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Inspection on 01/06/05 for Brockfield House Nursing Home

Also see our care home review for Brockfield House Nursing Home for more information

This inspection was carried out on 1st June 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has responded in a positive manner to the large number of concerns raised at the last inspection. New posts have been created including assistant manager and housekeeper to assist with the running of the home and a nurse consultant was employed to help bring about significant changes to the organisation of the home to improve the situation for the residents. They voluntarily stopped taking new admissions until they were able to meet the current residents needs and it is positive to note the changes made and the effect these have had both on the residents` behaviours and on staff morale.

What has improved since the last inspection?

The delivery of care has improved, care plans and healthcare records are now completed in more detail and the staff have access to the information they need to ensure residents needs are met in a consistent manner. There is good evidence of liaison with specialists including the tissue viability nurse (for pressure ulcers). The residents appear much more settled, less agitation was seen and staff were interacting and engaging with residents in a positive way. The activities have improved and a new activity organiser has been appointed, residents were seen to be encouraged to join in with both 1-1 and small group activities. Training has improved with staff reporting they are much clearer about what is expected and the organisation and leadership they have been receiving has helped them to feel better which in turn has made the residents more settled. The complaints procedure has been updated and is available in all communal areas to help people to know how to raise any concerns or worries. There have been changes to the environment to create a more homely feel and many areas have been redecorated with new furnishings and fittings purchased. Bathrooms have been updated and overall the home is clean tidy and pleasant fore the residents.

What the care home could do better:

Although the care plans are much clearer they need to monitor and ensure that staff are updating them whenever a residents needs change. There was no clear trail of the medication being received into and disposed from the home; in addition the homes policies and procedures for medication do not contain sufficient guidance for staff. There were concerns raised about the administration of medication and it was not clear if residents were getting their medication as prescribed. `Covert` medication administration was being used (when a resident is given medicine hidden in food or drink, without their knowledge) and although his may be necessary it can only be used as a last resort and with full agreement of people including the GP and families, this was not evident in this home. Residents` money is kept securely however there is no clear evidence of where the money comes from and no regular checks on the balances to ensure they are correct.

