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Inspection on 07/03/09 for Ambleside Residential Home

Also see our care home review for Ambleside Residential Home for more information

This inspection was carried out on 7th March 2009.

CSCI found this care home to be providing an Adequate service.

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.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynne Bennett Date: 0 7 0 3 2 0 0 9 Information about the care home Name of care home: Address: Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG 01242522937 01242522937 pepwalsh@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : James Christopher Walsh,Perpetual Walsh care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Ambleside is a large, detached, Victorian house that has been extended and adapted to provide accommodation for older people. It is situated in a residential area of Cheltenham close to a few shops and the bus route into town, which is approximately a mile away. The railway station is within easy reach, together with a number of churches. The accommodation is located on three floors that are all served by a shaft lift and stairs. All the bedrooms have en-suite facilities, approximately five have a bath Care Homes for Older People Page 2 of 19 Brief description of the care home or shower. There are three bathrooms two of which have hoists. Ground floor communal facilities include a dining room and two lounges one of which has a piano. The lounge at the rear of the property is an extension of the main building and gives an all round view of the large landscaped garden. A patio area provides a pleasant place for service users to sit in warmer weather. The provider supplies information about the home, including the most recent CQC report to current and prospective residents on request. The fees range from 480 to 598 pounds per week for local authority funded residents and 610 pounds per week for privately funded residents. Hairdressing, chiropody and any personal items are charged extra. The costs of these services are available as required. Care Homes for Older People Page 3 of 19 What we found: This inspection took place on 7th March and was completed by two inspectors. This random inspection was completed as a result of concerns expressed to us about the administration of medication. The manager was present for most of our visit and three staff were spoken with, time was spent with people living in the home and examining systems for the administration of medication. We arrived at the home around 10.15 am and there were three members of staff on duty, one had just completed the mornings medication round. The medication trolley was secured to the wall and the member of staff admitted that it had not been used that morning. She also admitted that she had not signed the medication records for people after they had taken their medication and was about to complete all the records when we arrived. The records had not been marked (such as with a dot) to indicate that medication had been given to people. There were some gaps in the records where it appeared medication had not been given to people. A large number of handwritten entries on the records had not been signed by the person making the entry or countersigned by a member of staff to indicate that they were correct. For two people staying for respite/long term care their medication records ended on 6th March and they needed a new administration record commencing 7th March, these had not been prepared in advance. These were put in place by the manager, once we had drawn his attention to them, during our visit. For one of these people records for the administration of Diazepam 2mg were overwritten on the record as starting on 13th February until the 27th February when the record finished. There were no records for administration of this tablet between 28th February and 7th March - this was a tablet which was administered in a prepacked blister pack. One person was in receipt of a controlled drug and the medication record indicated they were to have this every 72 hours, the record had been prepared to prompt staff to sign for this but it was at 7 day intervals. The controlled drug book had been signed to indicate that it was being given at 72 hour intervals but the dates did not correspond with those on the medication record. The controlled drug book indicated that this had been administered on the 4th March and the medication administration record was signed as being given on the 6th March. Records for three people were examined who had been prescribed Diazepam tablets of either 2 mg or 5 mg. The medication records indicated that two of these people were not currently taking this medication. There was no stock of the Diazepam 2 mg and 5 mg tablets for them in the cabinet. There was a bottle of Diazepam 2 mg liquid in the stock cupboard which had not been opened for a person staying on respite. One person was being prescribed Diazepam 2 mg twice daily and this was blister packed in a Nomad system prepacked by the pharmacy in a weekly dosette. There were two full blister packs and one almost completed pack which had tablets remaining for 6th and 7th March tea time administration, the tablets due to be administered on 6th March bedtime, 7th March morning and bedtime had been administered. One person staying for respite had been prescribed Diazepam 2mg in liquid form and the medication record stated that this had been discontinued - no date was recorded although the chart indicated that 13 doses had been given between 13/02/09 and Care Homes for