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Inspection on 17/02/09 for Crosshill Nursing Home

Also see our care home review for Crosshill Nursing Home for more information

This inspection was carried out on 17th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 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

Residents needs are fully assessed before they move into the home. This is important to ensure that Crosshills Care Home is able to meet their health and personal care needs. Care plans provide good information about the residents care needs, which helps to ensure they receive care and support in a way that they prefer. Residents are also treated with dignity and respect and relatives and friends can visit anytime they want to. Residents are supported to make choices about how to spend their time. And staff are good at ensuring residents remain independent. There are good activities which include trips out in warmer weather, 1:1 sessions with the activities co-ordinator, and for some people a holiday to Blackpool. The food is good with plenty of choices available. There is a good complaints procedure in place so that people know their views will be listened too. There are also good safeguarding procedures in place so that staff know when to refer incidents to the local authority. This is important to ensure that residents are fully protected. The home is clean. Many of the staff have completed the NVQ level 2 or 3 qualification in care. The manager has many years experience of working in care and also managing a care home and everyone we spoke to said that she was approachable. Residents said: "I like my room" "I don`t think anything could be better" "I think the foods quite good" "I think its clean" "staff would look after you if you were poorly". Relatives said: " Its always clean" "staff are very approachable, even the kitchen staff and cleaners are friendly" "XXX is always comfy and warm" "the staff make her laugh and smile". "its small, homely. Couldn`t care about the decor as long as mam is looked after". A visiting social worker said: "lovely personal touch, they will go out of their way to help people".

What has improved since the last inspection?

The manager has introduced a number of changes to improve the service for the residents. This has included the "focus on food committee" which is used to review the residents needs in this area, a "protected mealtime" policy to make sure a quiet,relaxed atmosphere is provided at mealtimes and the employment of an activities coordinator. There have also been some improvements to the environment, for example, the provision of a number of high low beds and further ceiling tracking fitted in two bedrooms.

What the care home could do better:

