Inspection on 17/04/07 for Brocklehurst Nursing Home

This inspection was carried out on 17th April 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

Brocklehurst Nursing Home 15/04/08

Brocklehurst Nursing Home 31/10/06

Brocklehurst Nursing Home 11/02/06

Brocklehurst Nursing Home 04/08/05

Brocklehurst Nursing Home 09/01/05

Brocklehurst Nursing Home 15/07/04

Brocklehurst Nursing Home 05/02/04

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

CARE HOMES FOR OLDER PEOPLE Brocklehurst Nursing Home 65 Cavendish Road Withington Manchester M20 1JG Lead Inspector Geraldine Blow Unannounced Inspection 17th April 2007 10:00 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 Brocklehurst Nursing Home DS0000021635.V334239.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. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brocklehurst Nursing Home Address 65 Cavendish Road Withington Manchester M20 1JG 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) 0161 448 1776 0161 434 3795 sharon.blackwell@anchor.org Anchor Trust Ms Cathryn Todd Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of patients for whom accommodation is provided at any one time shall not exceed 40 patients of either sex over pensionable age 31st October 2006 Date of last inspection Brief Description of the Service: Brocklehurst is a purpose built care home of 41 beds providing care for people over the age of 60 years. The home is on two floors with a passenger lift between the two floors. Accommodation is provided in 31 single and 5 double en-suite rooms with a variety of communal space for residents to use. The home is situated in West Didsbury on the site of the old Withington Hospital. The home is situated on a reasonably busy road used by local traffic. The centre of West Didsbury is about a quarter of a mile away. Main roads giving ready access to Manchester and the motorway network are close by. The charges for fees range from £444.40 to £710 per week. There are additional charges for magazines, papers hairdressing and holidays. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 31 October 2006 and supporting information received in the Pre Inspection Questionnaire submitted by the home prior to this visit as well as several returned resident comment cards. This visit forms part of the overall inspection process and took place on Monday 16 April 2007. The opportunity was taken to look at all the core standards of the National Minimum Standards (NMS). This inspection was also used to decide how often the home needs to be visited to make sure that it meets the required standards. As part of the visit time was spent talking with the home’s manager, the deputy manager, several residents, a visitor to the home and some members of staff. Time was also spent observing how staff work with the residents, assessing relevant documents and files and a tour of the premises was undertaken. What the service does well: Brocklehurst offers a clean and pleasant environment for the residents who live there. All received residents comment cards indicated that the home was usually clean and fresh, as did residents and a visitor spoken to during the inspection visit. The home provides a good standard of care from a well-trained and committed staff team. Staff were seen to be kind and patient with residents when carrying out their duties. One comment from a relative stated, “I am constantly impressed by the level of care given to my wife.” From observations made and from talking to residents and staff it appeared that the privacy and dignity of residents was protected and that residents were able to have choice with regard to their every day life. One resident spoken to said that “staff seem very kind and look after the residents very well.” The home carries out a pre admission assessment before a resident is admitted to the home to make sure that the home can meet the person’s needs. The residents spoken to said that there was a choice of meals at each mealtime and were complimentary about the standard of the meals. All residents spoken to confirmed that they could have a drink or a snack whenever they wanted. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 6 The home continued to offer a good programme of activities. One resident said she particularly enjoyed the arts sessions and another resident and her visitor said that the concerts on a Tuesday afternoon and exercises on a Wednesday were very good. The home offered training for staff to ensure that they had the necessary skills to meet the needs of the residents accommodated and carried out a robust recruitment procedure to ensure the staff employed are safe to work with residents. What has improved since the last inspection? 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. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 intermediate care is not provided at Brocklehurst). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes an assessment of prospective residents’ care needs prior to their admission. EVIDENCE: The home continues to have a documented pre admission assessment form that is used to ensure that prospective residents are only admitted on the basis of a full assessment and the manager said that for residents who are referred through Care Management arrangements the home obtains a summary of the Care Management Assessment. At the previous inspection it was recommended that following the pre admission assessment of a prospective resident the home confirms in writing to the resident that the home is able/not able to meet their assessed needs. The manager said that this recommendation had not been met but that she would implement a system to meet the recommendation. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 9 The home does not provide an intermediate care service Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New care plan documentation was in the process of being implemented to ensure that residents’ health and personal care needs are fully assessed. The administration of medication appeared safe, although some shortfalls were identified. EVIDENCE: Since the last inspection the care planning process had been reviewed and new documentation was in the process of being completed for each resident. The manager and deputy manager said that once the paperwork was completed for every resident staff training would be provided and then the new system would be implemented. It was anticipated that implementation would be in approximately 6 weeks. The deputy manager said that once the new system had been fully implemented regular audits would be undertaken. A random selection of the new care plans were examined. They were seen to be much improved and the files were well organised, well maintained and divided into relevant sections, which made them easy for staff to use daily as a Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 11 working tool. Care plans included the pre-admission assessment, which identified the needs of residents. The plans of care were found to be detailed, informative and clearly set out the action that needed to be taken by staff to ensure that all aspects of health and personal care needs of the residents are met. In addition the care plans maintained the dignity and independence of the residents. Of the new care plans examined evidence was seen of consultation with the resident. Risk assessments had been included, however it was noted that the risk assessments relating to the use of bed rails did not address the risk of using the bed rail but only the risk of the resident falling from the bed. A recommendation was made in the previous inspection report that all residents have a continence assessment on admission. This recommendation had not been met. However following a discussion with the deputy manager she assured the inspector that this would be included in the new care planning process. Staff were observed delivering appropriate care and support to a number of residents in the home and it was evident that staff had a good understanding of individual care needs. From observations made during the inspection and from talking to residents it appeared that the nurses and care staff treated the residents with respect and dignity. Medication Administration Record Sheets (MAR) were examined. Some medication for example creams and enemas had been prescribed, ‘apply to affected area’, ‘as directed’ and ‘apply each day’. Although the nurse was able to clearly describe the GP instructions and there was no evidence that the medication was not being administered correctly, the GP’s instruction should be fully recorded. As in the previous inspection report, there were several gaps in the recording of medication and it was not possible to evidence that the medication had been administered or refused. In addition it was found that some boxed medication had been signed for and not administered. The deputy manager assured the inspector that she would complete a full audit of the medication within the home to ensure that residents’ have received their medication as prescribed by the GP. It was found that some eye drops, with a limited life span, had been opened and did not have a recorded date of opening and therefore an expiry date could not be determined. Medication with a limited life should clearly document the date of opening to ensure out of date medications are not given to residents. During a discussion with the deputy manager she confirmed that a prescribed thickener, which is used to thicken drinks and soups for residents with a Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 12 swallowing impairment, continued to be signed for on the MAR sheet as being given 3/4 times a day. This did not accurately reflect the number of thickened fluids given to a resident. Following discussions, the deputy manager agreed that all thickened fluids given to residents would be accurately recorded, along with the details of the recommended consistency given by the Speech and Language Therapist (SALT). As identified in the previous inspection report excess bottles of Temazepam were being stored. On examining the Controlled Drugs cupboard there were 4 bottles of Temazepam liquid for the same resident, dated 16/12/06, 13/1/07, 10/2/07, 10/3/07, were being stored in the cupboard along with the bottle currently being used. Excess drugs must not be stored in the home. As reported in the previous inspection report the temperature of the drug fridge was recorded in the “safe zone” on a daily basis. However ensure that medication is being stored at the correct temperature it is recommended that the actual temperature is recorded on a daily basis. As identified in the previous inspection report the home has 4 drug trolleys in use and each trolley is currently stored, secured to the wall, in residents’ bathrooms. This is not an inappropriate storage space as it could compromise residents’ privacy and dignity if the trolley needs to be accessed while a resident is in the bath or using the toilet. In addition some medicines may need to be stored in such a way that the products themselves are not damaged by, for example by heat or dampness. Therefore medicines must not be stored in damp or steamy places such as bathrooms. A long discussion took place with the manager and the deputy manager. The manager said that it was her intention to convert a room on the first floor into a treatment room and 2 of the trolleys would be stored in there. Until further storage areas are identified for the other 2 trolleys a risk assessment must be carried out in liaison with the dispensing pharmacist regarding the continued storage of medication in bathrooms. Waste medication was appropriately stored and there was a record of the medication, however it is recommended that 2 staff witness and sign for the disposal of waste medication. Brocklehurst Nursing Home DS0000021635.V334239.