Older People Page 4 of 19 6/3/09. There were no returns noted for this medication. An unopened bottle of Diazepam 2 mg liquid (100mls) was found in the stock cupboard. Stock returns to go back to the pharmacy were kept in the directors office, which the manager said only he had a key to. These were inspected. A returns book had been completed by a member of staff with a list of tablets issued on 13/02/09 and date discontinued noted as 22/02/09. One open box of Diazepam containing 11 tablets had not been entered onto this return and was found on the top of the returns. Two other entries for the return of Diazepam 2 mg were entered for two people one tallied with the number of tablets in the box and the amount being returned, the other appeared to have a shortfall of 15 tablets, with 11 tablets being administered according to the medication administration record and only 2 tablets being returned. A medication record for another person indicated that on three occasions they had not received their dose of Diazepam 5mg no reason for this being given, the entry marked with an X. There were no returns recorded for these three tablets. Inspection on 13 and 17 March 2009. Because of the serious concerns about the arrangements for the handling of medicines found at the inspection on 7 March 2009 one of our (the Commission for Social Care Inspection) pharmacist inspectors carried out a detailed inspection of the medication arrangements on 13 and 17 March 2009. On 13 March 2009 we concentrated mainly on checking various records involving medication. We took copies of some of these records as we were concerned that these demonstrated poor handling and management of medication in breach of Regulation 13 (2) of the Care Homes Regulations 2001. See also saw that medication records for one person showed that a patch containing a pain relieving medicine was not being changed in accordance with the doctors directions as it was being left too long before replacing with a new patch. This would mean that the treatment would not be so effective. We spoke to this person who told us (s)he was not in pain. Medication records for another person admitted from hospital in February 2009 showed that a particular tablet was to be stopped after five days. Records showed that this tablet was still administered daily. The manager could provide no explanation for this at the time and we saw no record to indicate any change of dose from what the hospital had indicated. This could be a risk to the health and wellbeing of this person. Because of these issues we left an Immediate Requirement form to take action by 5pm on 14 March 2009 to make sure that the pain relief patches identified at the inspection for a particular person are changed every 72 hours in accordance with the doctors directions and make arrangements to determine with the doctor what is the correct dose of the 5mg tablets identified at the inspection for a particular person or if this should be discontinued. This is to reduce the risks to the health and wellbeing of these people that may be caused because the medicines have not been administered in the way the doctors have prescribed. The manager wrote to us immediately following this visit telling us about the actions he had taken and when we inspected again on 17 March 2009 we saw these noted in the medicine records. At the time of the inspections no people living in this home were assessed as able to self medicate and look after their medicines (except for one person who kept some Care Homes for Older People Page 5 of 19 inhaler solution). People living in the home were therefore totally dependent on the staff for this part of their care. Certain carers who had attended a training course about the safe handling of medication were responsible for medicine administration. On 13 March when we arrived at 9.35am the manager told us that he had just finished administering the morning medicines. On 17 March when we arrived at 9.40am the manager told us he had only administered the morning medicines to one person and we saw that he finished this for everyone at about 11.15am. We discussed the importance of following suitable intervals between medicine doses. This is to make sure that people obtain the best effect from the medicines and that they are not at risk of harm because of receiving their medicine doses too close together. This is particularly important for people taking medicines containing paracetamol as there must be a minimum four- hour interval between doses. This may be difficult to achieve particularly if medicine administration times vary significantly from what is printed on the records and staff do not record the time if they are running late. We pointed out that the times printed on many medicine charts (8am, 12 noon, 5pm and 8pm) do not always provide this four- hour interval for medicines containing paracetamol. This needs changing by liaison with the pharmacy who provide printed medicine charts each month. We saw that one person was prescribed two different medicines each containing paracetamol. Some of the medicine charts had information to draw the attention to staff to the fact that only one of these must be given at any one time. We were concerned to find that records were signed for both these medicines at 8am for six days in December 2008 indicating that both were administered. This would have been a risk to this person from receiving too much paracetamol. For one of these medicines the dose given was not recorded; the directions printed were for one or two tablets. We watched the manager administering some medicines