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Inspection on 13/06/05 for Acton Care Centre

Also see our care home review for Acton Care Centre for more information

This inspection was carried out on 13th June 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users and representatives feedback indicated that the staff are caring, professional and approachable. One service users representative stated "this is like home from home, we are not worried about him when we are going home". Staff are instructed in caring for service users in a competent, courteous and gentle manner, this was reflected in the comments from the service users and observations at the inspection. The home has a group of staff that are working together as a team in the interests of the service users. Leadership and management are strong and effective with an open approach and clear direction. Complaints management is effective and complaints are managed well.

What has improved since the last inspection?

The majority of requirements from the last inspection report have been addressed. A consumer survey had been completed, and work was underway to improve the bathing facilities for the service users. Activity provision has improved but could be further improved if further information was obtained about the service users social and leisure history. Some work had been undertaken on formulating service users plans on the social and leisure needs of service users. The construction and content of the service user plans have continued to improve, it is important that work continues to maintain the improvements.

What the care home could do better:

Wound care plans and assessments must be completed. Risk assessments on the use of bedrails must be undertaken. Improvement had been noted in medication management, however there were still some shortfalls, which needed to be addressed. The completion of staff employment records must be improved.

CARE HOMES FOR OLDER PEOPLE Acton Care Centre 48 Gunnersbury Lane Acton London W3 8EF Lead Inspector Clare Henderson Roe, Rekha Bhardwa & Jane Shaw Unannounced 13 & 14 June 2005 9.45 a.m. th th 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 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. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Acton Care Centre Address 48 Gunnersbury Lane, Acton, London W3 8EF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 896 5600 0208 992 7116 Vintage Care Ltd. Care Home 125 Category(ies) of Old Age, Dementia - over 65 and Terminally ill. registration, with number of places Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1.That the home is registered to provide nursing care for 71 service users over the age of 65 and for general nursing care for 54 service users with dementia over the age of 65. Of these 4 service users may be terminally ill. 2. The home must ensure that staff working with terminally ill service users are Registered Nurses with appropriate post qualification training in the care of the terminally ill. 3.On each of the Dementia Wings must have a minimum of seven staff, two of whom must be qualified Registered Nurses with appropriate post qualification training in care of dementia from 08:00 hrs to 20:00 hrs. From 20:00 hrs to 08:00 hrs there must be a minimum of 3 staff on duty, one of whom must be a Registered Nurse with appropriate post qualification training in care of dementia. 4.On each of the general nursing units there must be a minimum of six staff, two of whom must be Registered Nurses from 08:00 hrs to 20:00 hrs.From 20:00 hrs to 08:00 hrs there must be two staff on duty, one of whom must be a Registered Nurse. 5.The 15 bedded unit on the second floor must have a minimum of four staff, two of whom must be Registered Nurses from 08:00 hrs to 20:00 hrs. From 20:00 hrs to 08:00 hrs there must be two staff on duty, one of whom must be a Registered Nurse. Date of last inspection 13th & 14th December 2005 Brief Description of the Service: Acton Care Centre was registered in March 2003 to provide nursing care for 125 service users over the age of 65. The home provides 71 beds for general care and 54 beds for dementia care. It is a purpose built home with modern amenities close to Acton High Street set on the site of the old Acton Hospital. The home is able to access other health care professionals to supplement the nursing care already provided. The home has a large car park at its front and landscaped gardens at the rear of the building.At the time of inspection there were 99 service users accommodated at the home. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 37 hours was spent on the inspection process. The Inspectors carried out a tour of each unit of the home, and inspected service user plans, staff files and training records. The pharmacy Inspector carried out a pharmacy inspection. 15 service users, 8 visitors, 15 staff and two visiting healthcare professionals were spoken to at the time of inspection. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. What the service does well: What has improved since the last inspection? The majority of requirements from the last inspection report have been addressed. A consumer survey had been completed, and work was underway to improve the bathing facilities for the service users. Activity provision has improved but could be further improved if further information was obtained about the service users social and leisure history. Some work had been undertaken on formulating service users plans on the social and leisure needs of service users. The construction and content of the service user plans have continued to improve, it is important that work continues to maintain the improvements. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 6 What they could do better: 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. