CARE HOMES FOR OLDER PEOPLE
Conifers Nursing Home 158 Manchester Road Chorlton Manchester M16 0DS Lead Inspector
Geraldine Blow Unannounced 12 September 2005 09.00
th 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. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Conifers Nursing Home Address 158 Manchester Road Chorlton Manchester M16 0DS 0161 881 2514 0161 862 9635 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) Dr V.K. Trehan Care home with nursing (N) 23 Category(ies) of Old age, not falling within any other category registration, with number (OP) (23) of places Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The numbers of those requiring nursing care at any one time shall not exceed 23 patients of either sex aged 60 years or over. 2 3 A maximum of 2 persons per day are provided with nursing day care in the home. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice which was previously served in accordance with Section 25 (3) of the Registered Homes Act 1984 dated 4 April 2001. Date of last inspection 14 February 2005 Brief Description of the Service: Conifers Nursing Home is registered to provide accommodation and nursing care for up to 23 older persons. It is a part of family run business, which includes one other nursing home and a residential home. The registered provider is Dr V Trehan. The home is situated on a busy main road in the Chorlton area of Manchester. It is close to local facilities, bus routes and the city centre. Accommodation is provided on two floors, served by a passenger lift and the home is accessible to service users who use a wheelchair. Bedroom accommodation is on the ground and first floor. There were 7 single bedrooms, 2 of which offer en-suite facilities and 8 double bedrooms. All rooms offer the facility of a wash hand basin.There were 2 lounges, one lounge/ dining room and a dining room. There is a patio area, to the rear of the home, that is accessible to service users in wheelchairs via patio doors and a ramp. The proprietor has recently purchased further land to the rear of the property although no plans for the land have been submitted. There is a small designated smoking area on the ground floor.
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection, which was unannounced, took place over the course of 6 hours on Monday 12th September 2005. During the course of the inspection, time was spent talking to the Care/management consultant, the senior nurse, residents, a relative and several members of staff to find out their views of the home. Because of the problems that some residents have making themselves understood it was difficult to find out what the residents really thought of the home by talking to them. Because of this extra time was spent watching how staff support and interact with residents. Time was spent examining records, documents, residents and staff files. A tour of the building was also conducted. Since the last inspection, in February 2005, the CSCI has received one compliant, regarding the way staff were moving and handling one resident. The complaint was upheld and as a result the home were required to change the unsafe moving and handling practices. The majority of requirements from the previous inspection had been addressed and there was evidence that the home was working to develop the service. During this inspection only a selection of the key National Minimum Standards were assessed therefore in order to gain the full picture of how the home meets the needs of residents this report should be read with the previous and any future reports. What the service does well:
The home assessed prospective residents care needs before their admission to ensure their needs can be met. Following the pre-admission assessment the home confirms in writing, to the prospective resident, that the home is able/not able to meet their needs. Prospective residents and or their representatives are encouraged to view the home and speak to staff before a decision to move in is made. One relative spoken to confirmed this. The relative spoken to said that “the staff are very helpful and polite, they always give me a cup of tea when I am visiting”. She also said that “staff will do things if you ask them, like if my husband wants to go up to his room for a
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 6 lie down they will always take him and he was sat out in the garden last week and that he had enjoyed that”. One resident said that “the staff look after me here not like the other home I was in”. She also said that the staff took her out on Friday to have her haircut and that she going out soon to get a new dress for Christmas. Both the relative and the residents spoken to said that the home was always clean. One resident said “I have a lovely clean bedroom”. All new members of staff had an induction on the first day at work and then completed a 6-week induction training. The complaint policy was on display and every resident had been given a copy. What has improved since the last inspection? What they could do better:
The proprietor of home has purchased some further land to the back of the home. The land directly leads off the paved patio area and has become very overgrown and is unattractive to look at. It is recommended that some trellis be put up to separate the new land from the existing patio area. The home provided limited activities for residents and did not have a designated person responsible for organising activities. It is recommended that an activity co-ordinator is employed by the home and that residents are regularly consulted about activities. To ensure the dignity of residents who require help with feeding staff should not stand up while assisting residents to eat their meal. A number of pureed meals were seen. The whole meal had been pureed together and served in a
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 7 bowl. This did not look very appetising. The home must serve pureed meals in separate helpings in order to improve the presentation of the meal and the variety of tastes and textures available. Although some improvements were seen in the residents’ plans of care some of them did not contain enough detail for the care staff to follow to make sure all the residents needs are met. The home must make sure that all medication is signed for so that a full audit trail is available. Several areas of the home and much of the bedroom furniture were showing signs of ‘general aging and wear & tear’. Some of the bedrooms had drawer handles missing, which must be replaced and in one room an easy chair was found to be stained with food. At the time of inspection the home did not employ a manager. A senior nurse and the care/management consultant were managing the home. The previous manager had recently attended an interview with the Commission for Social Care Inspection for registration and had been refused. The post of manager was due to be advertised. The proprietor must ensure that the advertisement goes out as a matter of urgency and a suitably qualified manager is appointed as soon as possible. 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. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 8 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 Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 9 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 & 5 The home undertakes an assessment of prospective residents care needs prior to their admission. They and/or their relatives/friends are able to visit the home before making a decision to stay. EVIDENCE: Evidence was seen that prospective residents had a pre-admission assessment to ensure that the home could meet all of their assessed needs. The assessment included the involvement of the prospective resident, his/her representatives and any relevant professionals. For residents who are referred through Care Management arrangements the home obtains a summary of the Care Management Assessment prior to admission. Following the pre-admission assessment the home confirms in writing to the prospective resident that the home is able/not able to meet their assessed needs. Prospective residents and or their representatives are encouraged to view the home and speak to staff prior to making a decision regarding admission to the home.
