Inspection on 07/08/08 for Caversham Residential Home

This inspection was carried out on 7th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Caversham Residential Home 06/08/09

Caversham Residential Home 10/08/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Caversham Residential Home Astridge Road Witcombe Gloucester Glos GL3 4SY Lead Inspector Mr Adam Parker Unannounced Inspection 7th August 2008 08:30 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 Caversham Residential Home DS0000069091.V365171.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. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Caversham Residential Home Address Astridge Road Witcombe Gloucester Glos GL3 4SY 01452 862554 01452 545295 djunglee@hotmail.com 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) Nazdak Limited Tracy Sally Miles Care Home 8 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (8) of places Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following Categories: Old age, not falling within any other category (Code OP) Dementia over 65 years (Code DE (E)) maximum number of places 1 The maximum number of service users who can be accommodated is 8. The registered person may continue to accommodate 1 person identified to CSCI whose primary care needs on admission were within the category dementia (DE). This condition will lapse when this person leaves the home. 3rd October 2007 2. 3. Date of last inspection Brief Description of the Service: Caversham is a small care home set in a residential area of Witcombe on the outskirts of Gloucester. The home is close to a local shop. The single bedrooms with ensuite toilets are located on the ground and first floors, with a bathing facility available on the first floor. There is a sitting room at the front of the house with a dining room and kitchen combined at the rear. The residents also have the benefit of a garden at the rear of the house. Current fees are £329.60 to £414.65. Hairdressing, chiropody and newspapers are charged extra. The home makes information about the service, including CSCI reports available to service users and their representatives through a service user guide and statement of purpose available in the home. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection visit was carried out by one inspector on one day in August 2008. The registered manager of the home was present for the inspection visit as well as the responsible individual. The inspection visit consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of resident’s files were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Survey forms were received from residents, their relatives and staff working in the home. Four residents were spoken to during the inspection visit as well as a member of staff. We requested an Annual Quality Assurance Assessment (AQAA) from the home that was completed and returned to us. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Maintenance issues both inside and outside of the home had been attended to as well as some refurbishment. Work has also been carried out to improve the supply of hot water to residents’ bedrooms. Staff training needs have been identified and training provided in a number of subjects including medication administration. The registered manager now has a job description and visits and reports have been carried out by the responsible individual in line with regulations. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 6 Arrangements are now in place for servicing the stair lift and the bath lift. 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. Caversham Residential Home DS0000069091.V365171.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 Caversham Residential Home DS0000069091.V365171.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment process does not always ensure that information from local authorities is received about a resident’s needs before care in the home is offered, so that residents cannot be sure that they will receive the care they require. EVIDENCE: The assessment documentation for two residents recently admitted to the home was looked at. These had been completed following an assessment of the person’s needs recorded on a pre-admission assessment document. Assessments had been carried out by the registered manager. One resident had been transferred from another care home and information had been obtained from this source. Another resident was funded by the local authority. Although the home had carried out their assessment prior to the resident moving into the home, the local authority had been slow to supply theirs with this arriving on the day that the resident was admitted. The home must insist Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 9 on receiving the local authority care plan or assessment prior to the resident entering the home to ensure that their needs can be met. The homes own assessment document although comprehensive should have an area added to check if a prospective resident has a history of falls. The home does not provide intermediate care and so standard 6 does not apply. Caversham Residential Home DS0000069091.V365171.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. Although some attention is needed to areas of medication administration, the home works well to meet residents’ health and personal care needs whilst upholding their privacy and dignity. EVIDENCE: Care plans had been written that were specific to residents’ individual needs. They addressed a number of areas such as pain and illness, safe environment and social activities. One resident had been receiving input from mental health services and the registered manager had attended a review meeting under Care Programme Approach arrangements. However documentation from this meeting had not been supplied to the home and should be requested. Care plans had been reviewed on a regular if not always on a monthly basis although there were indications that the intention was to review them monthly. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 11 Out of six survey forms received from residents, five indicated that they “always” received the care and support they needed and one indicated “usually”. General risk assessments had been completed for all residents these addressed such areas as wandering out of the home. In addition a risk assessment for falls is also completed where the need indicates this. Resident’s weights were recorded on a monthly basis and assessments were also completed for physical health and mental health. A malnutrition assessment tool is also in use in the home. Where residents had been receiving input from health care professionals such as GPs this had been recorded. The arrangements for medication storage, administration and recording were checked. Medication was stored securely in a cupboard. The home was expecting delivery of a new cupboard that would be sited in a different area. Storage temperatures had been monitored and recorded in both the cupboard and refrigerator and all were within appropriate ranges. The majority of liquid medication containers had been dated on opening as an indication of their expiry date. The medication administration record (MAR) charts were looked at. A number of handwritten directions had only one signature and some had not been signed by the person making the entry. Hand written directions must be signed and dated by the staff member writing them and checked and signed by a second staff member. There were no gaps in the recording of administration on the MAR charts. Medication training had been provided to staff by the supplying pharmacist. One resident who went out of the home with a relative on occasions took some of their medication with them in a bottle. The home should check that all medication bottles that leave the home with residents are correctly labelled which should also include the name of the home. A risk assessment must be completed and the medication bottles must only be filled by staff that have achieved competence through medication training. Consideration must also be given in the risk assessment if the medication needs to be taken out of the home or if it could be taken at any other time during the day. Staff were observed treating service users with respect and residents confirmed that their privacy was respected by staff who knocked on doors before entering. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Residents are able to benefit from exercising choice and having some control over their lives in a number of areas including selecting their meals. EVIDENCE: Generally residents pursue their own interests and activities. These take the form of reading newspapers, listening to the radio, making use of the garden and going out with family members. The registered manager reported that although more organised activities are offered from time to time, residents usually decline to take part in these. Out of six surveys received from residents four indicated that the home “never” arranged activities that they could take part in. In view of these responses the home should check with residents that they are satisfied with the current situation in the home regarding activities. The home has a policy of open visiting. It was reported that there is still a lack of community facilities in the local area for older people. One resident had recently been involved in a campaign to keep the local post office open although this has now closed. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 13 Some residents in the home manage their own financial affairs and information is available on advocacy services should these be needed. Residents can bring personal possessions including furniture into the home. Meals are chosen by the residents on a weekly basis and a menu is produced. Residents spoken to confirmed that they were enjoying the variety of meals provided. Residents described the meals as “alright” and “good”. Out of six survey forms received from residents, five indicated that they “always” enjoyed the meals at the home and one indicated “usually”. One resident commented that the meals were “well cooked and enjoyable”. At the time of the inspection visit there were no special diets being provided for residents in the home. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available if any resident or their representative should wish to make a complaint, further staff training staff and improvements to the adult protection policy should ensure that residents are protected from abuse. EVIDENCE: The home has a complaints procedure that is given to all residents with a record of this kept on their files. In addition the complaints procedure has been sent to relatives of residents. There had been two complaints received since the previous key inspection. Although the response to the complaints was discussed at the inspection there was no written record made. All residents who returned surveys indicated that they knew how to make a complaint, as did all the relatives who answered the particular question on the survey form. The home had a ‘whistle blowing’ policy to guide staff in voicing serious concerns and a policy for protecting residents from abuse and dealing with reports of abuse to residents. However on examination this policy had no reference to contacting outside agencies such as the local authority, the Police or the Commission in the event of any adult protection issue. The policy must be reviewed to include such information. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 15 The registered manager and other staff had received training at a local college in adult protection. There were some staff that had not received training in adult protection and this must be addressed in the interests of protecting residents. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a well-maintained and clean, environment with personalised individual rooms. EVIDENCE: A tour of the premises was conducted and the home was noted to be generally clean. Maintenance issues noted at the last key inspection had been attended to. In addition the kitchen had undergone a complete refurbishment and a number of new carpets had been fitted. Residents have access to the rear garden either directly through bedrooms on the ground floor at the rear of the home or through the side door where a gentle slope and handrail has been provided. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 17 Resident’s rooms contained personal items and a number had undergone redecoration with further work planned. Issues with the supply of hot water to resident’s bedrooms had been addressed and rectified. It was noted that the communal toilet and bathroom on the first floor did not have a hand washbasin or any hand washing facilities. Consideration should be given improving this facility by installing such facilities. The laundry is situated in the rear garden detached from the home. Woodwork on the exterior of the building had been painted and a new floor covering had been installed and the interior wall surfaces painted. A sink was provided although there was no liquid soap or paper towels for hand washing. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 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 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 adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to staff training in the home as well as numbers of staff available. Recruitment practices although generally robust need some more attention to ensure that residents are protected. EVIDENCE: Staffing in the home is arranged so that the home is always covered by one member of care staff with 2 working at the home during the times of 8:00 to 10:00 in the morning and 12:00 to 14:00 in the afternoon. A cleaner works on weekdays. At night there is one member of waking night staff. The home has two members of staff who have achieved an NVQ with one currently undertaking the course. There were three care staff that did not have an NVQ. In terms of the residents being cared for by a trained staff group, further staff should undertake an NVQ. Records for three recently recruited members of staff were examined. With two members of staff, all the required information and documentation had been obtained including checks against the Protection of Vulnerable Adults list the Criminal Records Bureau. However one member of staff had been employed Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 19 with only one written reference. The second was received by the home but only after the person had commenced work. Staff who have started work in the home have been given an induction that largely relates to the premises and procedures in the home. The home must provide induction training to new staff under the nationally recognised Common Induction Standards. These standards have been developed by Skills for Care and set down minimum expectations as to the learning outcomes that need to be met so that new workers know all they need to know to work safely and effectively. The home has received support from a local care home support project and this has resulted in training being provided for staff in a number of areas including nutrition, wandering, dealing with aggression and person centred care. There are plans for a personal computer to be installed to provide a further training facility. Out of three staff surveys received, two indicated that they received training relevant to their role and one staff member outlined recent training provided. One staff member indicated that they were not given training relevant to their role, this was discussed with the registered manger during the inspection visit. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some quality checks are in place although further development of this area is needed as well as staff training in two important areas to ensure that the safety and welfare of residents is fully promoted and protected. EVIDENCE: The manager has been registered since April 2007. She has completed an NVQ level 4 in care as well as the registered managers award. She had recently undertaken training in care planning, dementia and helping people to eat and drink. The registered manager now has a job description as a formal reference point for her role in the home. There is no specific time allocated to fulfil the management role and as at the previous key inspection it was reported this Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 21 has to be carried out between care duties or in the manager’s own time. A discussion was held about this with the registered provider. A more formal arrangement should still be considered. The home provides secure facilities for resident’s money. The amount held for one resident was checked against records and was found to be correct. The home has no formal quality assurance system in place. However the responsible individual has recently undertaken visits and compiled reports under regulation 26 of the Care Homes Regulations. In addition a member of staff conducts weekly meetings with a group of residents. The main purpose of the meetings is to decide the menu for the coming week although other issues are discussed. A written record of the meetings had been kept. This is a useful way of keeping in touch with the views of residents. A discussion was held with the registered manager and the responsible individual about other approaches to quality assurance and such as surveys and audits. An Annual Quality Assurance Assessment (AQAA) document was completed by the registered manager and returned to us. Although the content was brief in some areas it generally gave us the information we asked for. A number of records relating to previous respite admissions were examined. The documentation was not kept in a good state of order and this is an area that needs addressing. In addition information from the local authority about one resident was not immediately available when the care records were checked. All records should be kept in a good state of order. Staff had received training in moving and handling, first aid and basic food hygiene. However despite requirements at the previous key inspection, staff had still not undertaken training in infection control or fire safety and this situation must be addressed. The responsible individual has recently completed training courses in fire risk assessment and health and safety. A new service contract had been put in place that had resulted in the servicing of the central heating system. Checks have been carried out on electrical appliances and the electrical system in the home. Checks on window restrictors are carried out by the responsible individual. A risk assessment had been completed for Legionella this should be checked against Health and Safety Executive guidelines to ensure that it fully addresses any potential risks. To ensure residents safety the home has a number of security arrangements in place. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 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 2 17 X 18 2 3 X 2 X X 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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. Standard OP3 Regulation 14 (1) (b) Requirement Timescale for action 31/10/08 2. OP9 13 (2) 3. OP9 13 (2) 4. OP16 17 (2) The home must insist on receiving care plans from the local authority where they are funding care for a prospective resident prior to the resident being admitted to the home. This is to ensure that a full assessment can be made and the home can check that they can meet the needs of the prospective resident. Handwritten directions on 31/10/08 medication administration records must be signed and dated by the staff member making the entry and checked and signed by a second staff member. This is in the interests of safe medication administration. 31/10/08 A risk assessment must be carried out on the practice of residents taking medication out of the home. This should address issues of staff competency and whether the medication could be taken at any other time of the day. The registered person must keep 31/10/08 DS0000069091.V365171.R01.S.doc Version 5.2 Caversham Residential Home Page 24 5. OP18 Schedule 4 Paragraph 11 13 (6) a record of all complaints made about the operation of the home and the response to these. In order to protect residents, the home’s adult protection policy must be reviewed to include procedures and information on contacting outside agencies. All care staff must receive training in protecting residents from abuse. In order to protect residents through robust recruitment procedures the information and documentation specified in Schedule 2 of the Care Homes Regulations 2001 must be obtained prior to employment in the home. This requirement has been repeated from the last inspection. Induction training must be provided to new staff in line with the Common Induction Standards so that residents are cared for by competent staff. Staff must undertake appropriate fire safety training in line with current fire safety regulations in order to ensure the safety of residents. This requirement has been repeated from the last inspection. Staff must receive training in infection control procedures in order to promote the wellbeing and safety of residents. This requirement has been repeated from the last inspection. 31/10/08 6. 7. OP18 OP29 13 (6) 19 (b) 31/12/08 31/10/08 8. OP30 18 (1) 31/12/08 9. OP38 23 (4A) (b) 31/12/08 10. OP38 13 (3) 31/12/08 Caversham Residential Home DS0000069091.V365171.R01.S.doc 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. Refer to Standard OP3 OP7 OP9 OP12 OP21 OP26 OP28 OP31 OP33 OP37 OP38 Good Practice Recommendations The pre admission assessment document should include an area for checking if any prospective resident has a history of falls. Where a resident is subject to Care Programme Approach arrangements the home should request copies of any relevant documentation from mental health services. A check should be made to make sure that all medication containers leaving the home are correctly labelled which should also include the name of the home. The home should check with residents that they are satisfied with situation in the home regarding activities. Give consideration to installing a hand washbasin or other hand washing facilities in the communal toilet on the first floor. Liquid soap and paper towels should be provided in the laundry for hand washing. More care staff should undertake NVQ training. The registered manager should be allocated set hours in which to carry out management duties. The home should consider the use of surveys and audits to check on the quality of the service provided. All records including those relating to past respite admissions should be kept in a good state of order. The Legionella risk assessment should be checked against Health and Safety Executive guidelines. Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Caversham Residential Home DS0000069091.V365171.R01.S.doc Version 5.2 Page 27 - 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!