Inspection on 01/04/08 for Ashford Lodge Care Home

This inspection was carried out on 1st April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashford Lodge Care Home 04/05/07

Ashford Lodge Care Home 09/05/06

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

CARE HOMES FOR OLDER PEOPLE Ashford Lodge Care Home 1 Gregory Street Ilkeston Derby DE7 8AE Lead Inspector Helen Macukiewicz Unannounced Inspection 1st April 2008 09:20 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 Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashford Lodge Care Home Address 1 Gregory Street Ilkeston Derby DE7 8AE 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) 0115 930 7650 0115 930 7650 andy@carnachan.plus.com Andrew David Carnachan vacant Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4th May 2007 Brief Description of the Service: Ashford Lodge is a large detached property adapted to meet the needs of 20 older people, primarily with nursing needs. The Home has 2 floors with bedrooms on both floors; the first floor is accessible by passenger lifts. There is a large conservatory, lounge and dining area, along with a smaller quiet lounge area. The Home has an accessible garden area and parking for 2 - 3 cars. The Home provides nursing care and has a registered nurse on duty 24 hours a day. The charges made for a room at Ashford Lodge Care Home range from £352 a week for Residents with residential needs, to £460.30 a week, for those Residents with high level nursing needs. The registered person provided this information during the Inspection. A copy of the most recent Inspection report is kept in the foyer. Alternatively copies of Inspection reports can be found on the internet at www.csci.org. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This Inspection was unannounced and lasted 6.5 hours during one day. The registered person (owner) had completed a self-assessment of the home and information from this was used in the planning of this inspection. Computer held records of all contact between the Home and the Commission for Social Care Inspection since the last Inspection were also referred to in the planning of this visit. During this Inspection discussion with 4 people who use the service and 2 relatives took place. Time was spent in discussion with the registered person, deputy manager and 3 staff. Three care files were looked at in detail and peoples’ care was examined to see how well records reflected care practices within the home. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. What the service does well: What has improved since the last inspection? Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 6 Care documentation had been reviewed making information easier to read and understand. There had been more financial investment in the environment. Amongst other improvements, bedrooms had been redecorated and new furniture and soft furnishings provided. A new staff call system and stair lift had been purchased. People said the changes were good. More training had been given to staff and recruitment systems for appointing staff were safer. The registered person had improved internal quality monitoring in the home. 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. The summary of this inspection report can be made available in other formats on request. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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 Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 did not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to choose a home that can meet their needs. EVIDENCE: The information about the home (Statement of Purpose and Service Users Guide) had been updated so they contained a copy of the contract stating terms and conditions. These also stated fees payable and any extras. A copy was seen in each bedroom. The latest Inspection report was kept in the foyer. Three people who had been recently admitted all had an assessment of need in their care files. Two had been admitted as an emergency and one was a planned admission. The assessment had been carried out prior to the planned Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 9 admission and the other two had been carried out shortly after admission. The person in charge said that verbal information about care needs was gained from Social Services prior to the emergency admissions. Copies of the Social Services assessments of need were also seen in the care files. People who were asked said they had enough information about the home before choosing it and had made a conscious decision to live there. One relative said they chose it because it was homely. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive the care they need although gaps in care documentation and medications means their wellbeing is not fully safeguarded. EVIDENCE: Three peoples’ care files were looked at in detail. The manager had updated the documentation used and put it in a logical order. It was easy to find the information needed and care plans flowed well from the pre-admission assessment of need. Care plans were in place and these looked at all areas of need. Alongside the care plans were daily records completed by nursing staff, and some completed by care staff. Some of the ongoing care needs recorded by care staff needed including in the nursing plan of care. Some of the information on a wound care plan was not clearly recorded and the care plan was incomplete. This made the tracking of the status of the wound problematic and did not allow for Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 11 systematic reviews of the care provided or required. Where care plans had been updated, these were not always accompanied by a date and signature of the assessing nurse. Pressure area care plans for people at risk of developing sores needed