It would be good if there was more information in the residents care plans about their hobbies and interests. The medication needs looking at to make sure the information on the prescribed medicine matches the information on the Medication Administration Record. There needs to be some improvements to the home, like replacing old worn furniture and refurbishing the bathrooms. There needs to be a training programme so that staff get the training they need to help them understand the different needs of the residents. The quality assurance needs developing to include things like annual surveys. This will help the home to find out where they may need to make improvements. Staff need regular fire instruction and drill so that they know what to do if there is a fire. Also the manager needs to talk to the fire authority about wedging open fire doors, as this may be a hazard if there is a fire. The management structure also needs looking at to make sure there is enough management time available.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crosshill Nursing Home 2A Paragon Street Stanhope Durham DL13 2NN     The quality rating for this care home is:   two star good 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: Nicola Shaw     Date: 1 7 0 2 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 28 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 28 Information about the care home Name of care home: Address: Crosshill Nursing Home 2A Paragon Street Stanhope Durham DL13 2NN 01388526205 01388526205 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) : Rayson Homes Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 0 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 25 Crosshill Care Home is situated in the historical town of Stanhope. The home provides 24hr personal care with nursing for up to 25 residents over the age of 65 years. The home is a single storey building, which is easily accessible to all residents and the corridors are wide enough to accommodate wheelchair users. There are 13 single and 6 double rooms, all of which are en suite. There is one large combined dining room and sitting room and 1 small quiet room. The staff team comprises of trained nurses, care staff and ancillary staff. Fees charged range between £2.48 per hour for residential care and £2.60 per hour for nursing care (excluding free nursing care). Care Homes for Older People Page 4 of 28 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: two star good 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: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations-but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the inspection visit: Care Homes for Older People Page 5 of 28 We looked at: Information we have received since the last inspection on 28th February 2007. How the service has dealt with any complaints and concerns since the last visit. Any changes to how the service is run. The providers view of how well they care for people. The visit: An announced visit was made on 17th February 2009. During this visit we: Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had knowledge, skills and training to meet the needs of the people they care for. Had a look around the home. Talked to residents, staff and visitors. Checked what improvements had been made since the last visit. We told the nurse in charge what we found at the end of the visit. What the care home does well: What has improved since the last inspection? The manager has introduced a number of changes to improve the service for the residents. This has included the focus on food committee which is used to review the residents needs in this area, a protected mealtime policy to make sure a quiet, Care Homes for Older People Page 7 of 28 relaxed atmosphere is provided at mealtimes and the employment of an activities coordinator. There have also been some improvements to the environment, for example, the provision of a number of high low beds and further ceiling tracking fitted in two bedrooms. What they could do better: 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 8 of 28 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 9 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to help prospective residents make an informed choice about where to live. The admissions process ensures that people are adequately assessed prior to care being offered. This means that residents are offered the right type of care at the home. Evidence: There is a Statement of Purpose and a Service User Guide which is given to all prospective residents and their families. These tell people about the home, its aims and objectives, who runs the home, what services and facilities are available and the weekly fees. Care Homes for Older People Page 10 of 28 Evidence: Residents said in surveys that they had received enough information about the home, before they moved in, so they could decide if it was the right place for them. A relative we spoke to said when we first came for a look around we got a brochure. Prospective residents are admitted to the home only after the manager has obtained a copy of the full assessment from social services or the primary care trust. Where possible a trial visit is arranged for a prospective resident so that the manager, or senior staff, can assess their needs in the care home environment. Otherwise the manager or senior staff would arrange to visit the prospective resident where they are currently living in order to complete the homes own pre-admission assessment. Care Homes for Older People Page 11 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good information in the care plans about the health and personal care needs of the residents. This ensures that everyone receives care and support in a way that they prefer. Although staff care practices preserve the dignity and privacy of the people who live here, medication administration procedures do not fully protect the residents. Evidence: A range of standardized assessments are in place that lead to the care plans being developed. These cover a number of areas such as communication, mobility and falls prevention, eating, drinking and nutrition, personal cleansing, behaviour and pressure area care. The care plans we looked at provided good information about the residents health and personal care needs. Some provided very detailed guidance to staff on how to support Care Homes for Older People Page 12 of 28 Evidence: the residents. For example, in one there was good information about a persons behaviour, situations or events that might trigger this behaviour and what staff should do in such situations. If a person is assessed as high risk of developing a pressure sore this is closely monitored by staff. One person who was assessed as such, when they were first admitted to the home, has since put on over one stone in weight, which considerably reduces this risk. It was also recorded in the care plans the importance of encouraging people to be independent, clearly showing that staff have a can do attitude rather than doing for the residents. They also had information about the residents preferred day and night time routines, for one person the importance of sleeping with a lamp on. Care plans are evaluated monthly. And records showed that residents weights are also monitored each month. Residents have access to all NHS facilities. There are regular visits from GPs and other health professionals, including opticians, dentists and continence nurses. We spoke to a social worker who was