Inspection on 26/10/05 for Allenbrook Nursing Home

This inspection was carried out on 26th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Allenbrook Nursing Home 17/07/08

Allenbrook Nursing Home 06/09/06

Allenbrook Nursing Home 01/06/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Allenbrook Nursing Home 34 Station Road Fordingbridge Hampshire SP6 1JW Lead Inspector Tim Inkson Unannounced Inspection 26th October 2005 09:00 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 Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Allenbrook Nursing Home Address 34 Station Road Fordingbridge Hampshire SP6 1JW 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) 01425 656589 01425 655410 Allenbrook Care Ltd Mr John Walker Care Home 43 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (43), of places Physical disability (8), Physical disability over 65 years of age (43), Sensory Impairment over 65 years of age (43), Terminally ill (8), Terminally ill over 65 years of age (43) Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Individuals in the categories of PD and TI must be aged between 50 to 64 years of age. 1st June 2005 Date of last inspection Brief Description of the Service: Allenbrook is a large Georgian period country house situated in extensive grounds and it was converted for use as a nursing home. It is owned by Allenbrook Care Ltd, a company formed with the specific purpose of purchasing and owning the care home and the day-to-day operation is the responsibility of managing agents, BML Healthcare Ltd. The home is located within a quarter of a mile of the small country town of Fordingbridge, with all its amenities. There is limited bus service from Fordingbridge to the centres of Ringwood and Salisbury the nearest large centres of population. The nursing home has three floors on which service users are accommodated. A passenger lift provides access to all floors. The home’s communal rooms comprising a lounge dining room and a separate lounge and a large sun lounge/conservatory are all located on the ground floor. Communal WCs and baths are located on all floors. Other facilities provided include a laundry service and full board. The home provides a limited meals on wheels service to people living in the local community. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second of two inspections of the home that must be undertaken in the 12-month period beginning on 1st April 2005. It started at 09:25 hours and finished at 15:30 hours. The inspection procedure included viewing a sample of some bedrooms (7), an examination of some documents and records, observation of staff practices where this was possible without being intrusive and discussion with residents (8) and staff (6) and relatives (2). At the time of the inspection the home was accommodating 43 residents and of these 9 were male and 34 were female and their ages ranged from 78 to 102 years. No resident was from a minority ethnic group. The home’s registered manager was present during the day and available to provide assistance and information when required. What the service does well: What has improved since the last inspection? The home’s fire safety system and consequently the welfare of the residents had been enhanced by the installation of equipment that enabled a bedroom door to remain open. This released the door if the home’s fire alarm was activated and ensured that the integrity of the fire safety system was maintained Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 the following standard(s): 3 The home’s admission procedures were good and they included comprehensive assessments of the needs of potential residents before they moved into the home to ensure that the home could provide the care and support that they required. EVIDENCE: The home had written policies and procedures concerned with the admission of new residents to the home and they stated among other things: “All potential service users will be assessed by the registered manager or their authorised representative to ensure that the home is appropriate to their needs. The assessment must be carried out in advance”. The records of 4 residents were examined and these included copies of detailed assessments that the home had arranged of the needs of the individuals concerned. On this occasion as at the last inspection of the home on 1st June 2005 it was apparent from discussion with residents and the documents examined that the needs of potential residents were identified before the persons moved into the home. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 9 Comments from residents about the home’s admission process included the following: • “I was in hospital in Fordingbridge hospital and John (the home’s registered manager) manager” came to see me and see what help I needed”. • “ Mr Walker (the home’s registered manager) came to see me in ……. hospital before I came here”. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 the following standard(s): 7 and 9 There were good plans of care in place that ensured that residents received the help and support that they needed. The written procedures and records that were in place to ensure that medication was administered safely were unsatisfactory. EVIDENCE: On this occasion as at the last inspection of the home on 1st June 2005, a sample of the care plans of residents was examined (4). The documents were detailed and the plans were based on assessments the home carried out in order to identify what help individuals needed (see also page 10). The plans set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. There was evidence from both the documentation and discussion with residents that wherever possible individuals or their representative signed the plans to indicate that they had been involved in developing the plan and agreed with the contents. Observation and discussion with residents confirmed that individuals received the help they required and that the equipment was in place as set out in their plans of care. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 11 Registered nurses and health care assistants spoken to were fully aware of the contents of the care plans that were sampled and of the assistance that the individuals concerned required. The care plans documents included recorded assessments of the potential risks to residents of among other things, pressure sores and malnutrition. Individual’s dependency profiles were evaluated and reviewed every month. It was noted from entries in care plan documents that the goals and the actions to be taken by staff promoted both good practice and the fundamental principles/values that underpin social and health care e.g. independence, dignity, choice e.g. • “Maintain A’s independence” - “A needs routine to be explained to her beforehand”. • “Ensure B’s privacy when assisting with toileting” - “B is sensitive about personal care and likes make up and perfume to be applied daily”. • “C likes her breakfast in bed and to sit in the conservatory”. • “D likes to go to bed at 10:00 p.m.” - “D can choose her own clothing but cannot dress herself”. Comments from residents about the care and support the home provided included: • “The staff are very good, both the nurses and the other staff. They do what they are supposed to do. They are a nice gang here”. • “They give me all the help that I need and all the staff are very kind”. The home had written policies and procedures concerned with the management and administration of medication. As a result of changes to the National Health Service contract for community pharmacists and to ensure the home complied with legislation about the disposal of waste the home had implemented new procedures for the disposal of unwanted and unused medication. They were using sealed containers for the storage of most unwanted medication and had an appropriate container to be used to “de-nature” any such controlled drugs to prevent their active ingredients being recovered. The home’s medication policies and procedures referred to above required amending because there was no reference in them to the new practice that the home had adopted. Medicines were stored safely and appropriately in; two locked and secure medicine trolleys; a locked metal cabinet in a locked secure room; and in a locked medical refrigerator. The temperature of the latter was regularly checked to ensure that it was working effectively and medical equipment was regularly serviced. The administration of medication in the home was the responsibility of registered nurses. There were copies of the signatures of those nurses who dispensed medication among other records concerned with medication and these included those concerned with the ordering, receipt and disposal of Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 12 medicines. A check of these records revealed some omissions/gaps in medication administration records. A check of records of some controlled drugs indicated that stocks being held were correct. There was some discussion about the amount of controlled drugs that had been retained for disposal beyond 7 days following the deaths of the individuals for whom they had been prescribed. This was because of the expectation set out in Standard 9.11 of the National Minimum Standards for Care Homes for Older People. Medication was dispensed from original containers. General practitioners had given written permission for the use of certain unprescribed or “homely” medications if their use was considered necessary e.g. cough linctus. Good practice noted during the inspection included; dating of certain medication containers when they were opened; and the ability of residents to manage their own medicines (self medicate) if they wished subject to a risk assessment. A requirement to address the following issues by 30th November was agreed with the homes registered manager. • Production of updated the written policies and procedures to reflect accurately the practice in the home, • Maintain accurate and complete medication administration records. • Appropriately dispose of any unwanted controlled drugs held longer than 7 days after the death of a resident for whom they were prescribed. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 the following standard(s): 14 The home had good procedures in place for ensuring residents could exercise self-determination. EVIDENCE: The home’s Statement of Purpose included in its aims and objectives the promotion of residents right to exercise choice and described this as “giving a resident the opportunity to select for themselves from a range of alternative options”. There was information on display in the home about advice and advocacy services/organisations that residents and their families and/or friends could contact for help or information. Residents spoken to said that they were able to manage their own financial affairs although most said that their relatives looked after such matters on their behalf. One resident described how she remained autonomous: “I deal with my own finances. They send me an invoice and I pay it. I have a say and I am independent”. Comments from residents about their ability to exercise control over their daily lives included the following: • “I get a catalogue and do my own shopping”. • “I choose to eat my meals in my room”. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 14 • “I get up and go to bed when I want”. Several residents spoken to said that they had brought some pieces of furniture into the home and terms and conditions/licence agreements issued to residents when they moved into the home included the following clause: “Residents are encouraged to bring personal item, including items of furniture, with them to the home……..”. There was a written policy and procedures concerned with residents ability to “access personal information and records”. All sensitive information about residents was kept securely in the home’s office and in lockable filing cabinets. