Inspection on 04/07/07 for Abiden Rest Home

This inspection was carried out on 4th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abiden Rest Home 21/05/08

Abiden Rest Home 09/05/06

Abiden Rest Home 29/11/05

Abiden Rest Home 08/06/05

Abiden Rest Home 28/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Abiden Rest Home 22/24 Rosehill Road Burnley Lancashire BB11 2JT Lead Inspector Mrs Julie Playfer Unannounced Inspection 09:30 4th July 2007 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abiden Rest Home Address 22/24 Rosehill Road Burnley Lancashire BB11 2JT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01282 428603 Mr John Alexander Pinder Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2006 Brief Description of the Service: Abiden Rest Home is registered with the Commission for Social Care Inspection to provide accommodation and personal care for 22 Older People. The home is situated within easy access of the town centre and public transport routes. The gardens are attractive and have patio areas, which are readily accessed by the residents. Accommodation comprises of 18 single rooms, 8 of which are ensuite and 2 double rooms both ensuite. There is a chair lift to the first floor. Communal space is provided in 3 lounges, 2 of which have a television and the other is used as a quiet room. The home also has two assisted baths and one shower room. At the time of the inspection the scale of charges ranged from £342.50 to £386.00 per week. All privately funded residents were charged £350.00 per week. Additional charges were made for personal newspapers/magazines, and incontinence pads. The registered provider made information available to prospective residents by means of a statement of purpose and service users guide. This document was usually given to relatives and/or prospective residents on viewing the home or at the point of assessment. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Abiden Rest Home on 4th July 2007. At the time of the inspection there were 20 people accommodated in the home, plus two people in hospital. The inspection comprised of spending time with the residents, looking round the home, looking at the residents’ care records and other documents and discussion with the staff and the registered person. As part of the inspection process the inspector used “case tracking” as a means of gathering information. This process allows to the inspector to focus on a small group of people living at the home. Prior to the inspection the registered person completed a detailed questionnaire about all aspects of the care home, which provided useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for the residents and their relatives. Five questionnaires were returned from relatives/visitors to the home and six questionnaires were received from the people who live in the home. What the service does well: Prospective residents were encouraged and supported to visit the home prior to admission. This provided the opportunity to meet other residents, have a look round the home and sample the meals. The daily routines were flexible and designed to meet the wishes of the residents, many of the residents chose to have a lie in and breakfast was served throughout the morning to suit their preferences. Activities were arranged in line with the needs and choices of the residents, which included trips out into the local area. Varied and well-presented meals were served. All residents spoken to described the meals as “very good” and “lovely”. Visitors were welcome in the home at any time and residents were supported to maintain good contact with their family and friends. The residents had access to a clear complaints procedure, which contained clear information about how to make a complaint or raise a concern. The residents were provided with clean, nicely decorated bedrooms that were well maintained. The residents could personalise their rooms with their own ornaments and small items of furniture. The sitting and dining areas were decorated in a homely and comfortable fashion, with a variety of armchairs, foot stools, side tables, ornaments and pictures. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 6 Residents spoken to felt they had a good standard of care and the staff respected their rights to privacy and dignity. One resident said “It’s lovely home, everything is very nice”. What has improved since the last inspection? What they could do better: The residents’ needs must be thoroughly assessed prior to moving into the home, to ensure the prospective resident and the registered person can be assured the person’s needs can be met within the home. The care plans must set out all the residents’ health and welfare needs, so that staff have clear information to ensure all needs are met. Improvements must be made to the management of the medication to safeguard the well being of the residents. When recruiting new staff the registered person must ensure that all appropriate records and checks are obtained in line with legal requirements. This is to ensure the residents are protected and the new staff are fully vetted before working in the home. The registered person must improve some aspects of the record keeping and ensure the Commission is kept informed about any significant incidents in the home. This is to ensure the registered person meets all legal requirements and protects the best interests of the residents. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were provided with useful information, to enable them to make an informed choice about living in the home. However, the assessment procedure did not identify all individual needs prior to admission. EVIDENCE: Written information was available for the people who live in the home in the form of a statement of purpose and service users guide. The guide and the statement of purpose had been amalgamated into one document and had been issued to all residents. The document provided useful information about the services and facilities available in the home and had been updated since the last inspection. Residents spoken to said they had a copy of the guide in their bedroom and one person said she had read it. All residents were issued with a statement of terms and conditions of residence or contract. It was noted the contract had been signed by the residents and/or Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 10 their representative and included information about the current level and payment of fees. The records of three residents were inspected as part of the case tracking process. It was evident the needs of two residents had been assessed prior to admission, however, the preadmission assessment had not been fully completed for one resident, which meant some information about the person’s needs was not available to the staff. The registered person had informed the residents in writing that, having regard to the assessment, their needs could be met within the home. Prospective residents were actively encouraged to spend some time in the home prior to making the decision to move in. This gave the person the opportunity to meet the other residents and staff and experience life in the home. One resident spoken to had spent half a day in the home before moving in. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on care plans was not always in sufficient detail to ensure all health and personal care needs could be fully met. EVIDENCE: From the case files seen, it was evident each resident had a plan of care, based on their assessment of needs. The plans were supported by records of personal care, which provided information on changing needs and any recurring difficulties. All records seen described the residents’ needs in respectful terms. Since the last inspection the care plan format had been updated. However, it was noted that not all information from the assessment had been transferred to the care plan, particularly the residents’ social and spiritual needs. There was documentary evidence to indicate the care plans had been reviewed once a month. The residents’ relatives were consulted and involved in the care of the residents. A visitor spoken to on the day of inspection, said the staff kept her informed about any important issues affecting her mother’s well being and she Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 12 felt confident they would contact her in the event of a concern. This was also reflected in the questionnaire responses received from relatives/visitors, which indicated they were always kept up to date about the care of their relative. Risk assessments in respect to moving and handling, pressure sores and nutrition had been incorporated, where necessary, into the care plan documentation. Health care needs were listed within the care plan and there was evidence to indicate the residents accessed NHS services and received specialist support as necessary. However, there was little guidance for staff within the care plan on how best to monitor and meet the all residents’ healthcare needs. A chart was maintained to monitor the residents’ weight. The residents spoken to felt the staff respected their rights to privacy and dignity and all made complimentary remarks about the staff, for instance one person said the staff were “very good, they always look after me”. The residents, who completed the questionnaires prior to the inspection, also made positive comments about the staff, for instance one person commented, “excellent”. The staff were observed to interact with the residents in a positive manner and they referred to the residents in their preferred term of address. Policies and procedures were in place to cover all aspects of the management of medicines. The home operated a monitored dosage system for the administration of medication, which was dispensed into cassette trays by a local pharmacist. Appropriate records were maintained in respect to the receipt, administration and disposal of medication and all staff designated to administer medication had received accredited training. However, it was noted that not all medication had been entered onto the medication administration record (MAR), information from the prescription labels had not always been transferred to the MAR sheet and prescribed cream had not always been applied in line with instructions. In addition, handwritten entries on the MAR charts had not always been witnessed by two staff, in order to minimise the potential for error. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were able to choose their lifestyle and social activity and kept in contact with their friends and family. The residents received a healthy and varied diet according to the assessed requirement and choice. EVIDENCE: The residents’ preferences in respect of social activities had been recorded as part of the assessment. The residents were encouraged by the registered person and the staff to pursue a range of activities both inside and outside the home. A record of activities had been maintained and was seen during the inspection. Activities inside the home included professional entertainment, film matinees, sing-a-longs, table top games, hand massage and parties. The residents said their birthdays were celebrated every year. Residents were also involved with activities outside the home which, included going to the local pubs and restaurants and attending the local churches. The residents had varied views about the frequency of the activities provided, of the 6 residents who returned a questionnaire 3 people said activities were “usually” arranged and 3 people indicated that activities were “sometimes” arranged. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 14 Residents were observed on the day of inspection, to be playing dominoes with a member of staff, watching the television, chatting to staff and looking at books and magazines. The routines in the home were well established and residents had a choice in the times they went to bed and got up in the morning. One resident said “I can get up when I want to” and another person said “I like to wake up at 6, for a cup of tea”. Breakfast was served throughout the morning to suit the wishes of the residents. The staff were observed to seek the residents’ views throughout the inspection and the residents spoken to said that they felt comfortable to comment on life in the home. The registered person operated a key worker system, which facilitated closer relationships between the staff and the residents. There were no restrictions placed on visiting times and residents were able to receive their guests in privacy of their bedrooms, should they wish to do so. All relatives and visitors who returned a questionnaire said they felt welcome in the home and all were satisfied with the level of care provided. One person commented, “The attention, care and cleanliness of this home is exceptional”. The residents described the meals as “absolutely lovely” and “very good”. They also said there was always plenty to eat and the food was a good quality. There was a choice of food each mealtime and residents were asked when the food was served what choice they wished to make. A range of different drinks was served with the lunch time meal on the day of inspection including various alcoholic beverages, fruit juices and tea and coffee. The meal looked appetising and was well presented. Drinks and snacks were served throughout the day and at other times on request. Residents were observed asking for drinks during the inspection and were promptly served by staff. The menu was displayed in the dining room and residents were aware of the forthcoming meal. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were able to express their views and had access to a clear complaints procedure. Policies and procedures were in place to respond effectively to any allegations or suspicions of abuse. EVIDENCE: The complaints procedure was incorporated in the statement of purpose and service users guide. The procedure contained the necessary information should a resident wish to raise a concern. The procedure had been updated since the last inspection to include the new local address for Commission. The residents spoken to said they could speak to any of the staff or the owner if they had a problem. The registered person had received two complaints since the last inspection. The complaints had been investigated by the registered person and a record had been maintained of the investigations and the subsequent outcomes. The policies and procedures for safeguarding vulnerable adults were available and provided guidance to staff should they suspect or witness any harmful practice. These issues were incorporated into the induction training and staff received specific tuition as part of their NVQ training. Staff spoken to were aware of whom to refer any incident to and the various agencies involved. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were provided with a clean, comfortable and well maintained environment. EVIDENCE: Abdien is a mature property with its own garden. The home is located within easy access of the town centre. Accommodation is provided in 18 single rooms, 8 of which have an ensuite and 2 double rooms both of which have an ensuite. There are also two assisted baths and a shower room. Communal space is provided in three lounges and one dining room. Since the last inspection, a new stair carpet with brass rods had been fitted, blinds had been fitted in the kitchen and lounge, several rooms had been fitted with new carpets and bedding and one bedroom had been decorated. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 17 The residents had access to well-maintained and attractive gardens, which included several seating areas. It was evident on a partial tour of the home that the residents had personalised their rooms with their own belongings and decoration was good throughout. The residents spoken to said they liked their rooms. One person said, “I have a lovely room and I enjoy keeping it clean and tidy”. The residents had been provided with appropriate aids and adaptations to assist their independence skills. These included grab rails, handrails raised toilet and ramps for wheelchairs. The provision of specialist equipment was determined by the needs of the residents. There was a call facility in every room. The doors to residents’ bedrooms had been fitted with appropriate locks and residents had been supplied with keys. Exposed pipework and radiators had been fitted with appropriate guards, with the exception of two radiators in the lounges. The unguarded radiators had been protected by furniture and a risk assessment had been carried out in respect to the risks to residents. The standard of cleanliness was good in all areas seen. All residents and the relative spoken to said the home was always clean and tidy. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst established staff had received appropriate training, the recruitment and selection procedure for new staff was not robust and did not protect the best interests of the residents. EVIDENCE: Since the last inspection a new staffing rota had been introduced and the staff had been split into teams. The rota was seen during the inspection and indicated that 3 care staff, plus a manager were on duty 8 am until 8 pm and 2 staff were on waking watch duty. The registered person and the acting manager were on call out of hours. The recruitment and selection policy had been updated to reflect current legal requirements and the implementation of the POVA (Protection of Vulnerable Adults) scheme. The files of three members of staff, who had commenced work in the home since the last inspection, were examined. It was noted that all the staff had completed an application form and attended the home for an interview. However, significant shortfalls were apparent in the recruitment process. An appropriate risk assessment had not been carried out following the receipt of one check, one person had not supplied a working history and one person had commenced working in the home prior to the receipt of a POVA check. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 19 Appropriate arrangements were in place for the induction of new staff, however, the records of one person’s induction training were not seen during the inspection. Staff had received health and safety training, including moving and handling, fire safety, food hygiene and first aid. Whilst training certificates were seen on the sample of staff files inspected, not all staff had training and development plan. Information supplied by the registered person indicated that 14 of the 15 care staff had achieved NVQ level 2 or above in care. This equated to 93 of the staff group. In addition, one person was working towards this qualification. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of the administrative processes did not fully demonstrate the home was run in the best interests of the residents. EVIDENCE: The registered person had overall responsibility for the management of the home and had completed an NVQ level 4 in Management and the Registered Manager’s Award. The registered person had also undertaken periodic training to update his knowledge and skills. Relationships within the home were good and staff spoke about the residents with respect. The residents valued the help and support they received from the staff. One person said the “Staff are very good, they look after everyone really Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 21 well”. A programme of staff supervision was in place and records were seen during the inspection. The service was awarded an Investor’s in People Award in 2004. The registered person had continued to develop the quality assurance processes in the home. Satisfaction questionnaires had been distributed to the residents, their relatives, staff and visiting professional staff in April 2007. The results of the surveys had been collated and action plan had developed in response to each comment. Residents meetings had been held approximately every 8 weeks and from the minutes seen, it was evident a varied range of topics was discussed. Since the last inspection an audit of medication was undertaken monthly. However, the registered person confirmed an annual development plan based on the findings of the quality assurance systems had not been devised. At the time of the inspection, the registered person was not managing the money for any resident. Records were maintained of money received in respect of the payment of fees and any additional charges. Not all records had been collated and maintained in accordance with the Care Homes Regulations 2001, for instance records relating to the management of medication and the care planning process. There was a set of health and safety policies and procedures available, which included the safe storage of hazardous substances. Staff received yearly health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Staff had also completed an infection control course. Documentation was seen during the inspection which, confirmed gas and electrical safety systems were serviced at regular intervals. The electrical safety certificate was dated 2003 and was valid for 5 years. The fire log demonstrated that staff had received instructions about the fire system and fire alarms were tested weekly. Appropriate arrangements were in place for recording accidents and incidents in the home. However, the registered person had not informed the Commission of events in the home detailed under Regulation 37. Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 2 Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) Requirement Timescale for action 04/07/07 2. OP7 15 (1) 3. OP9 13 (2) The needs of residents must be thoroughly assessed prior to moving into the home, so the prospective residents and the registered person can be assured the persons needs can be met within the home. The care plans must accurately 04/08/07 reflect the residents’ health and welfare needs, so that staff have the information they need to ensure all needs are met. All medication, including 04/07/07 prescribed creams must be administered in line with the prescribers instructions. (Previous timescale of 09/05/06 – not met). All medication must be entered onto the medication administration record, to ensure a full record is maintained of all medication taken or applied. All information from the prescription labels must be transferred to the medication administration records, to ensure staff are fully informed of the Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 24 prescribers’ instructions. 4. OP29 17, 18, 19 Schedule 2 (as amended) All records and checks for new 04/07/07 members of staff must be collated and maintained in line with the Care Homes Regulations 2001. This includes obtaining a full working history along with a written explanation of gaps in employment and ensuring POVA checks are received prior to employment. This is to ensure the staff are properly vetted and the residents are fully protected. All records listed under the Care Homes Regulations 2001 must be accurate and up to date at all times, to ensure the best interests of the residents are protected. 04/07/07 5. OP37 17, 18 and 19 6. OP37 37 The Commission must be notified 04/07/07 in writing without delay of all incidents and events listed under Regulation 37. (Previous timescale of 09/05/07 – not met). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations The care plans should include specific guidance for staff on how best to meet the residents’ healthcare needs to ensure all needs are met. Handwritten entries on the medication administration records should be witnessed by two staff, in order to minimise any potential for error. DS0000009469.V337030.R01.S.doc Version 5.2 Page 25 Abiden Rest Home 3. OP30 Each member of staff should have a training and development plan to ensure their training needs are clearly identified. All new staff should undertake induction training, which meets Skills for Care standards. This is to ensure new staff receive the necessary training to carry out their role effectively. An annual development should be developed based on the quality assurance systems in the home. This is demonstrate the residents have an input into the future plans of the home. 4. OP33 Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Abiden Rest Home DS0000009469.V337030.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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