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5. The home does not provide intermediate care. The pre-admission assessment process for prospective service users enables the home to ensure it can meet the needs to include specialist care needs of each individual. Prospective service users and their representatives are encouraged to visit the home in order to allow them to make an informed choice. EVIDENCE: Prior to admitting prospective service users, a pre-admission assessment is carried out by a registered nurse from the home. Samples of these were viewed and had been clearly completed. In addition, copies of continuing care assessments and/or Social Services needs led assessments are obtained. Therefore the home can ascertain if it is able to meet the needs of prospective service users. Where possible service users are encouraged to visit the home prior to admission, where this is not possible the service users representative is encouraged to visit. Two representatives of a service user confirmed that they Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 9 had visited the home, met the staff and viewed the facilities prior to their relative moving into the home. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Service users individual needs were not always identified and information held was not always up to date, and this can place service user at risk of not having their needs fully met. Shortfalls in the management of medications potentially place service users at risk. Staff are courteous to service users and personal support is provided in such a way as to promote and protect the service users privacy, dignity and independence. EVIDENCE: Samples of service user plans were viewed on each unit. These gave an overall picture of the service users needs. Care plans had not always been formulated for all the service users identified needs, for example, a service user who required assistance with feeding did not have a care plan in place to reflect this. There was evidence of care plans being formulated to meet newly identified needs, for example, for a service user who had developed a chest infection. The service user plans had been reviewed monthly, but updates had not always been included and the need to ensure that staff read through the service user plans thoroughly when reviewing them to ensure they are accurate and up to date was discussed. On one unit the risk assessment for falls had not been updated following a fall. This had been done on other units. Assessments for nutrition, moving & handling, continence and pressure sore risk were in place. For one service user the pressure sore risk assessment Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 11 available had not been completed and the previous one could not be found. Wound care documentation had not always been updated following changes in dressing regimes and it was not always clear as to when dressings had been changed. On one unit the service user had a pressure sore on their heel, no care plan on this was available. The care plan for another pressure sore had not been updated following a visit from the Tissue Viability Nurse. Wound assessment documentation was not always completed in full. Recommendations made by the Speech Therapist following a visit to one service user had not been incorporated into the care plan. Risk assessments for the use of bedrails had been completed, but the reasons for their use plus written consents had not always been obtained. The shortfalls identified were discussed with the registered nurses in charge of the units concerned on the days of inspection and also the Manager Designate said that she had been carrying out an audit of the service user plans on each unit and had identified shortfalls and would be following up on this. One GP practice with 5 GP’s provide cover for the home and the managers said that the GP’s are very supportive and carry out visits 3 times a week, plus any additional visits that might be required. One GP takes responsibility for each unit, and service user reviews are also carried out in addition to routine visits. One healthcare professional visiting the home said that the staff are very helpful and facilitate her work. Evidence of input from other healthcare professionals to include chiropodist, dentist, tissue viability nurse and optician were seen in the service user plans. The CSCI Pharmacist Inspector carried out an inspection on 13/06/05 and a separate report is available. The requirements and recommendations resulting from that inspection have been incorporated into this report. Staff were seen to address service users in a gentle and courteous manner. Service users and visitors spoken with were satisfied with the care given and the attitude of the staff. Staff receive ‘customer care’ training as part of their induction and this includes how to treat service users with respect and preserve their dignity. One service user said that staff always make visitors welcome and offer them refreshments. Service users can have a private telephone and payphone facilities are also available. Healthcare professionals see service users in the privacy of their own rooms. The home has introduced a document on which to record the wishes of the service users and their families in respect of death and dying. This gives a clear picture to staff and can be amended at any time. Policies and procedures for the care of the dying and care after death are in place. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 The activities provision is generally good and service users have a choice of whether they wish to participate, thus respecting their wishes. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The home has two full time activities co-ordinators. A monthly activities programme is displayed on each floor and additional events are also advertised. Care plans for service users social needs had not always been formulated, however some viewed had been personalised to the individual. A record of each service users’ participation in and enjoyment level of activities is maintained. The importance of finding out each individuals past social and leisure history, plus ascertaining if any particular activities could cause distress to service users, especially those with dementia, was discussed with the activities co-ordinators and the managers. Service users and their families could be asked to complete a social and leisure history to provide the staff with the information. The home has an open visiting policy and service users wishes with regard to visitors are respected. If necessary, advocacy services and the service users’ social worker can be involved in any issues with visiting. Copies of the monthly Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 13 newsletter are available to service users to keep them informed of what is going on in the home. There is a visitors signing in book and identification badges are provided for each visitor for security purposes. One Inspector viewed the kitchen and this was clean, tidy and the records were up to date. The Chef takes pride in keeping all documentation up to date and also ensuring that service user choices at mealtimes are recorded. He is also happy to look at any new systems that would enhance the management of service users meals and the kitchen areas. The lunchtime options were sampled on the first day of inspection and these were well presented and tasty. The home has a ‘cook/chill’ food provision system in operation and service users spoken with said that they were generally satisfied with the food provision. Each menu has a ‘legend’ – a document that gives information regarding the suitability of each menu item for service users with specialist dietary requirements. Meals for service users with cultural or religious requirements can easily be obtained and prepared. Mealtimes are unhurried and staff are available to offer assistance as needed. For service users being artificially fed via a percutaneous endoscopic gastrostomy (PEG) tube, records of the administration of each feed and water flushes are clearly recorded. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The home has a satisfactory complaints system with evidence that service users and representatives concerns are listened to and acted upon. Service users rights are protected and service users are able to exercise their legal rights directly. Staff have knowledge and understanding of adult protection issues which protect service users from abuse. EVIDENCE: The home has a clear complaints procedure and complaints are promptly addressed. Correspondence relating to each complaint is maintained and shows the progress and outcome. The home includes contact details for the First Voice Advocacy Services in the service users handbook. Information regarding the recent general election was included in the newsletter and those service users who wished to were taken to the polling station to vote. The homes’ policies and procedures for the protection of vulnerable adults (POVA) dovetail with the Local Authority Multi-Agency Adult Protection documentation. Staff spoken with were generally clear that they would report any concerns of this nature and also understood the Whistle Blowing procedure. The General Manager said that any issues that might come under this area are discussed with the Ealing Adult Protection Co-ordinator. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 22 & 26 The home is actively working towards the provision of new assisted bathing facilities so that service users hygiene needs can be appropriately and fully met. There is an ongoing issue with storage, which could limit space availability for service users in some areas. Overall the home was clean and systems for the prevention of the spread of infection were being adhered to, thus safeguarding service users. One exception to this was noted and discussed. EVIDENCE: A new assisted bath has been installed since the last inspection and this is being trialled with a view to installing this style of bath on the other units. There are problems with installing assisted baths due to the under floor heating provision which prevents any drilling into the flooring to fix such baths. There were still issues with storage noted and the General Manager said that plans for the provision of additional storage were still being made. This is an ongoing issue at present with the home. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 16 The home was clean and free from odours. There is a Housekeeper and a team of domestic staff who keep the home clean and deal with any spillages promptly. The laundry room is open from 8am to 9pm. Laundry staff spoken with were clear of the laundering procedures for items to include infected laundry and the laundry was clean and tidy. Service users clothing is labelled and for new service users their name is discreetly written in until the labels are available, unless relatives request this is not done. Unidentified items are kept in the laundry and available to relatives for identification purposes. There are two each of industrial washing machines and tumble dryers and the settings on the washing machines facilitate the washing of laundry items at appropriate temperatures for infection control. Sluice rooms with machines for the disinfecting of bedpans and such like items are available on each unit. Used razors and combs were found in one bathroom and removed at the time of inspection. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 The home was adequately staffed to meet the needs of the service users. Staff training is ongoing to ensure that staff have the skills to meet the needs of the service users. The vetting and recruitment practices need reviewing to ensure they are complete so as to safeguard service users. EVIDENCE: The units were staffed to meet the needs of the service users. Staff spoken with said that there is good teamwork on each unit and they enjoy their work. Fifteen care staff have attained an NVQ level 2 in care qualification. Thirteen are undergoing this training and a further eight at level 2 and eight at level 3 are planned for 2005/06, plus three booked for NVQ apprenticeships to commence in September 2005. The managers are very clear on the need for 50 of the care staff to be qualified to NVQ level 2 in care or the equivalent. The home also has four qualified NVQ assessors and four more undergoing the training. Evidence of other training to include mandatory training sessions was seen and there has been an increase in the training provision for the home. Staff spoken with said that they do attend regular training and update sessions in a variety of subjects relevant to the service user group they are caring for. Three sets of staff employment records were viewed. These were generally up to date. One health questionnaire and one photo were required, plus information regarding an unexplained gap in employment. The administrator has been in post for just over 2 months and is auditing the staff employment Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 18 files and has formulated a comprehensive check list to complete for each one. Terms & Conditions with the contract were seen in one file and the administrator explained that the provision of contracts for all new staff was being checked and these would be issued as necessary. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 38 The management structure of the home is clear and open and the managers are approachable, and service users and their representatives are secure in the knowledge that the home is being well managed. Staff receive training and updates in health & safety topics thus safeguarding the service users. EVIDENCE: A new Clinical Director has been appointed and she is going through the process of registration to become the Registered Manager for the home. The home also has a General Manager and both managers are clear of their roles and responsibilities. A service user and representatives survey has been carried out and work is being done to complete the annual development plan for quality assurance. Audits for aspects of care and the environment are carried out and shortfalls addressed. Standard 33 will be revisited at the next inspection. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 20 Staff mandatory health & safety training and updates had taken place. There are identified fire wardens and staff who have undertaken First Aid and Emergency First Aid training. Training in infection control had taken place in 2005 and all staff who handle food have received food hygiene training. The home has Health & Safety policies and procedures in place. All accidents and incidents are recorded and where required Regulation 37 notifications have been forwarded to the CSCI. The Maintenance Manager was not present at the time of inspection, so maintenance and servicing records will be viewed at the next inspection. The assistant Maintenance Manager was spoken with and was clear about his role and responsibilities. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x 3 2 x x x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x x x x 3 Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 7(1)(a) Requirement The service users plan must include all of each individual service users identified needs. It must be updated monthly and when a service users condition changes. (previous timescale 01/02/05 not met) Risk assessments for falls must be updated following a fall. Following the completion of the bedrail risk assessment, the appropriateness of and reason for the use of bedrails must be clearly stated and a written consent for the use of bedrails obtained. Assessments for pressure sore risk must be completed and clearly reflect the condition of the service users skin. Wound care plans must be in place, these must be regularly reviewed and updated to reflect the condition of the wound.Wound assessments must be completed in full. Advice received from the Speech Therapist must be reflected in the service users plan. Variable doses must be recorded All medicines must be labelled Timescale for action 22/07/05 2. 3. 7 7 13(4)(c) 13(7) 01/07/05 01/07/05 4. 8 17(1)(a) 01/07/05 5. 8 17(1)(a) 01/07/05 6. 7. 8. 8 9 9 13.2 13.2 13.2 01/07/05 01/07/05 01/07/05 Page 23 Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 9. 10. 9 9 13.2 13.2 11. 9 13.2 12. 13. 14. 9 9 9 13.2 13.2 13.2 15. 12 16(2)m 16. 17. 12 22 16(2)m 23(2)(l) 18. 29 Schedule 2(1)7,9,1 with the service users name and instructions for use. These instructions should correlate with the MAR. As directed should not be used for bendroflumethiazide Sticky labels must not be requested or attached to the MAR. To ensure that stock levels of medicines and dressings continue to be monitored and reduced particularly Westerly Unit. Brought Forward Quantities should be written on the MAR each month for medicines not in the MDS to aid stock control. To ensure that when medicines are received from hospital or home or midcycle they are fully recorded with quantities in all units. To ensure that in all units, all medicines are recorded accurately when administered. Dates of opening must be written on calogen in all units to avoid the use of expired stock When medicines are received at the beginning of each cycle they should be thoroughly checked to ensure a continuous supply. After consultation with the service users and their representatives, care plans on social and leisure interests must be formulated to reflect their individual needs and identify how these are to be met.(previous timescale of 1/3/05 not met) Information on the service users past social and leisure history must be available. Adequate designated storage facilities must be available.(previous timescale of 1/4/05 not met) The Responsible individual must ensure that all records required 01/07/05 01/08/05 01/08/05 01/07/05 01/07/05 01/07/05 01/08/05 01/08/05 01/08/05 01/07/05 Page 24 Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 9 in Schedule 2 of the Care Homes Regulations 2001, are in place. 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 9.9,9.10 9.4 Good Practice Recommendations To review those service users without pegs who are having their medicines crushed particularly on Donald Sword Unit. That the community pharmacist be requested to label the actual container and not just the outer top box. Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 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 Acton Care Centre G61-G10 S34968 Acton Care V229479 13.6.05 Stage 4.doc Version 1.30 Page 26 - 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. 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