Inspection on 30/04/09 for Blakesley House Nursing Home

This inspection was carried out on 30th 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blakesley House Nursing Home 10/08/09

Blakesley House Nursing Home 28/05/08

Blakesley House Nursing Home 17/05/07

Blakesley House Nursing Home 12/12/06

Blakesley House Nursing Home 25/04/06

Blakesley House Nursing Home 20/09/05

Blakesley House Nursing Home 08/10/04

Blakesley House Nursing Home 15/04/04

Blakesley House Nursing Home 24/11/03

Blakesley House Nursing Home 17/02/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blakesley House Nursing Home 7 Blakesley Avenue Ealing London W5 2DN     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: Jean Bovell     Date: 3 0 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: Blakesley House Nursing Home 7 Blakesley Avenue Ealing London W5 2DN 02089912364 02089915256 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) : Mrs Margaret Nyambura Lane care home 22 Number of places (if applicable): Under 65 Over 65 22 0 old age, not falling within any other category physical disability Additional conditions: 0 22 The maximum number of service users who can be accommodated is: 22 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 Physical disability - Code PD (E) Date of last inspection Brief description of the care home Blakesley House is a care home for twenty-two older people. There are sixteen beds for older people who need nursing care and six beds for service users who require personal care. The Registered Manager is also the owner of the home which is a four storey detached house located in a quiet residential area of Ealing. The home is close to Ealing Broadway, with its shopping centre, buses, and underground and main line station. There are eleven shared bedrooms and five bathrooms within the home. The lounge, separate meeting room, kitchen and conservatory, which is also used as a dining area, are situated on the ground floor. There are no communal areas on the upper floors. The home has a passenger lift and it can be accessed from the lounge via Care Homes for Older People Page 4 of 30 Brief description of the care home steps or a portable ramp. Laundry facilities and a food store are within an out-building that is located in the rear garden. The fees are approximately #500 per week for personal care and #600 per week for nursing care. 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 inspection was carried out between 10:10 and 3:40 on 30th April 2008. The Registered Manager, Deputy Manager, two student nurses, two care assistants, the cook, a young person on job experience and 17 residents were present. During the course of the inspection, records, documents policies and procedures relating to key Standards were examined. A tour of the building was undertaken and observations were made. Two student nurses, two care assistants, the cook, a person placed on work experience and ten residents were spoken with. A completed Annual Quality Assurance Assessment (AQAA) and surveys received from Care Homes for Older People Page 6 of 30 residents and care staff were considered. The requirements that were made at the last inspection and all key Standards were examined. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Needs led assessments regarding prospective residents are appropriately undertaken by the home prior to admission. Evidence: The home has a document it uses to carry out pre-admission assessments and to gain the information required to ascertain if they are able to meet the needs of any prospective resident. In addition they obtain a copy of the assessment carried out by social services, and those viewed were comprehensive. Copies of hospital discharge letters were also on file. Care Homes for Older People Page 11 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. The health and personal care needs of residents are not in each case being met as required. Current legislation regarding medication disposal are not being followed. Evidence: We viewed 3 service user plans as part of the inspection. There was evidence that the care plan documentation had been completed promptly following the admission of each resident. The information was well completed and monthly reviews had been carried out. These reviews are comprehensive and in some cases there was evidence of involvement from the resident. The need to involve all residents, or, where they do not have capacity their representative in the formulation and review of the service user plans was dicussed. Risk assessments for falls had not been completed. We case tracked one fall and it had been recorded in the daily record and an accident form completed. However, the risk assessment for falls had been updated and there was no mention of the fall having taken place in the monthly review, which had been carried Care Homes for Older People Page 12 of 30 Evidence: out shortly after the fall. The importance of updating all relevant information following falls was discussed. Risk assessments had been formulated for the use of bedrails, however, written consent for their use had not always been obtained. Correction fluid had been used on some documentation and this was discussed with the Deputy Manager, as this is unacceptable practice under the Nursing and Midwifery Council guidance. We viewed wound care documentation. In one instance there had been a delay in the formulation of a care plan following the discovery of a wound, and there was no evidence of input from the tissue viability nurse. The importance of ensuring that any wounds discovered are promptly examined, documented and reported, so that appropriate action can be taken to treat the would without delay was discussed. Pressure sore risk assessments were in place and there was evidence of pressure relieving equipment in use in the home. Moving and handling assessments had been carried out, but the specific equipment to be used for moving and handling had not always been identified. Continence care needs had been identified in the care plans, however, the home did