Inspection on 09/08/07 for Bradbury House

This inspection was carried out on 9th August 2007.

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

Bradbury House 27/10/06

Bradbury House 21/02/06

Bradbury House 31/08/05

Bradbury House 18/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Bradbury House Windsor End Beaconsfield Bucks HP9 2JW Lead Inspector Joan Browne Unannounced Inspection 9th August 2007 09:30 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 Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradbury House Address Windsor End Beaconsfield Bucks HP9 2JW 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) 01494 671780 01494 672533 wendy.s@bradburyhouse.co.uk The Abbeyfield Society Limited Mrs Wendy Stallwood Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Frail Elderly Date of last inspection 27th October 2006 Brief Description of the Service: Bradbury House is a purpose built residential home registered to provide care for up to forty-one elderly people. It is situated in a pleasant residential area of the old town of Beaconsfield, close to local shops, market place and the Church. There are transport links to the local towns such as High Wycombe and Amersham. The home provides comfortable accommodation for service users in single bedrooms and spacious social areas. There are accessible attractive and wellmaintained gardens. Car parking is available to the front of the home. The local Abbeyfield Beaconsfield Society is responsible for the Management of the home and provides a House Committee. Service users are registered with local General Practitioners’ (GP) surgeries and have access to local National Health Services through GP referral. The current fees payable for this service range from £602.31 to £692.31 per week. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’ and was carried out over one day. The inspector spent approximately six hours in the service and looked at how well the service was doing. The inspection took into account detailed information provided by the service’s manager Comment cards were sent to some residents their relatives and health and social care professionals. At the time of writing this report response to comment cards were received from two relatives, two residents and one health care professional. Their views and the views of residents and staff who were spoken to during the inspection are reflected in this report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Care plans were examined, which was followed by meeting with the individuals to see if the plan matched the assessed care needs. The medication system and accompanying records were examined along with staff rosters, staff recruitment files, training records and health and safety records. A tour of the premises was carried out and some time was spent meeting with residents and staff. From the evidence seen it was considered that the home was providing a good service to meet the diverse needs of individuals of various religion, race and culture. The inspector would like to thank everyone who assisted in this inspection in any way. What the service does well: The home ensures that prospective people to use the service needs are assessed to ensure that they diverse needs can be met. The home has systems in place to ensure that the health and personal care of people using the service is based on their individual needs. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 6 The home provides a variety of activities to ensure that people using the service have a range of opportunities to participate in stimulating and meaningful activities. The home ensures that people using the service maintain contact with family, friends and the local community. The home ensures that people using the service are provided with wholesome and nutritious meals, which are well presented and served in pleasing surroundings. The home ensures that people using the service have access to an effective complaints procedure and there are policies and procedures in place to protect them from any potential abuse. The home ensures that people using the service live in a well-maintained environment that is clean, pleasant and hygienic. The home ensures that people using the service are cared for by staff that are trained skilled and appropriately recruited. The home has systems in place to ensure that it is run in the best interests of people using the service. What has improved since the last inspection? The dining room and lounge areas have been redecorated to improve the ambience and to further enhance the physical appearance of these areas. People using the service have been empowered to look after the flowerpots in the garden to maximise their independence. The home has reviewed the assessment documentation, which is more detailed and forms the basis of individuals’ care plans. Care staff have undertaken training in report writing and record keeping which has improved the content of the daily report writing. To ensure that the garden is safe and accessible to people using the service, the patio area has been extended and a new gazebo purchased. The lighting in the corridors has been further enhanced to facilitate people using the service safety. The kitchenettes areas have been refurbished to enhance their appearance. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 7 The home has appointed an administrator to assist managers with administrative tasks. The home has addressed the dissatisfaction amongst a small number of people using the service relating to meals provided and has ensured that individuals’ needs and preferences are fully catered for. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 8 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 Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the 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’s assessment process ensures that positive outcomes are achieved for people using the service and the facilities provided meet individuals’ diverse needs. EVIDENCE: Case tracking confirmed good practice. All prospective residents have a preadmission assessment, which is undertaken by a manager or a senior carer. Individuals are encouraged to visit the home as often as they feel the need to enable them to experience what the home provides. One resident spoken to can remember receiving a copy of the home’s statement of purpose and an information pack. She also said that she had Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 10 visited the home several times before deciding to take up the placement. described staff as ‘patient and always available to answer any queries.’ She A second resident spoken to said that his daughter had made all the arrangements for him to be admitted and was very happy with the service. Three staff spoken to were able to describe the admission’s procedure and the importance of making sure that new residents were made to feel welcome. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to ensure that the health and personal care of people using the service is based on their individual needs and that they are treated with respect and their right to privacy is upheld. EVIDENCE: Residents’ plans showed signs of improvement and were generally complete. Two residents said that they contributed to their care plans. Plans seen contained specific information relating to individuals’ diverse needs with detailed action planning how needs should be met. Wherever possible, care plans were signed by individuals or their representatives. There was evidence that plans were reviewed monthly. Risk assessments relating to moving and handling, falls, mobility and tissue viability were in plans seen. It was noted that the nutritional risk assessment format was being reviewed. Staff spoken to were able to describe the care provided to individuals. Relatives who responded to the Commission’s comment cards were confident that the home Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 12 was meeting the needs of their relative and that they were ‘always kept updated with important issues affecting their care. For example, if they had been admitted to hospital or had an accident. All residents have access to health care services and were registered with a general practitioner. Some residents who are able to were encouraged by the staff to be independent and make their own arrangements to see the general practitioner when required. The home maintains medical intervention forms for individuals that record all visits undertaken by health care professionals. Professional advice about the promotion of continence is sought and acted upon and aids and equipment needed are provided. On the day of the inspection the general practitioner (GP) carried out a follow up visit on a particular resident. The individual said that she was pleased to see the GP and had confidence with the medical treatment that was being provided. The home uses a monitored dose medication system. The medication administration record (MAR) sheets for two of the groups were checked and no unexplained gaps were noted. The records for the receipt and disposal of medication were clear and accurate. The controlled drug register was checked and tablets in stock corresponded with records. It is recommended that staff should record their full signature and not initials in the controlled drug register to ensure that entries and signatures are clear and legible. It was noted that medicines for external use such as creams and lotions were stored with oral tablets and liquids. In the interest of safety the practice should be reviewed to ensure that they are kept on a separate shelf. There was a system in place to ensure that MAR sheets are monitored weekly. It was noted that carers had attended updated medication training. Some handwritten entries had been made on some MAR sheets examined and they were not countersigned by a second staff member to make sure that they were correct. This practice has the potential to put residents at risk. Individuals who are able to were being supported by the home’s staff to self-medicate with the appropriate risk assessment in place. Residents reported that their privacy and dignity were respected and staff were observed interacting with residents in a courteous and sensitive manner. Individuals’ preferred term of address was recorded in care plans seen. Residents’ attire was clean and tidy with attention to detail and some residents were enabled to wear their jewellery. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There are a variety of activities within the home to ensure that people using the service have a range of opportunities to participate in stimulating and meaningful activities. Meals provided are of a high standard, wholesome and appealing and are served in pleasing surroundings. EVIDENCE: The home’s daily routine is flexible to meet residents’ diverse needs and wishes. The home employs a part-time activity organiser who works thirty hours a week over five days. The activity organiser was spoken to and she confirmed that residents’ interests were recorded in their care plans and time is spent with individuals on a one to one basis exploring what they would like to do to ensure that each person’s social, cultural, religious and recreational needs were catered for. A weekly calendar of events is circulated to each resident to enable them to choose what they wish to participate in. In addition the weekly programme of activities is circulated in the home. Residents