Inspection on 24/08/07 for Avalon Residential Home

This inspection was carried out on 24th August 2007.

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

Other inspections for this house

Avalon Residential Home 26/08/08

Avalon Residential Home 05/03/07

Avalon Residential Home 15/01/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Avalon Residential Home 17 Barnwood Road Gloucester Glos GL2 0RZ Lead Inspector Key Unannounced Inspection 11:00 24 & 28th August 2007 th 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 Avalon Residential Home DS0000068030.V348166.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. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avalon Residential Home Address 17 Barnwood Road Gloucester Glos GL2 0RZ 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) 01452 417400 ARTI Services Ltd To be appointed Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th May 2007 Brief Description of the Service: Avalon is a detached Edwardian property situated on the corner of a residential road and the main Barnwood Road into Gloucester City. The House has been extended to offer personal care for fourteen elderly people. All bedrooms are for single use, although there is one bedroom that would be large enough to accommodate a couple if this was required. All bedrooms are en-suite. On the ground floor there is a sitting room, dining room and small sun lounge. Access to the first floor is via a main staircase that has been fitted with a chair lift. Outside of the building there are various places to sit and to the rear a small garden with an enclosed patio area with chairs and sun shades for use in the summer. There is also a small car park to the rear. The Statement of Purpose and Service User Guide are displayed in the hallway. Further copies are available from the manager. The fee ranges per week are from £400 to £450. Extras not included in the fees include chiropody and hairdressing. This information was given to the inspector after the inspection. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this site visit over two days in August 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The Registered Provider was available for one day of the inspection. A total of 24 standards were inspected. A number of people who use the service were spoken to and visitors to ascertain their views on the care and services provided. The comments received from the majority of people who use the service during the inspection all indicated they are very happy living at the home. Surveys were sent to the home to be distributed to people who use the service and visitors to the home prior to the inspection. Again all these had positive comments to make about the home. The Registered Provider and care staff were spoken with throughout the inspection and were helpful and co-operative. Five requirements have not been complied with since the last inspection and in one case since the last two inspections. On this occasion the timescales have been extended as indicated in the requirements made. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale may lead the Commission for Social Care Inspection to consider enforcement action to secure compliance. What the service does well: Avalon is a home with a small number of places that people who use the service find homely and friendly. The position of the home enables independent people to access the local city and a public transport route is situated on the main road outside the home. People who use the service said they find the staff helpful and friendly. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Avalon Residential Home DS0000068030.V348166.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 Avalon Residential Home DS0000068030.V348166.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): 3, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has admission processes in place; however the home needs to ensure these are always followed so they can provide assurances to people that their needs can be met. EVIDENCE: The pre admission assessments of two people who were recently admitted to the home were examined. Both assessments contained details about their care needs. One assessment had not been dated or signed by the person completing it and this could mean the home are not able to prove the assessment was undertaken prior to this person moving into the home. Therefore this person could have moved into the home and they might not have been able to meet their needs. The home was not able to find any evidence that they write to proposed people to confirm that following an assessment they can meet their needs. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 9 Following the inspection the Registered Provider sent evidence that the home confirms in writing to new people that their needs can be met by the home. One of these people said they visited the home prior to moving in and the other person said their family found the home for them. Both felt they had settled in well and are happy in the home. Intermediate care is not provided at this home. Avalon Residential Home DS0000068030.V348166.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): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people who use the service are based on their individual needs; however unsafe medication practices place people at risk of harm. The principles of respect, dignity and privacy are not always put into practice. EVIDENCE: The care of two people who use the service was examined in detail. This includes examining care records, speaking to the people where able and speaking to staff. Both people had a front sheet that contained personal information and an assessment of their needs and from this care plans were devised. Reviews were seen for one person as the other person had recently been admitted to the home. Care staff write in people’s ongoing records at each shift. Risk assessments are in place for individual needs and for moving and handling and Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 11 falls. Skin care records are also maintained. One person had signed