visiting the home. She was visiting some of the residents in order to carry out a review of their care needs. She said she felt that the residents health care needs were looked after and she had never came across any of the residents who had major skin problems. She said that one person was admitted to the home assessed as being at the end of their life, however, after six months in this home was 100 better. One relative we spoke said they know my mam inside out and I feel she is well looked after. The majority of residents commented in surveys that they always received the medical support they needed. Medication is stored in a locked, secure room. New cupboards have recently been installed in here. There is a medication fridge and staff monitor the temperature of this to make sure that medicines are stored correctly. Nurses order the medication from the prescriptions to ensure that residents are provided with the correct medication. There were some unexplained gaps on the Medication Administration Records, (MAR), Care Homes for Older People Page 13 of 28 Evidence: which we looked at. The instruction on some of the prescribed medication also did not correspond with the instruction on the MAR charts. For example, on one persons eye drops it said give 1, 3 x daily but on the MAR chart it said give as and when required. On another medication box it said give 1 at night but the MAR chart again indicated give as and when required. There was no record available to show that a resident had received their prescribed cream. We talked to the nurse in charge about this who confirmed that this resident administered this independently. There was no risk assessment in place relating to this. There is a small stock of controlled drugs. These are stored securely. A brief check of those held in stock balanced with the records. During our visit we found staff to be respectful in their approach towards the residents and ensured that their privacy was respected at all times. Personal and intimate care tasks were carried out in the privacy of the residents own bedrooms. Staff referred to the residents by their preferred name and it was clear there was a good rapport between the staff and residents. One relative said I feel staff are respectful, xxxx has always had a shave and always wears his own clothes. The visiting social worker said lovely personal touch, staff will go out of their way to help people. Care Homes for Older People Page 14 of 28 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. Residents enjoy a variety of activities, and are able to maintain family and other contacts if they want to. This ensures residents have opportunities to lead a fulfilling lifestyle and do not become socially isolated. Residents are able to exercise control and choice over their lives, as far as is possible, which enables them to remain independent. Residents receive a varied menu, which promotes their general health and wellbeing. Evidence: There is now an activities co-ordinator. She keeps an activities file where a record is maintained of what activity has been offered and information about who has taken part. There is an emphasis upon physical exercise and the activities co-ordinator has carried out her own research about this. Other activities have included arts and crafts, trips out for tea and cake, and one to one chats. Last year two residents went on holiday to Blackpool, supported by staff. Residents Care Homes for Older People Page 15 of 28 Evidence: told us that the local library visits the home and provides them with large print books. There are also regular visits from ministers of local churches. However, there is no activities programme or social care plans, which is an area for future development. Relatives said that whenever they visited they were made to feel welcome by staff. And it is the policy of the home for family to be involved in the daily life and social activities of the residents. Residents are able to spend time in the privacy of their own room or spend time with others in communal areas of the home. There is some information about the residents personal preferences and daily routines in their care plans. Although we did not have lunch with residents we noticed that the tables were nicely presented with table cloths and condiments. Residents said the foods not bad, I think its quite good, staff come around with a list of a choice of two things except for Sunday when you get a proper Sunday meal, tea on Sunday is lovely, with sandwiches and pork pies. Ive asked for mayonnaise and asked for all sorts and you get them, and you get a choice of fruit for pudding. The manager has introduced a protected meals policy. This is to avoid interruptions and maintain a peaceful environment when residents are eating. However, visitors are able to stay if they will be assisting their family member with their meal. The staff have completed a focus on food profile with each resident. This involves assessing each persons nutritional needs. An evaluation is then carried out each month to make sure that any risks identified in this area are quickly addressed. Care Homes for Older People Page 16 of 28 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. The home has a good complaints procedure so people know that their views will be listened to and acted upon. And staff training helps to ensure that the residents are protected from abuse. Evidence: The complaints procedure is displayed on the notice board at the entrance of the home. There is also an anonymous comments box which relatives and residents can use. There have been no complaints in the last 12 months. Relatives and residents we spoke to said that they would have no hesitation in making a complaint if they had any concerns. And everyone commented in surveys that they knew how to make a complaint. There has been no safeguarding referrals made in the last year. Staff said they received training in safeguarding adults as part of their NVQ level 3 qualification. Those staff we spoke to said that they knew what to do should they witness or suspect abuse. There are copies of the local authority adults procedure in the office for staff to read. The manager told us that she intends on liaising with the new adult protection team, which has been set up in Durham, in order to ensure she is kept up-to-date with any new guidelines issued by the local authority. Care Homes for Older People Page 17 of 28 Evidence: Relatives said I can go home and have peace of mind. Residents said I feel safe here. Care Homes for Older People Page 18 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home is clean residents do not benefit from a well maintained environment which meets their needs. Evidence: There have been some improvements to the environment in the last twelve months which have included replacing the flooring in 2 central toilets and the laundry, the purchasing of a number of high low beds and the provision of ceiling tracking in two bedrooms. New cupboards have also been fitted in the medication room and the kitchen. However, despite these improvements many other areas of the home still need attention. For example: Corridor carpets are badly marked and in one area we looked at, torn. One bathroom and the shower room are being used to store equipments such as wheelchairs, a radiator guard and garden chair. We talked to staff about this who told us these areas were not currently being used and although a new bath had recently been fitted in another bathroom many of the