Inspection on 06/04/09 for Beech House

This inspection was carried out on 6th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beech House 10/06/08

Beech House 16/07/07

Beech House 01/06/06

Beech House 11/12/05

Beech House 11/08/05

Beech House 04/12/04

Beech House 08/07/04

Beech House 08/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech House Yew Tree Lane Northenden Manchester M23 0EA     The quality rating for this care home is:   one star adequate service 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. Lead inspector: Geraldine Blow     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Beech House Yew Tree Lane Northenden Manchester M23 0EA 01619452083 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) : S J Care Homes Ltd care home 43 Number of places (if applicable): Under 65 Over 65 43 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 43. Date of last inspection Brief description of the care home Beech House is located in the Northenden area of South Manchester, close to local amenities. The home is registered with the Care Quality Commission to accommodate 43 residents over the age of 65. The large extended detached house is set in its own grounds and has some car parking spaces. Peoples living accommodation is available on the ground and first floor, access to which is facilitated by a passenger lift. The building is accessible to wheelchair users via a ramp and the home is wheelchair accessible. Shops and access to public transport is nearby and the home is within 1 mile of the M56. Care Homes for Older People Page 4 of 30 Brief description of the care home There are several lounge areas, a conservatory, and a separate dining room. The last inspection report is available on request. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report is based on information gathered by the Care Quality Commission (CQC) since the last inspection visit on 10 June 2008. Supporting information was also received in the Annual Quality Assurance Assessment (AQAA) submitted by the manager prior to this visit in September 2008, although the information it contained was limited. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. References to we or us in this report represent the CQC. Staff and some people living at the home were sent comment cards so that we could Care Homes for Older People Page 6 of 30 get their views on how the home is run. We received one completed comment card from a relative of somebody living at the home and four staff comment cards. Some of the comments are included in this report. This visit was unannounced, which means that the manager and staff were not told that we would be visiting. This visit took place on Monday 6 April 2009. This report is an overview of what the inspector found during the inspection. As part of the visit we spent time examining relevant documents and files. During the course of the inspection visit we spent time talking to people living at the home, the manager and some staff to find out their views of the home. We also walked round the home and looked at communal areas and a sample of bedrooms. Feedback was given to the operations manager during the course of this visit and on conclusion of the visit. Fees for accommodation at the home are 405 pounds per week. Additional charges are also made for hairdressing, chiropody services and newspapers. What the care home does well: What has improved since the last inspection? What they could do better: It is recommended, to ensure the home can meet all the assessed needs of people, that the pre admission assessment document is reviewed and updated to contain more detail and included an assessment of peoples social interests, hobbies, religious and cultural needs. Procedures must be put into place to assess peoples ability to make decisions under the Mental Capacity Act to ensure that peoples capacity to make their own decisions is appropriately assessed. Improvements are needed to the recruitment procedure to ensure that the people living at the home are fully protected. To make sure people are not put at any unnecessary risk the risk assessment used for the use of bed rails must be reviewed and updated to assess the actual risk of using bed rails and not just the risk of falling out of bed. Some improvements are needed to the recording of medication given to people and to ensure that people are receiving medication as prescribed by the GP the manager should carry out regular medication audits. Care Homes for Older People Page 8 of 30 The manager and staff spoken to identified that although some activities are provided the appointment of an activity coordinator would improve and extend the activities offered to people in the home. The manager has advertised the post but has been unable to appoint a suitable person. Some areas of the home are tired and worn in appearance. Some carpets are stained and marked. Some of the wallpaper is ripped in places. To ensure that people are fully protected all staff must receive appropriate safeguarding adults training. Staff must receive appropriate training to make sure they can meet the needs of the people living at the home. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process does not always ensure that peoples care needs are throughly assessed to ensure that people will receive the right type of care. Evidence: The manager stated that since her appointment, in January 2009, prior to any admission a nurse would go and assess the persons needs. The manager also said that information from the care managers assessment of the placing authority or the funded nurse assessment is obtained, usually prior to admission. A random selection of peoples care files were looked at. Two of the care files belonged to people who had lived at the home a long time so did not contain any pre assessment documentation. One of the care files was from a recent admission and evidence was seen of a pre admission assessment. However the assessment was very basic and did Care Homes for Older People Page 11 of 30 Evidence: not include information regarding the actual care needed and it did not include an assessment of social interests, hobbies or religious or cultural needs. To ensure that all peoples assessed needs can be met it is recommended that the pre admission assessment is reviewed and updated to ensure a thorough and detailed assessment of needs is carried out. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are not aways clearly identified so that staff have clear instructions about how to look after them properly. Evidence: The manager had been in post since January 2009 and has identified shortfalls in the care planning process. The manager was in the process of auditing , reviewing and updating all of the care files. During this visit we only looked at care files that had been reviewed and updated. We looked at care files for three people and found significant improvements since the previous inspection. The files were organised and easy for people to use and find information. Each person had a plan of care setting. Some parts of the care plan contained information regarding personal choice and preferences. For example there was information relating to peoples daily routine. This contained information regarding preferred getting up and retiring times, social interests and where they liked to sit during the day. There was also a catering form which included information Care Homes for Older People Page 13 of 30 Evidence: regarding any special dietary requirements and the persons likes and dislikes. A copy is kept on file for staff to access and a copy is also in the kitchen for easy access. These assessment forms are seen as good practice. Although some parts of the care plans contained detailed information of how peoples personal preference and were to be met, other parts were a bit vague. For example the personal hygiene care plans did not clearly set out the actual care that was needed to promote peoples independence and meet the care need. In addition all three files included a statement offer a bath/shower weekly. This statement could be misinterpreted that people can only have a bath or shower once a week and the plan of care should include information about whether people prefer a bath or shower and at what time of day. It was noted that people did not have an oral assessment of needs and the personal hygiene care plans were not specific to oral care needs. It is recommended that people have an assessment of oral health needs and the plan of care include detailed information of how that care need is to be met. Risk assessment had been undertaken to ensure that people are safe. However we were shown a blank risk assessment for the use of bed rails by the manager. The risk assessment seen was not a thorough risk assessment. However following the inspection we were sent a detailed and thorough risk assessment that the provider of the home assured us had been completed for the people who had bed rails in place. The completed survey from a relative of somebody living at the home identified that they thought their relative usually received the care and support they needed. One person spoke to said that she was well looked after. We examined the records and stocks of medication held for the three people whose care plans we looked at. In was of concern that one medication prescribed twice a day had not been signed for but had been given, for a three week period. Clear and accurate records of medicines administered to people must be maintained so that medicines can be fully accounted for to show that they are being given correctly and to prevent mishandling. The manager confirmed that there was no system of auditing medication. To ensure that people are receiving medication as prescribed by the GP medications should be accounted for at all times by means of an audit trail. One medication record sheet looked at identified that the person had been prescribed a drink thickener, which is used to thicken drinks and soups for people who have a swallowing impairment. The record sheet had been signed for as the thickener being given four times a day. The manager and a nurse confirmed that this was not an Care Homes for Older People Page 14 of 30 Evidence: accurate record of the number of thickened drinks given over a 24 hour period. To ensure that there is an accurate record of prescribed medication and that peoples needs are being appropriately met it is recommended that the medication record sheet should clearly cross reference to where there is a signed, accurate recored of thickened fluids given to people. It was noted that one person was self administering her own creams and gels. To ensure people are not put an any unnecessary risk prior to self administration of prescribed mediciation a risk assesemt must be undertaken. Suitable provision had been made for the safe disposal of unused medication from the home. Staff spoken to stated that people were treated with respect and dignity. This was confirmed by watching staff interact with people and helping with meals in a sensitive and unhurried manner. Comments from people living at the home supported this and included, the staff are lovely and the staff are very kind. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Limited activities are provided and people are able to maintain contact with family and friends. Evidence: The manager stated that the post of activity coordinator had been advertised but they have not been able to recruit a suitable person. The manager and staff spoken to confirmed that the activities provided were limited and the home would benefit greatly from a coordinator. The manager said that staff are trying, where possible, to provide activities which include one to one chats, going to the local shops, singing, and manicures. The manager had arranged an Easter raffle and was due to have a staff meeting to discuss how the money raised would be best spent in the interest of the people living at the home. The information obtained from the survey of a relative of somebody living at the home was that the home sometimes arranges activities. Since the last inspection visit the menus have been reviewed and now include an alternative at each meal. All people spoken to as part of this visit were complimentary about the food and confirmed that alternative meals are available if you do not like what is on the menu. In addition people said that snacks and drinks are available on Care Homes for Older People Page 16 of 30 Evidence: request. However the survey from a relative identified that their relative only sometimes liked the food and that she brought sandwiches in as she knew her mother wouldnt have had much to eat all day and has lost weight since being at the home. The manager and staff spoken to confirmed that people are encouraged to make choices around their every day lives and some people were seen to be freely moving around the communal areas. However there is a need to ensure that peoples capacity to make decisions is assessed and recorded as required under the Mental Capacity Act. Some of the bedrooms seen contained personal items brought in from peoples own homes. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to enable people to raise concerns. To ensure that people are protected from potential abuse, staff must receive appropriate training. Evidence: There is a complaints procedure on display in the main reception. However it was noted that the procedure did not contain a time frame for investigation and it is recommended that this is included. The manager stated that she had not received any concerns or complaints since taking up post in January 2009. It was discussed that the manager must keep a record of all complaints or concerns which includes details of the investigation and any action taken. The manager stated that she does encourage people to raise any concerns or complaints so they can be promptly investigated. All of the comment cards received from staff indicated that they knew what to do if somebody had a concern. However the comment card from a relative from somebody living at the home indicated that they did not know how to make a complaint and they only sometimes knew who to speak to if they were not happy. A comment was you can speak to a nurse about anything your not happy about but it doesnt mean they will do anything about it. Care Homes for Older People Page 18 of 30 Evidence: Records demonstrated that some staff had attended safeguarding adults training. However there were gaps in the training and some of the staff spoken to had not received the training, although the manager was discussing safeguarding in staff supervision sessions. The gaps in staff training does have the potential to put people at risk. There was a copy of the Manchester Social Services procedure for dealing with allegations of abuse of vulnerable adults. Since the last inspection visit there has been an allegation of abuse which is currently being investigated. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all areas of the home are well maintained to provide a clean and comfortable environment for the people living there. Evidence: During the course of this visit a tour of the building was undertaken which included the communal areas and some peoples bedrooms. The general cleanliness of the home has improved since the last visit. However some areas of the home were not well maintained and much of the furniture and carpets were tired and worn. For example many of the bedroom carpets were marked and stained. The furniture in bedrooms was a mis match of furniture and old and worn in appearance. Many of the arms on the lounge chairs were split and marked. Some of the wallpaper in the corridors was marked and. Since the last inspection visit all of the wheelchairs had been thoroughly cleaned as required in the last inspection report. In addition as recommended in the last inspection report several bedrooms were seen to have a small stock of personal protective equipment (PPE) such as gloves and wipes. The requirement made in last inspection report that the cracked glass in the conservatory door must be replaced had been met. Care Homes for Older People Page 20 of 30 Evidence: In an attempt to reduce the risk of cross infection the manager stated she was in the process of ordering individual slings for people who required the use of the hoist. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for the recruitment of staff need to be more robust to ensure suitable staff are employed to safeguard people. Evidence: From talking to the manager and from observations on the day of this visit it appeared there were sufficient staff on duty to meet the needs of the people living there. The manager confirmed that 14 care staff were employed. One person had successfully completed the National Vocational Qualification (NVQ) in care, Level 2 and one person had successfully completed NVQ Level 3. A further two members of care staff were currently working toward NVQ Level 3. In addition three staff members were due to commence NVQ Level 2 in the near future and a further three members of staff had requested to undertake the training. A sample of two staff files were looked at to see whether the required documentation was in place and if the necessary safety checks had been made. There was evidence of Criminal Record Bureau checks (CRB) having been undertaken and this was confirmed by a newly appointed member of staff. However some shortfalls were seen in the recruitment process. For example, one file did not have a photograph or proof of identity or home address. In another file there was no application form. This does not Care Homes for Older People Page 22 of 30 Evidence: fully protect people living at the home. In one file there was no evidence that a set interview format had been used or that notes were taken. It is recommended that a set interview format is used and notes are taken during the interview process. The files looked at contained some photocopied documents and there was no evidence that the original documents had been seen. It is recommended that all photocopied documents are signed and dated