CARE HOMES FOR OLDER PEOPLE Brockfield Nursing Home Villa Lane Stanwick Northants NN9 6QQ Lead Inspector Moira Mosley Unannounced 1 June 2005 10.00 st 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 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. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brockfield House Nursing Home Address Villa Lane Stanwick Northants NN9 6QQ 01933 625555 01933 461191 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) A.G.E Nursing Homes Ltd Mrs Lesley Turner Care Home with Nursing 40 Category(ies) of DE(E) Dementia - Over 65 (40) registration, with number MD(E) Mental Disorder - Over 65 (40) of places Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of the service users is 50 and over. Date of last inspection 26th April 2005 Brief Description of the Service: Brockfield Nursing Home is located in the small village of Stanwick, close to the larger towns of Rushden and Wellingborough. The home offers care for up to 40 people over the age of 50 years with dementia or a mental illness. The home provides nursing care and has a registered nurse on duty 24 hours a day. The home is over three floors with a passenger lift and staircase for access to all areas. Communal areas including 2 lounges and a dining room are on the ground floor along with some bedrooms, further bedrooms are on the first floor and the basement level contains laundry and staff facilities. The home sits within its own grounds and gardens and residents have level access to the gardens for their enjoyment. At the front of the home there is a car park area and access to the home is either via the front door which has a flight of wide stairs with handrails or level access via a side entrance. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector and a pharmacy inspector undertook this statutory announced inspection over 5.5 hours. The care of three residents was reviewed to include their care plans and other records and those three residents were spoken to during the visit. In addition a period of observation was undertaken in the communal areas and a number of residents spoken to. Eight staff and a visiting professional also gave comments about how they found the home. This inspection was arranged following a meeting with the provider in April 2005 where the concerns of the CSCI were discussed and agreement was made for the home to have until the 30th May 2005 to meet the requirements made from the last inspection (6th April 2005) and an additional visit on the 29th April 2005 to monitor compliance with requirements made. Since the previous inspections the registered provider has provided a detailed action plan outlining how they intended to meet the requirements made and a large number of changes have taken place including environmental improvements, reviews and updates of procedures and strategies to manage the home more effectively. What the service does well: What has improved since the last inspection? The delivery of care has improved, care plans and healthcare records are now completed in more detail and the staff have access to the information they need to ensure residents needs are met in a consistent manner. There is good Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 6 evidence of liaison with specialists including the tissue viability nurse (for pressure ulcers). The residents appear much more settled, less agitation was seen and staff were interacting and engaging with residents in a positive way. The activities have improved and a new activity organiser has been appointed, residents were seen to be encouraged to join in with both 1-1 and small group activities. Training has improved with staff reporting they are much clearer about what is expected and the organisation and leadership they have been receiving has helped them to feel better which in turn has made the residents more settled. The complaints procedure has been updated and is available in all communal areas to help people to know how to raise any concerns or worries. There have been changes to the environment to create a more homely feel and many areas have been redecorated with new furnishings and fittings purchased. Bathrooms have been updated and overall the home is clean tidy and pleasant fore the residents. 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. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 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 standard(s) None of these standards were assessed on this inspection. EVIDENCE: Since the last inspection no new residents have been admitted to the home. Intermediate care is not provided in this home. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 There is an effective care plan system that needs monitoring to ensure that regular reviews and updates are made in a timely manner to direct staff action. The service users are not fully protected by the home’s medication policies or medication handling practises. This could lead to a decline in their health if medication was not administered as prescribed. EVIDENCE: Care records showed detailed assessments of needs. There was a very useful “my needs at a glance” sheet in the care plans that outlined and directed staff to key areas. Care plans were cross-referenced to risk assessments and regular reviews were evident. There was evidence of liaison with external professionals including the tissue viability nurse, psychiatric services and dietetics. The tissue viability nurse was very positive about the actions of the staff in the home and pressure ulcer prevention and care was progressing well. Pressure ulcer assessments were completed and care plans in place where indicated. There was one resident for whom staff had observed some reddening of her skin and appropriate action and referral was taken. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 10 Nutritional assessments were in place with referral to the dietician where indicated and care plans in place. There was one resident who’s nutritional care plan stated she was to have all intake monitored but there were no charts for the past 2 days, the carer on duty was unsure why they were not completed but on checking found that the nurse had discontinued them as the resident had gained weight and was eating well again. This information had not been updated. Observations showed staff interacting positively with residents and showing care to maintain their privacy and dignity especially when involved in providing personal care needs. Five service users files viewed by the Pharmacist Inspector included recently completed assessments on the risk of developing a pressure sore, risk to falls, nutritional issues, continence and moving and handling needs. These were used to produce specific care plans that gave carers clear instructions on how to deal with the service users needs. The care plans viewed enabled cares to deal with