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 9 & 10 Some progress had been made on improving arrangements to ensure that health care needs of residents are identified and met. However some shortfalls were identified and have a potential to place residents at risk. EVIDENCE: Each resident had an individual plan of care and a random selection of care plans were inspected. Some improvements had been made to the care planning process. However, in some instances the action to be taken by care staff still remained vague. For example one plan of care stated change “position regularly”, another stated “requires assistance”. The care plans must clearly identify what specific help is needed. During a discussion with the senior nurse regarding a resident who was PEG fed it was identified that the resident was nil by mouth. This information was not referenced anywhere within the residents individual file and had not been incorporated into the care plan. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 11 Evidence was seen that the plans of care had been reviewed on a monthly basis. However one plan of care stated “check weight”. During discussions with the senior nurse it was identified that the home were unable to weigh the resident as she was nursed in bed, yet none of the reviews had identified this or revised the care plan. Nutritional assessments had been completed and there was evidence of weight recording. Evidence was seen that risk assessments had been incorporated into the individual plans of care. At the last inspection it was identified that the risk assessment being used required further development to include more detailed information. Evidence was seen that new paperwork had been developed and would be implemented as soon as staff had received training in using the new assessment tool. This was due to be implemented in November 2005.These will be assessed at the next inspection. In was noted that in one personal file the use of restraints i.e. bed rails and a wheelchair lap belt had not been thoroughly risk assessed and consent for use had not been obtained. It was reported by the acting manager that all the bed rails used in the home were accompanied by the use of bumpers to prevent a potential injury to service users. There was a daily evaluation for each identified problem. It was recommended that the evaluation include more detail to accurately reflect the events that occur over a 24-hour period. All residents were registered with local General Practitioners and had access to visiting healthcare professionals e.g., Dietician, Chiropody, Dentistry and Ophthalmology. There was evidence of the involvement of the tissue Viability Nurse and a plan of care in relation to the wound dressing. However the plan of care did not document how often the dressing was to be renewed. Equipment necessary for the promotion of tissue viability and the prevention or treatment of pressure sores was viewed during the inspection. Medication was found to be stored securely within the treatment room, which was kept locked when not in use. The drug fridge was situated within the treatment room and daily temperature recordings were seen. However on several occasions the temperatures were outside normal range, no action had been taken to ensure the medication had not been damaged by incorrect storage. It is essential that procedures are in place for staff to follow in the event of medication being stored at incorrect temperatures. This is in order to ensure patients receive safe medication.
