Inspection on 19/06/06 for Blenheim Care Centre

This inspection was carried out on 19th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Blenheim Care Centre 06/10/08

Blenheim Care Centre 08/10/07

Blenheim Care Centre 17/10/05

Blenheim Care Centre 25/04/05

Blenheim Care Centre 13/01/05

Blenheim Care Centre 01/06/04

Blenheim Care Centre 04/12/03

Blenheim Care Centre 01/07/03

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

CARE HOMES FOR OLDER PEOPLE Blenheim Care Centre Ickenham Road West Ruislip Middlesex HA4 7DW Lead Inspector Mrs Clare Henderson Roe Unannounced Inspection 10:30 19 & 20th June 2006 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 Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 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. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Blenheim Care Centre Address Ickenham Road West Ruislip Middlesex HA4 7DW 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) 01895 622 167 01895 622 240 blenheim@lifestyle.co.uk Life Style Care Plc Mrs Tatree Preece Care Home 64 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 8 beds for service users with a physical disability requiring nursing care. 12 Beds for service users in the category of old age requiring nursing care 10 Beds for service users with dementia requiring nursing care. Of these 10 beds, 5 may be used to accommodate service users with dementia requiring personal care or nursing care. 22 Beds for service users falling within the category of old age requiring personal care. 12 Beds for service users with Dementia requiring personal care. 4. 5. Date of last inspection 17th October 2005 Brief Description of the Service: Blenheim Care Centre is a purpose built Care Home providing care for 64 service users. There are 5 separate living units divided into the categories as stated in the Conditions of Registration. The units are designed to provide a homely environment consisting of single accommodation with en-suite toilet and hand washbasin facilities and fitted telephone sockets and service users can have a land line or mobile phone as they so wish. Each unit has a spacious lounge, with separate smoking areas available on two floors. There is an enclosed garden and some service users bedrooms and a communal lounge open out onto it. The home is located on the Ickenham Road next to West Ruislip underground station and visitors’ car parking is available. The Registered Manager has been in post for 6 months, and the home also has a Support Manager. There is also a Regional Manager for the home. The fees range from £393.58 to £949.84 dependent on the service users needs and the unit on which they are therefore accommodated. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 17 hours was spent on the inspection process. The Inspector carried out a tour of the home, and service user plans, medication records, staff records, financial records, management records, administration records, maintenance and servicing records were viewed. 19 service users, 14 staff, 8 visitors and a visiting healthcare professional were spoken with as part of the inspection process. The pre-inspection questionnaire, given to the home at the time of inspection, was also used to inform this report. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. What the service does well: What has improved since the last inspection? What they could do better: Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 6 Although it is acknowledged that the heating system has been repaired, there are now problems with leaking valves. The whole system must be in full working order prior to the autumn and there must be effective ongoing maintenance to maintain it in good order. 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. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 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 Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written information about the services the home provides is available to service users and their representatives, and is being updated to provide current information. Service users are assessed prior to admission, and the information gained is comprehensive, clearly ascertaining that the home is able to meet their assessed needs. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. There was evidence that some updating had been carried out and the Registered Manager was in the process of completing updates on these documents and said that copies of the Service User Guide would be provided for each service user and copies of both documents would be forwarded to the CSCI. Pre-admission assessments were viewed on each unit. These were comprehensive and provided a clear picture of the service users needs. Social Services assessments had also been obtained for prospective service users. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear system of care planning in place, which provides staff with the information they require to meet service users needs. Shortfalls identified should be easy to address. Medications are generally well managed in the home, however shortfalls identified could potentially place service users at risk. Staff care for service users in a courteous and gentle manner, respecting their privacy and dignity. EVIDENCE: A sample of service user plans were viewed on each unit. Overall these were comprehensive and up to date, giving a clear picture of the service users needs. A system of auditing has been put in place, and there was evidence that where service user plans had been audited by the senior registered nurses action had been taken by the unit staff to review and amend them. Some of the service user plans on the dementia care nursing unit needed personalising to the individual, but again this had been identified during the recent audit. There was evidence of monthly review and of care plans being formulated