during our visit on 17 March 2009. We saw that he followed safe practice in taking the trolley around the home so that the medicines and records were always very close to the appropriate person when doses were prepared and given. This should reduce the risk of mistakes. We did have to point out that the actual dose given must be noted on the medicine chart where a choice of dose was prescribed so that there was a complete and accurate record of all medicines administered. We saw other examples where this was not done. At about 12.45pm we also saw that some medicines for two people were not signed as administered for the morning of the 17 March yet the tablets supplied in the monitored dose packs were missing for this time. We asked the manager who confirmed and subsequently signed that he had administered these and one other tablet that was supplied in a box. There were arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person in the home. Complete and accurate records about medication are very important in a care home where there are a number of different staff involved with medication and where people living here were totally dependent on staff for their medicines. This helps make sure that people are not at risk from mistakes, such as receiving their medicines incorrectly, and there is a full account of the medicines the home is responsible for on behalf of the people living here. Our inspection found that medicine records were often poorly kept and not always Care Homes for Older People Page 6 of 19 complete and accurate. At the time of the inspections we also could not find all the medicine records we wanted to look at for the last six months. Not all medicines received into or leaving the home were fully recorded. Medicine administration records were not always complete and accurate. This made it difficult to check if all the medicines in the home could be accounted for. We were looking at particular medicines but the records did not account for all of them. For example there were standard code letters used to show the reason for missed doses but there were examples where different letters were used without explanation or there was just a gap in the record so we do not know whether or not the medicine had been given. The dates on some records were incomplete just showing the day but no reference to the month and year so it was very hard to know the period to which the record referred. Some entries did not define the strength of the medicine so we did not know the dose and some doses were wrongly written (mg instead of mcg). The printed directions for one persons eye drops were to use three times daily yet the medicine chart was only signed twice a day. The records did not state which eye. The manager told us that this person refused these drops at lunchtime. This should be noted on the records and consideration given to requesting a change of the instructions. This same person had recently been prescribed a seven day antibiotic course. 14 tablets were signed as received yet 18 tablets were signed as administered over a period of 10 days. There were other recent examples where the wrong courses of antibiotic treatments were recorded. A seven day course of antibiotic eye drops were signed for over ten and a half days. For another person 27 doses (over 11 days) of an antibiotic capsule to be administered three times daily were signed as given. The records indicated 21 capsules supplied which would be a seven day course. A number of medicines were prescribed to use as required but we found there was no written information or protocols recorded that provided further guidance to all staff responsible for administering medication to help understand what the direction as required meant for each person and medicine. The manager confirmed that this sort of information was not included in care plans nor were there any protocols. This is needed to help make sure people receive their medicines in a consistent way and to meet their identified needs. One person had been prescribed a 5mg tablet at night when required for anxiety. Until 27 February this was signed as administered every night. We could find no information in the care plan or a protocol to guide staff on when to administer it to meet this persons assessed needs. Another person was prescribed a tablet at night to help them sleep and records showed that these were signed as given most nights. The directions printed on the medicine chart indicated to use occasionally, please wean off and do not take every night. The handwritten medicine chart for one person was inaccurate in respect of two medicines that were muddled up. The wrong tablet name, strength and directions had been entered into one section yet the manager and provider told us that the record actually referred to a different tablet given at night to help with sleep. The tablet written in this section was being given twice a day as it was included in a weekly medication pack used for this person yet there were no records for the doses administered. The directions on the medicine pack were for one tablet twice a day when required yet the tablets were included in the pack for regular administration so presumably given twice a day. There was nothing in the care plan to give guidance to Care Homes for Older People Page 7 of 19 staff about using this medicine. This person also had certain health needs which meant (s)he needed a careful diet and to maintain blood sugar levels within agreed limits. In the care plan there was no information about this or how to identify and deal with low or high blood sugar