not have a specific continence assessment in place. It is acknowledged that continence assessments are carried out by the Primary Care Trust for the provision of continence products. Nutritional assessments had been carried out and residents are weighed monthly. In one instance, information provided by a dietician had not been followed up with the GP, as requested by the dietician. Other assessments to include physical and mental health, behaviour, plus overall care needs were seen and monthly reviews of each section of the service user plan had been carried out. There was evidence of input from some healthcare professionals to include GP, optician and chiropodist. We viewed the medication records and management. There is a list of staff signatures and initials, to identify who signs the medication records. The homes medication policy had been updated since the last inspection, with further input needed to reflect all aspects of medication management. The home has a copy of the Royal Pharmaceutical Society publication The Handling of Medications in Social Care and this contains the information required to ensure the policy is up to date. Medication receipts and administration had been signed for, and when a medication had been omitted for some reason, this had been recorded using the appropriate coding to identify why the medication had been omitted. Receipts were recorded, to include medications received mid-cycle, plus any medication in stock at the end of the cycle had been carried forward and recorded on the next medication administration record (MAR) chart. The home uses a monitored dosage system (MDS) and the majority of medication is supplied in 28 day blister packs. We viewed 3 sets of morning medication so supplied and stocks were correct. We also carried out a stock check for 9 medications supplied in boxes. In 3 instances the stock available did not tally with the number of tablets left Care Homes for Older People Page 13 of 30 Evidence: in the boxes, which is a repeat finding, and in one instance the medication had run out 5 days previously and was still to be replaced. An immediate requirement was issued at the time of inspection in respect of these shortfalls. A document on which the completion of a weekly audit of medications had been signed for was available, however, it was clear from the shortfalls identified that the auditing process being followed is not effective, and this must be reviewed. Risk assessments were available for self-medicating and for use of oxygen, and appropriate signage was available for oxygen use. Liquid medications had been dated when opened. Incorrect lancing devices were in use for blood glucose testing. We viewed the controlled drugs register, and with one exception this had been correctly completed and each entry signed by 2 people. We noted that one medication had been listed as having been returned to the pharmacist fordisposal, which is contrary to current medication disposal legislation for nursing homes. From various points discussed, it was clear that the assistant manager was not up to date with all current medication guidance and associated legislation. The need to ensure registered nurses involved with the management of medications in the home have up to date knowledge to enable them to fulfil their role effectively was discussed. Since the last inspection, comprehensive guidance has been included in the service user plans regarding end of life care. However, there was no evidence that the wishes of each individual and their families in respect of health deterioration and end of life care had been discussed. The Manager explained that she was progressing registering for the Gold Standards Framework, a recognised programme for provideing effective and individualised end of life care. The need to give the residents and their families the opportunity to express their feelings and wishes in respect of this sensitive topic, and for for these to be clearly recorded so they can be respected, was discussed. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An adequate variety of activities for meeting the needs of residents are not being provided. An open visiting policy is in place. People are able to exercise choice regarding their daily living routines. Wholesome and varied cooked meals are being provided. Evidence: Residents were observed sitting in silence in the main lounge and appeared to be ignoring the TV which was on at the time. Two people listened to music in a small adjoining lounge. Others rested, used computers, read newspapers or watched television in separate bedrooms. One person was seen walking around the garden. The social needs of people who use the service were identified within individual care plans. Eleven of 12 completed service users surveys indicated that there were always activities arranged by the home in which they could participate. However, people in Care Homes for Older People Page 15 of 30 Evidence: the main lounge that were spoken with revealed that the only regular activity was a sing-a-long session presented by a visiting organ player, and we sit all day. They also confirmed that outings within the community did not occur. Bingo games involving all care staff covering duty and in which residents in the lounge were seen to take part in, were played on the afternoon of the inspection. We observed that people in separate bedrooms received no staff supervision during that period. An open visiting policy is being operated at the home and contact between residents and their respective relatives, friends and/or advocates are encouraged and facilitated. One resident confirmed receiving weekly visits from his/her daughter but there were no visitors to the home at the time of the inspection. People are able to exercise choice regarding their daily living routines such as when they get up on mornings, retire at night, whether they remain in separate bedrooms or join others in the main lounge. Individual choices and interests are also reflected in separate personalised bedrooms. Generous portions of nutritious and appealing lunch options were offered to residents at the time of the inspection. Hot meals such as freshly cooked soups were provided at supper. Athough fresh fruit, cakes and a variety of biscuits were being locked away in storage at the end of the garden, only a limited number of plain biscuits were available to residents at the time of the inspection and fresh fruit were not accessible. This was discussed with the Registered Manager and were assured that people were offered choice of biscuits and/or cake and fruit. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is in place and appropriately detailed. Residents are being adequately protected from abuse but care staff are at all times availabe when needed. Evidence: The complaints procedure was in place, clearly detailed and accessible. People who replied to CQC surveys indicated that they knew how to make a complaint. It was reflected in the complaints book that the service had received no complaints following the last inspection. We were, however, aware that complaints regarding failure to follow specific medication procedures and deliver appropriate personal care to people receiving respite care, had been investigated by the placing authority. These issues were identified in relation to a resident placed on respite care during this inspection. Social services were subsequently informed and appropriate action has been taken. An immediate requirement made to the home was met within the required time. Although accidents and incidents were documented and notifications were submitted to Care Homes for Older People Page 17 of 30 Evidence: the Commission where required, allegations by residents that an individual fell and lay on the floor, in the lounge, for some time before a member of staff appeared, were not seen in daily recordings. This was discussed with the Registered Manager. We were informed that she had no knowlege of the alleged incident but that an investigation would be carried out. Policies and procedures on the protection of vulnerable adults and also whistleblowing were in place. It was indicated on staff training records that care staff received training and refereshers on safeguarding adults. We were informed by the Registered Manager that relatives or placing authorities were responsible for the financial affairs of residents but personal allowances were held in safekeeping by seinor care staff at the home. The financial records of individual residents were viewed at random and no discrepancies were identified in relation to income and outgoing expenditure. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is fairly well maintained and the environment is calm and homely. Armchairs provided to residents are not suitable for meeting their needs. Evidence: The home is adequately spacious, suitable for shared and/or separate activity and appropriately furnished. We observed that several people were seated uncomfortably in armchairs and on closer investigation discovered that armchairs were made of patterned plastic which imitated fabric. Residents comments included: can never rest my back properly cause I keep slipping down and too low for me, I need a higher chair. One resident sat leaning forward in a chair without adequate back support throughout the inspection. These issues were discussed with the Registered Manager and were initially denied. However, residents were subsequently enabled to confirm to the Manager in our presence, that they were not comfortably seated in their chairs. The garden was adequately maintained. Issues regarding the laundry were not identified. Care Homes for Older People Page 19 of 30 Evidence: The meeting room needed thorough cleaning. This was reported to the Registered Manager and we were assured that appropriate action would be taken. Overall, the home was clean and reasonably well maintained. The kitchen and bathroom areas were hygienic and there were no unpleasant odours. The environment was safe, calm and homely. Residents who replied to CQC surveys indicated that the home was always fresh and clean. Care Homes for Older People Page 20 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. Although the records are indicative of staff being appropriately trained and qualified. student nurses are being rostered to provide personal care to residents. As a consequence the number of qualified staff covering duty during waking hour are insufficient for meeting the needs of residents. The homes recruitment procedures are satisfactory. Evidence: It was reflected on staff rotas that two student nurses, one registered nurse and two care assistants were on duty during waking hours and one registered nurse and one care assistant covered waking duty at night. Two student nurses, two care assistants, the Assistant Manager who is also a registered nurse covered duty at the time of the inspection. The cook and a young person on job experience were also present. We observed that student nurses were not supernumerary in relation to staffing numbers and were providing unsupervised personal care to residents. Issues regarding student nurses being required to perform duties expected from qualified staff were included in previous inspection reports and appropriate requirements were made. As a Care Homes for Older People Page 21 of 30 Evidence: consequence, this was again raised with the Registered Manager but she was unable to explain satisfactorily why salaried workers are continually replaced by student nurses. Residents reported that nurses were nice but very young, always busy, only two: one up, one down, no-one to talk to, have had to wait up to two hours for someone to see to us. We were informed by social workers that incidents reported by residents during reviews relating to their health and welfare had not been included in daily records, and resulted in peoples specific needs being overlooked. This was discussed with the Assistant Manager who acknowledged that although student nurses provided personal care, daily recordings were made by staff nurses and there may have been a breakdown in communication. A resident reported