more detail to include clear instructions for staff as to what equipment was in use/needed and how frequently changes of position should occur. Risk assessments in areas such as continence, skin care, nutrition and falls were seen. There was evidence that these had been reviewed, although some risk assessments needed updating. A scoring system was needed for one falls assessment sheet so that anyone reading it could instantly see what degree of risk the numbers indicated. Some of the changes to care identified through review of risk assessments had not been transferred into the plan of care, so the two did not always correspond. Despite gaps in recording of care plans there were systems for communication of care needs between staff. Staff told us they read the care plans. There was documentary evidence in peoples’ bedrooms that changes of position took place where needed and that people were regularly checked through the night. Nursing equipment was in place on chairs and beds and hoists were being used to transfer people who needed them. Additional height adjustable beds and pressure relieving equipment had been purchased. Staff had guidelines to assist them in wound classification and grading and were contacting the tissue viability nurses for support and advice. People said they were well looked after and had their care delivered in a private and respectful way. People said they received visits from the dentist, G.P. and chiropodist when needed. One visitor told us that they had been ‘pleased with how they had seen staff treat people’ during their visits. Medication Administration records were mostly signed for with the occasional gap in signing for medications, which the nurse in charge felt was due to the recent use of a number of agency or bank staff. The registered person told us that the manager checked that all tablets have been signed for as given on a regular basis and usually reminded staff when gaps were noted. However, there was no written evidence to support this and it was noted that one sheet contained a run of 7 days where the medication had not been signed for. The registered person (owner) thought that staff had not used the coding system correctly in this instance as the person often refused their medication. The nurse on duty checked that the tablets had gone from the packet, which indicated they had either been given, or destroyed following refusal. Without records it was unclear as to whether or not the person had received their medication. On one sheet where medicines were prescribed as a variable dose (either 1 or 2 each time), staff had not recorded how many had been given. Later additions to medication charts were not always dated and signed. The Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 12 nurse in charge was observed following correct procedures for the administration of medicines on the day of this Inspection. Stocks of homely remedies were checked. Four versions of homely remedies policies were in the treatment room making it hard to tell which homely remedy policy local G.P.’s had agreed to the use of. Some homely remedies were not recorded on all lists. One pack of water for injections had expired but the nurse in charge said they were never used. All eye drops were correctly stored and labelled. Although we were told that the manager checks the management of medicines in the home there was no documentation to support the extent of, and regularity of such checks. The nurse in charge had not received any refresher training in medication but said the manager was planning this. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12-15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the opportunity to lead a varied and fulfilling lifestyle. EVIDENCE: Care files contained an assessment of social needs and a care plan for meeting those needs. There were ongoing individual records of the social activities provided for each person although it was clear that staff provided more social care than was recorded. Staff had a weekly activity plan, which generally took place during the afternoons. People told us that entertainers visit now and again and that they enjoyed these visits. Staff were talking to people and painting some peoples’ nails during the afternoon of the visit. Staff told us they take people into Ilkeston on an individual basis; one person goes out every week. Visitors told us that people received visits from Church representatives as needed. A hairdresser was present during this Inspection and people living in the home told us the hairdresser visited weekly. In their pre-inspection self-assessment the Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 14 registered person recorded that social activities was an area they would like to improve over the next 12 months. People told us that they do get bored occasionally but could not think of what they would like to do more of. There was no residents/relatives’ committee at the time and this is advised as a way to encourage people to make informed choices about their lifestyle. People had televisions in their bedrooms. Some people were provided with newspapers free of charge. People were moving freely around the home and there were several seating areas within the ground floor to choose from. Individual preferences were recorded in care plans. Staff appeared to have a good knowledge of what people liked to do and their individual routines. Visitors told us their relatives were always well presented and clean when they visited. They said staff treated their relative with respect. People told us that the food was ‘very good’. Food provided on the day looked appetising and was home cooked. Visitors were welcomed to join their relatives for lunch free of charge and one visitor told us that they regularly did this. The cook had a good understanding of individual requirements. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are kept safe through effective complaints and safeguarding procedures. EVIDENCE: People told us they could complain at any time and said the management team in the home were very approachable. The complaints procedure was on display in the foyer. One complaint was recorded on file, records showed it had been dealt with, staff told us they had been made aware of the issue and the manager had taken appropriate action to prevent recurrence. We had received no complaints about this service since the last Inspection. Staff knew where to find the safeguarding (adult protection) policy and confirmed they had all received safeguarding training. The homes’ training records supported this. There had been no safeguarding incidents at the home. Where equipment that carried a degree of restraint was in use (bedrails) there was documentation in care files to show that staff had assessed the need for its use, and had gained consent from the relevant person. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 – 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in an environment, which is suited to their needs. EVIDENCE: A member of staff showed us around the home. Peoples’ bedrooms contained pictures and items from home. Some bedrooms had been redecorated and new furniture had been provided. A new stair lift had been fitted which allowed greater freedom of movement around the home for people who used a wheelchair. There was clear evidence that significant financial investment had been made to improve peoples’ living areas. Staff and visitors said they had appreciated Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 17 all the improvements that had been made so far. The registered person was aware of the need to continue to redecorate and re-carpet the home. Screens were provided in shared bedrooms. People using these had made a conscious agreement to share. People had the facility to lock their bedroom door if needed and most rooms contained some form of lockable space inside. Visitors said they found the home clean and tidy, one bedroom contained a urine odour but the registered person told us that a professional company undertook regular carpet cleaning to minimise this. People told us they liked the home because it was homely in size and décor. One bathroom was out of use and contained some decorating equipment and boxes. As this was unlocked it could be accessed by people living in the home and should be cleared, or locked. There was suitable equipment for the laundering of peoples’ clothes and for dealing with soiled laundry. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27-30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs met through sufficient numbers of suitable and competent staff. EVIDENCE: Staffing rotas showed there were consistent numbers of staff throughout the day and night. Extra staff were planned for some shifts as no annual leave was being taken for the period seen so there was extra staff available. Wherever possible regular staff covered unexpected absences due to sickness, although the registered person had provided agency staff if needed. Staff, visitors and people living in the home all confirmed there were enough staff on each shift to ensure care needs were met. People told us that staff were quick to come when they used the staff call bell. People told us that staff were ‘very good’, friendly and provided the care they needed. All but two recently employed staff had National Vocational Qualifications (NVQ) to level 2 or 3 in care. Staff told us there were plenty of opportunities for training and two had asked to attend an in depth mental health course which the registered person had approved and supported. A training company was used to provide mandatory training such as moving and handling, continence and first aid. Staff confirmed they had all received Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 19 mandatory training including fire safety. Staff training certificates, records and notices around the home all supported that a high level of training was offered. Staff told us they felt valued as a result and that it had made them better carers. They told us they worked well together. There was evidence of a low turnover of staff. People living in the home and their visitors told us they knew the staff well and said ‘we can have a laugh with them’. People were happy with the level of care provided. Staff told us that newly employed people got a number of shifts where they worked as extra to the numbers, and worked with a more experienced member of staff. A semi-completed induction programme was seen for the newest employed member of staff. The home used the skills for care induction and foundation packs for all staff commencing employment. However, all new care staff were being enrolled on NVQ courses. Recruitment files were seen, these had been improved in line with the requirements of the last Inspection. The only missing information was a written explanation in one file why the person had ceased working in another care home. Job descriptions, application forms, health and safety information, interview checklists were among the information kept in recruitment files, indicating good practice in this area. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is managed to promote the wellbeing of people living in the home although lack of internal monitoring means needs of people are not fully met. EVIDENCE: The manager has had a temporary period of absence, which has caused a delay in achieving registration with us. The registered person told us that her application was being re-submitted in the near future now she has returned to full time work. The manager is a registered nurse and has an NVQ level 4 in management. In her absence, the registered person and deputy manager had been providing management support to the home. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 21 Since the last Inspection surveys had been sent out to people living in the home as part of an internal quality assurance process. Comments returned via this method included ‘I see no reason at all to change the running of Ashford Lodge, it’s a lovely place’. Another person had written ‘I am very satisfied’. The registered person had also been completing a monthly report on the home. Documentation to support both these improvements was seen. The internal quality monitoring did not record checks on the medications and in light of the medication issues found on this visit, one of which was also found at the previous Inspection, this would be a useful safeguard. The registered person had completed a self audit on quality (AQAA) which was submitted to us on time, and in sufficient detail to inform us about how the home was running. People told us they were happy with the way the home handled money on their behalf, only a small amount of cash was kept. This was kept securely and there were records kept of transactions. A visitor told us that they were informed of how much is left each time. Receipts were seen for items purchased on behalf of people. Staff supervisions had fallen behind due to the managers’ temporary absence. However, staff told us they found the management team approachable and felt supported. All staff who were consulted told us they received an annual appraisal. Service records for equipment used around the home were sampled. Where seen, these were up to date. People were visiting the home to undertake maintenance on lift equipment on the day of this visit. There was documentation to support that staff received health and safety training and had access to relevant training. All areas within the environment appeared safe with the exception of the bathroom where decorating equipment and boxes were stored, this area was unlocked and so people living in the home could potentially gain access. There was no fire detection in this area as it was a designated bathroom. Also, the sluice areas contained soiled waste and chemical cleaning agents, these did not lock and again, there was potential for people to access these. The registered person told us he already had locks that could be used to make these areas safe and said he would fit them. A risk assessment for the environment was seen, this was dated 2004/05. The deputy manager told us it needed updating but that all areas of the inside and outside had been included in the original version. The registered person had upgraded some rooms since the assessment was carried out, and there were some risks such as the unlocked sluice areas and presence of equipment for decorating in a bathroom that may not have been included in the original Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 22 version. Therefore it will need review to accurately reflect any current risks that may be present. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 23 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 3 2 Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1)(2)( b) Requirement Care plans must include all areas of need. Each need must be separately identified so it provides clear directions for staff. Care plans must be updated as changes to care needs are identified. Care needs identified in carers records and through review of risk assessments must be crossreferenced and added into the plan of care. 2. OP8 14(2)(a)( b) Risk assessments must be 31/05/08 updated and reviewed as care needs change and include scoring systems for staff to reference. If an alteration or an additional 31/05/08 medication is necessary on the Medication Administration Record (MAR) sheet, this must always be signed and dated. Previous timescale of 29/06/07 not met. Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 25 Timescale for action 31/05/08 3. OP9 13(2) All medications administered must be signed for, recognised coding systems must be used where a signature is not required. The actual number of medicines given must be recorded each time, where a variable dose prescription applies. Homely remedies kept in stock must be consistent with a single approved Homely Remedies policy. When appointing new staff, all the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004, are obtained. Written reasons why a person ceased working in former employment with vulnerable adults or children must be obtained when appointing new member of staff wherever possible. Internal quality assurance must be effective in ensuring that medications are managed appropriately in the home. The risk assessment for the environment must be accurate. The bathroom and two sluices must be made safe. 4. OP29 19(1)(b)(i ) 31/05/08 5. OP33 24 31/05/08 6. OP38 13(4) 30/04/08 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 Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 26 1. OP9 2 staff signatures should accompany changes to the medication administration record. All out of date stock should be removed from the medicines store. Nurses should receive refresher training in management of medicines. A residents/relatives/advocates committee should be established as a way to encourage people to make informed choices about their lifestyle. The home should be kept free from offensive odours. The carpet identified during the Inspection should be cleaned or replaced. The Acting Manager should complete the application for registration as soon as possible. Care staff should be supervised at least 6 times a year. 2. 3. 4. 5. OP12 OP26 OP31 OP36 Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ashford Lodge Care Home DS0000066561.V361562.R01.S.doc Version 5.2 Page 28 - 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!