levels. There was a risk assessment for high blood sugar; we advised this be discussed with the district nurse as there may have been some confusion about some of the information noted. The directions for some medicines such as eye drops were not always specific, for example about which eye the treatment was to be applied. The arrangements for checking medicines when people are first admitted to the home must be improved. Records showed for one person recently admitted with two different courses of the same antibiotic tablets, both were being administered; information provided on admission indicated one course should be completed before the next course of a different dose was taken. There was a print of medicines obtained from the GP but this was not clear so staff should have clarified this directly. For the same person a laxative was labelled to be taken daily yet the medicine chart was written for twice daily and some additional non prescribed laxatives were included. The need for extra medicines should have been checked with the GP. The file with the medicine charts was left on the top of the medicine trolley in the dining area. These personal health records must be kept where only authorised staff can access them in order to respect the privacy and dignity of people in the home. We looked at the arrangements for controlled medicines. There was a record book in use but entries need improving so that each page was always headed with the full name and strength of the medicine as well as the persons name. The times of administration were not always clear as where the 24 hour clock was not used it was not always possible to see if the time was am or pm. This is needed to help check that the right intervals between doses are followed. We checked the recorded stock levels with what was in the cupboard and found two errors where the recorded stock was not in the cupboard. The manager has since informed us of the actions he has taken to investigate this and the police have been informed about one of these. Staff did not make regular stock checks of these medicines in order to make sure they were correct. Regualr signed checks must be put in place. We saw some of these medicines were transferred to plastic boxes just with the persons name. This was poor practice and we told the manager to keep these medicines in the original packs as supplied by the pharmacy as this makes sure the label with the persons name and dose is always with the pack of medicines. On our visit on 13 March 2009 we found that some 10mg tablets of a schedule 3 controlled medicine were not correctly stored. The manager took action to deal with this during our inspection. This had been pointed out by another inspector on 7 March 2009. When we checked the records and stock we found that there were two more tablets than the records showed there should be. This indicated some more inaccurate recording or administration. Medicines were stored in various places in the home in locked containers. We pointed out to the manager that the location of some storage in the hallway was not appropriate and should be moved. The medicine trolley was only secured to the wall with tiny padlocks which would offer little security so this also needs improvement. On Care Homes for Older People Page 8 of 19 17th March 2009 when we looked in the medicine fridge the temperature was 20 degrees C which was room temperature and so too warm. This was because the fridge at some stage had been unplugged. Temperature records were kept of medicine storage areas and these showed that the medicines were generally kept at a safe temperature. The manager must make arrangements to make sure the fridge cannot be accidently unplugged. We also advised the maximum and minimum temperature of the fridge are also recorded each day as well as the actual temperature at the particular time it is checked. The medicine trolley was very full and we saw examples of poor practices in here. There were unlabelled containers of medicines although the manager could tell us who they were for. Generally medicines did not have dates when first opened to use. This helps to make sure stock can be rotated properly particularly where there are good practice guidelines or the manufacturers give a limited shelf life after opening. It also helps with audit checks to show if the medicine stocks agree with the records. These can indicate whether people have received their medication correctly. Some packs of medicines had been combined which is a risk and poor practice. There was half a white tablet loose on a shelf and a loose single blister of one tablet. There was an old eye drop container dispensed for one person in November 2008 but no opening date and the records indicated this treatment had now finished. There was also one unlabelled box of tablets in the cabinet in the dining room. In the ground floor office was a jar of wasted doses of medicines and some packs of various medicines awaiting return to the pharmacy. The office door was left open and unattended during the inspection so these medicines were not always kept securely. There were no records kept about the wasted doses of medicines. We saw the manager throw away a used medicated patch in the normal waste bin; he did not know about the correct way to inactivate these and dispose of as clinical waste. There was no space to keep new stocks of medicines when the new supply arrives each month during the few days before the changeover date. The manager told us these were kept in a locked room on the second floor. This could be hard to restrict access only to authorised