Inspection on 27/07/06 for Delph House

This inspection was carried out on 27th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Delph House 04/02/09

Delph House 13/02/07

Delph House 16/11/05

Delph House 28/06/05

Delph House 21/09/04

Delph House 24/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Delph House 40 Upper Golf Links Road Broadstone Poole Dorset BH18 8BY Lead Inspector Catherine Churches Key Unannounced Inspection 11:00 27th & 31st July 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000020458.V305672.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000020458.V305672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Delph House Address 40 Upper Golf Links Road Broadstone Poole Dorset BH18 8BY 01202 692279 01202 658210 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jacqueline Lesley Haigh Mrs Janice Anne Jenkins Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places DS0000020458.V305672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 24 service users who require nursing care. 16th November 2005 Date of last inspection Brief Description of the Service: Delph House is registered with Commission for Social Care Inspection to provide accommodation for a maximum of 39 older people, some with nursing needs. It is owned by Mrs J L Haigh and managed by Mrs J Jenkins. The home is situated in a pleasant residential area of Broadstone, Poole. Accommodation is on two floors accessed by a lift. Nursing care is provided in the older part of the home and residential care in the newer purpose built unit. Each area has a lounge and conservatory. There is a small dining room in the residential unit. Delph House is set in small, well-tended garden that is accessible to service users. Fees range from £550 to £600 per week. DS0000020458.V305672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key, unannounced inspection undertaken 27th and 31st July 2006 with feedback given to the manager on 7th August 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection was November 2005. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and compliance with requirements and recommendations made during the previous inspection. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. Prior to the inspection survey/comment cards were sent out to residents, relatives, GP’s, healthcare professionals and care managers. Twenty-one responses were received from residents (many of which were completed by relatives on their behalf), one from a GP and 2 from care managers. Responses were mixed, with positive comments about the manager, staff and care provided but concerns raised about staff turnover, unpleasant odours, delays in answering the door and quality of laundering. All comments and issues were discussed with the manager who agreed to give full consideration to these. What the service does well: What has improved since the last inspection? The owners of the home have an ongoing programme of improvements in place for the structure and facilities of the home: since the last inspection DS0000020458.V305672.R01.S.doc Version 5.2 Page 6 major changes have taken place as the kitchen has been refitted and new carpets laid in communal areas and many rooms redecorated. Following the last inspection 4 recommendations were made. All of these were reviewed during this inspection. Requirements regarding policies for the Protection of Vulnerable Adults and whistle blowing have been amended and staff have received training in infection control and fire protection with required records of this being maintained. Checks of emergency lighting systems and fire extinguishers have also been carried out as required, therefore resulting in a better standard of care, health and safety and administration. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000020458.V305672.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000020458.V305672.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents needs continue to be satisfactory. This means that residents can be certain that the home is aware of their requirements prior to their admission to the home and that the staff will therefore be able and prepared to meet these needs. EVIDENCE: Documentation for four residents was examined as part of the case tracking procedure used during this inspection. Two of these residents had been newly admitted to the home since the last inspection. Both assessments were viewed. They contained good information about each persons needs and a letter was also available on file to confirm, that having carried out the assessment, the home could meet the persons needs. DS0000020458.V305672.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Care planning and documentation of residents needs requires some improvement: systems for the consultation and participation in the assessment and care planning process are inconsistent and some care plans and risk assessments were too generic and lacking specific detail relating to individuals. This means that information may not be detailed enough for staff to provide effective care and that there is no evidence that care needs are fully understood and planned for. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. In the main medication in the home is well managed. Systems are weak for the management of medication changes and new prescriptions that are not typed on the record sheet. This means that there is a greater possibility of an error occurring. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled at the home and their privacy is respected. DS0000020458.V305672.R01.S.doc Version 5.2 Page 10 EVIDENCE: Documentation for four residents was examined as part of the case tracking procedure used during this inspection. All four residents were spoken with/observed either in the privacy of their rooms or in one of the lounges. Care plans were examined and found to be up to date with reviews taking place at least once a month. There was very little evidence available that care plans had been drawn up with the involvement of either the resident or their representative. Risk assessments were in place but in the case of the use of bed rails, was a generic document and lacked specific individual information and evidence of consultation with relevant parties such as the resident, representative, GP and other relevant professionals. Evidence was available on file and through discussion that GP’s, district nurses, specialist nurses and other health professionals are called upon whenever the need arises. One resident, who had been identified as having nutritional needs in daily recording, did not have a care plan for their nutrition. Medicines in the medication cupboard were examined together with administration records. These were found to be satisfactory. Those staff responsible for medication administration have received appropriate training. It was noted that only one signature was present for medicines added to the MAR (Medicine Administration Record) by hand. Policies for the promotion of privacy and dignity were reviewed and satisfactory. Observation of interaction between residents and staff evidenced that residents are respected and a number of staff actions evidenced that privacy is actively promoted. Residents also confirmed during discussions that they felt their privacy was respected and their dignity promoted. Staff confirmed that they promote and maintain resident’s privacy when receiving personal visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. DS0000020458.V305672.