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Inspection on 08/11/05 for Alston View Nursing & Residential Home

Also see our care home review for Alston View Nursing & Residential Home for more information

This inspection was carried out on 8th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What has improved since the last inspection?

All relevant documentation in respect of a resident`s admission was now kept on file. This meant that it could be demonstrated that an assessment had been done before admission and a decision made about whether the needs could be met at the home. Residents` care records were in the process of being changed. The information in these had improved and contained more detail on how residents` needs were to be met. A full range of assessments were being done to ensure that all health risks were identified. Some progress had been made with involving residents and their relatives in planning and reviewing care. One service user spoken to said that she had been asked to sign her plan of care after reading it. There were substantial improvements to the recruitment practices at the home. These were now thorough and ensured that all checks were done before the new member of staff started work. This was a way of safeguarding and protecting residents. There were now always two Registered Nurses on duty during the daytime. This meant that there was sufficient Nurses to meet the nursing needs of residents.

What the care home could do better:

Records of any medication disposed must be kept. This is so that it can be shown if any are missing. Staff should also sign to show when they have administered creams, ointments and inhalers. This is so that it is known who has taken responsibility for doing this. The lack of a Social Therapist meant that some residents felt that their recreational needs were not being met. One resident said "I miss playing dominoes in an afternoon". Some form of daily activity should be planned and put into place until the new Social Therapist starts work. In order to ensure continued protection of residents all staff must receive regular training in the protection of vulnerable adults and be aware of whom to contact should such an incident occur. There should be records to show what information a new member of staff has received on their first day of work. All staff must receive a minimum of 3 days paid training each year. This training must cover all aspects of care, health and safety, moving and handling and fire procedures. This is in order to ensure that all staff are competent to do their work and to protect residents and staff. There must be a recent photograph kept on file for each staff member. This is so there is proof of their identity.

CARE HOMES FOR OLDER PEOPLE Alston View Nursing & Residential Home Fell Brow Longridge Preston Lancashire PR3 3NT Lead Inspector Mrs Janet Proctor Unannounced Inspection 8th November 2005 09:05 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 Alston View Nursing & Residential Home DS0000022500.V262116.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. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Alston View Nursing & Residential Home Address Fell Brow Longridge Preston Lancashire PR3 3NT 01772 782010 01772 785649 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) MPS (Investments) Limited, Green & Co Mrs Patricia Dixon Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (44) of places Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A max of 44 service users requiring nursing care who fall in either the category of OP or PD A max of 15 service users requiring personal care of the category OP Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 12 May 2000 26th April 2005 Date of last inspection Brief Description of the Service: Alston View provides long and short stay care for a maximum of 44 service users who are elderly and need personal care, or who are elderly and have physical needs for which they need nursing care. The home can also accommodate adults aged 18-64 for nursing care. The registered persons are MPS (Investments) Limited, Green & Co. The day-to-day management of the home is undertaken by a Registered Manager, Mrs Patricia Dixon. The home is located within the village of Longridge in a residential area. Access to shops, a Church and other facilities is within walking distance. The building is a modern purpose built home, which overlooks landscaped grounds to the side and rear of the home. All bedrooms, except for one, are single rooms. All of the rooms are en-suite, with the exception of two single rooms. There are separate lounge areas and dining areas located on each floor of the home. Service users have access to garden and patio areas to the side and rear of the home and a small car parking area is located to the front of the home. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day on the 8th November 2005. The previous inspection was done on 26th April 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk . On the day of the inspection there were 44 residents at the home. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to 8 service users, the Acting Manager, the Administrator, 2 staff members and 2 visitors. Wherever possible the views of residents were obtained about their life at the home. Due to memory and communication difficulties, some of the residents were unable to engage in conversation or make comment about their experience of living in the home. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: What has improved since the last inspection? Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 6 All relevant documentation in respect of a resident’s admission was now kept on file. This meant that it could be demonstrated that an assessment had been done before admission and a decision made about whether the needs could be met at the home. Residents’ care records were in the process of being changed. The information in these had improved and contained more detail on how residents’ needs were to be met. A full range of assessments were being done to ensure that all health risks were identified. Some progress had been made with involving residents and their relatives in planning and reviewing care. One service user spoken to said that she had been asked to sign her plan of care after reading it. There were substantial improvements to the recruitment practices at the home. These were now thorough and ensured that all checks were done before the new member of staff started work. This was a way of safeguarding and protecting residents. There were now always two Registered Nurses on duty during the daytime. This meant that there was sufficient Nurses to meet the nursing needs of residents. What they could do better: Records of any medication disposed must be kept. This is so that it can be shown if any are missing. Staff should also sign to show when they have administered creams, ointments and inhalers. This is so that it is known who has taken responsibility for doing this. The lack of a Social Therapist meant that some residents felt that their recreational needs were not being met. One resident said “I miss playing dominoes in an afternoon”. Some form of daily activity should be planned and put into place until the new Social Therapist starts work. In order to ensure continued protection of residents all staff must receive regular training in the protection of vulnerable adults and be aware of whom to contact should such an incident occur. There should be records to show what information a new member of staff has received on their first day of work. All staff must receive a minimum of 3 days paid training each year. This training must cover all aspects of care, health and safety, moving and handling and fire procedures. This is in order to ensure that all staff are competent to do their work and to protect residents and staff. There must be a recent photograph kept on file for each staff member. This is so there is proof of their identity. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 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 the following standard(s): 3 Residents could be confident that the home could meet their needs. This was because they had their needs assessed before moving into the home and received a letter confirming whether the home could meet these needs. EVIDENCE: An assessment was done before a resident came to live at Alston View. The assessment covered a full range of personal and health care needs. It gave sufficient information for the manager to make a decision about whether the proposed resident’s needs could be met at the home. A letter was then sent to the prospective resident telling them whether the home could meet their needs or not. This documentation was now being filed in the new style of care plan. Alston View Nursing & Residential Home DS0000022500.V262116.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, 8 and 9 Residents’ health, personal and social care needs were identified and set out in a plan of care. This meant that staff had information on what to do to care for the residents. The medication practices ensured that residents’ health was safeguarded. EVIDENCE: The style of paperwork for care planning was being changed. The new style was based on ‘self-care deficits’. This identified what the residents could and couldn’t do for themself and gave information to staff what they had to do to ensure that all care needs were met. The new style of care plan had a section for the resident or their relative to sign to show that they had been consulted about the plan. The new care plans were to be reviewed on a monthly basis. Not all of the care plans had been changed over to the new paperwork so this could not be fully assessed. This will be checked on the next inspection. The new style of paperwork contained all the assessments needed to ensure that residents’ health care needs were identified. These included: risk of developing pressure sores; nutrition; risk of falls; risk of using bed-side rails; Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 11 moving and handling needs. Their were also risk assessments for other issues specific to the resident e.g. smoking and use of alcohol. As the new plans of care were still being implemented the system of reviewing and updating health care needs could not be fully assessed. This will be checked on the next inspection. The new style of care planning also ensured that every resident received an assessment on whether they were able to administer their own medications. The medication storage area was clean and tidy and the temperature of the room and fridge were recorded daily. The trolley was secured correctly. There were policies and procedures for staff to refer to about the control of medications. There were records of medications received into the home and those administered. There were no records of medications disposed of. The administration of creams and ointments and some inhalers was being demonstrated by a tick and not a signature. Hand written annotations to the Medication Administration Records were not signed or witnessed. The copy of the British National Formulary was dated September 2002. This meant that staff could not look up information on medications issued since that date. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 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 the following standard(s): 12 and 15 The reduction in daily recreational activities meant that residents’ social interests and needs were potentially not being met. Residents were happy with the meals served at the home. EVIDENCE: There was no Social Therapist employed at the time of the inspection. This meant that there was no programme of activities on a daily basis. There had been a fireworks party the previous week and events planned coming up to Christmas but there was little stimulation on a daily basis. Other residents said that they usually entertained themselves. They said liked to read, do crossword puzzles, or watch TV in their bedroom. One member of staff spoken to said that it could be possible for care staff to do some activities with the residents in the afternoon period. Residents spoken to were happy with the meals at the home. They were offered a choice of food at mealtimes and could have alternatives to this if they wished. They were issued with two menus each week. One to make their choices on and return to the kitchen and one to keep to remind themselves of what was to be served. A resident who had felt previously that she did not have enough choice due to her medical condition and personal food preferences was spoken to. She said, “I have a very restrictive diet but they accommodate this.” Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 13 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): 16 and 18 Residents and visitors spoken to were confident that their complaints would be taken seriously and acted upon. The lack of staff training in protection of vulnerable adults may result in abusive practices being unrecognised and unreported. EVIDENCE: There was a complaints procedure displayed on the notice board. This gave clear directions on who to make a complaint to and that a response would be made within 28 days. The procedure also had the address and telephone number of the Commission. A record of complaints made was kept at Alston View. None had been recorded since the previous inspection. No complaints had been made direct to CSCI in this period. Residents spoken to said that they’d no complaints about the way they were looked after. A visitor spoken to said that “The staff seem very caring. I’m confident that they’d respond to any concern raised”. There were policies and procedures for the Protection of Vulnerable Adults. Residents spoken to said that they felt safe at Alston View. Staff had not received training in Protection of Vulnerable Adults. This meant that the Manager could not be assured that they would be aware of and implement the correct procedure should a situation occur. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 14 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 Residents were happy with their accommodation at the home and lived in a safe, clean, well-maintained environment. EVIDENCE: The majority of the bedrooms were viewed. Locks were not fitted to these. The admission documents recorded that residents had been offered the opportunity to have a lock provided to their bedroom door if they wished. Residents said that they were happy with their bedrooms and that they were kept clean. They could bring in items of their own to personalise their bedroom. One resident said that she had brought a lot of things from her previous home, which had helped her settle at Alston View. The temperature of the hot water of a bath on each floor was tested. This was found to be around 43 degrees Centigrade. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 15 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): 27, 28, 29 and 30 There were enough staff on duty to meet the needs of the residents. The recruitment procedures had improved and ensured the protection of residents at the home. There was insufficient evidence that staff were provided with sufficient training at the start of employment and thereafter. This may result in residents being placed at risk or their needs remaining unmet. EVIDENCE: There was a duty rota showing which staff were on duty and at what times. There were two Registered Nurses on duty during the daytime hours. There were sufficient numbers of care and ancillary staff on duty. The files for three new members of staff were viewed. These showed that there had been an improvement in the recruitment practices at the home. References were now being taken up before the person started work. There was only one written reference in the file for one staff member. There was insufficient detail on why a verbal reference had been sought, what date the verbal reference was sought, who was spoken to and what the content of the conversation was. A CRB check was done and no new member of staff started work without the POVA First clearance being received. A recent photograph of the staff member was not available in each file. Staff were issued with a copy of General Social Care Council’s code of conduct and practice. They received a contract of employment after their probationary period of 3 months. There was a first day Induction programme that covered a general introduction to the home, fire safety and health and safety procedures. Not all of the new Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 16 employees had written evidence that this had been done with them. One new staff member said that one of the Registered Nurses had gone through all the information with him. He had also been given some papers to take away and read. Some of the completed first day induction sheets had been filled in correctly. There was an Induction and Foundation Training Programme for staff to follow. There were training record sheets for all members of staff. These did not show that each staff member had received three days training each year. 37 of the care staff had NVQ Level 2 in care. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 17 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, 37 and 38 The residents’ finances were well managed ensuring that these were safeguarded. The manager was a Registered Nurse and had the necessary experience and qualifications to manage the home. Residents and relatives were offered an opportunity to make comment about how the home was run and whether this was being done in their best interests. All staff had not yet received training in mandatory subjects. This meant that the health, safety and welfare of residents and staff might not be fully promoted and protected. EVIDENCE: The Registered Manager for the home was on extended sick leave. This had been notified to CSCI and arrangements made for this period. The Acting Manager was a Registered Nurse and was working 3 days each week in the home to ensure that the home continued to run smoothly. The rest of the working week she held the post of Deputy Manager at another home owned by the registered persons. She could be contacted by phone and was only a short distance away if her presence at the home was needed in-between times. The Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 18 Acting Manager did not have any management qualifications. She had experience as a Deputy Manager and said that she was well supported by the registered persons and other managers in the group. The Acting Manager had an audit plan but had not yet implemented this. She intended to look at the level of care, record keeping and facilities provided. This was to ensure that these met legal and good practices requirements and were in the best interests of residents. Resident and relative questionnaire sheets had been sent out for the annual survey. Once these had all been received the results would be made available for people to read. A staff meeting had been held in September 2005 to introduce the Acting Manager. Residents meetings were no longer held due to lack of attendance. Instead each set of relatives and residents had been offered the opportunity to be involved in a ‘case conference’. This allowed them to make an appointment with the manager to discuss their stay at the home and any concerns or comments they may have about this. The Administrator collected the benefits for 3 residents. There were records to show the receipt of this. There was a record of the personal allowance allocated each week. Small amounts of money were kept for residents. This was securely stored in a safe. Receipts were issued for any money or valuables left with staff. There was a recording system to show amounts deposited, withdrawn and the balance. The money held for 3 randomly selected residents was checked against the records. One of these had 86 pence more than the balance shown. An external contractor had checked the Fire alarm and emergency lighting in September 2005. The fire alarms and fire doors were checked two weekly. Water temperatures were last tested in August 2005. The temperature of the hot water outlets of the baths were not tested, just the sinks in bedrooms. There was a current electrical installation certificate. There were records to show that Portable Appliance Testing had been done in April 2005, although stickers had not been put on the appliances. The servicing of the gas boilers and appliances had been done in February 2005. The hoists had been serviced in June 2005 and the lift in August 2005. Arrangements were in place for the removal of clinical waste. All staff had received moving and handling training in June 2005. Fire safety training was overdue and arrangements were being made for this to be done. Three staff members had First Aid certificates. Some of these were due to be updated. There must be a First Aider on each shift and all staff should receive some awareness in first aid training. Not all of the Cooks, Kitchen staff and care staff had up to date Food Hygiene training. Training in infection control was in the process of being arranged. Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 19 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 20 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 Standard OP9 OP18 Regulation 13(2) 13(6) Requirement There must be a record of all medications disposed of by the home. All staff must receive initial training and an annual update on protection of vulnerable adults. (Previous timescale of 31/07/05 not met) There must be a recent photograph of each staff member All staff must receive 3 days paid training in a twelve month period to enable them to have the skills and competence to undertake their duties. All staff must receive training in:fire safety; infection control; basic food hygiene; and first aid. Timescale for action 09/12/05 31/12/05 3 4 OP29 OP30 Schedule 2 18(c)(i) & (ii) 09/12/05 31/12/05 5 OP38 18 (c)(i) 31/01/06 Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 21 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 3 4 5 Refer to Standard OP9 OP9 OP9 OP12 OP29 Good Practice Recommendations The administration of creams and ointments and inhalers should be signed for if done by staff. All hand written annotations on Medication Administration Record charts should be signed and witnessed by a second member of staff. There should be a recent copy of the British National Formulary The possibility of care staff doing some activities with residents on a daily basis should be explored until the new Activities Organiser is employed. If a verbal reference has been sought there should be details of: why this was done; what date the verbal reference was sought; who was spoken to; and what the content of the conversation was There should be accurate evidence that a first day Induction has been done. The Induction & Foundation training programme should be checked against the information from Skills For Care to ensure that it complies with their specifications. The audit plan should be commenced. The results of the resident and relative survey should be forwarded to the Commission. The balance of money held should be checked after each transaction to ensure that it is correct. The temperature of the baths should be recorded when the water temperatures are tested. A PAT sticker should be put on the appliance as evidence that it has been tested and of the date of the test. 6 OP30 7 8 9 10 OP33 OP35 OP38 OP38 Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Alston View Nursing & Residential Home DS0000022500.V262116.R01.S.doc Version 5.0 Page 23 - 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. 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