hold regular service users and relatives meetings, service users questionnaires are completed on a regular basis, suggestions box which may be anonymous and standard audits completed monthly. We saw that monthly visits were being made by the owners to monitor care. Reports of these were seen in the managers office. They showed that people were Care Homes for Older People Page 22 of 28 Evidence: being consulted for their views during these visits, and that action points for improvements were being made. We also saw records of regular audits of care plans and health and safety undertaken by the manager. She also showed us completed satisfaction surveys that had been sent out to people living in the home and their relatives. We were told this happened every six months. We saw safe systems in place for the handling of peoples personal money. Records of all transactions were being monitored and signed off by the operations manager who visited monthly on the owners behalf. The last check was signed in January 2009. Health and safety risk assessments for the environment were seen, the manager had updated these in January to ensure they were accurate. She had also completed a fire risk assessment which we saw. She had displayed some warning notices around the home based on the fire risk assessment. The kitchen was still being refurbished, as a result some roof tiles were missing. This impacted on the food handling risk assessment, which had been completed and reviewed but not updated to include the roof tiles. The cook agreed to do this. All other service certificates for equipment used in and around the home that we saw were completed and showed that equipment was maintained at regular required intervals. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must show that 30/04/2009 people have been consulted about their care. They must be kept up to date and provide clear instructions for staff on what peoples needs are and how they should be met. Care plans must be reviewed. This is to ensure care needs are not overlooked. 2 18 13 7) Specialist tip back chairs 30/04/2009 and lap belts that carry an element of restraint must be used only following a documented multidisciplinary assessment. Consent from the person or their advocate must also be documented. Equipment must also be subject to a documented review at regular intervals. This is to ensure equipment is used appropriately for the Care Homes for Older People Page 25 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action safety of the person so as not to affect their human rights. 3 21 12 4)a) All toilets and 30/04/2009 bathrooms must be provided with a working privacy lock. This is to ensure the privacy needs of people are met. 4 29 19 and Schedule 2) There must be written evidence to support the continued employment of staff whose CRB has offences disclosed. This is to ensure that people are kept safe. 5 29 19 and Schedule 2) All staff must have recorded preemployment checks consistent with the requirements of regulation 19 and Schedule 2. This is to ensure people are not exposed to unsuitable workers and that they are kept safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/04/2009 30/04/2009 1 1 The Statement of Purpose should be updated to include the full complaints procedure and give more accurate information for people about the policy on allowing pets Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations into the home. This is so that people have the right information to base their decision on, about moving in. 2 3 Pre-admission paperwork should be dated and signed and completed in full to support that the home are fully assessing peoples needs to prevent inappropriate admissions. Prescribed creams should be stored in a locked cupboard and staff should ensure that they sign for them on the medication record each time they are applied. This is to show that people are getting the treatment they need. Air conditioning should be provided for the medications store room to ensure they are stored at correct temperatures. Peoples spiritual and cultural needs should be identified, recorded and care planned for to ensure care is holistic and meets all needs. A written interview record should be kept. This would also help in recording gaps in employment history and any discussion in relation to CRB disclosures. This is to ensure the homes records support that people are being kept safe. All newly appointed staff should receive a full induction and foundation training when new documentation is acquired, to ensure people have their needs met by competent workers. The food handling risk assessment kept by the cook should be updated to include any risk to food safety caused by the missing roof tiles. To ensure food is not contaminated by falling dust. 3 9 4 9 5 12 6 29 7 30 8 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!