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12,13,14 and 15 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities are dependent on individual preferences and the resident’s capacity for involvement. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. It would appear that dietary needs of residents are well catered for with a balanced and varied selection of food available, however records were not available to support this. Foods were not always stored appropriately which may lead to contamination. EVIDENCE: The home employs an activities organiser for 24 hours per week over 4 days, Monday to Thursday. This person organises various group activities such as quizzes and bingo and also undertakes one to one sessions with those who are unable or chose not to leave their rooms. The home also arrange for visiting DS0000020458.V305672.R01.S.doc Version 5.2 Page 12 entertainers to come to the home to provide exercise classes and music/singing sessions. Comprehensive records were available to support this. Question 7 of the resident’s questionnaire sent out prior to the inspection asked “Are there activities arranged by the home that you can take part in?” 7 people responded “Always” 4 people responded “Usually” 6 people responded “sometimes” 0 people responded “never” The others either recorded “Not applicable” or stated the following: “Mother can’t participate” “Activities very poor” “Mother is not mobile” At the time of the inspection the Activities Organiser had been off sick for a number of weeks. This meant that the level of activity available had decreased although other staff had tried to fill in where possible. Residents are encouraged to maintain contact with family and friends. The visitor’s book showed that there is a constant stream of visitors to the home and discussions with staff confirmed this. Discussion with residents and staff as well as examination of records and observation during the inspection evidenced that residents are assisted to exercise choice and control over their lives. The home employs a full time chef. At the time of the inspection the Chef was on annual leave and the weekend cook was filling in. Lunch was observed both during its preparation and whilst residents were eating. It looked appetising and those residents spoken to confirmed that they enjoyed their meals. Question 8 of the resident’s questionnaire sent out prior to the inspection asked “Do you like the meals at the home?” 7 people responded “Always” 8 people responded “Usually” 2 people responded “sometimes” 0 people responded “never” One person wrote “yes”, three people raised specific issues that were discussed with the manager during feedback. Food stocks were examined: it was noted that some products were not being properly stored and that there was a higher proportion of cheaper brand products than during previous inspections. Records of food provided for residents were not being kept. DS0000020458.V305672.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 16 and 18 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. Delph House has a satisfactory policy and procedure for the making of complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be listened to and matters of concern will be acted upon. Arrangements for protecting service users from abuse were satisfactory. This means that Delph House is a safe environment that will protect residents from abuse. EVIDENCE: Since the last inspection one complaint has been made to CSCI regarding Delph House. This was passed to the manager of the home to investigate using their complaints investigation procedure. Mrs Jenkins undertook a comprehensive investigation and provided a detailed report of her investigation and suitable evidence to support her investigation. The complaint was found to be upheld. Question 9 of the resident’s questionnaire sent out prior to the inspection asked “Do you know who to speak to if you are not happy?” 13 people responded “Always” 6 people responded “Usually” 1 person responded “sometimes” DS0000020458.V305672.R01.S.doc Version 5.2 Page 14 1 person responded “never” The person that responded “never” expanded on this further and this was discussed with the manager. Question 10 of the resident’s questionnaire sent out prior to the inspection asked “Do you know how to make a complaint?” 15 people responded “Always” 4 people responded “Usually” 1 person responded “sometimes” 1 person responded “never” Policies and procedures for adult protection and whistle blowing were checked and found to be satisfactory. The CSCI address and telephone number have been added to these documents as a result of a recommendation made in the last report. Staff have received training in recognising abuse and the actions they should take should they suspect abuse has occurred. DS0000020458.V305672.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 19 and 26 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. The home is very well presented: it is nicely decorated and furnished and has a homely atmosphere. The grounds are also well maintained, providing lots of colour and interest as well as a variety of places to sit and relax. The home maintains a good standard of hygiene and all areas seen were clean and free from offensive odours. EVIDENCE: A tour of the premises confirmed that the home is well decorated, furnished and equipped. Dorset Fire and Rescue Service has visited the home and confirmed that it complies with their requirements. Issues regarding a fire door in the kitchen were identified and are detailed in the health, safety, and welfare of resident’s category under the management section of this report. DS0000020458.V305672.R01.S.doc Version 5.2 Page 16 Staff had a good understanding of infection control procedures and the relevant protective clothing was available. There was a detailed infection control policy in the home that covered all of the required areas and staff confirmed that they had received training in this area. Training records were also available to support this. A number of resident’s questionnaires highlighted that they felt there were often strong odours detectable in the building. None were found during this inspection but the matter was raised with the manager. Other concerns were reported regarding the standard of laundry and ironing. All residents were wearing clean and fresh looking clothes throughout the inspection but the manager confirmed that she was aware of some problems and would continue to try to resolve this. DS0000020458.V305672.