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Inspection on 25/04/05 for Clarence Care Home

Also see our care home review for Clarence Care Home for more information

This inspection was carried out on 25th April 2005.

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

The inspector 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 environment is comfortable, homely, clean and smelled fresh. Health and safety is well managed. Meals are varied, well balanced and nicely presented. The majority of service users spoken with praised the food. The staff team manage the daily activities and entertainments well providing opportunities for service users to join in with activities inside and outside of the home. The majority of service users spoke with were happy with the variety of activities provided. Flossie the pet dog has been a welcome addition to the home, service users clearly state that she is obedient and affectionate.

What has improved since the last inspection?

There is evidence that the care planning structure has improved and that the manager and staff team have put a lot of effort into improving service users care records. Care plans are being reviewed, however, staff need to be consistent with the evaluation process to ensure that they are reviewed at least monthly. Medicines management in the home, was noted to be improved and the recommendations made by the pharmacist inspection in 2004 had clearly been taken on board.

What the care home could do better:

There are some areas which require improved documentation to ensure service users healthcare needs are fully monitored and met.

CARE HOMES FOR OLDER PEOPLE Clarence Care Home Clarence Residential Home Huthwaite Road Sutton in Ashfield Nottinghamshire NG17 2GS Lead Inspector Jayne Hilton Unannounced 25 April 2005 10:00 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. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Clarence Care Home Address Clarence Residential Home Huthwaite Road Sutton in Ashfield Nottinghamshire NG17 2GS 01623 558422 01623 558113 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) Mimosa Healthcare Group Limited Unit 2 Bowden Drive Beeston, Nottingham NG9 2JY Ms Joan Clare Cannan Care Home (CRH) 47 Category(ies) of Old age, not falling within any other category registration, with number (OP) 12 of places Dementia (DE) 35 Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager undertakes training on Adult Protection issues and the mental health needs of older people within the next twelve months 2. Service users shall be within categories OP (12) or DE (35) Date of last inspection 14/12/04 Brief Description of the Service: The Clarence is a purpose built two storey home situated outside the centre of Sutton in Ashfield. It provides residential care only for up to 47 service users. The category of registration is being changed to reflect the needs of the service users to whom care is provided. The home can now cater for up to 12 service users within the category of old age, and for up to 35 service users with Dementia (excluding other mental health problems). 8 of the beds are provided in the Oak unit which is a specialist facility catering for people with Dementia whose behaviour may challenge. All bedrooms are single with en suite facilities and the home has four lounges and dining rooms available. There is an enclosed garden to the rear accessed by patio doors from the units on the ground floor and plenty of car parking spaces to the side of the building. The home is pet friendly, recently acquiring a pet dog for the service users in addition to the budgies and goldfish already resident in the home. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 4 hours. An additional visit took place on the 8th April 2005 as a result of a complaint made to the Commission. Letters sent to the registered person following this visit can be obtained from the CSCI office on request. A tour of the premises took place and care records were inspected. As the manager was not at the home, several records such as staff records were not available for inspection. Out of six care staff and a general assistant on duty, three were spoken with plus the cook and a laundry person. Five Service users and two visitors were spoken with. What the service does well: What has improved since the last inspection? There is evidence that the care planning structure has improved and that the manager and staff team have put a lot of effort into improving service users Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 6 care records. Care plans are being reviewed, however, staff need to be consistent with the evaluation process to ensure that they are reviewed at least monthly. Medicines management in the home, was noted to be improved and the recommendations made by the pharmacist inspection in 2004 had clearly been taken on board. 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. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 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 Clarence Care Home C53 C03 S8746 Clarence V222206 250405 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) 3 [standard 6 is not applicable] Service users needs are appropriately assessed fully prior to moving to the home. EVIDENCE: Four service users assessments and care plans were examined. All contained detailed and appropriate assessments, which meet standard 3.3 of the National Minimum standards. Where social workers had been involved in placing service users their assessments were seen on the file. Social assessments were seen in the care plan documentation. Care reviews records were also seen. The assessment documentation includes service users preferences and wishes, including, meal arrangements, beverage preferences and wishes at the end of life. Three service users confirmed that the home is meeting their needs, this was supported by two relatives who were spoken with during the inspection. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 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, 10 There is a good care package in place for service users, which identifies the health, personal and social care needs of service users are well addressed. There are some minor areas that should further improve the care provision for service users. EVIDENCE: Of the four care plans examined by the inspector, all contained individual and specific care plans relating to the assessed needs of each individual. All contained signed agreements by the service user or their representative. All were neatly and well - presented and daily notes were written in a style that reflected the daily lifestyles, health and well being of the individual. [Holistically documented. The reviewing of care plans was evident, however there were some gaps noted for some months and these varied depending on the key worker overseeing the plan of care. Service users spoken with were aware of their plan of care, but couldn’t relay what this meant to them. 3 Service users reported that they were well looked after and that the staff were very kind to them. Bathing records were in place and recorded where service users refuse. Records of participation in activities were seen in care plans. There were no records in the care plans of who had been offered a door key, neither were any risk assessments for those not able to do so. A service user Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 10 confirmed that she had a key to her bedroom door but not for the lockable facility in her room. Staff confirmed that several service users hold their own keys. There was detailed record keeping of healthcare needs of service users including the monitoring of service users mental health. Records were seen for GP visits, Chiropody and dentist etc. Risk assessments tools were in place for pressure sores, nutrition, mobility including risk of falls, behaviour, manual handling and dependency levels. One service user had numerous falls and accident records were examined and found to correspond to the daily records. The assistant manager reported that a specialist in the prevention of falls has been contacted and that the service user will be referred. The inspector advised that a separate running record/history of falls is kept to pattern times, places and staff on duty at the incident of the fall and what action is to be or has been taken to minimise the risk of falls. Staff explained that intake/care charts are used where there is noted concern regarding service users intake and evidence was seen in this respect. A relative reported that staff, require training in fitting batteries into hearing aids as his relatives hearing aid battery had been incorrectly placed which had caused damage to the aid. Bowel records were not consistently completed, which left gaps in records, some for up to 6 days. Therefore the process of monitoring bowel movements of service users should be reviewed. Where service users have diabetes, care plans should clearly state whether diet, or medication controlled and how frequent blood sugar levels need monitoring as this was not clear within the documentation and one service user had not had been tested since March 05. One service user who was cared for in bed had no pressure areas and bedrails and bumpers, were, observed to be appropriately used. None of the service users were self medicating and there was no evidence of risk assessments for self medication on the care plans, despite there being a policy and copy in the staff manual. An inspection of the medicines management in the home demonstrated that medication charts were fully completed, however an observation of the drug round found that medicines were signed as given, prior to a visual observation that the medicines had been taken, which is not appropriate. An examination of the clinic room storage and procedures for use of Controlled drugs was satisfactory. The assistant manager reported that all staff have undertaken medicines management training. The drug error policy did not inform staff that all drug errors should be notified to the CSCI. A Service user spoken with confirmed that staff respect privacy and dignity, relatives [2] also reported that when visiting the home, service users privacy and dignity is always respected and that staff knock before entering rooms etc. Staff members were observed to practice this during the inspection and a new member of staff confirmed that the topic had been covered within the induction Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 11 process. Staff members were observed to cover a service user, who had removed her lower garments of clothing in the lounge, with a towel Within the care plan format service users can choose to have their door locked at night and refuse night checks. Service users were, observed, to be spoken to with respect by staff. Service users were observed to be clean, well presented, relaxed and happy [smiling and interacting with staff and other service users] in their environment. A comment from a relative was made that some staff had been observed sitting with service users but failing to interact or engage with them and that further training may be needed regarding basic care values. Relatives had concerns about missing and incorrect laundry and that their relative was wearing someone else’s clothing, despite labelling the clothing correctly. The laundry system appeared well organised and the laundry person stated that they make every effort to ensure service users get their correct belongings and showed the inspector the tagging system for labelling which is used by the home. Several labels were hanging off and was clear that the system is not working in practice. The system therefore needs reviewing and to include service users and relatives in the review. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 Service users are encouraged to make choices and decisions in their daily lives and routines. The activities provision is varied and provides occupation and stimulation for those service users who choose to participate. EVIDENCE: 3 Service users spoken with reported that they did not know what they were having for lunch. A member of staff reported that the cook usually asks service users what they prefer from the menu and a list then comes back from the kitchen with the food. however the system for menu options had lapsed due to the regular chef being off sick. There were no recent records available to support this. Service users confirmed that they had choice of when to go to bed, get up, participate in activities. Rooms examined x 5 were personalised. One service user had her own double bed. Service users were generally happy with the food offered. There was an activities programme posted on the notice board, which included movement to music, beauty therapy, crafts, reminiscence, cooking/baking, garden ornaments and games. In addition an annual entertainment plan is posted on the board, which informs service users and visitors of trips out, including boat trips, fetes, clothing sales etc. 3 service users confirmed that there is plenty of activities arranged, including shopping trips out, which one service user particularly requests. The home employs an activities coClarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 13 ordinator, however staff reported they organise the majority of activities, as the role of the co-ordinator is limited. There is a well - equipped ‘snoozlan’ room which staff reported is used often. There were no activities taking place at the time of the inspection, however a display of handmade cards was observed and many of the lady service users had their nails painted. The menu provided appeared varied and nutritious and the mealtime observed was relaxed. Staff members were observed assisting two service users in bed, with their lunchtime meal. Staff were observed to be sensitive and discreet when assisting service users. The meal served looked appetising and 4 service users stated that the meal was served hot and was lovely. One stated that the food is always nice and one service user commented that they had, had better. Drinks of juice were served with the meal. A service user reported that drinks were available regularly. A relative reported that when asked about the food his father states “its lovely”. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Complaints are generally documented appropriately. EVIDENCE: A complaints procedure was observed in the home and both a service user and relative confirmed they were aware of how to make a complaint and that they had received the welcome pack, which details the complaints procedure. service users and relatives were confident that that complaints are listened to and dealt with. Policies and procedures for adult protection are in place. A service user reported that the manager was very nice and that they were very confident any complaint would be dealt with appropriately. There were 3 complaints documented in the complaints folder since the last inspection, one of which had been made to the CSCI. One of the complaints was regarding missing items of clothing, a damaged hearing aid and food crumbs in the lounge area. The complaint was partly substantiated but some issues are ongoing and unresolved. One was from a staff member about remarks from another and appears to have been resolved. The complaint made to CSCI was regarding cleanliness of the kitchen and food stocks and a summary of the investigation outcome is attached to this report. The complaint was found, to be, not upheld. The complaint investigation details do not clearly indicate if the complaints made to the home have been upheld, not upheld or unresolved and this should be included in the outcome report. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 15 A Service user stated that they felt very safe in the home. Staff members x3 who were spoken with appeared clear about reporting anything that concerned them about the treatment of service users. Staff reported that training for abuse awareness, has been attended, by some staff, however records could not be checked due to the manager not being available on the day of the inspection. Records examined demonstrated that two staff had been referred to the POVA list after a recent adult protection investigation. Appropriate policies and procedures were in place. Including safe storage of money and valuables. A sample of service users financial records were examined and found to have two signatures for transactions, which appeared satisfactory. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 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, 26 Service users benefit from an accessible, safe and well maintained environment, which is furnished in a homely way. The home is clean, pleasant and hygienic and provides a safe environment for service users to live. EVIDENCE: A tour of the home was made. The homely environment appeared comfortable and furniture and soft furnishings were in good order and the layout of the home is spacious and service users were observed moving freely within their designated units. The garden area is enclosed and on the day of the inspection the doors to access the garden were open. The patio area was level and accessible. A handy man is employed full time in the home to address minor repairs as needed. Records for fire safety and environmental health were not examined at this inspection. Service users bedrooms were free from hazards and window restrictors were in place throughout. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 17 Keypads are in place for security. There was no mal odour present in the home on the day of the inspection and all areas examined were clean and pleasant throughout. Staff, were observed to wear protective clothing for care tasks and colour coding of buckets and mops were evident on the cleaning trolley that was in use. The kitchen was inspected, it was clean, the microwave was inspected and found to be clean. The laundry was inspected and found to be clean with systems in place to prevent cross infection. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 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 Staffing levels are appropriate to meet service users needs. EVIDENCE: The staff rota was examined and matched the staffing levels found on the day. Staffing levels appear to be meeting service users needs, with positive feedback from all three service users asked in relation to whether they feel there are sufficient staff to see to peoples’ needs. Staff were observed by the inspector to be calm and unhurried, when carrying out their duties and were seen to be taking time to sit down and speak with service users. Currently the home has 42 service users in residence. 2 staff member supports 8 service users with dementia in The Oaks. 1 staff member supports 9 service users who are more independent, in Jasmine. 3 staff and a general assistant support 25 service users. [1st Floor] Another general assistant covers both ground floor units. 4 staff cover nights. Domestic, laundry and kitchen hours appear to be sufficient. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 19 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) 33,38 The home has an effective quality monitoring system, which service users are contributing to. Service users health and safety is safeguarded, by the practices of staff in the home. EVIDENCE: There was evidence of a quality audit recently being carried out which included service users and relatives survey questionnaires. Action points were clearly visible. The inspector has received regulation 26 visit reports from the provider, which demonstrates self- monitoring. Staff spoken with reported that health and safety training had been provided and there was a health and safety policy available in the home. Other training Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 20 undertaken by staff was reported as frequent and included fire safety, first aid, food hygiene and medicines management. Records of training were not available as the manager was not at work on the day of the inspection. Several water outlets were tested and found to be within a safe temperature range. Temperatures were recorded of bath water, prior to service users use. Cleaning materials were labelled and identified correctly and cleaning staff, were observed, to carry out their tasks safely. Accident records were examined and found to be in order and cross referenced to care plans. An appropriate accident book was in use. An induction booklet was examined and health and safety topics were clearly covered. The home has recently acquired a pet dog, ‘Flossie’ who service users adore and will bring lots of benefits to service users, however Flossie was observed to be a potential trip hazard to service users during the inspection and therefore needs to be risk assessed. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 21 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 3 Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 22 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. Standard OP7 Regulation 12, 13, 14, 15 Requirement Ensure service users healthcare need in relation to diabetes are detailed to inform staff of the actual frequency of blood sugar monitoring rather than stating it needs taking regularly Ensure that where service users have a history of falls that a process of evaluation and action taken to minimise the falls is accuratly recorded in the care plan and risk assessement. Ensure that the medication administration record is only signed after visibly observing the medication has been taken. Ensure service users are consulted regarding their choice of menu option and that this is documented Timescale for action 25/7/05 2. OP8 12, 13, 14, 15 25/7/05 3. OP9 4. OP14 12, 13, 16, Medicines Act 14, 25 Shcedule 4[13] 25/7/05 25/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Document within care plans whether service users have C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 23 Clarence Care Home 2. 3. 4. 5. 6. 7. 8. 9. 10. OP7 OP8 OP9 OP9 OP9 OP10 OP10 OP16 OP38 been issued with a key to their bedroom door and lockable facility unless a risk assessment states otherwise. Care plans and risk assessments should be reviewed at least monthly. Review the process for monitoring bowel movements to ensure the healthcare needs of service users are fully observed. Care staff should be instructed how to fit hearing aid batteries correctly. Add to the drug error policy that all drug errors must be notified to the CSCI Ensure service users have the opportunity to self medicate wherever possible unless a risk assessment details otherwise. Address the comments made by visitors regarding their observations of some staff not interacting/engaging with service users. Address the issue of missing laundry and review the current labelling system Include in complaint outcomes whether complaint is upheld, not upheld or unresolved. Provide risk assessments in realtion to Flossie the pet dog. Clarence Care Home C53 C03 S8746 Clarence V222206 250405 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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