that even though care staff had been made aware that he/she needed to see a Dentist, no action had been taken. The resident displayed his/her gums which were sore and complained of being unable to chew. This was reported to the Registered Manager who did not accept that a problem existed until it was confirmed by a particular resident in our presence. A training programme was in place and reflected that regular training and refreshers suitable for meeting the needs of people who use the service were being delivered. It was indicated on the homes completed Annual Quality Assurance (AQAA) that eight members of staff had achieved NVQ level 2 or above. Three staff recruitment files were viewed at random and each file contained all required recruitment documents. Care Homes for Older People Page 22 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. The Registered Manager is appropriately qualified and experienced. An annual quality assurance document has been completed as required. The personal allowances of people who use the service are being safely secured. The health, safety and welfare of residents are being protected. Evidence: The Registered Manager is also the Provider and she is suitably trained, qualified and experienced. An annual quality assurance document was appropriately completed by the home and returned to the Commission at the required time. Care Homes for Older People Page 23 of 30 Evidence: The personal allowances of residents are being held in safekeeping at the home. Residents cash was seen to be secured separately and appropriately and individual financial records were in place. These were examined at random and no discrepancy was identified. All health and safety records viewed and were satisfactory. Fire drills were being carried out on a three monthly basis and clearly recorded. Environmental risk assessments had been undertaken. It was reflected on training records that staff received training on Manual Handling, Basic Food Hygiene, Health and Safety, Fire Safety and Infection Control. Greater attention should be given to monitoring on a day to day basis to ensure that issues are dealt with in a timely fashion. For example: lack of activities, inappropriate furniture, failure to ensure that residents are at all times supervised and receive access to appropriate dental care when required, inadequate medication audits and infrequent availability of fresh fruit and cakes. The Registered Manager has overall responsibility to ensure that there is sufficient calibre of senior staff to carry out effective monitoring of all aspects of the home to ensure that residents care needs are being met all times. Care Homes for Older People Page 24 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 25 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 1 12 16 The Registered Person must make sure that a range of activities in which residents are able to take part are organised in the home and also within the community. This is to ensure that their social needs needs are being met. 30/06/2009 2 19 16 The Registered Person must ensure that chairs provided to residents are of good quality, comfortable and appropriate to their needs. To ensure that residents needs are being met. 30/06/2009 3 31 12 The Registered Manager 30/06/2009 must make sure that there is sufficent calibre of senior staff are employed at the home. This is to ensure that the overall needs of residents are being met. 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 7 18 Correction fluid must never 30/06/2009 be used on legal documents. Care Homes for Older People Page 26 of 30 This is to ensure compliance with relevant legislation 2 7 13 Written consent must be availabe for the use of bedrails. This is to ensure the use of bedrails has ben fully discussed and identified as appropriate for use. 3 7 13 Following any falls, the falls risk assessment and all related documentation must be updated. This is to ensure appropriate action is taken to minimise the recurrence of falls. 4 9 18 All staff involved in the management of medications must have an up to date knowledge of current medication guidance and associated legislation. To ensure medications are being managed effectively at all times. 5 9 13 All entries in the controlled drugs register must be signed by 2 staff. To ensure they are checked by 2 staff. 6 9 13 Medications must be disposed of in line with current legislation. To ensure medications are disposed of correctly. 7 9 13 Lancing devices approved for professional use must be 30/06/2009 30/06/2009 15/06/2009 15/06/2009 30/06/2009 30/06/2009 Care Homes for Older People Page 27 of 30 used for blood glucose monitoring in line with current legislation and guidance. To minimise the risk of infection. 8 9 13 Further work must be carried out to provide a comprehensive medications policy for the home, in line with current legislation and guidance. To ensure medications are managed effectively. 9 11 12 There must be evidence that 30/06/2009 residents and their families have been offered the opportunity to discuss their wishes in respect of health deterioration and end of life care, and the outcome of such discussion must be recorded. This is so that their wishes are known and can be respected. 10 18 13 The Registered Person must ensure that residents in the lounge are at all times supervised. To ensure that their needs are being met. 11 19 16 The Registered Person must 30/06/2009 make sure that residents are at all times provided with appropriately comfortable chairs. 17/06/2009 30/06/2009 Care Homes for Older People Page 28 of 30 This is to ensure that there needs are being met. 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 7 That the input from residents and their representatives in the formulation and review of the service user plans be evidenced for each resident. That the home formulate a continence assessment appropriate to the needs of the residents for inclusion in the service user plan. 2 7 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. 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