staff. The storage arrangements for medicines must be reviewed and amended to take account of the issues we found so as to make sure that medicines are always kept safely and can be accounted for. The provider showed us a medicine policy dated August 2007 contained within a large policy folder. Some but not all staff had signed as having read the folder. The medicine policy was a generalised one provided by an outside company and so not specific to this home and contained little detail about procedures. The manager also showed us other sheets of more local information he had produced. All this must be extended in order to provide staff with proper guidance about how the home expects them to safely handle and manage medicines. The evidence from this inspection shows that staff were not always following safe procedures in handling and recording medicines. The arrangements for homely remedies need properly defining. One of the cough medicines listed was not really appropriate for elderly people already taking a number of prescribed medicines. Staff said they had specific training about medicines from the pharmacy and some were completing a distance learning course about the safe handling of medicines. It was not clear what arrangements were in place to assess staff competence in dealing with medicines following their training. From the evidence of this inspection there are many issues which raise questions about the competence and training of staff to safely Care Homes for Older People Page 9 of 19 handle medicines which must be addressed urgently. We saw some medication audit forms that the manager had recently begun completing each month. In view of the issues we found at our inspection we would question how effective this process was. At the last key inspection in April 2008 two statutory requirements were set involving medication with a timescale for action of 30 June 2008. This latest inspection found that these requirements had not been met. We also looked at records being maintained in the home for staff. Despite the suspension of two members of staff, sufficient staffing had been maintained with staff covering the shifts left vacant by the suspensions. The home still has less than 50 per cent of its care staff trained to NVQ level two or three although six staff are planning to commence NVQ training. A number of staff had been recruited since the previous inspection and the documentation in relation to their recruitment was examined.There had been no improvement in recruitment practices since the previous inspection.Two staff had been employed without submitting full employment histories and others had submitted employment histories that only indicated the years of employment which was not accurate enough.The interview notes for one member of staff did show that a a question had been asked about gaps in employment although this person had not submitted an employment history. In one case a member of staff had been employed with only one written reference and although the manager stated that another reference had been obtained, this could not be found. Another staff member had been employed without a specific reference from their previous employment. A reference had been written by the manager of Ambleside in his previous capacity as manager of another care provider.However as he was no longer employed by this care provider he would not have been in a position to give an informed employers reference on behalf of the staff member. There was no record kept of when important documentation such as Criminal Records Bureau disclosures and references had been received into the home.A record should be kept to demonstrate where correct procedure is being followed. Staff had however been employed with the correct Criminal Records Bureau checks in place although some of these had revealed cautions and convictions that should be risk assessed in relation to protecting residents. It was unclear if new staff had been receiving induction training to national specifications and this will be looked at in more detail at the next inspection. Records showed that staff had also received training in protecting vulnerable adults, medication handling and moving and handling. We queried how the providers monitor standards within the home. Although it was reported that one of the registered providers visits the home on a weekly basis, no regulation 26 reports had been written since April 2008. This was initially discussed with the manager who had no awareness of such reports.The registered provider was reminded of the requirement to carry out visits under regulation 26 and to keep copies of the reports of these visits in the registered care home. The judgements contained in this report have been made from evidence gathered Care Homes for Older People Page 10 of 19 during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 19 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 5A (2) (a) The Fees Invoice must show information about what services the fee relates to in terms of accommodation, including the provision of food and personal care. The registered person must ensure that all care plans contain clear instructions as to how the care needs of each resident are to be met. This is to ensure that care staff have the correct information to follow. 