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 12 On examination of the Medicine Administration Record (MAR) sheets the majority of prescribed medication had been signed for. However one resident was prescribed Movicol and it had not been signed for on a number of consecutive days. The senior nurse said it had not been given, as the resident had not required it. All prescribed medication must be signed for to facilitate audits and to ensure that the records are clear and accurate. A current list of staff signatures was available. The senior nurse said that verbal orders of medication changes were only taken upon receipt of a fax from the General Practitioner. It is also recommended that where changes are hand written by staff on the MAR sheet that it be checked by a second person and referenced back to the original prescription to minimise the risk of error. The original prescriptions are sent directly to the home form the General Practitioner and the senior nurse cross references them with the medication requested. They are then sent to the dispensing pharmacy. At the time of inspection the dispensing pharmacy were continuing to dispose waste medication. Due to legislation that came into effect in April 2005 it is recommended that the home contact the pharmacy to ensure they have a valid waste disposal certificate. From observations and discussions with residents and a relative it appeared to respect residents dignity. However during the midday meal 2 members of staff were observed feeding a resident while standing over them. This practise is inappropriate and does not respect resident’s dignity. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 Only limited activities were available to residents. Meals appeared nutritious and there was some evidence that a choice was available. EVIDENCE: During discussions with the care/management consultant it was apparent that the home only provided limited activities for residents, usually on a 1 to 1 basis. There was no designated staff member employed to co-ordinate activities. The social history sheets and the resident activity sheet were not up to date and there was no evidence that the residents had been consulted in developing a programme of activities. The menu inspected had been developed on a 6-week rota system. The meals provided appeared to be ‘simple home cooked food’. The main meal of the day is served at lunchtime. The meal observed on the day of inspection was chicken casserole, potatoes peas and sweet corn or meatballs, potatoes, peas and sweet corn. The menu did not offer a second choice of meal however it did state “an alternative choice could be provide for any resident on an individual basis”. The care/management consultant told the inspector that the current menu was under review and it was being proposed that a choice of 3 meals be available. This will be reviewed at the next inspection. The chef must serve the pureed meals in separate helpings.
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 14 A tour of the kitchen was made. Generally the kitchen was clean and tidy. However the cooker and grill must be deep cleaned. At the time of inspection the home was not catering for residents with any specific cultural or religious dietary needs. These needs would be assessed pre admission to ensure they could be met. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The complaints procedure was on display and residents had been given a copy. The home’s policies and procedures served to protect the residents from abuse. EVIDENCE: The home had the complaint procedure on display and a copy had been left in all residents’ bedrooms. One residents spoken to said that if she had a complaint she would go to Sarah (the senior nurse). The home maintained a complaint file, which contained details of the complaint, staff statements, the actions taken and the outcomes. Since the last inspection the home had not received any complaints. The home had policies and procedures in relation to protection of adults from abuse and Whistle Blowing. The home had a copy of the Department of Health “No Secrets” Guidance, the Manchester and Trafford Multi-Agency Policy on the Protection of Vulnerable Adults from Abuse. During discussions it was evident that the care/management consultant was aware of the correct procedure to take in the event of an allegation of abuse. It was reported that all staff had received training on the action to be taken in the event of an allegation of abuse. There have not been any allegations of abuse since the last inspection and no staff members had been reported for inclusion on the Protection of Vulnerable Adults (POVA) list.
Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 16 The home had a policy prohibiting the acceptance of gifts and as required at the last inspection this has been further developed to preclude staff involvement in assisting in the making or benefiting from service users’ wills. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25 & 26 The homes environment was generally clean, however a number of shortfalls were observed including the majority of bedroom furniture showing signs of “wear and tear”. EVIDENCE: The inspectors undertook a tour of the premises along with the senior nurse. A number of shortfalls were observed: • • • • • It was noted that that some areas of the home looked “tired in appearance” and the majority of bedroom furniture was quite old and worn. Bedroom 12 had 2 drawer handles missing and a broken drawer handle. Bedroom 15 had 2 drawer handles missing. The arm of the easy chair in bedroom 16 was found to be dirty and encrusted with food. Several of the bedrooms had broken window restrictors and several of the bedrooms did not have a lockable storage space. A large number of bedrooms did not provide a lockable storage space for residents.
