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Inspection on 17/04/09 for Clarondene Residential Care Home

Also see our care home review for Clarondene Residential Care Home for more information

This inspection was carried out on 17th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

People living at the home provided positive feedback regarding the service provided. Within the surveys returned to CQC one person wrote that `Alison and the staff are always attentive and caring`. All of the people who completed surveys stated that staff always listen and act on what they say. An assessment of need is completed prior to people moving in, to ensure that the home will be able to meet their needs. People are able to visit the home to assess the services provided. People are able to participate in a range of activities and receive appropriate support to meet their social and leisure needs. Relatives provided positive feedback regarding the service. Two relatives commented that it is `very homely`, and one person that the `staff and care provided is excellent`. There are appropriate policies and procedures in place to safeguard people living at the home. Clarondene provides a comfortable and homely environment. Bedrooms have been personalised to reflect individuals tastes and preferences. There is sufficient communal areas to meet peoples` needs. People are able to access a small area of garden with seating provided. The home is maintained to a good standard of cleanliness. The high staff ratio ensures that people living at the home are provided with appropriate support to fully meet their needs. The home operates a robust recruitment procedure to ensure that only appropriate staff are employed. Ms Curtis regularly seeks feedback from people regarding the service provided and holds Residents meetings every three months.

What has improved since the last inspection?

Care plans have been reviewed and now provide detailed guidance regarding people`s needs and preferences. All staff have received training on the Protection of Vulnerable Adults. The home was assessed by the Environmental Health Department on 10/11/08 and achieved a five star rating. The home has established a website providing people with further information regarding the home, pictures and news from the home.

What the care home could do better:

The Statement of Purpose and Service User Guide could not be located at this inspection. The registered person must ensure that these documents are available, andthat they have been updated to reflect the changes in ownership at the home. All medication must be stored securely to ensure that people are only able to access those medications that have been prescribed to them. Medication administration records (MARs) must be appropriately maintained. This includes ensuring that all hand written entries include the date, quantity of medication and staff signature. A signature must be recorded for all medication given, or a definition used as appropriate to ensure that records clearly record what medication has been taken by each person. Within one bedroom it was found that the wardrobe had not been fixed to the wall. A risk assessment must be completed and action taken as necessary.The flooring in the laundry must be replaced to ensure that this area can be thoroughly cleaned. The hot pipes that run along the skirting board within the lounge / dining room must be covered within the re-decoration pro gramme for the home. A staff matrix has been developed but does not provide accurate information regarding the training completed. The registered person should regularly review staff training records to ensure that any gaps can be clearly identified and appropriate actions taken. Staff should receive supervision at least six times each year. Food stored within the fridge must be dated. Food hygiene records must be appropriately maintained. The hot tap within the hand washing basin in the kitchen must be mended. Fire alarms must be tested on a weekly basis. It is recommended that the registered person reviews staffing arrangements to provide sufficient time for them to maintain records required for the running of the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clarondene Residential Care Home View Road Lyme Regis Dorset DT7 3AA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Murphy     Date: 1 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Clarondene Residential Care Home View Road Lyme Regis Dorset DT7 3AA 01297442876 01297442025 clarondene@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Mary Alison Curtis care home 12 Number of places (if applicable): Under 65 Over 65 12 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Clarondene residential care home is registered to provide care and accommodation for up to twelve older people who require assistance with personal care. The home is situated in a quiet residential area of Lyme Regis. All but one bedrooms are situated on the ground floor. Communal facilities comprise of a large lounge dining room. There is also a large bathroom and shower room with appropriate adaptations. The home has a small garden with seating provided, that can be accessed from the lounge. The proprietor lives on the premises and seeks to provide a homely feel. Ms Curtis takes an active role in the running of Clarondene and is present within the home each day. Weekly fees range from £462 to £500 with additonal charges being made for hairdressing, chiropody and newspapers. Care Homes for Older People Page 4 of 29 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and was completed by one Inspector over one day. Prior to the inspection the registered providers returned the Annual Quality Assurance Assessments (AQAA). Comment cards (surveys) were also sent to people living at the home, and visiting health and social care professionals. Information contained within these have been included within the report. During the inspection we talked with people living at the home, staff members, and the registered persons. Records relating to care, medication, staff training and recruitment and health and safety were examined. We also conducted a tour of the premises. The term we is used throughout this report to show that this is the view of the Care Homes for Older People Page 6 of 29 Commission for Social Care Inspection. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide could not be located at this inspection. The registered person must ensure that these documents are available, and Care Homes for Older People Page 8 of 29 that they have been updated to reflect the changes in ownership at the home. All medication must be stored securely to ensure that people are only able to access those medications that have been prescribed to them. Medication administration records (MARs) must be appropriately maintained. This includes ensuring that all hand written entries include the date, quantity of medication and staff signature. A signature must be recorded for all medication given, or a definition used as appropriate to ensure that records clearly record what medication has been taken by each person. Within one bedroom it was found that the wardrobe had not been fixed to the wall. A risk assessment must be completed and action taken as necessary.The flooring in the laundry must be replaced to ensure that this area can be thoroughly cleaned. The hot pipes that run along the skirting board within the lounge / dining room must be covered within the re-decoration pro gramme for the home. A staff matrix has been developed but does not provide accurate information regarding the training completed. The registered person should regularly review staff training records to ensure that any gaps can be clearly identified and appropriate actions taken. Staff should receive supervision at least six times each year. Food stored within the fridge must be dated. Food hygiene records must be appropriately maintained. The hot tap within the hand washing basin in the kitchen must be mended. Fire alarms must be tested on a weekly basis. It is recommended that the registered person reviews staffing arrangements to provide sufficient time for them to maintain records required for the running of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not have a Statement of Purpose and Service User Guide available to enable people to make an informed decision regarding admission to the home. An assessment of need is completed prior to people moving in, to ensure that the home will be able to meet their needs. People are provided with a written contract to ensure that they are aware of the terms of residency at the home. Evidence: Within the information provided by the home (AQAA) the registered person advises that a website has been established, providing people with information regarding the services and facilities provided. Care Homes for Older People Page 11 of 29 Evidence: The Statement of Purpose and Service User Guide could not be located at this inspection. The registered person must ensure that these documents are available, and that they have been updated to reflect the changes in ownership at the home. Two pre-admission assessments were seen. One assessment had not been signed or dated. Pre-admission assessments included appropriate information regarding the persons needs, and that confirmation had been provided to the prospective service user that the home would be able to meet their needs. The written contract was seen for one person. This provided appropriate information regarding the terms and conditions of residency at the home, including notice periods and what is included within the weekly fee. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are detailed and provide staff with sufficient guidance to fully meet peoples personal care and health needs. Failure to store medication securely and incomplete recording of medication administration places people at risk of harm. The management of medication must improve to follow safe practice. Evidence: Care plans are maintained for each person. Three care plans were examined in detail during this inspection. Care plans provided detailed information regarding peoples needs and preferences. A moving and handling assessment had been completed for each person. Pressure and nutritional risk assessments had been completed. There was evidence of regular liaison with health care professionals, including the GP, District Nursing team and Speech and Language therapists. Care Homes for Older People Page 13 of 29 Evidence: Within the surveys received from people living at the home, all those who returned surveys stated that they always receive the care and support they need. A detailed diabetes care plan had been developed for one person. This provided clear guidance to staff of the actions being taken in the event of them becoming hyper or hypoglycemic and further information regarding their diabetes care needs. Information had been gathered regarding peoples wishes regarding their care when they are dying and after death. This is good practice to ensure that people have the opportunity to share their wishes and beliefs, however these record should be signed and dated. The home was providing palliative care to one person. Food and fluid and positional monitoring charts had been completed. The person confirmed that they were comfortable and pleased with the care provided. Interaction between staff and people living at the home was friendly and respectful. The recording, administration and storage of medication was examined. At the start of the inspection it was found that the medication cabinet had not been locked. This is situated within a communal area of the home. Therefore all of the medication, including an insulin pen were accessible. This is not safe practice, the home must ensure that all medication is stored securely. Medication administration records (MARs) were examined. It was found that generally these had not been appropriately maintained. For three people there was no signature, date or quantity of medication recorded. For a further person hand written entries had only one signature recorded, and there was no evidence that these had been checked and signed by a second staff member to reduce the risk of human error. For an another two people there was no signature recorded for medications due at 8am that morning. The records for one person also showed four occasions where a signature had not been recorded for the administration of two different types of eye drops, and two further occasions for paracetamol. For one person who has medication on an as required (PRN) basis, directions had been provided regarding when this medication would be needed, but these had not been signed or dated, so it was not clear that this reflected the current guidance for this individual. A record had been maintained of all Controlled Drugs. Insulin is administered by Mrs Curtis, who has been assessed as competent to undertake this task by the District Nursing team. Care Homes for Older People Page 14 of 29 Evidence: Failure to store medication securely and incomplete recording of medication administration places people at risk of harm. These areas were discussed with the registered person who advised that the home was in the process of changing medication systems, and that all staff were completing training packs on medication. Discussion was also held regarding the benefit of regular audits of medication management and the development of a system that identified which member of staff had been responsible for the medication keys and the administration of medication on each shift. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with appropriate support to meet their social and leisure needs. Meals are of a good standard and provide a balanced diet. Evidence: On the day of inspection there was gentle exercise taking place in the lounge. There were a range of books and activities available. Those people spoken with during the inspection confirmed that the range of activities provided is appropriate to their wishes and needs. Care plans included information regarding peoples social and cultural needs. Local clergy regularly visit the home. The registered person also advised that people living at the home have use of a beach hut on the seafront, and are supported to attend events held locally. Discussions were held with the relatives of two people. Relatives confirmed that they were pleased with the care provided and that they were always made welcome and that there was good communication with the home. Both commented that the service Care Homes for Older People Page 16 of 29 Evidence: was very homely and one that the staff and care provided are excellent. Lunchtime was observed. People had been asked earlier in the day whether they wanted to have the main meal or an alternative. There was a pleasantly relaxed and unhurried atmosphere at lunchtime. Music was playing and people were supported to enjoy this as a social occasion. People living at the home provided positive feedback regarding the meal and dessert provided. Within the surveys returned to CQC all of the respondents stated that they are always satisfied with the meals. They confirmed that there is always a choice of meals available. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate policies and procedures in place to safeguard people living at the home Evidence: The home has an appropriate complaints policy. Within the surveys returned to CQC, all of the respondents confirmed that they would know who to speak to if they were not happy and did know how to make a complaint. Two complaints have been received since the last inspection. Both relate to items of clothing being returned to the wrong person after being laundered. The registered person has addressed both of these complaints and put in place measure to ensure that this does not re-occur. There are appropriate policies in place regarding the protection of vulnerable adults, whistle blowing and the receipt of gifts. The registered person has attended training on the Mental Capacity Act and the Deprivation of Liberties. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live within a comfortable and homely environment. There is sufficient communal and bathing facilities to meet peoples needs. The registered persons must take some further actions to improve the health and safety of people living at the home. Evidence: Clarondene is a large house situated within a residential area of Lyme Regis. Communal areas comprise of a large lounge dining room. A small area of garden can been accessed from the lounge, that has seating provided. Clarondene provides a homely environment, with rooms being decorated with pictures and ornaments. It was noted that hot pipes run along the skirting board within the lounge / dining area. These should be covered as part of the redecoration program for the home. The registered person advised that there are plans in place to replace the carpet and furnishings within this room. One bedroom is available as a double for those people wishing to share. The remaining rooms are single occupancy and are located on the ground floor. There is one Care Homes for Older People Page 19 of 29 Evidence: registered bedroom on the first floor, however this is currently being used by the manager as office space. Those bedrooms seen had been personalised to reflect peoples individual tastes and preferences. Within the surveys one person wrote that My room and all the rest of the home are always kept clean to a high standard. Within one bedroom it was found that the wardrobe had not been fixed to the wall. This may pose a risk of injury from falling onto people. A risk assessment must be completed and action taken as necessary. There is a large bathroom and a shower room. Hot water outlet temperatures were tested and found to be within recommended limits. Liquid soap and paper towels had been provided. It is recommended that foot operated flip top bins are provided in all areas where personal care takes place, and the laundry to reduce the risk of cross infection. The laundry is has two domestic style washing and drying machines. The floor has become damaged and requires replacement. The home had been maintained to a good standard of cleanliness. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The high staff ratio ensures that people living at the home are provided with appropriate support to fully meet their needs. Staff have received the training required to safely undertake their role. Evidence: Duty rotas are maintained. These show that there are always two members of staff on duty throughout the day and one waking and one sleeping in member of staff at night. At the time of inspection there were two staff and the registered person working at the home. People spoken with during the inspection stated that staff are very good and that you just need to ring the bell and they are here. Recruitment records were examined for five recently appointed members of staff. A POVA first check and satisfactory references had been obtained prior to each person starting work. A CRB disclosure had been received for each staff member. On the day of inspection training was being provided on dementia care by an external provided for staff from this home and two other homes nearby. Staff are in the process Care Homes for Older People Page 21 of 29 Evidence: of completing training packs on the safe handling of medication. A staff matrix has been developed but has not been updated regularly, and therefore does not provide accurate information regarding the training completed. Two staff members training records were sampled and it was found that they had received training on: moving and handling, coping with aggression, fire safety, infection control, health and safety, adult protection, first aid and diet and nutrition. The registered person should regularly review staff training records to ensure that any gaps can be clearly identified and appropriate actions taken. Within the AQAA the registered person advises that they have undertaken training to become a manual handling trainer, and therefore able to provide training to staff on site. Six of the eight care staff employed have obtained the NVQ level 2 qualification or its equivalent. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is present within the home each day and seeks regular feedback from people living at the home and staff members regarding the service provided. The registered person must take some further actions to improve record keeping, and to promote the health and safety of people living and working within the home. Evidence: The registered provider and manager is Alison Curtis. She also lives at the premises, and is present within the home each day. Ms Curtis seeks feedback from people on an informal basis, and also holds a Residents meetings every three months. Staff have supervision contracts, however regular supervision is not yet established and is an area for improvement. Staff meetings are held regularly. Care Homes for Older People Page 23 of 29 Evidence: As previously stated within this report there are some areas requiring improvement. These include the management of medication, ensuring that records and signed and dated, the management of staff training and development of staff supervision. The home displays the registration certificate and appropriate Employers Liability insurance. Food hygiene was examined. Some foods stored within containers in the fridge had not been dated. Fridge and freezer temperatures had been recorded on a daily basis. The remaining food safety checks had last been recorded on 1/3/09. The kitchen has been maintained to a good standard of cleanliness. The hot tap in the hand washing basin near the back door does not work and requires attention. The home was assessed by the Environmental Health Department on 10/11/08 and achieved a five star rating. Fire records were examined. The system had been serviced, and checks undertaken on extinguishers and emergency lighting as required. The last recorded entry for testing the fire alarm was 26/3/09. This must be tested on a weekly basis. Portable appliances and the electrical hardwiring have been serviced as required. Hazardous substances had been stored securely. From reviewing care records, it was evident that not all significant events had been notified to CQC in accordance with regulation 37 of the Care Home Regulations 2001. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 A copy of the Statement of Purpose and Service User Guide must be available. Prospective service users must be provided with up to date information to ensure that they are able to make an informed choice regarding admission to the home. 26/06/2009 2 9 13 All medication must be stored securely. All handwritten entries on medication records must include the date, quantity of medication received and staff signature. A signature must be recorded for all medication given, or a definition used as appropriate. This is to ensure that people do not have access to medication that has not 08/06/2009 Care Homes for Older People Page 26 of 29 been prescribed for them. There must be a clear audit trail for all medication received into the home. Records must evidence what medication has been taken by each person. 3 19 13 13 (4) A risk assessment must be completed in relation to unrestricted wardrobes and any necessary actions taken. This is required to reduce risk of injury to people living at the home. 4 26 13 The flooring in the laundry must be replaced. This is required to reduce the risk of cross infection. 5 38 16 16 (2) [j] Food stored within 26/06/2009 the fridge must be dated. Food hygiene records must be appropriately maintained. The hot tap within the hand washing basin in the kitchen must be mended. To follow best practice regarding food hygiene and to protect people living at the home. 6 38 23 23 (4) [c] Fire alarms must be tested on a weekly basis. To ensure that equipment is working appropriately to alert people in the event of a fire. 13/06/2009 10/07/2009 26/06/2009 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 All pre-admission assessments should be signed and dated to evidence when and by whom the assessment was completed. All entries within care records must be signed and dated. This includes information regarding peoples wishes regarding death and dying, and guidance relating to the administration of PRN medication. Hand written entries on medication records, should be checked and signed by a second staff member to reduce the risk of human error. The hot pipes that run along the skirting board within the lounge / dining room must be covered within the redecoration pro gramme for the home. It is recommended that foot operated flip top bins are provided in all areas where personal care takes place, and the laundry to reduce the risk of cross infection. Staff should receive supervision at least six times a year. It is recommended that the registered person reviews staffing arrangements to provide sufficient time for them to maintain records required for the running of the home. 2 7 3 9 4 19 5 26 6 7 36 37 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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