spoken to said that they were Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 14 able to choose what activity they wished to participate in. On the day of the inspection residents participated in a church service in the morning and a game of skittles in the afternoon. It was noted that the home’s activity centre was nearly completed. The deputy manager said that residents were involved and consulted about choosing the fabric and décor for the centre. The home does not have any restrictions on visiting. Relatives and friends are encouraged by staff to visit and play an active part in residents’ lives. Residents said that their visitors were made to feel welcome by staff and there were facilities provided for them to make refreshments if they wished to. One particular resident spoken to was looking forward to his birthday party, which was imminent. He had invited the entire staff team along with family members and friends to join him in celebrating his special birthday. A number of residents do not need any support to go out and own their own vehicles. From discussions with staff members it became apparent that residents are encouraged to exercise control over their lives and to maximise autonomy and choice. They are encouraged to bring personal possessions and furniture to personalise their rooms. There was no resident on the day of the inspection that was using the services of an advocate. Relatives who responded to the Commission’s comment card said that the service ‘always’ or ‘usually’ support individuals to live the life they choose. The following additional comments were noted: ‘Bradbury House does not regiment its residents, but gives them the freedom to participate in community life or to keep themselves to themselves as they choose. Residents are also encouraged to maintain their independence and are free to go out as they wish.’ The manager said that residents’ views on meals and menus were continually sort. The menu seen was varied to ensure that individuals’ likes and dislikes were catered for. The chef manager spends time with residents to ascertain their preferences. At the last inspection a requirement was made for the home to address residents’ issues about meals. It is pleasing to report that the requirement had been complied with. Residents spoken to said that ‘they were happy with the meals provided.’ They also said that an alternative would be provided if they did not like what was on offer. The following comments were noted: ‘The meals are very good and there is always a choice.’ Residents were able to have their meals in their bedrooms or the dining area. Lunchtime seemed a relaxed and social occasion. Staff were available to offer assistance in eating to individuals discretely and sensitively. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use the service are able to express their concerns and have access to an effective complaints procedure. There are policies and procedures in place to protect them from any potential abuse. EVIDENCE: The home has a complaints procedure and each resident is given a resident’s handbook, which contains information on how to make a complaint. Residents and relatives who responded to the Commission’s comment cards said that they knew how to make a complaint and the home was responsive to complaints. The home keeps a record of all complaints that are made including any response and actions taken. To date the home had not received any formal complaints since the last inspection and no complainant had contacted the Commission with information concerning a complaint made to the service. No allegations of any suspicion or evidence of abuse or neglect had been reported to the Commission about the service since the last inspection. Discussions with staff regarding their understanding of the safeguarding adult procedure confirmed that they had undertaken training. The home has policies and procedures for safeguarding adults in place to support staff’s Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 16 practice. Staff were aware of what action should be taken if they suspected or witnessed a resident being abused. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People, who use the service live in an environment that is safe, clean, pleasant, hygienic and well maintained to meet their diverse needs. EVIDENCE: The home is purpose built and provides a homely, safe, clean and comfortable environment for residents to live in. There is a programme of routine maintenance and renewal of the fabric and decoration of the premises in place. Residents are consulted about the décor in the home and are able to request changes if they wish for the colour scheme in their rooms to be changed. Grounds were tidy, safe attractive and accessible to residents. All the bedrooms are single with en suite facilities and were equipped with a wide range of equipment and aids to assist residents with specialised needs and to promote maximum independence. Residents are encouraged to move Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 18 in with their own furniture and possessions. Bedrooms seen were personalised and reflective of the individuals’ characters. The home has five bathrooms, which are adapted to meet the needs of individuals with physical disabilities. There are a number of communal areas where residents can sit in private with their friends if they wish to or be actively engaged with other people who use the service. Each wing has its own kitchenette for residents and relatives to use as and when required. The main kitchen was well maintained and equipped to allow for the provision of catering for the residents. On the day of the inspection the home was clean hygienic and free from offensive odours. The laundry room floor and walls were clean. It was noted that the home had a laundry facility with an ozone washing system, which the manager said was extremely effective and helped to minimise the risk of cross infection. Residents and relatives who responded to the Commission’s comment cards said that the home was ‘always ‘ fresh and clean. Additional comments noted were as follows: ‘Bradbury house is a relatively new purpose-built home with good accommodation and spacious common areas. It has an attractive convenient and peaceful location with pleasant gardens.’ Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home ensures that staff are trained skilled and appropriately recruited to care for people using the service diverse needs. EVIDENCE: From discussion with residents and staff it was evident that the staffing numbers and skill mix of staff were appropriate to meet residents’ diverse needs. The manager said that seven staff were rostered to work in the morning. The number is reduced to six in the afternoon and three at night. Information submitted in the home’s annual quality assurance assessment (AQAA) reflected that twenty-two of the thirty –six care staff employed by the home had achieved national qualification (NVQ) in direct care at level 2 and 3. The file for the most recently recruited staff member was examined. It was found to contain all the information required by the legislation to ensure the safety of the residents. It was noted that the home had introduced a new recruitment and selection process. Residents and staff were on the interviewing panel allowing them to give their views on the suitability of prospective staff members. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 20 Staff spoken to were clear about their roles, knew what was expected from them and showed a good understanding of the actions they needed to take to meet and promote equality and diversity. The training records examined indicated that all staff were receiving mandatory training updates and other specialist training on a rolling programme basis to meet residents’ basic needs and to improve their practice. Relatives who responded to the Commission’s comment cards said that the home’s staff ‘always’ or ‘usually’ have the right skills and experience to look after people using the service. The following additional comments were noted: ‘The management and supervisory staff generally seem to do a sound, professional job and observation suggests that ongoing training is provided for staff.’ ‘The staff generally give the impression of being willing to put themselves out to help the residents.’ Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the 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 management and administration of the home is based on openness and respect. Effective quality assurance and health and safety systems are in place to ensure that people using the service health, welfare and safety were protected and promoted. EVIDENCE: The registered manager is a trained nurse and holds the registered manager’s and assessor awards qualification. She is competent and experienced to run the home and has been working at the home for approximated thirteen years. A deputy manager, a senior team and an enthusiastic group of care and ancillary staff along with an executive committee support the manager with the Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 22 day- to- day operation of the home. There were clear lines of accountability within the home. Members of the executive committee are all volunteers with a sound knowledge of financial, operational and business planning to ensure effective budgetary control of the service. Staff said that the manager communicated a clear sense of direction and leadership and they were actively encouraged to be involved in all aspects of the running of the home. Regular staff and residents’ meetings take place to enable individuals to express their views on the running and development of the home. The home has an annual development plan that is based on a system of planning, reviewing and reflecting outcomes for the residents. Annual quality audits are carried out. The results are analysed and an action plan is developed to address any issues raised. The organisation ensures that monthly regulation 26 visits are carried out and the home receives a written report of the outcome of the visit. The home was recently re-assessed and has maintained the Investors in People award. The home is responsible for the safe keeping of a small amount of some residents’ money. Written records of all transaction were being maintained. Two residents’ records were checked and found to be in good order. Examination of a sample of health and safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals to maintain the home as a safe and risk free environment for residents. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X X X X X 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 X 3 X X 3 Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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. 2 3 Refer to Standard OP9 OP9 OP9 Good Practice Recommendations Staff should record their full signatures when recording entries in the controlled drug register to ensure that entries and signatures are clear and legible. In the interest of safety medication for external use such as creams and lotions should not be stored on the same shelf with oral medication. Handwritten entries on the medication administration record sheets should be checked and countersigned to make sure that they are correct and to minimise any potential error. Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bradbury House DS0000019182.V348326.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!