F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 18 Conifers Nursing Home • • • • • The majority of residents were not provided with adjustable beds and risk assessments had not been competed to ascertain the urgency of need. At the last inspection the freestanding wardrobes were required to be secured to the wall in an effort to reduce the possibility of avoidable accidents. The care/management consultant stated that this had been unachievable as the securing instrument had been pulled away from the wall and in the process pulled chunks of plaster away. He stated that he was in the process of purchasing new more substantial wardrobes. Risk assessments must be completed until the new wardrobes are in place. It was noted that in the downstairs residents bathroom that a carpet cleaner and a pair of stepladders were being stored. Bathroom 21 had 3 boxes of syringes stored on the floor. Both sluice doors were open and did not have a lock insitu. Laundry facilities are sited away from the food preparation area. The home had policies relating to infection control and had received the guidelines from the infection control nurse. It was noted that some of the bathrooms and toilets rooms had a supply of gloves, aprons and wipes as recommended by the infection control nurse. Assurances were given to the inspector that gloves aprons and wipes would be available in all bathrooms, toilets and residents bedrooms where personal care is delivered. To prevent the risk of cross infection it was recommended that an individual sling should be provided for each resident requiring the use of the hoist. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 28, 29 & 30 Staff were available in sufficient numbers to meet the needs of the residents. The homes recruitment policies and procedures appeared to promote the safety and wellbeing of the residents. EVIDENCE: At the time of the inspection the home accommodated 20 residents. The numbers and skill mix of the staff, at the time of inspection, appeared to be sufficient to meet the needs of residents accommodated. The home employed 10 care staff, 2 of those had achieved NVQ level 2 and 4 care staff were oversees adaptations nurses who were all currently working through their 12 months experience before undertaking their adaptation training. The sample of staff files inspected contained all the information and documents listed in Schedule 2 of the Care Home Regulations 2001. Each member of staff had a training and development plan, with copies of the certificates obtained held on file. All new members of staff had a basic induction on the first day of employment and then completed a 6 weeks TOPPS induction programme. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 36 At the time of inspection the home did not employ a manager. Staff appear to appropriately supervised. EVIDENCE: The post of manger must be advertised as a matter of some urgeny and the properiator must ensrue that a suitably qualified and experienced person is appointed to the position of manager. Evidence was seen of regular staff supervision and annual appraisal. Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 2 x x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x 3 x x Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 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 7 Regulation 15 Requirement Timescale for action 31/10/05 2. 7 13 Each resident must have a plan of care which sets out in detail the action which needs to be taken by care stff to ensure all aspects of care are met. (Previous timescale of 30/4/05 not met.) The use of restraints i.e bed rails 31/10/05 and wheelchiar lap belts must be risk assessed and the consent for their use must be obtained from the resident. (Previous timescale of 30/4/05 not met.) The wound care plan must 31/10/05 include details regarding the frequency of dressing changes. The home must ensure the 31/10/05 assessment of residents needs is kept under reivew and revised at any time when it is necessary to do so. 1.The home must ensure that 31/10/05 the temperature of the drug fridge is within normal range (between 2 & 8 degrees centigrade) and have a clear understanding of the action to be taken if the temperature is outside of that.
Version 1.40 3. 4. 8 8 17 Schedule 3 14 5. 9 13 Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Page 23 6. 10 12 7. 12 16 8. 15 12 & 13 2. All prescribed medication must be signed for to facilitate audits and to ensure that the records are clear and accurate. To ensure that residents dignity is protected staff must not stand up while assisting residents to eat. Evidence must be provided that residents are consulted regarding the planning of activities, outings and entertainment. 1. Liquidised meals must be presented in a manner which is attractive and appealing in terms of texture, flavour and appearance in order to maintian appetite and nutrition. 12/9/05 31/10/05 31/10/05 9. 21 13 2. The cooker and grill must be deep cleaned 12/9/05 1. The carpet cleaner and step ladders must not be stored in the residents bathroom. 2. To prevent any unnecessary risks to the health and safety of residents the sluice door must be kept locked when not in use. 3. The 3 boxes of syringes being stored in bathroom 21 must be removed. The broken and missing drawer handles identified in this report must be relaced and/or repaired. Risk assessments must be carried out on the free standing wardrobes until the properiator has purchased new furniture. A risk assessment must be completed to asertain the urgency of the need for an adjustable bed. 10. 11. 24 24 23 13 31/10/05 31/10/05 12. 24 16 31/10/05 Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 24 13. 24 23 14. 31 8&9 Each resident must be provided 30/1105 with a lockabel storage space for medication, money and valuables. The properiator must ensure that a person, who complies with the criteria established within the Care Standards Act 2000 and the Care Homes Regulations 2001, is appointed as the home’s manager. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 9 9 Good Practice Recommendations It is recommended that the daily evaluation include more detail to accurately reflect the nursign care/events that occur over a 24-hour period. It is recommended that the home contact the dispensing pharmacy to ensure they have a valid waste disposal certificate. It is recommended that where changes are hand written by staff on the MAR sheet that it be checked by a second person and referenced back to the original prescription to minimise the risk of error. It is recommended that the home employs the services of an activity co-ordinator. It is recommended the proprietor erect trellis work to section off the overgrown newly purchased land from the residnets patio area. To prevent the risk of cross infection it was recommended that an individual sling should be provided for each resident requiring the use of the hoist. 4. 5. 6. 12 19 26 Conifers Nursing Home F55 F05 s21639 Conifers V247896 D120905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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