their care records. Records are maintained of health professional visits and this includes GPs, Community nurses. A Consultant Psychiatrist has visited one person at the home. Weight charts were seen in place for both people. From discussions with both people who use the service they were aware of what was written in their care records. Care staff were able to demonstrate good knowledge of the people whose care was examined in detail. A number of surveys returned prior to inspection asked people who use the service if they felt they receive the care and support they need; six people said ‘always’, three people said ‘usually’ and one person said ‘sometimes’. Another question asked people who use the service if they receive the medical support they need; five people said ‘always’ and five people said ‘usually’. Relative and visitors to the home were asked in their surveys if the care home meets the needs of their relative/friend; three said ‘always’ and three said’ usually’. Medication systems used by the home were examined. The home has two trolleys in place that are secured and they are used to store and transport medication around the home. A copy of the home’s medication policy and procedure is stored with the Medication Administration Records (MAR) along with information about expiry timescales for all types of medication. Records were seen for medication received into the home, administered and where necessary returned to the local pharmacy. The MAR sheets were examined and it was found that in places hand written entries had not been signed by the member of staff completing them and they had not been checked and signed by a second member of staff. One hand written entry had “as directed by GP” this is unsafe practice, as staff must have clear direction on how to administer medication. One person who uses the service has Warfarin but the home had written the directions for administration as “according to INR results” but these were not available near to the MAR. A written protocol must be in place to manage this. Not all liquid medications were dated on opening but the majority of boxed medication was. Controlled medication records were examined and found to be correct and additional checking of this medication has taken place as required following the last inspection. Assessments were seen in two peoples’ records for self-medication and they had signed these. Medication stored in the fridge was checked and found that two eye drops were past their expiry date and should have been disposed of. The home has a lockable facility but this is not fixed in the fridge. Care staff confirmed that they have to undertake accredited training before administering medication and they are also ‘shadowed’ until competent. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 12 A number of requirements remain outstanding since the last inspection and must be addressed to ensure safe systems are in place for people to receive their medication. People who use the service felt the staff in the home maintain their privacy and dignity. However it was noticed that at the start of the inspection a member of staff was outside in the back garden of the home discussing the medical condition of two people with the hairdresser whilst the inspector was waiting at the back door to be let in. Whilst this member of staff meant no malice, all staff must be reminded of confidentiality. Avalon Residential Home DS0000068030.V348166.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): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style, with the majority of people having their recreational needs and interests met by the home. EVIDENCE: The home has a member of staff responsible for providing activities for people who use the service. However they have been away from the home for a month so activities have not taken place, but now they are back at work they have plans to re-start the activities programme. This member of staff is currently undertaking a training course in relation to activities. Photographs are displayed in the entrance hall of people who use the service and staff taking part in activities. Some people spoken to said they take part in the activities provided however others said they wish to undertake their own and are given the choice about whether they wish to join in. One visitor to the home commented on their survey “the staff respect the wishes of their relative as they do not wish to take part in the activities”. One person who uses the Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 14 service said they like to spend time in their room and are very happy with their own company. A number of people who use the service were sat in the lounge talking to each other. The hairdresser was visiting the home on the first day of the inspection. People spoken with were not religious therefore did not want to take part in any service. The survey sent out to people who use the service prior to the inspection asked people if the home arranges activities they can take part it; two people said ‘always’, four people said ‘usually’ and four people said ‘sometimes’. One person who uses the service said they go out for walks around the home and their family takes them out. This person said they inform the staff they are going out and no restrictions are placed on them. People who use the service confirmed that visiting is not restricted and during the inspection a number of visitors were seen. People confirmed that they could make choices about their daily lives in the constraints of living in a care home. People said they could choose where to eat their meals, how to spend their time each day and the time they wish to get up or go to bed. People are able to bring in furniture with them and one person has brought in their electric reclining chair as it helps them to remain independent with getting out of the chair. The kitchen was inspected but not in detail as the home had recently had an Environmental Health Department visit. Following this visit the home has been awarded 3 stars. Records relating to health and safety checks and food were examined and all were in place. The cook is in the process of reviewing the menus and said alternatives are provided. People spoken with said alternatives are provided if they don’t like the main course but more choice is available for breakfast and evening meals. Cakes are provided for afternoon tea and one person said how much they enjoy the cakes provided. One person chooses to have a therapeutic diet and the home is able to cater for this. One person received a birthday cake, as it was their birthday on the first day of the inspection. The majority of people said they enjoy the food provided but one person said, “it is not very special”, other people said it was “lovely”. People were seen being offered an alternative to the pudding on the first day of the inspection. Avalon Residential Home DS0000068030.V348166.