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities were provided and residents were able to maintain contact with family and friends. Meals served at the home were nutritious, well balanced and offered a healthy and varied diet for residents. EVIDENCE: A ‘recreation team’ from Withington Hospital continue to go into the home daily, Monday to Friday, to provide a variety of activities. As already referenced in this report the residents spoken to said they enjoyed the activities provided. The recommendation that the home keep a record of what activity each resident takes part in had not been met, although the deputy manager said that this would be implemented. It was encouraging to note that photos were on display of residents enjoying various activities and photos of a holiday in Wales. The manager said that the home has the use of a holiday cottage in Wales and 2 holidays were arranged and very much enjoyed last year. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 14 It was clear from observations that residents appeared relaxed and settled in their environment and there was a calm atmosphere throughout the day during this visit to the home. Details regarding Advocacy services were on display in the home and the manager said that Age Concern acted as advocates for 2 of the residents accommodated. From speaking to residents and staff it appeared that residents were able to exercise choice and control over their lives and that residents are encouraged to bring personal possessions into the home, as many of the bedrooms had been personalised with residents’ own belongings. It was evident that those residents who are independently mobile were able to move around all areas of the home at will. Residents and staff confirmed that the home operated an ‘open’ visiting policy and visitors could be seen in the privacy of the resident’s own room or in any of the communal areas. One resident said, “my visitors can come whenever they like and are always made to feel very welcome.” A visitor to the home said she comes visiting every week and has her lunch “which is always very nice and I stay and enjoy the afternoon activities.” The menu examined demonstrated that the home provided a varied diet, which was nutritionally balanced and included adequate supplies of fresh fruit and vegetables. Residents spoken to were complimentary regarding the quality and quantity of food. Brocklehurst Nursing Home DS0000021635.V334239.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home encouraged and supported people to raise their concerns and complaints and had the policies, procedures and systems in place to protect residents from abuse. EVIDENCE: The home had a complaint procedure, which was on display in the main reception area and a booklet for making a complaint is given to residents on admission. The manager said that she operates an open door policy and relatives/visitors, staff and visiting professionals to the home are encouraged to raise any concerns or complaints. The manager said that all complaints are logged and investigated, although there have not been any complaints since the last inspection visit in October 2006. There had been no complaints direct to CSCI. Residents spoken to said that they had never wanted to make a complaint but would go to the nurse in charge and would feel quite happy doing this and felt their complaint would be taken seriously. Evidence was seen that staff had attended Protection of Vulnerable Adults (POVA) training and further dates had been arranged. The homes policy Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 16 relating to the Protection of Vulnerable Adults from Abuse had been reviewed and updated to accurately reflect the Adult Protection Guidance. Since the last inspection one allegation has been appropriately investigated under POVA and the allegation was not upheld. Brocklehurst Nursing Home DS0000021635.V334239.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean comfortable, well maintained environment was provided for residents. EVIDENCE: As evidenced in the previous inspection report the home has its own handyman who maintains the building appropriately and deals with minor matters when they are raised with him by staff or residents. The accommodation is well furnished and is suitable for the residents living there. On the day of this visit the home was odour free and was found to be clean and tidy which created a pleasant environment for the residents and their visitors. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 18 The home offered a variety of communal areas, which included a number of lounges on both floors of the home, a dining room and a hairdresser’s room. The garden area was well maintained and accessible to residents. The home provided adequate toilet and bathroom facilities. Toilets were conveniently located in close proximity to bedrooms and communal areas. A variety of bathing facilities were provided to meet a range of needs. It was noted that hoist slings were stored on the hoists on top of each other. To prevent the risk of cross infection to the residents the hoist slings must be stored in an appropriate manner. Brocklehurst Nursing Home DS0000021635.V334239.