31/07/2008 2 7 15 (1) 31/07/2008 3 9 13 (2) Medication administration or 30/06/2008 omission must be signed for as an accurate record that residents are receiving the medication that they require to meet their health needs. Before a person starts work 30/06/2008 in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations must be obtained to ensure that residents are protected through robust recruitment procedures. This requirement has been repeated from the previous inspection. Page 12 of 19 4 29 19 (1) (b) Schedule 2 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 13 of 19 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Always keep complete and 17/04/2009 accurate records of all medicines received, administered and leaving the home or disposed of so that all medicines can always be accounted for. This is to make sure that there is no mishandling or abuse of medicines and that people living in the home receive the right amount of their medicines. 2 9 13 Make arrangements to review and improve the storage arrangements for medicines so as to reflect current legislation and best practice guidance. This is to make sure the shortfalls identified at this inspection are corrected so that all medicines are always stored safely and do not present a risk to anyone in 31/05/2009 Care Homes for Older People Page 14 of 19 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the home. 3 9 13 Investigate the anomalies in 17/04/2009 the quantities of medicines remaining in stock identified at the inspection and let the Commission know of the outcome. Put in place regular audit systems that will promptly identify inaccuracies with medication. This is to help make sure people receive the correct levels of medication and that all medicines can always be accounted for. 4 9 13 When people are admitted to 17/04/2009 the home make sure there are always robust arrangements to fully check with the doctor or other appropriate health professional that the correct medicines are administered. This is to make sure that people receive the correct medication. 5 9 13 When medicines are 30/04/2009 prescribed to be administered when required make sure that there are clear written guidelines to staff on how to reach decisions about the administration of all these in accordance with the provisions of the Mental Capacity Act 2005. Where people may lack Page 15 of 19 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action capacity in respect of taking medicines staff must include consideration of how they have reached the decision to administer these medicines, in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure people receive the correct amounts of medication in a consistent way. 6 9 13 When medication is 17/04/2009 administered to people who live in the home it must always be administered in accordance with the doctors directions and clearly and accurately recorded. This will help to make sure people receive the correct amounts of medication. 7 9 13 The registered person must 11/04/2009 make sure that entries by staff onto medication administration records are clear and provide information supplied by the pharmacist. This is to make sure people are receiving the correct medication. 8 9 13 The registered person must 11/04/2009 make sure that the controlled drugs records and the medication administration record provide confirmation that controlled Care Homes for Older People Page 16 of 19 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action drugs have been given on the prescribed day. This will make sure that people receive the correct medication. 9 29 19 The registered person must ensure that before a person starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations are obtained. This is to safeguard people from possible harm. 10 29 19 The registered person must 17/04/2009 complete a risk assessment relating to any information disclosed by Criminal Records Bureau checks in the interests of protecting residents. This is to protect people from possible harm. 11 33 26 The registered person must 17/04/2009 complete unannounced visits to the home and produce reports in accordance with regulation 26 keeping copies in the home. This is so that the registered provider can demonstrate that they are checking that the home is being managed in the interests of the residents. 17/04/2009 Care Homes for Older People Page 17 of 19 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 When stocks of medicines are carried forward to the next medication cycle record the stock balance carried forward. This is to allow audit checks that medicines are being used correctly. Review and update the medicine policy and local procedures (including homely remedies) so as to provide all staff with precise direction about the way medicines are safely managed and handled in this home. Write the date on all containers of medicines when they are first opened to use to help with good stock rotation in accordance with the manufacturers or good practice directions and to help with audit checks that the right amount of medicines are in stock. Handwritten medication administration records for people staying for respite or longer stays must be prepared in advance so that there is continuity of recording. Staff competency in the administration of medication should be assessed regularly and systems should be in place to deal with staff poor practice in the administration of medication. Medication should be administered to people directly from the medication trolley. Handwritten entries on medication records should be checked and countersigned by a second member of staff. A record should be kept of when Criminal Records Bureauu disclosures and references are received by the home. 2 9 3 9 4 9 5 9 6 7 8 9 9 34 Care Homes for Older People Page 18 of 19 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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