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): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure and the home has policies and procedures in place to protect people from abuse. EVIDENCE: The Registered Provider said the home has not received any complaints since the last key inspection. Since the last key inspection the Commission has undertaken two random inspections to look at key areas and from this the home have had several requirements to addresses areas that needed improvement. The home has copies of their complaints procedure on the notice board. People who use the service who were spoken with at the time of the inspection said they know how to make a complaint and whom they would speak to. Surveys completed by people who use the service prior to the inspection were asked if they know how to make a complaint and nine people said ‘yes’ and one person said ‘no’. Relatives and friends of people who use the service were also asked this question in their surveys and seven said ‘yes’ and one person said ‘no’. The home has policies and procedures in place for staff in relation to abuse and the protection of vulnerable adults. Staff have to sign a form to confirm they Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 16 have read the policies and procedures provided by the home. Several staff have completed training by the local council in relation to the ‘Alerters’ guide. Staff that have not completed this training are booked on POVA training in the next couple of weeks and this was confirmed by staff members and the Registered Provider. The home has not referred any staff to the POVA list. Criminal Records Bureau Disclosures and POVAfirst checks are now taking place. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 17 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): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable environment. EVIDENCE: A tour of the environment took place with a number of rooms belonging to people who use the service observed. At the last inspection radiator covers and window restrictors to the first floor windows have been applied and were not followed up at this inspection. Room five was found to be odorous. People said they like having their own en-suite facilities. At a previous inspection the Registered Provider said they have plans to improve the communal lounge. People who use the service who were spoken with during the inspection said they were happy with the cleanliness of the home and results on their surveys Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 18 received prior to the inspection also indicated this. The home has a designated member of staff to undertake domestic activities. The laundry area was examined and it is away from food preparation areas. A member of staff explained how linen is transferred to this area and how they deal with soiled linen. People said they are happy with the standard of laundry and no complaints were received in relation to their clothing. Staff were observed wearing protective clothing where necessary and these were available in the home. The home has a waste contract in place to dispose of incontinence pads. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that the number and competency of the staff on duty is sufficient to meet the needs of the people who use the service, however robust pre employment checks must be undertaken to ensure people who use the service are not put at risk. EVIDENCE: The home has not made any changes to the number of care staff on duty. The home has two care staff on each shift but at night one member of staff is a sleep in. When the acting manager is on duty she is extra to the numbers. A cook and domestic are also extra to the staffing numbers. Maintenance is provided when needed. The majority of people who use the service said the staff are very good and always helpful, however one person said they are unhappy at the home due to the staff changes that have taken place in the recent months. Staff said they like working at the home, as there is a good team spirit amongst them. The Registered Provider said two care staff have NVQ 2 training and is planning to enrol other staff on this course. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 20 The personnel records of five staff appointed since the last inspection were examined. All had evidence that the required pre employment checks had taken place, however the home had not explored any gaps in employment for four of the five members of staff. One member of staff has a criminal record but the home had not completed a risk assessment. The homes application form does not request information about any cautions that people may have received. The Registered Provider said this would be added to the application form. One member of staff had two written references but it was difficult to ascertain the positions of the people who had written them and what organisation they worked for, as this person had worked in care before. Interview records were not completed for all these staff and others did not contain a lot of detail and gaps in employment were not examined at interview. The home uses the induction programme from the Skills for Care Council as the home have registered with this scheme. Records were seen for a number of staff as evidence they have completed this training. The home also has a checklist that is completed which is pertinent to the home. A number of staff files were randomly selected to evidence that training is provided. Some staff require training in the areas of first aid and food hygiene. The Registered Provider said that training is booked for a number of staff to attend food hygiene. Moving and handling training has been provided at the home recently but they are waiting for certificates. Some of the new staff still require training and the Registered Provider said they have plans to address this. Staff confirmed that training opportunities are available. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 21 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): 31, 33, 35, 36 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home needs to appoint a suitably qualified and competent person to manage the home and to ensure effective quality assurance systems are in place, so that the home is run in the best interests of the people who use the service. EVIDENCE: Since the last inspection the manager has stepped down and become the acting manager whilst the home looks to appoint another manager and then they must apply to the Commission to be considered for registration. The home will have been without a Registered Manager for nearly a year, whilst the Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 22 Commission is aware of the difficulties that have happened with previous managers the home must look to address this as a matter of urgency. The Registered Provider was not able to find evidence that monitoring checks as part of their quality assurance are taking place. Accident records were found but no auditing had taken place. A checklist was in place that documents monitoring to be done of certain areas but no records were found of these checks. An infection control audit had taken place in June 2007. The Registered Provider said questionnaires have been sent out but no results were found or collation of these. The acting manager was away during the inspection and the Registered Provider said she would know where the records are stored for their monitoring systems. Residents meetings take place on a frequent basis and records were seen of these. One was planned a couple of days after the inspection. Staff confirmed that they have meetings and are able to discuss any concerns or ideas they may have. The home manages monies for a number of people who use the service. A number of these were randomly selected to check; one person’s records and money were not the same. It appears that staff had not taken off a service from their money, however receipts are kept so the home is able to find any errors. Records relating to staff supervisions were examined. A plan is in place that lists the dates of when staff are due, however records could not be located for all staff. Staff spoken with confirmed they receive supervision sessions. Records relating to servicing of equipment were examined. Records relating to some testing of equipment were not available in the home but the Registered Provider said they have been undertaken and would send evidence to the Commission. This was sent to the Commission a few days after the inspection. The home has a detailed fire risk assessment that has been devised with help from the local Fire Service. The home has assessed all people in the home as part of their evacuation procedure to find out what assistance they would need in the event of fire and staff are made aware of this. Avalon Residential Home DS0000068030.V348166.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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 3 Avalon Residential Home DS0000068030.V348166.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 OP9 Regulation 13(2) Requirement Keep clear and complete records of any medicines administered, to always include the strength of each medicine, the actual dose administered, full directions of how to use, so that clear information is available about how people who use the service receive their medication. This requirement remains outstanding since the last inspection. Improve the medicine storage by providing a fixed locked container for medicines in the domestic fridge. This requirement remains outstanding since the last inspection. Review the homely medicines protocol so that the medicines used are fully described to include the strength and dose to use in order to make it clear what medicines can be given to service users. This requirement remains outstanding since the last DS0000068030.V348166.R01.S.doc Timescale for action 27/08/07 2. OP9 13(2) 10/09/07 3. OP9 13(2) 30/09/07 Avalon Residential Home Version 5.2 Page 25 inspection. 4. OP9 13(2) When medicines are administered to people who live in this home this must be in accordance with the directions of the doctor with full records made if there are any changes to these directions. This is to make sure people receive the correct levels of medication. This requirement remains outstanding since the last inspection. The registered person must ensure that all employment checks as required in this Regulation are undertaken to reduce the risk to people who use the service. (This relates to not exploring gaps in employment) This requirement has been repeated from the last two inspections. The registered person must appoint a suitably qualified and competent person to become the manager for the home and submit an application to the Commission to be considered for registration. This is to ensure the home is run in the best interests of people who use the service. 27/08/07 5. OP29 19 30/09/07 6. OP31 8 30/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 26 No. 1. Refer to Standard OP9 Good Practice Recommendations Devise a written protocol for people who use the service for when they are receiving Warfarin medication. Avalon Residential Home DS0000068030.V348166.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Avalon Residential Home DS0000068030.V348166.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. 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