CARE HOMES FOR OLDER PEOPLE
Alexander Court Care Centre 320 Rainham Road South Dagenham Essex RM10 7UU Lead Inspector
Rhona Crosse Unannounced Inspection 03 June 2005 06:30 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. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Alexander Court Care Centre Address 320 Rainham Road South, Dagenham, Essex RM10 7UU 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) 020 8709 0080 020 8593 7584 Life Style Care PLC vacant CRH Care Home 82 Category(ies) of DE(E) Dementia - over 65 (30) registration, with number OP Old age (40) of places PD Physical disability (12) Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10 February 2005 Brief Description of the Service: Alexander Court is a care home providing 24 hour nursing care to 82 service users. The home is divided into 5 units providing care for older people, older people with dementia and people with a physical disability. The home was purpose built and is operated by Life Style Care PLC. The home is in a residential area of Dagenham. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection, this means that the home did not know the inspector was coming. The inspection commenced at 06.30 in the morning. Very few service users were up at this time. The night staff were still on duty. Some service users were in the process of getting up as they were awake. The inspector looked at daily records, care plans, risk assessments, medication and accident records. A random selection of bedrooms, bathrooms, lounges and the main kitchen was undertaken. Breakfast and lunch was also observed. Lifting and handling procedures being carried out were observed. The inspector spoke with service users and visitors to the home. What the service does well: What has improved since the last inspection?
Although the recording of care plans now shows they are being updated monthly, care must be taken to ensure that the information is current. Privacy and dignity was seen to be respected whilst staff dealt with any personal hygiene. Staff were able to give good information about the current needs of service users when the inspector spoke with them.
Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 6 The deputy manager is now no longer placed on the rota as a nurse, caring for service users. This is to enable her to carryout a manual handling assessment for each service user. She is also reviewing the manual handling procedures with staff individually. Decorating of the home is taking place as well as some refurbishment, this is improving the home. What they could do better:
The information in care plans, risk assessments and nutritional care plans needs to be updated as changes occur, so that the current needs of service users are being met. The completion of food charts, fluid charts and peg feed charts is poor with the home not being able to evidence the care it is providing from the records held. This must be dealt with as an urgent matter, as these are outstanding requirements not met from the last inspection. Lifting and handling practice is poor (staff were observed manually moving a service user who required a hoist for transfer). This is very poor practice. The inspector saw staff bending down when putting a sling of a hoist in place instead of going down to that level. Poor manual handling procedures puts both service users and staff at risk of injury. Service users were also seen by the inspector sitting for long periods of time in wheelchairs not designed for that purpose this must be urgently addressed. Medication recording was poor when the medication was audited on unit 1. The home has been requested to carryout an investigation into why an antibiotic that was dispensed to the home (on the 31/5/05) from the pharmacy was not recorded as being received and not administered to the service user. No information in the daily records or the GP visits record could established who prescribed this medication. This is poor practice and places vulnerable service users at risk. All medication must be recorded and administered in line with the prescribing instructions. A random selection of bedrooms inspected found that several had stained linen on the beds and several pillows were lumpy, misshapen and unsuitable for use. The beds had been made up ready for re-use. All bedding must be suitable for use at all times. Infection control was poor in one en-suite where a catheter was dripping onto a footrest. Equipment must not be stored in en-suites (the home has adequate storage space on each unit where items can be placed when not in use). This was a requirement that was made at the last inspection and this poor practice is still taking place. One bedroom had an odour of urine and faeces this room must have the carpet deep cleaned. Another had faeces on the head board that needed cleaning. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 7 A fire extinguisher had been removed from it’s hook and taken to prop open a fire door. Although this was said to have been done by the decorators the staff should not allow this practice. Paint and white spirit were also found stored under a stair well. A further stair well had a mattress and a lounge chair stored under it. No combustible material should be stored under stair wells. 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. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3, the home does not provide the service standard 6 relates to. These standards were met, with the paperwork evidencing that the home assess service users prior to admission. EVIDENCE: The Statement of Purpose and the Service Users Guide have been updated so that service users are able to see what services the home provides. From a random selection of service users files inspected there was evidence that the home carries out a written pre assessment before the service user enters the home. Placing authorities assessments were also held on file. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_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, and 9 The home is operating below the required standard and this places service users at risk. Records inspected showed examples of lack of appropriate recording in instances where service users needs were high/service users were at risk. There needs to be closer monitoring of care plans, risk assessments nursing records, daily records and medication practices by the home to ensure that service users’ needs are being appropriately met. EVIDENCE: A random selection of care plans and risk assessments were inspected and cross-referenced with daily records and pre assessment information and accident reports. The majority of care plans are now being updated on a monthly basis. However, for one service user who is said to have behaviour problems, the risk assessment for bathing had not been updated since 15/2/05. The manual handling risk assessment had also not been updated since the 31/3/05. The care plan had been updated and this stated that due to the risk of pressure sores specialist equipment was being provided (mattress and cushion). For another service user the pre admission assessment stated that this person has Osteoporosis, however there was no care plan for this condition. The
Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 11 manual handling assessment did not identify that the service user had Osteoporosis (this condition brittle bones has implications for lifting and handling) and had not been updated since 4/4/05. This is poor practice. Bruising was recorded in the care plan but there was no corresponding record made in the daily records or any details of action taken about this. For another service user who is diabetic the care plan stated that blood sugar levels must be monitored on a weekly basis. When the blood sugar monitoring sheet was inspected it was found that this was not taking place weekly for March, April, or May 2005. This is poor practice. A further service user’s file stated that the person had fallen on 19/5/05 no further action was taken after this fall other than to state that there was no bruising. However on the 20/5/05 the daily record states that the arm is now red and swollen. The record for the 21/5/05 states ‘left hand remains swollen and bruised’. At a later time on the 22/5/05 the report states ‘left arm still bruised more visible and swollen’ but still no action is taken to seek medical help for this service user. There is no night report for the night of 22/5/05 into the day of the 23/5/05 or for the rest of the day and night of the 23/5/05 into the morning of the 24/5/05. The daily records continue with an entry on 24/5/05. Therefore the home cannot evidence what action they took about this swollen arm after the night report of the 22/5/05. This service user had no medical attention for a badly swollen wrist/arm after her fall on the 19/5/05 – 24/5/05. There are then 2 contradictory entries for the 24/5/05 and 25/5/05 stating on both days that the service user was sent for an x ray of their arm. The home did not make appropriate arrangements for the care of the service user leaving her for 5 days without medical treatment. This is very poor practice. It is also of concern that there is missing documentation in relation to the care of this service user. On the 27/5/05 there is a further fall documented in the daily records but no accident report of this could be found. On this occasion she was seen by a locum GP. However after this entry there is nothing recorded for the night of the 27/5/05 or during the day until a record at 19.28 hours. Both falls happened after she tried to get out of a wheelchair, however this service user is not wheelchair bound and should not have been left unattended in a wheelchair. During the inspection other service user’s were seen sitting in wheelchairs not designed for this purpose. All service user’s who require a wheelchair for transfer must be placed in an arm chair and not left in wheelchairs to suit staff practice. Fluid balance charts are not being completed appropriately with gaps in the recording therefore the home cannot evidence that it has provided service users with the appropriate diet by peg feeding in line with the dieticians instructions (on the 19/5/05, 24/5/05 and 25/5/05). For another service user the fluid intake did not identify the maximum amount of fluid the service user would take, or show what amount of fluid the service user should not fall below
Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 12 in any one 24 hour period to keep them appropriately hydrated. One fluid balance chart dated the 18/5/05 documented that only 90mls of fluid was offered and taken at 06.00 hours. Nothing else is recorded on the fluid chart as being offered on this day. On the 24/5/05 only 450 mls of fluid are recorded as being offered and taken. On the 25/5/05 only 300mls of fluids were recorded as offered and taken. For this day there was a gap 11 hours from 09.00 hours to the next entry where Ensure was provided at 21.00 hours. For one service user who was not eating properly and was now needing to be fed by staff, a weight loss was recorded. The nutritional screening tool was incorrect as the information provided in discussion with nursing staff showed that the total of 6 which was recorded recently on this chart was incorrect. The service users needs were such that this changed the level of risk to ‘high’ risk. However no food chart was being completed to show what diet was being taken, this must be put into place. Medication recording was inspected on unit 1. ( medication other units will be inspected at further inspections). Concern was raised with the nurse in charge. A medication was not signed on 29/5/05 as being administered but had been administered when cross referenced with the monitored dosage system. For another service user Aspirin was not signed as being administered on 27/5/05 and had not been administered and no code was used to define why this medication had not been given. For a further service user the antibiotic Augmentin was prescribed and 21 tablets had been dispensed. However a count of the signatures showed 24 signatures had been recorded. One Augmentin tablet remained in the box therefore this medication has not been administered in line with the prescribing instructions. For the same service user another antibiotic had been prescribed, however there was no entry on either the daily records or the medication administration sheet to identify why or who prescribed this antibiotic. The date of dispensing was 31/5/05 when 6 tablets had been dispensed these remained un-used in the box. The home must investigate this. The majority of service users looked clean and well groomed, however 2 service users were observed with brown deposits under their nails. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. These standards are met. EVIDENCE: The home has an activities co-ordinator and an activities room where service user’s go to join in the daily activities. On the 2/6/05 several service user’s went out to Brentwood to have afternoon tea. One service user who joined in this activity said ‘we went out, just a few of us to have our tea and it was very nice’. On the day of the unannounced inspection a ‘quiz’ had been arranged and ‘dial a ride’ transport was used to bring service user’s from another home to take part in the quiz. A record of all activities taking place is held. Links with relatives and friends are encouraged and any links that service users wish to keep if they have come from the local community are also encouraged. Relatives visiting at the time of inspection had varying views of the service being provided. One relative felt that the home had deteriorated and that staff shortages often happened. Another was happy with the service provided. Relatives stated that they are made to feel welcome and can come and go when they please. Breakfast time was observed and it was seen that staff took time to ask service users what they wanted for breakfast and did not hurry them to give
Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 14 an answer. Some service users took time to answer the question put to them but the staff did not presume what they wanted and waited for a reply this is seen as good practice. Service users were fed individually (there had been information provided to the inspector that suggested that several service users were being fed by one member of staff at the same time). However on the day of the unannounced inspection staff appeared from other units to assist feeding, including the activities co-ordinator. Unit 4 had a very relaxed atmosphere during breakfast time staff knew the needs of the service users well and the unit was well organised. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected at this inspection but will be inspected at further inspections. The Commission will establish what action is required to be taken as a result of the findings of the investigation carried out by the Adult Protection Coordinator once this investigation is completed. EVIDENCE: A current adult protection investigation is being carried out by the Barking and Dagenham Adult Protection Co-ordinator, in conjunction with the Social work team. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 25, and 26 Standards 20, 21, 22,23 and are met. Refurbishment is taking place within the home therefore standard 19 and 25 should be met when this is completed. Inspection of the premises will be undertaken at further inspections. Individual bedrooms were personalised and well presented. However infection control in en-suites of service users bedrooms was poorly managed. EVIDENCE: The home is carrying out a programme of decorating. Contractors were decorating the hallways at the time of the inspection. A random selection of bedrooms on the units were inspected. Rooms held lots of personal possessions and small pieces of furniture. Specialist equipment is provided by the home for pressure relief and lifting and handling with different types of lifting equipment and lifting aids. These were observed in use and also recorded in care plans for service users. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 17 The majority of bedrooms were well kept and free from odours. However, bedroom 44 had an odour of stale urine. Room 7 had an odour of stale urine coming from the en-suite when this was investigated it was seen that a catheter bag was hanging over the drop down arm of the standing aid by the W.C. pan next to this was a table top for a wheelchair and a wheelchair cushion. Directly below the catheter tubing was a foot plate for a wheelchair this had urine on it as did a wheelchair head rest next to the foot rest. Behind the soil pipe there were two wheelchair straps. Bed rail protectors were seen stored next to the W.C.’s of two bedrooms. This is poor infection control. The homes laundry was clean, tidy and well organised Infection control was good in this area. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 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 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, standards 29 and 30 will be inspected at further inspections. Staffing levels were seen to be below an acceptable level on one unit- this means service users’ needs cannot be met. Staffing levels on all units must be monitored to ensure that any shortages of staff are replaced and that this does not impact on the needs of the service users. EVIDENCE: On the day of inspection Unit 5 was short of one member of staff until 2p.m. As this unit is a unit where service users often require the attention of 2 staff to use lifting equipment this means that all other service users at that time are in the care of one staff member. This unit must not fall below 1 nurse and 3 carers during the waking day. Alternative arrangements (agency staff if necessary) have to be provided to keep staffing levels appropriate. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_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 standard 38 was not looked at fully but will be fully inspeted at further inspections. The home is not being run in the best interest of service users. A great deal of work is required to improve the standard of care being provided. EVIDENCE: The new manager must put forward an application to register with the Commission. From the monitoring of service users’ care during the day the inspector saw service users who were not identified as needing to stay in wheelchairs being left in wheelchairs that were not designed for this. Accident reports were seen showing ‘skin tears’ and bruising whilst transferring from wheelchairs to bed/chairs. One wheelchair being used to transfer a service user with only one foot rest attached to it. This is poor practice.
Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 20 The inspector also saw poor practice when staff were lifting and handling service users which was not in line with current practice. For one service user who was deemed to require 2 staff and a hoist to be transferred, the inspector saw this service user being transferred by two staff without the use of a hoist. This places the service user at risk of injury and also places staff at risk of injury. The homes kitchen was not clean, during previous unannounced visits the kitchen had been kept to a high standard. The gas hobs where very dirty, with food spills from pervious days burnt on them. When the inspector asked the chef how often these were cleaned it was stated ‘when necessary’. The cleaning schedule was inspected, the gas hob had not been cleaned during this week (it was now Friday). All food spills on hobs must be cleaned up daily. Two heated food trolleys were found to have old food in the bottom of them, these must be cleaned on a daily basis and any food debris removed. The fridges and freezers were clean and the food store was clean and tidy. A fire extinguisher had been removed from it’s place in a corridor to prop open a fire door, (it was said to have been done by the decorators working in the building). The door was closed and the fire extinguisher returned to it’s designated place. Paint and white spirit was stored underneath a stair well and was seen to be blocking access to a fire extinguisher. The inspector spoke with the contractors who removed the items. Access to fire extinguishers should not be blocked. Under another stairwell a mattress and an armchair were stored. The must be removed. No combustible material should be stored under stair wells. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 2 1 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x x x x 1 Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_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. 2. 3. 4. 5. 6. Standard OP7 OP7 OP7 OP7 OP8 OP8 Regulation 15(1) & (2) 17(1)(a) schedule 3(k) 13(4)(b) 17(1)(a) schedule 3(k) 12(1)(a) & (b) 13(1)(b) Requirement All areas of care plans must be updated to ensure the current needs of service users are met. Fluid charts, food charts and Peg feeding charts must be completed fully at all times. Risk assessmsnts must be updated as changes occur. Diabetic Blood sugar monitoring must be carried out in line with the instructions in the care plan The home must make proper provision for the health and welfare of service users. The home must make arrangements for service users to receive treatment and other services from health care professionals. The home must make arrangements for the recording, handling, safekeeping and safe administration of medicines received into the home. Ensure appropraite storage for equipment that is not being used -walking sticks, wheelchair cushions, wheelchair straps, head rest, wheelchair table top. Remove the odour of urine from the carpet in bedroom carpet of Timescale for action 30/8/05 30/6/05 30/8/05 30/6/05 30/6/05 30/6/05 7. OP9 13(2) 30/6/05 8. OP24 23(2)(l) 30/6/05 9. OP26 13(3) 30/6/05
Page 23 Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 10. 11. OP27 OP31 18(1)(a) 8 12. 13. OP38 OP38 17(2) schedule 4 12(a) 13(6) bedroom 44. Bed rail protectors and other equipment must not be stored in en-suites, this is poor infection control. The home must ensure that the staffing levels do not fall below the required level on unit 5 The new manager must apply for and put forward an application to be registered with the Commission. The home must keep a record of all accidents. The home must make arrangements, by training staff or by other means to prevent service users being harmed or being placed at risk of harm (poor manual handling practices) Service users must not be left in wheelchairs not designed for that purpose. The cooker hob must be kept clean. Fire extingusihers must not be used to prop open fire doors at any time Furniture and combustible materials should not be stored under stair wells. Heated food trolley to be kept clean and free from food debris at all times. Access to fire extinguishers should not be restricted at any time. 30/6/05 and ongoing. 30/8/05 30/6/05 30/7/05 14. 15. 16. 17. 18. 19. OP38 OP38 OP38 OP38 OP38 OP38 12(1)(a) & 13(6) 16(2)(j) 13(4)(c) 13(4)(c) 16(2)(j) 13(4)(c) 30/6/05 3/6/05 and ongoing action. 3/6/05 and ongoing action. 3/6/05 and onting action. 3/6/05 and ongoing action. 3/6/05 and ongoing action. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations
G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 24 Alexander Court Care Centre 1. 2. OP7 OP7 The manager should monitor the nursing records to ensure that these are up to date and appropraitely completed. The manager should ensure that staff in charge of a shift are able to undertake these responsibilities. Alexander Court Care Centre G55_S0000029331_Alexander Court_V229829_030605_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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