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff available appeared sufficient to meet the residents’ assessed needs and the home’s recruitment and selection process provides protection for the residents from potential abuse. EVIDENCE: At the time of this visit the home accommodated 39 residents. From observation during the inspection the numbers and skill mix of the staff appeared to be sufficient to meet the needs of the number of residents accommodated. The home employed 24 care staff, 10 of which had achieved NVQ level 2 or above. It was encouraging that one of the deputy manager’s was currently undertaking the NVQ Internal Verifiers course. A small number of staff files were examined. They contained the required documentation and there was evidence of 2 written references and satisfactory checks with the Criminal Record Bureau (CRB) or POVA first checks and the manager confirmed that these staff were working under supervision until a clear CRB is obtained. Evidence was seen that PIN numbers of the RGN’s had Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 20 been checked with the NMC and the manager said that NMC register is checked approximately every 2 months for nurse suspensions or exclusion from the register. Evidence training, Palliative training. was seen of ongoing staff training which included Fire Awareness Manual Handling training, Health and Safety Training, Continence, Care, Diabetics and as already referenced in this report POVA Staff training was recorded on an individual training record Staff spoken to said confirmed that training was provide but one member of staff said that “training is not provided as much as it used to be.” The manager said that all newly recruited members of staff must complete the structured induction training which is a programme develop by Anchor. Brocklehurst Nursing Home DS0000021635.V334239.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates in the best interests of the residents EVIDENCE: The manager is supported through the organisation by the operations director and in the home by 2 deputy managers, who job share. She has the skills, experience and qualifications to manage the home. She has worked at the home for over 15 years and is a registered nurse. She had the Registered Managers Award and also a Masters Degree in gerontology. The manager and the deputy manager demonstrated a clear view of the need to continually develop care services in the best interests of the residents. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 22 Evidence was provided that the home had appropriate service contracts in place for equipment and installations used in the home and that servicing is undertaken at the required intervals to ensure the safely of residents. Residents who are able to manage their own finances are encouraged to do so. For those residents who are no longer able to deal with their money the home has a system to protect their financial interests. Satisfactory records with receipts covering expenses are retained for auditing and inspection purposes. At the time of this inspection visit the manager said that Anchor were in the process of reviewing their formal quality audit tool. The manager said that in addition to the formal tool, feedback regarding the quality of care provided is discussed with residents and their relatives during their review sessions, which are undertaken as a minimum every 6 months. In addition the staff regularly have 1:1 discussions with residents and their visitors and the manager encourages comments and feedback via her open door policy. Brocklehurst Nursing Home DS0000021635.V334239.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 2 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 2 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 Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO No iSTATUTORY 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. Standard OP7 Regulation 13 (4) (c) Requirement Timescale for action 21/05/07 2. OP9 13 (2) To ensure the health and safety of residents risk assessments relating to the use bed rails must be reviewed and further developed to adequately assess the risk of the actual use of the bed rail. 21/05/07 1. To ensure that residents receive medication as prescribed by the GP the registered provider must make arrangements for the accurate recording and auditing of medication. 2. To ensure medication is stored at the correct temperature and humidity the registered provider must ensue a risk assessment in undertaken, in liaison with the dispensing pharmacist, regarding the continued storage of medication in bathrooms. 3. Excess Controlled Drugs must not be stored in the home. To prevent the risk of cross infection the hoist slings must be stored in an appropriate manner and not stored on top of each other. DS0000021635.V334239.R01.S.doc 3. OP26 13 (4) (c) 23/04/07 Brocklehurst Nursing Home Version 5.2 Page 25 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. Refer to Standard OP7 OP9 Good Practice Recommendations It is recommended that an assessment of continence needs is completed on admission. 1. It is recommended that the actual temperature of the drug fridge is recorded on a daily basis. 2. It is recommended that the MAR should clearly cross reference to where there is a signed accurate recording of thickened fluids given to residents. 3. It is recommended that 2 staff witness and sign for the disposal of waste medication. 4. The GP’s instructions should be recorded to ensure that medication is given as intended. 5. It is recommended that all eye drops with a limited life should clearly document the date of opening to ensure out of date medications are not given to residents. Brocklehurst Nursing Home DS0000021635.V334239.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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. 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