residents found it uncomfortable to use. The bathrooms we looked at were bare and not very homely. Tiles were missing above Care Homes for Older People Page 19 of 28 Evidence: the sink in one and the floor damaged in another. Furniture is old and worn, for example in the quiet lounge there are only two chairs for people to use. The varnish on the legs of these is chipped and worn and there is a stool in here with the plastic torn exposing the foam. Some of the paintwork on the cupboards in residents bedrooms is also damaged. The locks on some of the bathroom and toilets are broken. Staff said that some of the carpets have not been replaced since the home opened. There were no unpleasant odours and residents said in surveys the home was always clean and fresh. Residents we spoke to said that they liked their bedrooms. Thirty staff have completed training in infection control. Care Homes for Older People Page 20 of 28 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. Staff training is satisfactory, however, does not include specialist training, which would help staff to meet the diverse needs of some of the residents. Staff recruitment procedures fully protect the residents. Evidence: There is a low turnover of staff, which is good for continuity of care. All housekeeping staff and kitchen staff have an NVQ level 2 qualification in their respective areas and over 70 of staff have achieved either the NVQ level 2 or 3 qualification in care. We spoke to staff on duty who said training is good and said that in the last year they had had training in moving and handling, focus on food, as well as their NVQ level 2 and 3 training in care. However, the training records we looked at did not support this as some of the certificates we saw were dated 2003. There was also no evidence of specialist training being provided, for example, in relation to challenging behaviour, which would help staff to meet the diverse needs of some of the residents. There was also no training Care Homes for Older People Page 21 of 28 Evidence: programme available for the forthcoming year to indicate what future training is planned for all staff. Relatives we spoke to said that the staff were very friendly and staff said its a nice atmosphere, we are a close knit community and thats our quality assurance. All of the residents spoke positively about the staff and there was clearly a good rapport between the residents and staff. Staff files showed that the companys recruitment procedures are followed. This includes obtaining two written references and an Enhanced Criminal Records Bureau check to ensure that the prospective staff member is suitable. Care Homes for Older People Page 22 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current management systems generally ensure the health, safety and welfare of residents. Quality assurance systems need to develop. This is to ensure the views of residents, where they are able to communicate their wishes, know their rights and views will be listened to and acted upon. Evidence: The manager is a first level Registered Nurse and has completed the Registered Managers Award. She has worked in the home for eleven years, three of which as the manager. We spoke to staff who said that they felt supported by management. A visiting health care professional said the manager is a really nice lady. The Annual Quality Assurance Assessment provided good information about the Care Homes for Older People Page 23 of 28 Evidence: changes made in the last twelve months and also where they still need to make improvements. However, some of the records were not up-to-date, for example fire drills/ instruction, the staff training file and staff development programme. There was no evidence of a quality assurance system, such as surveys to find out the views of residents, relatives, staff and other stakeholders, such as health care visitors. The owner, however, does regularly visit the home and meet with staff to discuss any concerns they may have and the nurse in charge said that some time ago there was a food committee who carried out a survey of the menu. The deputy manager has recently retired and this post has been empty for approximately 6 months. Some of the management tasks, such as staff training, have been delegated to the nurses in charge. One nurse said that they felt that they would benefit from some clinical leadership and that taking on board additional management tasks, as well as leading their shift, was at times difficult. On the day of our visit, in the absence of the manager, the nurse had to deal with telephone calls, visiting health care professionals as well as overseeing the health needs of the residents and arranging cover for staff sickness. They were very busy and it was difficult to see where they would have additional time to deal with specific management tasks. It was also noted at the beginning of our visit the manager had felt it necessary to call into the home on her day off in order to deal with a residents discharge. Residents are encouraged to look after their own finances. Where the home manages this on their behalf, satisfactory records are maintained. A number or residents bedroom doors were wedged open as well as the laundry, which could present as a hazard if there was a fire. There are good records kept of accidents kept, together with a system to monitor the occurrence of these. Care Homes for Older People Page 24 of 28 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 28 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 9 13 Residents must receive their 17/06/2009 medication as prescribed by their GP. This is to ensure the health of the residents is fully protected. 2 19 23 All areas of the home, both 17/08/2009 private and communal, that residents use must be decorated and furnished to a reasonable standard. This is to ensure residents are provided with a well maintained place in which to live. 3 21 23 Residents must be provided with sufficient bathing facilities which meet their assessed needs. This is to promote the health and welfare of residents. 13/10/2009 Care Homes for Older People Page 26 of 28 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 9 A risk assessment should be completed for all residents who look after and administer their own medication. This is to ensure the health of the residents is fully protected. Social care plans should be introduced and from this an activities programmme developed. This will ensure that activities provided reflect the likes and interests of the residents. A training programme should be developed which highlights training planned for each year. Training should be provided which reflects the diverse needs of the residents. For example; training in challenging behaviour. It is recommended that a review of the current management structure be implemented. This is to ensure that residents benefit from a well managed home at all times. The quality assurance system should develop to include the views of residents and other stakeholders. There should also be an annual development plan for the home based upon a process of self monitoring of standards of care. The manager should seek advice form the fire authority concerning the provision of wedging open doors throughout the home. This is to make sure that residents are safe in the event of a fire. 2 12 3 4 30 30 5 31 6 33 7 38 Care Homes for Older People Page 27 of 28 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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