to address newly identified needs. Risk assessments for falls were in place, and there was evidence of updates following falls. Risk assessments had also been Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 10 formulated for other identified areas of risk. There is a daily feedback sheet that the senior staff on each unit complete and this provides the Registered Manager with a good picture of the unit and the service users welfare over the 24 hour period. At the time of inspection two service users had pressure sores, which developed in the home. Clear wound care documentation was in place, and there was evidence of wound progress and healing. Pressure relieving equipment was seen in use in the home, and had been identified in the service user plans. On the dementia care nursing unit some service users were noted to have some unexplained bruising and the need to document and report any such findings was discussed with the registered nurse and the Registered Manager. Assessments for continence, nutrition and moving & handling had been completed and where a need had been identified a care plan formulated. There was evidence of service users being weighed monthly and where a problem was identified the frequency had been increased and where necessary a referral made to the GP. On the personal care units where service users are receiving input from the District Nurse this had been identified in the service user plan. Care plans for any specialist healthcare intervention needs had been formulated. Risk assessments and written consents for the use of bedrails were in place. There was evidence of input from visiting healthcare professionals, and Life Style Care plc has appointed a Tissue Viability Nurse Specialist, who has provided input with wound care management. One visiting healthcare professional spoken with at the time of the inspection said that staff are helpful and referrals are well completed. The home has 2 GP practices providing medical care for the service users. The Inspector sampled the medication records on each unit. Liquid medications are dated when opened. For service users on anticoagulant therapy copies of the latest blood test results were available. For medications with variable doses these had been clearly written up on the medication administration record (MAR) chart. The air conditioning units were working effectively in all the clinical rooms. Fridge and room temperatures were within safe limits, and where there had been a drop in the minimum temperature action was to be taken to ensure this stayed between 2-8° centigrade. There were some discrepancies noted between doses administered and the number of tablets still in stock for one service user on the ground floor young physically disabled (YPD) unit and one service user on the first floor personal care unit. There was also discrepancy between stock and doses signed for in respect of one night medication on the second floor dementia nursing care unit. The Registered Manager said that these findings would be investigated. An up to date copy of the medications policy and procedures were provided to each unit at the time of inspection. Correct procedures for the disposal of medications are in place. Receipts, administration and disposal/returns of medications were recorded and signed for. The one exception to this was on the second floor dementia personal care unit where night staff had not signed for administration of three doses of one medication. On the ground floor general nursing unit one Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 11 medication had been out of stock for 3 days. The service user did have another medication prescribed that could be administered in place of this. Following the inspection this issue was investigated and a satisfactory explanation regarding manufacturers supply problems has been received. There has been a review in medications training for staff and this is now comprehensive and includes practical and theory assessments. Additional training materials have also been received from the dispensing pharmacist and the training co-ordinator said that she is planning update training for all staff administering medications. Medications are generally well managed within the home and with more attention to detail the shortfalls identified should be easy to address. Staff were seen to be caring for and conversing with service users in a gentle and courteous manner. Service users spoken with expressed their satisfaction with the home and said that they were being well cared for. Clothing for service users is individually named and service users were appropriately dressed and looked well cared for. The home accommodates some service users who are related, but whose care needs are different, thus they are accommodated on different units. It was clear when speaking with some of the service users and with staff that time is taken to ensure these service users spend time in each others’ company and the importance of this is understood by staff. Representatives spoken with said that they are kept up to date with any changes in the health of their loved one. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an activities programme to keep the service users active and stimulated. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. Information regarding advocacy services is available, thus ensuring service users rights and interests are upheld. The meal provision is good, offering both choice and variety and catering for special dietary needs. EVIDENCE: The home has a full time activities co-ordinator, and it was clear from discussion with her that she works hard to provide activities suited to the service users. Care plans for activities had been formulated and there is a monthly budget for expenditure on activities. There was an activities programme on display in the home, plus there was an activities file evidencing outings, entertainment and seasonal activities taking place throughout the year. The possibility of some additional activity personnel hours in relation to the size of the home was discussed, especially with the home having 5 different units and therefore service users with widely differing needs for whom to provide suitable activities. It was noted that television or radio programmes suited to the service users needs were in progress in the sitting rooms on each unit. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 13 Visiting is encouraged and visitors spoken with said that they are made welcome at the home, and staff are friendly and offer them refreshments. Service users can receive visitors in the communal rooms or in the privacy of their own bedrooms, as they so wish. The home has input from the Age Concern Advocacy Service, and the advocate is very active in the home and attends residents meetings. The Registered Manager said that she is aware of other advocacy services that can be accessed should the need arise. The home receives input from the local Church of England and Roman Catholic churches. Several of the bedrooms viewed were personalised and service users can bring in their own possessions in line with fire safety. The kitchen was viewed and this was clean and tidy. Risk assessments for equipment and safe working practices are in place. Cleaning records plus fridge, freezer and food temperature records were up to date. There was evidence of stock rotation in the storeroom. A record of each service users dietary needs is provided to the kitchen staff. The home has a six week menu and the meals available tallied with the menu choices. Service users spoken with said that they enjoy the food and that a choice is always provided. The lunchtime meal was observed on one unit and service users were enjoying their meal, with three different meal options seen. Staff are available to assist service users with their meals and do so in a discreet and unhurried manner. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by service users and their visitors. Systems were in place for the protection of vulnerable adults. EVIDENCE: The home has a clear complaints procedure. Seven complaints had been received since the last inspection and the documentation was comprehensive and showed that complaints are acknowledged, fully investigated and the results of the investigation are shared with the complainant. The homes policies and procedures for adult protection dovetail with the Hillingdon Safeguarding Adults documentation. There had been no POVA issues since the last inspection. Staff spoken with said that they would report any concerns. On the first day of inspection a concern regarding unexplained bruising was raised, and the Registered Manager followed procedure and reported this appropriately. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, thus providing a clean and homely environment for service users to live in. Infection control procedures are in place and adhered to, thus safeguarding service users. EVIDENCE: The home has a new maintenance man in post. A full environmental audit of the home had been carried out and there was evidence of ongoing redecoration within the home, with the work on the ground floor having been completed. The Registered Manager said that once the shortfalls on each unit identified in the audit had been addressed, then an ongoing programme of redecoration and refurbishment was to be drawn up with timescales for completion. The Inspector carried out a tour of the home and overall the home was being well maintained. The garden was tidy and accessible to service users. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 16 Assisted bath and shower facilities appropriate to meet the service users needs are available on each unit. All bedrooms have an en suite facility to include a toilet and wash hand basin. Additional toilets are situated near to the communal rooms. The lighting was satisfactory and there was good ventilation throughout the home. There had previously been ongoing problems with the heating system, and work to repair this has been carried out. It was noted that some of the valves fitted to parts of the pipe work were leaking. The need to ensure that these issues are addressed and the heating system is in full working order prior to the autumn was discussed. Confirmation of this must be forwarded to the CSCI. The home was clean and tidy throughout and smelled fresh. Items were being stored appropriately. The laundry was in good order and the cleaning records were up to date. Risk assessments for equipment and safe working practices were available. Information on infection control, first aid and fire safety procedures was on display. The laundry person said that the equipment is maintained and any repairs are carried out promptly. Protective clothing to include gloves and aprons was available throughout the home. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was appropriately staffed to meet the needs of the service users. Systems for vetting and recruitment practices are in place and protect service users. There is a comprehensive ongoing training programme, providing staff with the skills to meet the needs of service users, to include specialist care needs. EVIDENCE: Staffing rosters were available on each floor, and changes had been clearly made to evidence any changes in duty for staff. At the time of inspection the home was being staffed to meet the needs of the service users. The home was clean and smelled fresh. Domestic, kitchen and maintenance staff are employed to maintain environmental standards and to ensure that the full needs of service users are met. The home has a training co-ordinator and clear, individual training records are kept. There is an induction and foundation training programme in place to meet the Skills for Care core standards. Staff spoken with said that they are encouraged to attend training and that the topics are relevant to the diagnoses and care needs of the service users. The home is aware of the need for 50 of care staff to be trained to NVQ level 2 in care or the equivalent, and works hard to maintain this percentage. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 18 Staff employment records were viewed. These were clear and contained the information required. With the exception of their most recent employment, the application form does not ask prospective employees to give the reason for leaving previous jobs in the care sector, and the Registered Manager said that she would clarify this with Life Style Care plc. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the qualifications and experience to manage the home. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Service users monies are well managed and securely stored. Staff receive supervision, thus promoting communication and review of practice. Systems for the management of health and safety throughout the home are good, thus safeguarding service users, staff and visitors. EVIDENCE: The Registered Manager is a first level registered nurse with relevant management experience. She has several post-graduate qualifications and is intending to complete the relevant additional training in respect of her role. She has been in post since 2006 and is working with the each unit leader to Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 20 learn more about the service user groups and their specialist needs. Staff spoken with said that the Registered Manager is supportive and approachable, and takes time to visit each unit to keep up to date with the care management of the service users. Quality monitoring information is obtained each month and the results are published. Internal and external home audits are carried out. Regular audits are carried out to include medications, service user plans and the environment. Regular meetings are planned and carried out for unit staff, relatives, ancillary staff and heads of unit. In addition service user meetings are being arranged with an advocate also in attendance. Regulation 26 reports of the monthly unannounced visits carried out on behalf of the Responsible Individual are forwarded to the CSCI. The Registered Manager said that the audit system is part of the quality assurance programme for the home, which she will be working to complete. The home had current employers’ liability insurance, with the certificate on display. A copy of the homes annual budget was viewed and this evidenced the individual amounts being budgeted for areas of expenditure at the home. The Registered Manager said that the budget provides a clear picture of the money available. The budget is calculated on an annual basis and the Registered Manager will put together a projected list of required expenditure to be considered for the budget for the following year. Records of service users’ monies were sampled. These tallied with the money held for each service user, and the records are maintained on the computer. The home has safe facilities and details of any valuables are also entered onto the computer system. The Registered Manager said that she has re-introduced a key worker system within the home, and is endeavouring to ensure that all staff receive a minimum of 6 supervision sessions per year, with responsibility for this being cascaded down through the staff. Samples of the maintenance and servicing records were viewed at random, and those viewed were up to date. The records are kept in good order for ease of access. Records of staff training in health & safety to include fire safety are maintained and records of fire drills evidence that these are undertaken at regular intervals for day and night staff. Risk assessments for equipment and safe working practices are in place and the home has a health & safety manual with policies and procedures in place. The Registered Manager said that she is aware of the current legislation relevant to the home, to include health & safety legislation. The home was being well maintained and there were no health & safety issues noted at the time of inspection. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X X 3 Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO 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. 2. Standard OP8 OP9 Regulation 17, 13(6) 13(2) Requirement Timescale for action 20/06/06 3. OP9 13(2) 4. OP25 23(2)(p)3 7 Any injury to include bruising must be clearly documented and reported. A system of stock control must 07/07/06 be in place to ensure medications are administered as prescribed and any discrepancies are promptly identified and investigated. Medications must be signed for 20/06/06 at the time of administration. Any gaps in signing must be investigated. Action must be taken to ensure 01/08/06 that all aspects of the heating system for the home are in full working order. Thereafter systems must be in place to ensure the ongoing effective maintenance of the system, thus preventing breakdown. The CSCI must be kept up to date with any failures in the heating system and the action taken to address them. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is strongly recommended that the activity co-ordinator employment hours allocation be reviewed to ensure that there are appropriate activity provision hours available to meet the needs of all service users. Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection West London Area Office 11th Floor West Wing 26-28 Hammersmith Grove Hammersmith London W6 7SE National Enquiry Line: 0845 015 0120 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 Blenheim Care Centre DS0000010926.V288617.R01.S.doc Version 5.1 Page 25 - 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. 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