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is judged as poor. This judgement has been made using available evidence including a visit to this service. The deployment and number of staff on each shift is sufficient to meet the needs of the residents. The home has a core group of staff that are reliable and provide consistent care. However, there are clearly some issues regarding staffing in the home that need to be addressed before the problems result in inconsistent and unsatisfactory services to the residents. Most staff have experience in caring for the elderly and some are undertaking training to further develop their abilities and competencies. The home places great emphasis on training. This means that residents are in safe hands. Vetting and recruitment practices are weak with appropriate checks not being carried out therefore potentially leaving residents at risk. The home has introduced induction and training programmes to ensure that staff have the necessary skills to enable them to undertake all aspects of their role competently. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the needs of residents. DS0000020458.V305672.R01.S.doc Version 5.2 Page 18 Actual numbers of staff employed has decreased meaning the home has had to rely on staff goodwill to undertake additional hours. Staff clearly had a good relationship with residents but morale amongst the staff was lower than on previous inspections. Staff turnover and sickness levels could be attributed to low morale. Eleven of the twenty-three care staff have now achieved NVQ level 2 or higher, 2 are currently studying for this qualification. This means that the home is very close to meeting the requirement of 50 of care staff being trained to a minimum level of NVQ2. A number of foreign staff also have training from their own countries but no evidence was available to show that this was equivalent to an NVQ level 2 or higher. Staff records were examined for three members of staff, two of whom were new employees since the last inspection. Records demonstrated serious omissions as both staff had commenced their duties without updated POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) checks. Also one person had a criminal conviction. Mrs Jenkins stated that she had looked into this prior to appointing the person but no written evidence was available regarding this. Staff induction programmes had been updated in accordance with the new Skills for Care guidelines and records demonstrated that the work was being undertaken within the required timescales. Discussion with staff and examination of training records evidenced that the home is providing the minimum 3 paid days training per year. Some staff, particularly the trained nurses, are also undertaking further training in their own time which they also pay for themselves and which they then cascade back to other staff in the home. DS0000020458.V305672.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is judged as poor. This judgement has been made using available evidence including a visit to this service. Mrs Jenkins has completed the necessary training and has the relevant experience. She is a competent, committed and approachable manager and both residents and staff confirmed this. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Sound practices and procedures are in place regarding resident’s finances. The health, safety and welfare of residents and staff is, in general, protected by the systems that the home has in place for staff training, maintenance and risk assessment. However, poor practice with regard to wedging fire doors and delayed maintenance on the kitchen fire door was putting residents and staff at risk. DS0000020458.V305672.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Jenkins has a number of years experience in a management capacity of a care home with nursing, is a qualified nurse and has also undertaken the NVQ level 4 in management and the Registered Managers Award. All staff and residents spoken with spoke positively about her and were comfortable with approaching her if they needed to. Since the last inspection, Mrs Jenkins has completed a quality monitoring review of the home, which involved questionnaires to residents. The results of these questionnaires have been analysed. As a result of the analysis an informative report has been written and actions taken where issues have been identified. Mrs Jenkins confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. At present Fire records, staff training records and accident books were examined and found to be up to date and detailed. However, it was noted that a number of bedroom doors were being wedged open as resident’s preferred not to feel “shut in”. This is understandable but in such circumstances swing free closers should be fitted. Of greater concern was the long delay in ensuring that the kitchen door met the required standard and would operate effectively in the event of a fire in such a high-risk area. DS0000020458.V305672.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 DS0000020458.V305672.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement The registered person must provide, in adequate quantities, suitable, wholesome and nutritious food, which is varied and properly prepared. Records should be kept to demonstrate that a suitable diet is provided. Foods must be appropriately stores and of good quality. The registered persons must ensure that all persons employed are fit to work in the home. The registered persons must obtain in respect of each person the documents listed in schedule 2 of the Care Homes Regulations 2001 and must be satisfied as to the authenticity of the references and information received. New staff must only be confirmed in post following completion of a satisfactory CRB and POVA check. The registered person must make adequate arrangements for the containment of fires. Doors identified as fire doors by Dorset Fire and Rescue Service must be maintained as such and no fire door should be wedged open. DS0000020458.V305672.R01.S.doc Timescale for action 1. OP15 16(2) 30/09/06 2. OP29 19 30/09/06 3. OP38 23(4) 30/09/06 Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP7 Good Practice Recommendations Care plans should be drawn up with the involvement of the resident, recorded in a style that is accessible tot hem and agreed and signed by the resident whenever capable and/or representative (if any). Risk assessments and care plans must be individual and specific. This is particularly the case regarding risk assessments for bed rails and care plans for diabetes and nutrition. Any changes to prescription details or new prescriptions that are hand written on to medication administration records should be checked and counter signed by a second member of staff. 1. 2. OP8 3. OP9 DS0000020458.V305672.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000020458.V305672.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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