Inspection on 10/11/05 for Bluebirds Nursing Home

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bluebirds Nursing Home 31/07/07

Bluebirds Nursing Home 25/09/06

Bluebirds Nursing Home 14/07/05

Bluebirds Nursing Home 25/01/05

Bluebirds Nursing Home 23/08/04

Bluebirds Nursing Home 05/01/04

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

CARE HOME ADULTS 18-65 Bluebirds Nursing Home Faraday Drive Shenley Lodge Milton Keynes Bucks MK5 7FY Lead Inspector Gill Wooldridge Unannounced Inspection 10th November 2005 10:00 Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 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 Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 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 Adults 18-65. 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. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bluebirds Nursing Home Address Faraday Drive Shenley Lodge Milton Keynes Bucks MK5 7FY 01908 234092 01908 233901 debbie@pjcare.co.uk 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) P J Care Limited Mr Peter Flawn Ms Deborah Cank Care Home 22 Category(ies) of Dementia (22) registration, with number of places Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mental Health Nursing Care - 40 years plus Date of last inspection 14th July 2005 Brief Description of the Service: Bluebirds is a small nursing home opened in May 2001 by the present owner. The home provides 22 beds, for younger and older people with complex physical and mental health needs brought about by cognitive impairment. Eighteen of the rooms are single bedrooms and two are shared. All eighteen bedrooms have en-suite facilities. The garden is designed to meet the needs of residents. The home is close to public transport links and has its own transport to facilitate residents social activities. The home is situated in a residential area of Milton Keynes which has all the facilities that a modern city can provide. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place at 10am until 3.00 pm on 10th November 2005. The inspection was carried out by two inspectors, Joan Browne and Gill Wooldridge, and consisted of a tour of the home, although most bedrooms were observed from the corridors. Two care plans were studied and the care of residents tracked which led to the studying of a further care plan. Residents and staff were spoken to and lunch was observed. The manager, responsible individual and the clinical nurse made contributions to the process of inspection. The requirements set at the last inspection were discussed and on the whole these issues were met or are in the process of being met. There are some outstanding issues. It is noted that the home has met many of the standards assessed with some shortfalls in a small number of areas. The care observed and described by residents, staff and relatives was of a high standard, this is supported by a well trained work force. The home has an established staff team which has a range of skills to support residents. What the service does well: The manager stated and it was noted that residents and staff have developed positive relationships and staff are trained and supported to ensure that the care of each is tailored to meet their needs. There is a holistic approach to care with an emphasis on affection. Residents receive a quality service, this was confirmed by relatives, observations, and the detail recorded in some care records. There is an emphasis on training and personal development for all staff. The home promotes staff development through internal promotion. Staff are supported through supervision and mentoring. The care observed and described by residents, staff and relatives was of a high standard this is supported by a well trained work force. The home has an established staff team with a range of skills to support residents. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The responsible individual must produce a report and send to the Commission under Regulation 26 visits which identify areas of improvement and action plans. Residents and staff must be supported to ensure that there is no implied financial impropriety. Where staff hold residents ‘PIN’ numbers this must be discussed with social workers and or social services departments. Details of all correspondence must be maintained for inspection purposes. It was confirmed by the manager that an advocacy agency has been contacted but paper work regarding this matter was not shown to the inspector. Care plans must identify all needs and issues of recording practice addressed formally. Care plans and medication procedures must be supported by audit systems with records maintained for inspection purposes. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 7 Medication audits must be developed to address any issues identified for example,staff scribbling over entries and these matters addressed with records maintained for inspection purposes. 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. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Care plans are in place which on the whole enable staff to appropriately support residents in line with their assessed needs and personal goals. All care plans must contain identified needs to support residents care. EVIDENCE: Two care plans were studied and the residents’ care was tracked leading to a further care plan being studied. Care plans covered areas such as personal care, nutrition, incontinence, diabetes, and social activity. The care plans studied were on the whole clear documents. However, the quality of the care plans was noted to be dependent on the authors. It is required that the manager ensure that care plans contain all identified needs for example, in the daily log staff described caring for a resident’s toe and that the individual was prone to ‘tissue ulcers’. It was noted that staff were applying Cavalon spray, however, this information was not detailed in the care plan. Senior nurses described regular communication with the tissue viability nurse which is noted as good practice. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 11 It is imperative that care plans are written with a positive slant. For example one care plan indicated that the resident was at times ‘demanding and impatient’ this is not objective and does not indicate that the resident is appropriately respected. In one care plan the sections within the document did not interrelate. One entry dated 10/8/04 stated ‘Dietician and speech therapy visit regularly to be weighed weekly needs full assistance to take food’. Other parts of the care plan did not indicate that this was taking place as weights were recorded monthly. A further entry stated on the 3/11/05 ‘please weigh weekly’. It was not evident that this instruction had been carried out as the last entry on the records seen was Weight ’Oct 2005 42.2’. This entry is unhelpful as it doesn’t give the full date. The manager stated that weights had been carried during the morning of the inspection. It was recommended at the previous inspection that that residents suffering with diabetes should have their blood pressure checked and recorded monthly. From going back through the daily log it was generally noted that this was taking place however, if a nurse was trying to monitor the blood pressure readings this would prove difficult to do as the record was not on a separate sheet and these records were in the process of being archived. One care plan described ‘ observe for signs of distress during eating and treat accordingly. This entry may not be clear if the reader was a new member of staff. Care plans did not always confirm all residents likes and dislikes. Although dislikes of food were noted on one assessment. Good practice examples noted included clearly described approaches to residents and step by step instructions which would facilitate good care if the reader was a newly appointed member of staff. one care plan detailed that a residents oral care must be carried out at least four times a day and in between as required. The manager stated that training and support in care planning for staff is ongoing and an audit system is in place to ensure an overall standard for the home. The audit system appears to depend on a system of staff supervision with no apparent follow through system. The manager and senior nurse acknowledged that this is an issue which needs to be addressed. It is acknowledged that care plans are evaluated monthly and on the whole signed by staff and dated. Residents and relatives signatures were not evident on the care documents seen. However, residents and relatives spoken to confirmed being involved in decisions regarding the care. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 12 Reviews and consultation with a range of health professionals employed by the company support the care. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 16 & 17 Residents are presented with opportunities to access leisure activities both in house and in the wider community. Interactions between staff and residents indicate that residents rights and responsibilities are recognised. Residents are encouraged to develop the menus in consultation with the chef which should promote independence and choice. EVIDENCE: Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 14 Activities described by residents included small group activities, in house, and individually based ones. Residents described going to the shops and visiting a lake to feed the ducks, trips into the city and going out for meals. Three residents were sat watching the television and two residents were playing a board game and another was blowing up balloons. One resident had desiged a poster to remind football fans of the England match at the weekend. Interactions between residents and staff were noted as natural and comfortable with positive body language and lots of touching. The manager has a young puppy dog that visits the home. This was noted to have a positive effect on residents who asked to take him for a walk. The home has its own transport along with a team of activity organisers who facilitate activities. Relatives spoken to confirmed that they are encouraged to visit the home and are involved in the care of their relatives. They also confirmed that the home is welcoming and has flexible visiting times. Relatives confirmed that staffing levels are constant and the care for the residents is good. The lunchtime meal was relaxed with choices, portions were large and attractively presented. Observed practice at lunchtime was sensitive and discreet, staff sat next to residents encouraging residents to respond, this included picking up on residents body language, and lots of positive reinforcement. The responses from residents included smiles and positive eye contact. Residents and staff interactions showed mutual respect and good humour. Observations of staff indicated their awareness of other residents’ needs in close proximity to them. A relative had raised concerns at the last inspection regarding the consistency of the soft diet. The relative confirmed that the manager had been working to address this concern. Unfortunately it was noted that staff were still using two bowls, one to dispose of food and a further bowl to place used cutlery in. This practice was more discreetly handled than at the previous inspection. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 & 20 Medication procedures are in place however, good recording practice must be reinforced and supported by developments in the homes quality audit system. These measures must be in place to protect residents. EVIDENCE: It was noted that all personal care was carried out in bathrooms and bedrooms which helped to maintain residents’ privacy and dignity. There was some evidence of one resident being distressed during the inspection, staff were very attentive and supportive to this resident. They were seen to be calm and reassured the resident. Some evidence was seen in care plans which would indicate that residents physical and emotional needs were being met. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 16 The Medication Administration Records sheets studied showed some inconsistencies with a number of entries scribbled over. Staff must be reminded that they should place a line through the entry and there explanation should be at the bottom or reverse of the MAR sheet. Some staff were not being consistent in use of codes when residents were prescribed PRN medications. For example some staff were using ‘o’ code whilst other staff were leaving the box blank. A review of staff practice should ensure inconsistencies are not the norm. Trained nurses must again be reminded of their accountability relating to the Nursing and Midwives Council (NMC) Code of Conduct. Records must be kept of these discussions and maintained for inspection purposes. A more frequent formal quality audit of Medication Administration Records sheets, which is recorded should ensure that errors are kept to a minimum. Staff must be reminded that when they are administering liquids it is advisable not to administer over the MAR sheet. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The manager is approachable which should encourage residents and their relatives to voice any concerns. The responsible individual and manager must ensure that residents and staff are protected by thorough consultation with Social Services relating to the holding of residents ‘pin’ numbers. EVIDENCE: Records regarding an ongoing concern were perused. These records must be available for inspection purposes at all times. The communication indicted that the issue has been handled satisfactorily although advics was given during the inspection with regard to this matter. Two residents’ personal records of money (personal allowance) were studied which tallied with the small amounts of money held in the home. It is of concern that staff still hold residents ‘PIN’ numbers, the manager and proprietor need to explore this further with Social Services to protect residents and staff. The responsible individual confirmed that he had contacted an advocacy service to support the process however, no documentation was produced regarding this matter. This requirement was set at the previous inspection and the responsible individual must write to the Commission explaining why this requirement has not been fully met within two weeks of receipt of this report. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The environment including the garden has been designed to ensure that residents reside in an environment that meets their care and comfort needs. Standards of cleanliness in the home are good which should ensure that residents live in a clean home protecting their health, safety and welfare. EVIDENCE: The home was purpose built in 2001 with 20 bedrooms, 18 single and 2 shared. All bedrooms have en-suite facilities. There are bathrooms and shower rooms at each end of the building. The gardens are well maintained and landscaped with clear pathways to support residents. A tour of the building took place with bedrooms viewed from the corridor. Furniture and fittings are of a high standard. Pictures displayed added to the ambience. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 19 The standard of housekeeping was high and there was no odour. The housekeeping staff are to be commended for the cleanliness of the home. It is noted that the home has a warm friendly atmosphere, which is facilitated by the residents and staff. A number of aids and adaptations were noted which have been detailed in previous reports. At the previous inspection the hot water tap in the staff toilet was recorded at 56 degrees centigrade. Since the previous inspection the manager has displayed a hazard sign to warn staff that the water is very hot. To aid infection control the manager has replaced the waste bin in the staff toilet with a pedal bin. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Recruitment procedures at the home appear robust which should ensure that residents are appropriately protected. Staffing levels as indicated on the rota and during the inspection, should benefit residents’ care. EVIDENCE: From observing staff practice and their interactions with residents it was noted that staff have a clear understanding of their roles and responsibilities. Throughout the inspection staff were observed smiling, this was noted as having a positive effect on residents. From observing staff practice throughout the inspection it was clear that staff were not phased by the inspection process. It was noted that there is an emphasis on individual care and it appeared that needs are being met. It was noted that the staff team appeared to be sufficient in number, skills and experience to meet the needs of residents. Staff training was clearly indicated by discussions with staff and ongoing support including promotion for hard work. Staff described their roles and responsibilities clearly and from observing their practice it is evident that they can meet residents needs. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 21 Two staff personnel files were sampled, one of the staff had recently arrived from South Africa, both files contained the required information including CRB and two references. Work permits were in place where appropriate along with health declarations and job offers with terms and conditions. It is recommended that the manager holds photographic identification of each staff member. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Systems are in place, however records indicate recording is not in line with the Regulations this has the potential to place residents at risk. EVIDENCE: Following discussions with residents and relatives it is evident that their views are important to the management and that their views underpin the care of residents. It is recommended that the manager develop further the home’s quality audit systems involving residents and staff in the processes. In recent months the responsible individual has not sent to the Commission Regulation 26 reports. This is a requirement of this report. Some records regarding health and safety were not available in the home or not completed for example, no records were available for fire equipment checks for August and October. The manager confirmed that these checks had Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 23 taken place. Records pertaining to the hoists were also not available in the home. The responsible individuals and manager are required to ensure that all records pertaining to the home are kept in the home. Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bluebirds Nursing Home Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000019180.V265047.R01.S.doc Version 5.0 Page 25 YES Are there any outstanding requirements from the last inspection? 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. 2. Standard YA20 Regulation 13 (2) Requirement The manager must ensure that she develops further the audit systems to ensure staff inconsistencies on MAR sheets do not occur. Records must be maintained relating to addressing these issues with staff. (Previous timescale of the 31/10/05 not fully met.) The manager and responsible individual need to explore further with Social Services systems to protect residents finances. (Previous timescale of the 31/10/05 not fully met.) All residents identified needs must be supported by a care plan. Instructions must be followed through and supported by regular assessments. The responsible individual must ensure that Regulation 26 reports be sent to the Commission on a monthly basis. The manager must ensure that all records pertaining to health and safety be available in the home for inspection purposes. Timescale for action 31/03/06 4. YA23 13 (6) 31/12/05 1 YA6 14 (1) & 15 (1) 31/05/06 2 YA42 26 31/12/05 3 YA42 13 (4) 31/12/05 Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 26 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 YA6 Good Practice Recommendations It is strongly recommended that the manager develops a quality audit system and supports staff practice with ongoing support and training to ensure an overall standard for the home and that documentation contained within the care plan interrelates. It is recommended that the manager ensures that residents suffering with diabetes have their blood pressure taken and recorded monthly on a sheet that staff are able to readily refer to. It is strongly recommended that the responsible individual and manager review the process of disposing of food at meal times to give the home a less institutional feel. 2. YA6 3. 4. YA17 YA19 Staff must be reminded that when they are administering liquids it is advisable not to administer over the MAR sheet. It is strongly recommended that the manager should ensure staff practice is consistent when they use codes when residents are prescribed PRN medications for example, some staff were using ‘o’ code whilst other staff were leaving the box blank. It is recommended that the manager holds photographic identification of each staff member.. 5. YA19 6. YA34 Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Bluebirds Nursing Home DS0000019180.V265047.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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