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 the following standard(s): 17 and 18 The home had good procedures in place to ensure that residents could exercise their civic rights and that vulnerable adults were protected from abuse. EVIDENCE: The home included in its information pack for new residents a “voter registration form” that could be sent to the district council to enable individuals to be included on the electoral roll. Residents said that they were able to vote in elections and one said, “I have a postal vote, they put me on the register in October”. There were written policies and procedures in place concerned with the protection of vulnerable adults from abuse these included the following: • Gifts and gratuities • Physical restraint The home had a copy of the local authority’s guidelines adult protection guidelines and this was directly referred to in the home’s own new procedures about abuse. Staff spoken to were familiar with the home’s policies and procedures and demonstrated an understanding of the different types of abuse that could occur and knew what action to take if they suspected or witnessed any such abuse in the home. When following a risk assessment it was considered necessary to use bedrails to prevent a resident suffering injury the agreement and decision of all interested parties was documented. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 the following standard(s): 19, 24 and 25 The home’s general environment including residents’ bedrooms was well maintained, furnished and equipped for service users safety and specific needs. EVIDENCE: The home was not purpose built and is a large Georgian county house that was converted for use as a care home that was also extended to include some purpose built accommodation. It is located on the edge of Fordingbridge, a small country town and situated in extensive attractive landscaped grounds. The buildings were in good repair and there was evidence from documents and discussion with staff, residents and visitors that the maintaining a safe and comfortable environment is a priority. Records indicated that staff received regular fire safety training and fire drills took place and also that fire safety equipment and systems were checked, tested and serviced at appropriate intervals. A recent report (14/10/05) from the local environmental health officer stated among other things: “There are good systems in place with regular documentation and records and good practice to prevent contamination”. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 17 The home’s manager said that a handy man was employed “full time” to work in the home and undertake minor repairs and that a painter and decorator was employed 4 times a year for a week on each occasion to ensure the standard of the décor was maintained. He also said that the purchase of any new furniture or the need for any major expenditure on the building had to be agreed with the home’s managing agents (see page 5). At the last inspection of the home on 1st June 2005, it was noted that the door to a resident’s room was being kept open with a wedge, a practice that undermined the fire safety precautions in the home. The home had subsequently and within a very short period of time installed equipment on the door that enabled the individual to keep the door open but ensure that in the event of the home’s fire alarm being activated that the door would be released and closed in order to maintain the integrity of the home’s fire safety system. Residents spoken to generally said that they were content with the standard of décor, furnishings and equipment in the home including their bedroom accommodation. One resident did say that she would like more room for storing her knitting and that she felt the lighting in her room could be improved because her sight was poor. All residents spoken to were content with the level of heating throughout the building and the natural ventilation in their bedrooms. Some indicated that they particularly appreciated the privacy afforded to them by single rooms. All residents spoken to used the term “comfortable” to describe their rooms. All bedrooms seen were furnished and equipped as expected by Standard 24 of the National Minimum Standards for care Homes for Older People. Radiators were guarded to prevent residents from the risk of burns and hot water was sampled at wash hand basins in 2 bedrooms and it was about 43°C. The home kept records of regular checks of the temperature of hot water being “delivered” at outlets throughout the home. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 The home had sufficient staff with appropriate qualifications and skills to meet the needs of residents and its recruitment procedures for new staff were satisfactory, ensuring the protection of residents. EVIDENCE: The home was employing 33 health care assistants at the time of the inspection and of these 17 (i.e. 52 ) had National Vocational Qualifications (NVQs) in care (or their equivalent) to at least level 2. Staff spoken to were enthusiastic about working in the home and the opportunity to pursue and obtain formal qualifications. One health care assistant who had been working at the home for 2 years said, “I love it”. The records of 2 staff that had been employed to work in in the home since the last inspection were examined. There was evidence that all the statutorily required information and pre-employment checks had been obtained and carried out before they started work in the home. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 37 The home’s manager had the experience and skills necessary to run the home effectively. The home did not comprehensively monitor the service it provided and consequently the potential for identifying the need to improve or indeed maintain quality was poor. Systems for safeguarding residents’ financial interests were good. Record keeping was weak and not all records were complete and up to date and consequently residents’ interests were compromised. EVIDENCE: The home’s registered manager was a registered general nurse with previous experience of managing nursing homes before taking up his current post in which he had been employed for some 10 years. He said that in July 2006, he was hoping to complete a foundation degree in the “management of care homes” that was pursuing at a local university. Staff spoken to indicated that they had confidence in the manager’s abilities and in particular his clinical knowledge and skills. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 20 In the information pack that the home provided to new residents there was reference to a “quality forum” that met bi-monthly and consisted of representatives of residents, relatives and staff. There was also a section in the home’s Statement of Purpose and Service Users Guide about “monitoring and quality” and it stated that comments about the home were regularly sought about the service provided from residents and relatives and that there were monitoring systems in place. At the time of the inspection apart from monthly visits on behalf of the managing agents (see below) there was little evidence of any organised or regular means of ascertaining what interested parties (i.e. stakeholders) thought about the service the home provided. The registered manager was open in admitting that internal audits of some of the homes management systems that were normally done frequently had not been done for some time e.g. care plans, medication records, response to call system, etc. Also the same applied to formal methods (e.g. questionnaires and meetings) for seeking the views of residents, relatives and other people with an interest in the home. It was acknowledged that the purchase of the home by new owners in the late Spring of 2005, with their own methods for monitoring quality may have resulted in some delay in implementing a new system that would include consulting concerned individuals. The new owners arranged visits to the home at least monthly in accordance with Regulation 26 of the Care Homes Regulations 2001. During these the person conducting the visit, interviewed residents and people working in the home, and inspected the premises and documentation to form an opinion on the standard of care that was provided. Copies of reports of these visits were provided to the Commission for Social Care Inspection (CSCI). The home had a range of policies and procedures that informed care practice in the home. There was evidence with some exceptions that these were reviewed and updated or renewed to reflect new legislation and changes in practice (see pages 12 and 16). Staff comments about the importance of the policies and procedures included the following: • “If I don’t know what to do I look in them. I got information from them for my NVQ. They are important to the work I do every day. Say for example if I was going to whistle-blow its in there”. • “We look at them from time to time. If a new one comes out they ask us to look at it”. There had been 2 requirements arising from previous inspections of the home on 1st June 2005. One required the home to obtain advice from the local fire and rescue service about the integrity of the home’s fire safety system. This had been actioned without delay (see page 19) The timescale for the second requirement concerning formal staff supervision had not been exceeded at the time of this inspection and as a result it is carried over in this report and will be followed up at the next inspection of the home. The home did not act as agent or appointee for any residents but it looked after some monies on behalf of some residents. The records concerning 2 Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 21 residents were examined and the balance of money being held for them was correct. Among the statutorily required records examined during the inspection visit were the following documents: • • • • • • • • • Assessments and care plans for residents and related records. Statement of Purpose Service Users Guide Medication Fire safety including tests of equipment and drills and staff training Record of furniture brought by a service user into accommodation occupied by them Money held on behalf of residents Staff Visitors to the home There were some deficiencies noted with the following records: • Gaps were noted in medication administration records (see page 12). • A number of residents’ records did not include their photographs as required in accordance with Schedule 3 paragraph 2 to the Care Homes Regulations 2001. Photographs may be used to help confirm the identity of a resident in situations such as the administration of medication or if an individual “goes missing”. The many benefits of using digital photography were discussed with the homes registered manager. Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 3 X X X X 3 3 X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 X Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 23 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 OP9 Regulation 13(2) Requirement The registered persons must: • Produce written medication procedures that accurately reflect the practice in the home. • Keep accurate, up to date and complete medication administration records. • Dispose of stocks of unwanted controlled drugs. The registered persons must ensure that all care staff receive formal supervison at least 6 times a year. (This requirement is carried over as the timescale from an inspection of the home on 6th December 2004 and has not expired) The registered persons must ensure that all statutorily required records are complete and are kept up to date. Timescale for action 30/11/05 2 OP36 18(2)(a) 31/12/05 3 OP37 17 30/11/05 Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 24 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 Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Allenbrook Nursing Home DS0000064164.V260800.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!