to indicate that the original has been seen. The manager stated that she has checked NMC website to ensure that the details of the nurses employed at the home are up to date and that they have not been suspended or excluded from the nurse register. She said it was her intention to set up a system for these checks to be undertaken on a regular basis. There was an induction program in place and a newly recruited member of staff said she was currently working through the induction and had found all staff to be very supportive. Since the last inspection visit a staff training matrix had been developed. The manager acknowledged that there were gaps in staff training. For example not all staff have received safeguarding adults training, infection control and fire training. Nobody had received dementia care, challenging behavior, COSHH or RIDDOR. All staff must receive training appropriate to the work they are undertaking. In addition nobody had received any training in the Deprivation of Liberty Safeguards (DoLS), which came into force on 1 April 2009 and forms part of the Mental Capacity Act. To ensure that everybody is aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) staff must attend training in accordance with legislation. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all areas of the home are managed in the best interest of the people living there. Evidence: Since the last inspection visit a new manager has been appointed and has been in post since the 5 January 2009. The manager confirmed that she has very recently applied to CQC for registration. The manager was aware of the shortfalls within the home with particular reference to staff training, staff recruitment and need to review and update all the original care plans. The individual financial records for people were looked at. There is a system in place for small amounts of money to be held and used on behalf of people. The system was secure and records provided evidence of running totals for individual people and included receipts for any purchases made on peoples behalf. Since the last visit the policies and procedures relating to finances have been reviewed and updated to set out the systems to be followed at the home. However it is recommended that written Care Homes for Older People Page 24 of 30 Evidence: agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. Evidence was seen that a quality audit was carried out in 2008 and the results of the audit were on display in the main reception. This is seen as good practice. The manager said it was her intention to continue with an annual quality assurance audit. In addition the manager stated that it was her intention to start regular meetings for people living at the home and relatives. The information provided in the AQAA demonstrated that the homes maintenance certificates and records were up to date. This was also confirmed by the manager. The maintenance man stated that he carried out regular fire safety checks but when asked he said that he did not keep a record. However following the inspection visit we were sent copies of the records kept by the administrator, who is also the fire warden for the home. It is recommended that these records are available on request during inspection visits. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 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, Care Homes 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 17 Clear and accurate records 11/05/2009 of medicines administered to people must be maintained. To ensure that medicines can be fully accounted for to show that they are being given correctly and to prevent mishandling. Prior to self administration of prescribed mediciation a risk assesemt must be undertaken. To ensure people are not put an any unnecessary risk 11/05/2009 2 9 13 3 14 14 Procedures must be put in place relating to peoples choice and the need to ensure that peoples capacity to make decisions is assessed and recorded as required under The Mental Capacity Act. 31/05/2009 Care Homes for Older People Page 27 of 30 To ensure peoples capacity to make decisions is appropriately assessed. 4 18 13 All staff must receive appropriate Safeguarding Adults training. To ensure people are fully protected from abuse 31/05/2009 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 3 To ensure that all peoples assessed needs can be met it is recommended that the pre admission assessment is reviewed and updated to ensure a thorough and detailed assessment of needs is carried out. It is recommended that all parts of the individual plans of care include details of peoples personal choice and preferences. It is recommended that people have an assessment of oral health needs and the plan of care include detailed information of how that specific care need is to be met. To ensure that people are receiving medication as prescribed by the GP medications should be accounted for at all times by means of an audit trail. To ensure that there is an accurate record of prescribed medication and that peoples needs are being appropriately met it is recommended that the medication record sheet should clearly cross reference to where there is a signed, accurate record of thickened fluids given to people. To ensure people are given the opportunity for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities it is recommended that the manager continue to make every effort to appoint a suitable activity coordinator . It is recommended that the complaint procedure is reviewed and updated to include a time frame for Page 28 of 30 2 7 3 8 4 9 5 9 6 12 7 16 Care Homes for Older People investigation. 8 19 It is recommended that some improvements are made to the decor and furnishing of the home in order to provide a well maintained environment for the people who live there. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. It is recommended that the reocrds of fire safety checks are made available for inspection. 9 35 10 38 Care Homes for Older People Page 29 of 30 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!