service users needs appropriately on a day-to-day basis. A service user who was assessed as “high risk” to falls, the relevant interventions had not being followed through in the care plan. The daily notes did not state he had any recent falls but described him as being “unsteady” and “assistance” was given. This service user’s risk to falls in not appropriately managed. A more in depth care plan was required which was to document whether other healthcare professionals such as a falls team were consulted along with preventative interventions carried out by the home. The medication handling policy does not cover all aspects of medication handling practises that are currently being carried out in the home. There is no guidance to deal with refusal to take their prescribed medicines or any protocol for staff to follow if covert administration is to be carried out. In addition the way to deal with medication being removed from the premises as described in the policy was different to what actually was being followed by the nurse. The home was not maintaining documentation when sending medication back to the Pharmacy for disposal. The nurse on duty stated that two service user’s medications are administered in a manner where they do not know they are taking them (Covert Administration). The nurse explained that this is carried out because the service user repeatedly refused to take their medicines. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 11 This practise of “Covert Administration” is not covered in the home’s policy. There was no entry made on the care plan to describe how this is being carried out. A copy of letter sent by the home, for one of these service users was seen, which requested GP authorisation to carry this out but there was not one available for the other. No documentation was seen on the day to state that a multidisciplinary team of health professionals agreed to the covert administration, and that a GP had given the home permission to alter the medicines in a particular way. A letter from a next of kin had been obtained, again only for one of the service users. It was concluded that inconsistencies in the home’s practises existed for dealing with Covert Administration. The Pharmacist Inspector viewed all service users current MAR sheets. In addition the previous sheets, for the five service users whose care plans were tracked, were also reviewed. Confirmatory signatures for the quantities of medicines received where not obtained on the printed sheets when they arrived from the Pharmacy. Prescribed medication is being recorded as administered according to the Prescriber’s instructions for majority of service users but there are shortfalls noted on some medication administration records (MAR). Medication is obtained in the “Monitored Dosage Blistered System” and with computerised printed 4-weekly MAR sheets. On occasions a handwritten administration sheets had been produced for a couple of service users. On one of these sheets, it was not clear which month it was referring to. Also the quantity supplied was repeatedly omitted on these sheets. For one service user, it was apparent from the annotations made by the home that she was continually refusing to take her medication. These included essential medicines. There was no information available to indicate that this had been reported to her GP. The home was requested to deal with this matter on the day of this inspection. Refusal to take medication by service users is not being dealt with consistently and appropriately at the home. Consequently service users health may decline prior to this being reported to the GP. There was evidence to indicate that there had been improvements made to the amount of un-annotated gaps on these sheets. A nurse who was appointed in a consultant role explained that two medication audits had been carried by her to identify and prevent the reoccurrence of anomalies in the administration and recording systems. The majority of sheets were noted to record administration as stated on the Pharmacy-dispensed label. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 12 All areas where medication was being stored were viewed and it was noted that access was restricted to only those who had permission to administer. This would safeguard the service users and prevent medication being used inappropriately. The shortfalls noted on the current MAR sheets and in general include the following: • Occasional doses omitted but there is no annotation made for the reason this occurred. • • Doses not given but the medication is not in the corresponding blister pack. MAR sheet annotated that the drug is out of stock at the morning drugs round but then is available for the evening round. Then this is repeated the followings 5 days. Indicating that either another service users medication was used or that a particular nurse was able to locate a backup supply. On the day of the inspection a medicine was not given in the morning round. The nurse on duty stated it was out of stock. The Pharmacist Inspector was able to locate a box for this service user in the medication trolley and a fresh supply in the back-up cabinet. Medication that administered. no longer within it’s “in use” date was being • • • • Medication was being continually ordered when it was evidenced that the service users consistently refused. The thermometer used to read the maximum and minimum temperature readings for the clinical fridge was not used correctly. These were feedback to the management team on the day of the inspection. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 Daily activities and interactions are managed well to provide residents with choice and positive engagement. EVIDENCE: There were 2 activity organisers present in the home and a detailed activity programme in place. This included games, arts, outings and one to one interactions to engage all of the residents at some time. There are a number of planned training sessions for dementia care including person centred care from Age Concern. The residents were settled and staff were seen to be spending time interacting positively and encouraging residents to engage. Most of the residents are unable to communicate more than basic needs however they were observed to be more settled than on previous visits with lots of smiling and less agitated behaviours. Mid morning snacks and the lunchtime meal were served during this visit and the systems for supporting residents through mealtimes have been changed to give both staff and residents more time to enjoy a relaxed unhurried meal with the support required. The dining room was pleasant with tables set for dinner Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 14 and a constant check maintained on the cleanliness with spills being cleaned up immediately. There were 2 residents who remained in their rooms due to ill health and this was clearly documented and staff had a system in place to ensure regular checks were made. Another resident spoken to chooses to remain in his room and he has his own keys to move freely around the home. Individual risk assessments have been put in place to identify any restrictions in place. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There is an effective system in place to ensure any concerns or complaints will be dealt with appropriately. EVIDENCE: The complaints procedure is available in communal areas and outlines clearly how a complaint could be made and included the CSCI information. There have been no further complaints received since the last inspection. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19,21 and 26 Residents are provided with safe and comfortable surroundings suitable for their needs. EVIDENCE: A programme of redecoration and refurbishment has been progressing with many significant improvements to the home. It was clean tidy and appeared more homely on this visit with evidence of renewal of furnishings and décor. The communal lounge has been reorganised to provide a more homely seating arrangement and residents were seen to be sitting looking relaxed and comfortable. The bathrooms and toilets have been upgraded and the showers in the resident’s en suites have been replaced. Staff spoke of the improvement to the environment and the better conditions for the residents; they confirmed that they have sufficient bathing facilities to meet the resident’s needs. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 17 A new post of housekeeper has been appointed and the general maintenance and cleanliness of the building, its facilities and equipment is being maintained. The laundry is clean and hygienic with systems to ensure the safe handling of soiled laundry. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 There is a proactive system in place to ensure that suitable staff are employed in sufficient numbers and with the support and training to ensure resident needs can be met. EVIDENCE: An action plan provided by the registered provider shows they intend to increase the number of registered nurses on duty to 2 during the day and offers of employment have been made to 5 new nurses including an assistant manager post, they are awaiting recruitment clearances. Staff spoken to confirmed that staffing levels have increased and there are fewer agency carers being used that helps them offer consistent care to the residents. A new member of staff was working alongside a senior carer as part of her induction and she confirmed a detailed recruitment process including the uptake of references and criminal records bureau (CRB) clearance prior to commencing employment. Staff commented positively about recent changes and they felt the support and organisation of the home has greatly improved things and morale is better. Comments included “feel more confident that things are getting done and the residents are more settled” and “… much improved recently, new systems in place and better support, its less stressful”. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 19 The training programme shows that a range of training has been arranged for both statutory training and further development of staff skills and knowledge including dementia care. The staff spoken to were aware of the training planned and were positive about the outcomes. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 37 and 38 The residents’ money is not safeguarded due to the lack of a clear audit trail. There are effective systems in place to ensure that residents’ health and safety is not compromised. EVIDENCE: The residents’ money is kept in a locked tin within the office and individual records are maintained. The records were not regularly reviewed to check the balances of money retained. There were no receipts to evidence where money came from and on some occasion’s only one signature against a transaction. Manual handling plans were available in care handling procedures showed appropriate use required. Staff confirmed they have received including manual handling, food hygiene and Brockfield Nursing Home plans and observations of manual of equipment and aids as statutory training in all areas fire. Version 1.30 Page 21 D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Policies and procedures have been updated and staff confirmed they have received copies of key procedures and they feel they are working in a more consistent manner. Fire records showed regular checks and maintenance of the systems and regular fire drills. A first aid qualified staff member is available on all shifts. A maintenance person has been employed to oversee all regular maintenance and compliance with health and safety legislation. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 2 x 3 3 Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 23 no 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. 1. 2. Standard 7 9 Regulation 12(1)(a)( b) Requirement Timescale for action 30/7/05 3. 9 4. 9 5. 35 Falls risk assessments must be completed and all interventions recorded. 13(2) The medication policy must 30/7/05 cover guidance to staff on how to deal with refusal to take prescribed medication (include whether to rmove from blister) and a protocol for the consideration of Covert administartion 13(2) and Medication received and 30/7/05 17 removed from the premises must (1)(a)(3)(i be recorded ) 13(1)(b) Covert administration must only 27/6/05 and 13(2) occur after prescribers authoriation and via approval from multidisciplinary team as set out in the RPSGB guidelines and NMS code of practice. 17(2) A clear audit trail including 30/7/05 Schedule receipts and signatures must be 4(9) available for residents money received into the home. Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 24 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 7 9 9 Good Practice Recommendations Changes to resident needs should be recorded in the care plan to ensure consistency of action by staff. All staff shoould be retrained on the acceptable standards for recording whether a medicine was administered or not. Frequent medication audits should be continued to ensure medication os givn as prescribed. The homes management team may consider dealing with poor practice as a disciplinary issue. it is recommended that all staff receive a refresher session delivered by the supplying pharmacist about Manrex blisters. All Service Users medication profiles should be completed in the indivisual care records. 4. 5. 9 9 Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB 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 Brockfield Nursing Home D C51 C08 S12603 Brockfield House V230319 010605 Stage 4.doc Version 1.30 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. 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